Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-77c89778f8-m8s7h Total loading time: 0 Render date: 2024-07-17T04:43:07.770Z Has data issue: false hasContentIssue false

Chapter 6 - Twin-Twin Transfusion Syndrome

from Section 2

Published online by Cambridge University Press:  19 November 2021

By
Rupi Mavi Parikh  and
Jose L. Peiro
Edited by
Olutoyin A. Olutoye
Olutoyin A. Olutoye
Affiliation:
Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois
Get access

Summary

Twin pregnancies, especially those in which the twins share one placenta but have separate amnion sacs (referred to monochorionic, diamniotic or Mo-di twins), are at risk for a number of complications. Most notable of these is twin-twin transfusion syndrome. This condition can result in fetal morbidity or intrauterine fetal demise but is also amenable to surgical intervention. Severe discordance in amniotic fluid volumes between each twin is the prenatal finding that highlights this diagnosis. Selective laser photocoagulation has greatly improved the survival of twins with this condition. With a posteriorly located placenta, laser ablation of the abnormal placenta vascular communications can be achieved with local anesthesia and maternal sedation. Anterior placenta location may present a challenge for uterine access that may require modification of the anesthetic technique.

Keywords

twin-twin transfusionplacental anastomoseshydropsrecipient twindonor twinlaser photocoagulationanemiapolycythemiamnioreduction
Type
Chapter
Information
Anesthesia for Maternal-Fetal Surgery
Concepts and Clinical Practice
 , pp. 83 - 94
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Faye-Peterson, O, Crombleholme, T. Twin-twin transfusion: part 2: infant anomalies, clinical intervention and placental examination. Neoreviews. 2008;9(9):e380.Google Scholar
Bamberg, C, Hecher, K. Update on twin-to-twin transfusion syndrome. Best Pract Res Clin Obstet Gynaecol. 2019;58:55–65.Google Scholar
Society for Maternal-Fetal Medicine, Simpson LL. Twin-twin transfusion syndrome. Am J Obstet Gynecol. 2013;208(1):3–18.CrossRefGoogle Scholar
Michelfelder, E, Gottliebson, W, Border, W, et al. Early manifestations and spectrum of recipient twin cardiomyopathy in twin-twin transfusion syndrome: relation to Quintero stage. Ultrasound Obstet Gynecol. 2007;30(7):965–971.Google Scholar
Johnson, A. Diagnosis and management of twin-twin transfusion syndrome. Clin Obstet Gynecol. 2015;58(3):611–631.CrossRefGoogle ScholarPubMed
Quintero, RA, Morales, WJ, Allen, MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol. 1999; 19(8 Pt 1):550–555.CrossRefGoogle ScholarPubMed
Khalil, A, Rodgers, M, Baschat, A, et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2016;47(2):247–263.Google Scholar
Oepkes, D, Sueters, M. Antenatal fetal surveillance in multiple pregnancies. Best Pract Res Clin Obstet Gynaecol. 2017;38:59–70.CrossRefGoogle ScholarPubMed
Stagnati, V, Zanardini, C, Fichera, A, et al. Early prediction of twin-to-twin transfusion syndrome: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017;49(5):573–582.Google Scholar
Senat, MV, Deprest, J, Boulvain, M, et al. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004;351(2):136–144.Google Scholar
Salomon, LJ, Ortqvist, L, Aegerter, P, et al. Long-term developmental follow-up of infants who participated in a randomized clinical trial of amniocentesis vs laser photocoagulation for the treatment of twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2010;203(5):444.e1–444.e7.Google Scholar
Ville, Y, Hyett, J, Hecher, K, Nicolaides, K. Preliminary experience with endoscopic laser surgery for severe twin-twin transfusion syndrome. N Engl J Med. 1995;332(4):224–227.Google Scholar
Slaghekke, F, Oepkes, D. Solomon technique versus selective coagulation for twin-twin transfusion. Twin Research Hum Genet. 2016;19(3):217–221.Google Scholar
Quintero, RA, Comas, C, Bornick, PW, et al. Selective versus non-selective laser photocoagulation of placental vessels in twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2000;16(3):230–236.Google Scholar
Ngamprasertwong, P, Habli, M, Boat, A, et al. Maternal hypotension during fetoscopic surgery: incidence and its impact on fetal survival outcomes. ScientificWorldJournal. 2013;2013:709059.Google Scholar
Van Mieghem, T, Klaritsch, P, Done, E, et al. Assessment of fetal cardiac function before and after therapy for twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2009;200(4):400.e1–400.e7.Google Scholar
Lopriore, E, Middeldorp, JM, Oepkes, D, Klumper, FJ, Walther, FJ, Vandenbussche, FP. Residual anastomoses after fetoscopic laser surgery in twin-to-twin transfusion syndrome: frequency, associated risks and outcome. Placenta. 2007; 28(2-3):204–208.Google Scholar
Gupta, R, Kilby, M, Cooper, G. Fetal surgery and anaesthetic implications. BJA Educ. 2008;8(2):71–75.Google Scholar
Rossi, AC, Kaufman, MA, Bornick, PW, Quintero, RA. General vs local anesthesia for the percutaneous laser treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2008;199(2):137.e1–137.e7.CrossRefGoogle ScholarPubMed
Lewi, L, Jani, J, Blickstein, I, et al. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. Am J Obstet Gynecol. 2008;199(5):514.e1–514.e8.Google Scholar
Slaghekke, F, Zhao, DP, Middeldorp, JM, et al. Antenatal management of twin-twin transfusion syndrome and twin anemia-polycythemia sequence. Expert Rev Hematol. 2016;9(8):815–820.CrossRefGoogle ScholarPubMed
Van de Velde, M, Van Schoubroeck, D, Lewi, LE, et al. Remifentanil for fetal immobilization and maternal sedation during fetoscopic surgery: a randomized, double-blind comparison with diazepam. Anesth Analg. 2005;101(1):251–258.Google Scholar
Middeldorp, JM, Lopriore, E, Sueters, M, et al. Laparoscopically guided uterine entry for fetoscopy in twin-to-twin transfusion syndrome with completely anterior placenta: a novel technique. Fetal Diagn Ther. 2007;22(6):409–415.Google Scholar
Papanna, R, Johnson, A, Ivey, RT, et al. Laparoscopy-assisted fetoscopy for laser surgery in twin-twin transfusion syndrome with anterior placentation. Ultrasound Obstet Gynecol. 2010;35:65–70.Google Scholar
Shamshirsaz, AA, Javadian, P, Ruano, R, et al. Comparison between laparoscopically assisted and standard fetoscopic laser ablation in patients with anterior and posterior placentation in twin-twin transfusion syndrome: a single center study. Prenat Diagn. 2015;35(4):376–381.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×