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Chapter 32 - Twin-to-Twin Transfusion Syndrome: Treatment by Fetoscopic Laser Coagulation of the Placental Vascular Anastomoses on the Chorionic Plate

from Complications of Monochorionic Multiple Pregnancy: Twin-to-Twin Transfusion Syndrome

Published online by Cambridge University Press:  21 October 2019

Mark D. Kilby
Affiliation:
University of Birmingham
Anthony Johnson
Affiliation:
University of Texas Medical School at Houston
Dick Oepkes
Affiliation:
Leids Universitair Medisch Centrum
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Summary

Monochorionic twin placentation occurs in 20% of spontaneous twin pregnancies and almost 5% of those are obtained by medically assisted reproduction [1]. Monochorionic twin fetuses have the unique characteristic of living upon one single placenta and therefore share some cotyledons through vascular anastomoses running on the chorionic plate. This situation can lead to specific complications, including twin-to-twin transfusion syndrome (TTTS) [2, 3], twin-anemia-polycythemia sequence (TAPS) [4, 5], and selective intrauterine growth restriction (sIUGR) [6]. These complications are likely to explain most of the 6- to 12-fold increase in perinatal mortality in monochorionic compared with dichorionic twins [7–10].

Type
Chapter
Information
Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
, pp. 353 - 362
Publisher: Cambridge University Press
Print publication year: 2020

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References

Salomon, LJ, Stirnemann, JJ, Bernard, JP, et al. Prenatal management of uncomplicated monochorionic biamniotic pregnancies. J Gynecol Obstet Biol Reprod. 2009; 38: S45–50.Google ScholarPubMed
Chalouhi, GE, Stirnemann, JJ, Salomon, LJ, et al. Specific complications of monochorionic twin pregnancies: twin-twin transfusion syndrome and twin reversed arterial perfusion sequence. Semin Fetal Neonatal Med. 2010; 15: 349–56.Google Scholar
Bebbington, M. Twin-to-twin transfusion syndrome: current understanding of pathophysiology, in-utero therapy and impact for future development. Semin Fetal Neonatal Med. 2010; 15: 1520.Google Scholar
Lopriore, E, Middeldorp, JM, Oepkes, D, et al. Twin anemia-polycythemia sequence in two monochorionic twin pairs without oligo-polyhydramnios sequence. Placenta. 2007; 28: 4751.Google Scholar
Slaghekke, F, Kist, WJ, Oepkes, D, et al. Twin anemia-polycythemia sequence: diagnostic criteria, classification, perinatal management and outcome. Fetal Diagn Ther. 2010; 27: 181–90.Google Scholar
Lewi, L, Gucciardo, L, Huber, A, et al. Clinical outcome and placental characteristics of monochorionic diamniotic twin pairs with early- and late-onset discordant growth. Am J Obstet Gynecol. 2008; 199: 511. e1–7.Google Scholar
Sebire, NJ, Snijders, RJ, Hughes, K, Sepulveda, W, Nicolaides, KH. The hidden mortality of monochorionic twin pregnancies. BJOG. 1997; 104: 1203–7.Google Scholar
Hack, K, Derks, J, Elias, S, et al. Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study. BJOG. 2008; 115: 5867.Google Scholar
Lewi, L, Van Schoubroeck, D, Gratacós, E, et al. Monochorionic diamniotic twins: complications and management options. Curr Opin Obstet Gynecol. 2003; 15: 177–94.Google Scholar
Hamilton, EF, Platt, RW, Morin, L, Usher, R, Kramer, M. How small is too small in a twin pregnancy? Am J Obstet Gynecol. 1998; 179: 682–5.CrossRefGoogle Scholar
Ville, Y. Monochorionic twin pregnancies: ‘les liaisons dangereuses’. Ultrasound Obstet Gynecol. 1997; 10: 82–5.CrossRefGoogle ScholarPubMed
Lewi, L, Jani, J, Cannie, M, et al. Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome: is there more than meets the eye? Am J Obstet Gynecol. 2006; 194; 790–5.Google Scholar
