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Chapter 13 - Management of Twin–Twin Transfusion Syndrome

Published online by Cambridge University Press:  11 October 2022

By
Christian Bamberg  and
Kurt Hecher
Edited by
Leanne Bricker ,
Julian N. Robinson  and
Baskaran Thilaganathan
Leanne Bricker
Affiliation:
Corniche Hospital, Abu Dhabi
Julian N. Robinson
Affiliation:
Brigham & Women's Hospital, Boston
Baskaran Thilaganathan
Affiliation:
St George's Hospital Medical School, University of London
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Summary

Twin-twin transfusion syndrome (TTTS) is a severe complication that affects 10-15% of monochorionic multiple pregnancies. It is caused by an imbalanced blood flow through communicating placental vessels on the chorionic surface between the donor and recipient twin circulations. Regarding treatment, evidence demonstrates that fetoscopic laser ablation is superior to serial amnioreductions in terms of survival and neurological outcome for stage II-IV TTTS. However, the optimal management of stage I TTTS remains controversial. It is well established that all chorionic plate anastomoses should be closed by laser. Compared to the selective laser method, the Solomon technique yields a significant reduction of recurrent TTTS and post-laser twin anemia-polycythemia sequence (TAPS). Over the past 25 years, survival rates after fetoscopic laser surgery have significantly increased. High-volume centers report up to 70% double survival, and >90% survival of at least one twin after laser treatment of TTTS. About 10% of laser surgery survivors exhibit long-term neurodevelopmental delay. In this chapter, we discuss TTTS pathophysiology, diagnosis, and optimal treatment, as well as long-term outcomes after laser intervention.

Type
Chapter
Information
Management of Multiple Pregnancies
A Practical Guide
 , pp. 135 - 146
Publisher: Cambridge University Press
Print publication year: 2022

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