Document Detail


The twin-twin transfusion syndrome.
MedLine Citation:
PMID:  12234743     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The aetiology of twin-twin transfusion syndrome (TTTS), which affects 10-15% of monochorionic (MC) twin pregnancies, remains poorly understood. Although all MC twins have placental vascular anastomoses, unbalanced intertwin transfusion has been shown by ex vivo injection and in vivo Doppler studies of chorionic plate vasculature to be mediated by > or =1 arterio-venous anastomoses (AVA) in association with absent bi-directional arterio-arterial anastomoses (AAA). TTTS presents in the mid trimester with the oligo-polyhydramnios sequence, the donor may have a small or non-visible bladder and abnormal umbilical artery Doppler, while the recipient has a large bladder and may develop cardiac hypertrophy, triscupid regurgitation, and eventually hydrops. Recently, discordant renal renin angiotensin expression, endothelin and atrial natriuretic peptide have been implicated in the pathogenesis. Survival has increased from <20% to <60-70% with modern treatments, although survivors remain at increased risk of antenatally acquired cerebral white matter injury, and neurodevelopmental sequelae are documented in c.10% (range 5-23%). The recent introduction of a staging system for TTTS facilitates selection of therapy with less invasive amnioreduction and septostomy preferred for early stage disease, and more aggressive modalities such as laser ablation and cord occlusion with their attendant risk of procedure related fetal loss, reserved for advanced stage disease.
Authors:
Ling Y Wee; Nicholas M Fisk
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Seminars in neonatology : SN     Volume:  7     ISSN:  1084-2756     ISO Abbreviation:  Semin Neonatol     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-09-17     Completed Date:  2002-12-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9606001     Medline TA:  Semin Neonatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  187-202     Citation Subset:  IM    
Affiliation:
Centre for Fetal Care, Queen Charlotte's & Chelsea Hospital, Imperial College of Science, Technology and Medicine, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK. l.wee@ic.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Developmental Disabilities / etiology
Female
Fetofetal Transfusion* / complications,  diagnosis,  mortality,  physiopathology,  surgery
Humans
Infant, Newborn
Obstetric Surgical Procedures
Placental Circulation
Pregnancy
Survival Rate
Treatment Outcome
Ultrasonography, Prenatal

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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