Quintero, RA, Morales, WJ, Allen, MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol. 1999; 19: 550–5.Google Scholar
Wee, LY, Fisk, NM. The twin-twin transfusion syndrome. Semin Neonatol. 2002; 7; 187202.Google Scholar
Weir, PE, Ratten, GJ, Beischer, NA. Acute polyhydramnios: a complication of monozygous twin pregnancy. BJOG. 1979; 86: 849–53.Google Scholar
Robyr, R, Lewi, L, Salomon, LJ, et al. Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2006; 194: 796803.Google Scholar
De Lia, JE. Surgery of the placenta and umbilical cord. Clin Obstet Gynecol. 1996; 39: 607–25.Google Scholar
Haverkamp, F, Lex, C, Hanisch, C, Fahnenstich, H, Zerres, K. Neurodevelopmental risks in twin-to-twin transfusion syndrome: preliminary findings. Eur J Paediatr Neurol. 2001; 5; 21–7.Google Scholar
Senat, MV, Deprest, J, Boulvain, M, et al. A randomized trial of endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome at midgestation. N Engl J Med. 2004; 351: 136–44.Google Scholar
De Lia, J, Fisk, N, Hecher, K, et al. Twin-to-twin transfusion syndrome – debates on the etiology, natural history and management. Ultrasound Obstet Gynecol. 2000; 16: 210–13.Google Scholar
Saade, GR, Belfort, MA, Berry, DL, et al. Amniotic septostomy for the treatment of twin oligohydramnios-polyhydramnios sequence. Fetal Diagn Ther. 1998; 13: 8693.CrossRefGoogle ScholarPubMed
Garry, D, Lysikiewicz, A, Mays, J, Canterino, J, Tejani, N. Intra-amniotic pressure reduction in twin-twin transfusion syndrome. J Perinatol. 1998; 18: 284–6.Google ScholarPubMed
Moise, KJJ, Dorman, K, Lamvu, G, et al. A randomized trial of amnioreduction versus septostomy in the treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2005; 193: 701–7.Google Scholar
Johnson, JR, Rossi, KQ, O’Shaughnessy, RW. Amnioreduction versus septostomy in twin-twin transfusion syndrome. Am J Obstet Gynecol. 2001; 185: 1044–7.Google Scholar
Gilbert, WM, Davis, SE, Kaplan, C, et al. Morbidity associated with prenatal disruption of the dividing membrane in twin gestations. Obstet Gynecol. 1991; 78: 623–30.Google ScholarPubMed
Feldman, DM, Odibo, A, Campbell, WA, Rodis, JF. Iatrogenic monoamniotic twins as a complication of therapeutic amniocentesis. Obstet Gynecol. 1998; 91: 815–16.Google Scholar
Rujiwetpongstorn, J, Tongsong, T. Amniotic band syndrome following septostomy in management of twin-twin transfusion syndrome: a case report. J Perinatol. 2008; 28: 377–9.Google Scholar
Cruz-Martinez, R, Van Mieghem, T, Lewi, L, et al. Incidence and clinical implications of early inadvertent septostomy after laser therapy for twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2011; 37: 458–62.CrossRefGoogle ScholarPubMed
Winer, N, Salomon, LJ, Essaoui, M, et al. Pseudoamniotic band syndrome: a rare complication of monochorionic twins with fetofetal transfusion syndrome treated by laser coagulation. Am J Obstet Gynecol. 2008; 198: 393. e1–5.CrossRefGoogle ScholarPubMed
Hecher, K, Diehl, W, Zikulnig, L, et al. Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid-trimester twin-to-twin transfusion syndrome. Eur J Obstet Gynecol Reprod Biol. 2000; 92: 135–9.Google Scholar
Gray, PH, Cincotta, R, Chan, FY, Soong, B. Perinatal outcomes with laser surgery for twin-twin transfusion syndrome. Twin Res Hum Genet. 2006; 9: 438–43.Google Scholar
Lenclen, R, Paupe, A, Ciarlo, G, et al. Neonatal outcome in preterm monochorionic twins with twin-to-twin transfusion syndrome after intrauterine treatment with amnioreduction or fetoscopic laser surgery: comparison with dichorionic twins. Am J Obstet Gynecol. 2007; 196; 450. e1–7.Google Scholar
Roberts, D, Neilson, JP, Kilby, M, et al. Interventions for the treatment of twin-twin transfusion syndrome. Cochrane Database Syst Rev. 2008; 1: CD002073.Google Scholar
