Zwillingstransfusionssyndrom

Das Zwillingstransfusionssyndrom oder Twin-Twin Transfusion Syndrome (TTTS) betrifft monochoriale Mehrlingsschwangerschaften. Monochorionizität bedeutet, dass sich die Feten eine Plazenta teilen, und in praktisch allen Fällen gibt es Gefäßverbindungen zwischen den umbilikalen Kreisläufen auf der Plazentaoberfläche. Drei verschiedene Anastomosentypen sind beschrieben: arteriovenös, arterioarteriell und venovenös. Daraus resultiert, dass eine Imbalance bezüglich der Blutvolumina beider Feten möglich ist. Derzeit ist nicht endgültig geklärt, warum ein TTTS entsteht, jedoch scheint die Anzahl, der Typ und das Kaliber der Anastomosen das Risiko zu bestimmen [1]. Etwa 10 – 15% der monochorialen Zwillinge zeigen ein TTTS [2], welches sich typischerweise zwischen der 16. und 26. SSW entwickelt.

• Literatur

• 1 Benirschke K, Masliah E. The placenta in multiple pregnancy: outstanding issues. Reprod Fertil Dev 2001; 13: 615-622
• 2 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: 514.e1-514.e8
• 3 Khalil A, Rodgers M, Baschat A. et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 2016; 47: 247-263
• 4 Oepkes D, Sueters M. Antenatal fetal surveillance in multiple pregnancies. Best Pract Res Clin Obstet Gynaecol 2016; 38: 59-70
• 5 Simpson LL. Twin-twin transfusion syndrome. Am J Obstet Gynecol 2013; 208: 3-18
• 6 Baxi LV, Walsh CA. Monoamniotic twins in contemporary practice: a single-center study of perinatal outcomes. J Matern Fetal Neonatal Med 2010; 23: 506-510
• 7 Quintero RA, Morales WJ, Allen MH. et al. Staging of twin-twin transfusion syndrome. J Perinatol 1999; 19 (8 Pt 1): 550-555
• 8 Yamamoto M, Essaoui M, Nasr B. et al. Three-dimensional sonographic assessment of fetal urine production before and after laser surgery in twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol 2007; 30: 972-976
• 9 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: 965-971
• 10 Rychik J, Tian Z, Bebbington M. et al. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol 2007; 197: 392.e1-392.e8
• 11 Wohlmuth C, Gardiner HM, Diehl W. et al. Fetal cardiovascular hemodynamics in twin-twin transfusion syndrome. Acta Obstet Gynecol Scand 2016; 95: 664-671
• 12 Berghella V, Kaufmann M. Natural history of twin-twin transfusion syndrome. J Reprod Med 2001; 46: 480-484
• 13 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: 136-144
• 14 Khalil A, Cooper E, Townsend R. et al. Evolution of stage 1 twin-to-twin transfusion syndrome (TTTS): systematic review and meta-analysis. Twin Res Hum Genet 2016; 19: 207-216
• 15 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: 790-795
• 16 Lopriore E, Middeldorp JM, Oepkes D. et al. Residual anastomoses after fetoscopic laser surgery in twin-to-twin transfusion syndrome: frequency, associated risks and outcome. Placenta 2007; 28: 204-208
• 17 Slaghekke F, Lopriore E, Lewi L. et al. Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: an open-label randomised controlled trial. Lancet 2014; 383: 2144-2151
• 18 Slaghekke F, Lewi L, Middeldorp JM. et al. Residual anastomoses in twin-twin transfusion syndrome after laser: the Solomon randomized trial. Am J Obstet Gynecol 2014; 211: 285.e1-285.e7
• 19 Lanna MM, Faiola S, Consonni D. et al. Increased risk of placental abruption after solomon laser treatment of twin-twin transfusion syndrome. Placenta 2017; 53: 54-56
• 20 Akkermans J, Peeters SH, Klumper FJ. et al. Twenty-five years of fetoscopic laser coagulation in twin-twin transfusion syndrome: a systematic review. Fetal Diagn Ther 2015; 38: 241-253
• 21 Diehl W, Diemert A, Grasso D. et al. Fetoscopic laser coagulation in 1020 pregnancies with twin-twin transfusion syndrome demonstrates improvement in double-twin survival rate. Ultrasound Obstet Gynecol 2017; 50: 728-735
• 22 Stirnemann J, Chalouhi G, Essaoui M. et al. Fetal brain imaging following laser surgery in twin-to-twin surgery. BJOG 2016; 125: 1186-1191
• 23 Schou KV, Lando AV, Ekelund CK. et al. Long-term neurodevelopmental outcome of monochorionic twins after laser therapy or umbilical cord occlusion for twin-twin transfusion syndrome. Fetal Diagn Ther 2018; DOI: 10.1159/000491787.
• 24 van Klink JM, Koopman HM, Rijken M. et al. Long-term neurodevelopmental outcome in survivors of twin-to-twin transfusion syndrome. Twin Res Hum Genet 2016; 19: 255-261
• 25 Herberg U, Bolay J, Graeve P. et al. Intertwin cardiac status at 10-year follow-up after intrauterine laser coagulation therapy of severe twin-twin transfusion syndrome: comparison of donor, recipient and normal values. Arch Dis Child Fetal Neonatal Ed 2014; 99: F380-F385
• 26 Hecher K, Gardiner HM, Diemert A. et al. Long-term outcomes for monochorionic twins after laser therapy in twin-to-twin transfusion syndrome. Lancet Child Adolesc Health 2018; 2: 525-535
• 27 Chmait RH, Chon AH, Korst LM. et al. Risks of preterm premature rupture of membranes and preterm birth post fetoscopy based on location of trocar insertion site. Am J Perinatol 2018; 35: 801-808
• 28 Petersen SG, Gibbons KS, Luks FI. et al. The impact of entry technique and access diameter on prelabour rupture of membranes following primary fetoscopic laser treatment for twin-twin transfusion syndrome. Fetal Diagn Ther 2016; 40: 100-109
• 29 Shaw CJ, Civale J, Botting KJ. et al. Noninvasive high-intensity focused ultrasound treatment of twin-twin transfusion syndrome: a preliminary in vivo study. Sci Transl Med 2016; 8: 347ra395
• 30 Mackie FL, Hall MJ, Morris RK. et al. Early prognostic factors of outcomes in monochorionic twin pregnancy: systematic review and meta-analysis. Am J Obstet Gynecol 2018; 219: 436-446
• 31 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: 573-582
• 32 Bamberg C, Diemert A, Glosemeyer P. et al. Discordance of umbilical coiling index between recipients and donors in twin-twin transfusion syndrome. Placenta 2019; 76: 19-22