Document Detail

MedLine Citation:
PMID:  25188139     Owner:  NLM     Status:  In-Data-Review    
Chronic twin-to-twin transfusion syndrome (cTTTS) complicates 4-35% of monochorionic diamniotic (MCDA) twin pregnancies and untreated carries a mortality of some 80%, with significant neurological disability in 30-35% of survivors. MCDA twin pregnancies are usually closely monitored for cTTTS, which is identified by discordant growth of the twins with polyhydramnios and a distended bladder in the larger one (the recipient) and oligohydramnios and an absent (i.e., collapsed, empty) bladder in the smaller (the donor). Onset is usually in the late second trimester and later onset is usually associated with mild disease. Occasionally, whilst a pregnancy with cTTTS is being monitored, prior to, or following intervention, the cTTTS is seen to reverse, with the donor appearing to become the recipient and vice versa. Alternatively a previously stable MCDA pregnancy suddenly develops rapidly progressive, severe cTTTS in the third trimester. Understandably, the fetal medicine team and the family want an explanation for these occurrences. I shall present 3 different causes of late-onset or apparent reversal of cTTTS. 1) Spontaneous occlusion of protective anastomoses. 2) Fetal abnormality. 3) Post-laser ablation of anastomoses. Careful examination of the placenta and of the twin fetuses by the pathologist may provide an explanation in these unusual cases.
Phillip M Cox
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pathology     Volume:  46 Suppl 2     ISSN:  1465-3931     ISO Abbreviation:  Pathology     Publication Date:  2014 Oct 
Date Detail:
Created Date:  2014-09-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0175411     Medline TA:  Pathology     Country:  England    
Other Details:
Languages:  eng     Pagination:  S33     Citation Subset:  IM    
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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