Rossi, AC, D’Addario, V. Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a meta-analysis and review of literature. Am J Obstet Gynecol. 2008; 198: 147–52.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 versus laser photocoagulation for the treatment of twin-to-twin transfusion syndrome (TTTS). Am J Obstet Gynecol. 2010; 203; 444. e1–7.Google Scholar
Benirschke, K, Kim, CK. Multiple pregnancy. N Engl J Med. 1973; 288: 1276–84.Google Scholar
De Vore, G, Dixon, J, Hobbins, JC. Fetoscope-directed Nd:YAG laser: a potential tool for fetal surgery. Am J Obstet Gynecol. 1983; 143: 379–80.Google Scholar
De Lia, JE, Cruikshank, DP, Keye, WR. Fetoscopic neodymium:YAG laser occlusion of placental vessels in severe twin-twin transfusion syndrome. Obstet Gynecol. 1990; 75: 1046–53.Google ScholarPubMed
Ville, Y, Hyett, JA, Vandenbussche, FP, Nicolaides, KH. Endoscopic laser coagulation of umbilical cord vessels in twin reversed arterial perfusion sequence. Ultrasound Obstet Gynecol. 1994; 4: 396–8.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: 224–7.CrossRefGoogle ScholarPubMed
Ville, Y, Hecher, K, Gagnon, A, et al. Endoscopic laser coagulation in the management of severe twin-to-twin transfusion syndrome. BJOG. 1998; 105: 446–53.CrossRefGoogle ScholarPubMed
Klaritsch, P, Albert, K, Van Mieghem, T, et al. Instrumental requirements for minimal invasive fetal surgery. BJOG. 2009; 116: 188–97.Google Scholar
Nizard, J, Barbet, JP, Ville, Y. Does the source of laser energy influence the coagulation of chorionic plate vessels? Comparison of Nd:YAG and Diode Laser on an ex-vivo placental model. Fetal Diagn Ther. 2007; 22: 33–7.Google Scholar
Chalouhi, GE, Essaoui, M, Stirnemann, J, et al. Laser therapy for twin-to-twin transfusion syndrome (TTTS). Prenat Diagn. 2011; 31: 637–46.Google Scholar
Salomon, LJ, Nasr, B, Nizard, J, et al. Emergency cerclage in cases of twin-to-twin transfusion syndrome with a short cervix at the time of surgery and relationship to perinatal outcome. Prenat Diagn. 2008; 28: 1256–61.Google Scholar
Van Peborgh, P, Rambaud, C, Ville, Y. Effect of laser coagulation on placental vessels: histological aspects. Fetal Diagn Ther. 1997; 12: 32–5.Google Scholar
Deprest, JA, Van Schoubroeck, D, Van Ballaer, PP, et al. Alternative technique for Nd:YAG laser coagulation in twin-to-twin transfusion syndrome with anterior placenta. Ultrasound Obstet Gynecol. 1998; 11: 347–52.CrossRefGoogle ScholarPubMed
Huber, A, Baschat, AA, Bregenzer, T, et al. Laser coagulation of placental anastomoses with a 30 degrees fetoscope in severe mid-trimester twin-twin transfusion syndrome with anterior placenta. Ultrasound Obstet Gynecol. 2008; 31: 412–16.CrossRefGoogle ScholarPubMed
Quintero, RA, Bornick, PW, Allen, MH, Johson, PK. Selective laser photocoagulation of communicating vessels in severe twin-twin transfusion syndrome in women with an anterior placenta. Obstet Gynecol. 2001; 97: 477–81.Google ScholarPubMed
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: 409–15.Google Scholar
De Lia, JE, Kuhlmann, RS, Harstad, TW, Cruikshank, DP. Fetoscopic laser ablation of placental vessels in severe previable twin-twin transfusion syndrome. Am J Obstet Gynecol. 1995; 172: 1202–8.Google Scholar
Stirnemann, JJ, Nasr, B, Quarello, E, et al. A definition of selectivity in laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome and its relationship to perinatal outcome. Am J Obstet Gynecol. 2008; 198: 62. e1–6.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: 230–6.Google Scholar
Martinez, JM, Bermudez, C, Becerra, C, et al. The role of Doppler studies in predicting individual intrauterine fetal demise after laser therapy for twin–twin transfusion syndrome. Ultrasound Obstet Gynecol. 2003; 22: 246–51.CrossRefGoogle ScholarPubMed
Quintero, RA, Martinez, JM, Lopez, J, et al. Individual placental territories after selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. Am J Obstet Gynecol. 2005; 192: 1112–18.Google Scholar
Crisan, LS, Kontopoulos, EV, Quintero, RA. Appraisal of the selectivity index in a cohort of patients treated with laser surgery for twin-twin transfusion syndrome. Am J Obstet Gynecol. 2010; 202: 157. e1–5.Google Scholar
Lopriore, E, Slaghekke, F, Middeldorp, JM, et al. Residual anastomoses in twin-to-twin transfusion syndrome treated with selective fetoscopic laser surgery: localization, size, and consequences. Am J Obstet Gynecol. 2009; 201: 66. e1–4.Google Scholar
Sago, H, Hayashi, S, Saito, M, et al. The outcome and prognostic factors of twin-twin transfusion syndrome following fetoscopic laser surgery. Prenat Diagn. 2010; 30: 1185–91.CrossRefGoogle ScholarPubMed
Thilaganathan, B, Gloeb, DJ, Sairam, S, Tekay, A. Sono-endoscopic delineation of the placental vascular equator prior to selective fetoscopic laser ablation in twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2000; 16: 226–9.Google Scholar
Ierullo, AM, Papageorghiou, AT, Bhide, A, et al. Severe twin-twin transfusion syndrome: outcome after fetoscopic laser ablation of the placental vascular equator. BJOG. 2007; 114: 689–93.CrossRefGoogle ScholarPubMed
Morris, RK, Selman, TJ, Harbidge, A, Martin, WL, Kilby, MD. Fetoscopic laser coagulation for severe twin-to-twin transfusion syndrome: factors influencing perinatal outcome, learning curve of the procedure and lessons for new centres. BJOG. 2010; 117; 1350–7.CrossRefGoogle ScholarPubMed
Sepulveda, W, Wong, AE, Dezerega, V, Devoto, JC, Alcalde, JL. Endoscopic laser surgery in severe second-trimester twin-twin transfusion syndrome: a three-year experience from a Latin American center. Prenat Diagn. 2007; 27: 1033–8.CrossRefGoogle ScholarPubMed
Johnston, TA, Cameron, AD. Atosiban for the primary prevention of preterm labour. BJOG. 2001; 108: 886–7.Google Scholar
Yamamoto, M, Barki, G, Ville, Y. Direct visual control on cord coagulation using a fetoscopy-guided bipolar forceps. Description of a new technique. Prenat Diagn. 2010; 30: 156–8.Google Scholar
Cheong-See, F, Schuit, E, Arroyo-Manzano, D, et al. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. BMJ. 2016; 354: i4353.Google Scholar
Robyr, R, Lewi, L, Yamamoto, M, Deprest, J, Ville, Y. Permanent feto-fetal transfusion from the recipient to the donor twin: a complication of laser surgery in twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2004; 191: 42.Google Scholar
Ville, Y, Hecher, K, Gagnon, A, et al. Endoscopic laser coagulation in the management of severe twin-to-twin transfusion syndrome. BJOG. 1998; 105: 446–53.CrossRefGoogle ScholarPubMed
Yamamoto, M, El Murr, L, Robyr, R, et al. Incidence and impact of perioperative complications in 175 fetoscopy-guided laser coagulation of chorionic plate anastomoses in fetofetal transfusion syndrome before 26 weeks of gestation. Am J Obstet Gynecol. 2005; 193: 1110–16.Google Scholar
Merz, W, Tchatcheva, K, Gembruch, U, Kohl, T. Maternal complications of fetoscopic laser photocoagulation (FLP) for treatment of twin-twin transfusion syndrome (TTTS). J Perinat Med. 2010; 38: 439–43.CrossRefGoogle ScholarPubMed
Habli, M, Bombrys, A, Lewis, D, et al. Incidence of complications in twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation: a single-center experience. Am J Obstet Gynecol. 2009; 201: 417. e1–7.Google Scholar
Grannum, PA, Copel, JA. Invasive fetal procedures. Radiol Clin North Am. 1990; 28: 217–26.Google Scholar
Deprest, JA, Van Ballaer, PP, Evrard, VA, et al. Experience with fetoscopic cord ligation. Eur J Obstet Gynecol Reprod Biol. 1998; 81: 157–64.Google Scholar
Quintero, RA. Treatment of previable premature ruptured membranes. Clin Perinatol. 2003; 30: 573–89.CrossRefGoogle ScholarPubMed
Harrison, MR, Mychaliska, GB, Albanese, CT, et al. Correction of congenital diaphragmatic hernia in utero. IX: Fetuses with poor prognosis (liver herniation and low lung-to-head ratio) can be saved by fetoscopic temporary tracheal occlusion. J Pediatr Surg. 1998; 33: 1017–22.Google Scholar
Bilic, G, Brubaker, C, Messersmith, PB, et al. Injectible candidate sealants for fetal membrane repair: bonding and toxicity in vitro. Am J Obstet Gynecol. 2010; 202: 85. e1–85. e9.Google Scholar
Liekens, D, Lewi, L, Jani, J, et al. Enrichment of collagen plugs with platelets and amniotic fluid cells increases cell proliferation in sealed iatrogenic membrane defects in the foetal rabbit model. Prenat Diagn. 2008; 28: 503–7.Google Scholar
Devlieger, R, Millar, LK, Bryant-Greenwood, G, et al. Fetal membrane healing after spontaneous and iatrogenic membrane rupture: a review of current evidence. Am J Obstet Gynecol. 2006; 195; 1512–20.CrossRefGoogle ScholarPubMed
Lopriore, E, Lewi, L, Oepkes, D, et al. In utero acquired limb ischemia in monochorionic twins with and without twin-to-twin trnsfusion syndrome. Prenat Diagn. 2008; 28: 800–4.Google Scholar
Akkermans, J, Peeters, SH, Klumper, FJ, Lopriore, E, Middeldorp, JM, Oepkes, D. Twenty-five years of fetoscopic laser coagulation in twinetwin transfusion syndrome: a systematic review. Fetal Diagn Ther. 2015; 38: 241. e53.Google Scholar
Djaafri, F, Stirnemann, J, Mediouni, I, Colmant, C, Ville, Y. Twin-to-twin transfusion syndrome: what we have learned from clinical trials ? Sem Fetal Neonatal Med. 2017; 22: 367. e375Google Scholar
Stirnemann, JJ, Nasr, B, Proulx, F, Essaoui, M, Ville, Y. Evaluation of the CHOP cardiovascular score as a prognostic predictor of outcome in twin–twin transfusion syndrome after laser coagulation of placental vessels in a prospective cohort. Ultrasound Obstet Gynecol. 2010; 36: 52–7.Google Scholar
Taylor, MJ, Govender, L, Jolly, M, et al. Validations of the Quintero staging system for twin–twin transfusion syndrome. Obstet Gynecol. 2002; 100: 1257–65.Google Scholar
Dickinson, JE, Evans, S. The progression of disease stage in twin–twin transfusion syndrom. J Matern Fetal Neonatal Med. 2004; 16: 95101.Google Scholar
O’Donoghue, K, Cartwright, E, Galea, P, Fisk, NM. Stage I twin-twin transfusion syndrome: rates of progression and regression in relation to outcome. Ultrasound Obstet Gynecol. 2007; 30: 958–66.Google Scholar
Wagner, MM, Lopriore, E, Klumper, FJ, Oepkes, D, Vandenbussche, FP, Middeldorp, JM. Short- and long-term outcome in stage 1 twin-to-twin transfusion syndrome treated with laser surgery compared with conservative management. Am J Obstet Gynecol. 2009; 201: 286. e1–6.Google Scholar
Khalil, A, Cooper, E, Townsend, R, Thilaganathan, B. Evolution of stage 1 twin-to-twin transfusion syndrome (TTTS): systematic review and meta-analysis. Twin Res Hum Genet. 2016; 19: 207–16.Google Scholar
Molina, S, Papanna, R, Moise, KJ Jr., Johnson, A. Management of Stage I twin-to-twin transfusion syndrome: an international survey. Ultrasound Obstet Gynecol. 2010; 36: 42–7.Google Scholar
Stirnemann, JDjaafri, FKim, A, et al. Preterm premature rupture of membranes is a collateral effect of improvement in perinatal outcomes following fetoscopic coagulation of chorionic vessels for twin-twin transfusion syndrome: a retrospective observational study of 1092 cases. BJOG2018; 125: 1154–62.Google Scholar
Vayssiere, C, Benoist, G, Blondel, B, et al. Twin pregnancies: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2011; 156: 1217.CrossRefGoogle ScholarPubMed
Kilby, MD, Bricker, L. Management of monochorionic twin pregnancies. BJOG. 2016; 124: e145.Google Scholar

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