PDF herunterladen
Am J Perinatol 2024; 41(05): 531-538
DOI: 10.1055/s-0042-1744259
Review Article

Ultrasonographic Diagnosis of Twin-to-Twin Transfusion Syndrome

Eduardo Reyna-Villasmil
1   Obstetrics and Gynecology Department. Central Hospital Dr. Urquinaona, Maracaibo, Venezuela
,
Carlos Briceño-Pérez 
2   Obstetrics and Gynecology Department, University of Zulia, Maracaibo, Venezuela
,
Juan C. Briceño-Sanabria
3   Obstetrics and Gynecology Department. San Juan de Dios Hospital, Río Negro, Colombia
› Institutsangaben Funding None.
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Introduction Twin-twin transfusion syndrome (TTTS) is a typical complication of monochorionic twin pregnancies (MCTP). Placental vessels that communicate in the chorionic plate between donor and recipient, are responsible for the imbalance of blood flow. Circulatory imbalance causes hypovolemia in donor and hypervolemia in recipient fetus. In a typical case, recipient fetus develops polyhydramnios, weight gain, cardiomegaly and hydrops fetalis. In contrast, donor fetus develops oligohydramnios and fetal growth restriction.

Aim The objective of this review is to evaluate in detail the main diagnostic aspects and add other important data for diagnosis of TTTS.

Scientific bases The main diagnostic event for this condition is based on the ultrasonographic discovery of oligohydramnios-polyhydramnios sequence. Other useful elements for diagnosis, staging and prognosis are fetal urinary bladder visualization, urinary bladder volumen measurements, edema of subcutaneous and/or generalized tissue edema, Doppler flow velocity waves and cardiac evaluation.

Conclusion Considerations regarding diagnosis of TTTS make it possible to emphasize that role of physicians treating patients with MCTP is to identify ultrasound sequence of oligohydramnios-polyhydramnios. Other ultrasonographic fetal data as fetal urinary bladder visualization, urinary bladder volumen measurements, edema of subcutaneous and/or generalized tissue edema, Doppler flow velocity waves and cardiac evaluation; may help diagnosis, staging and prognosis of TTTS. It is their responsibility to accurately assess severity, therapeutic possibilities and prognosis.

Key Points

  • The role of physicians treating patients with MCTP, regarding diagnosis of TTTS, must be to identify ultrasound sequence of oligohydramnios–polyhydramnios.

  • Other ultrasonographic fetal data may help diagnosis, staging, and prognosis of TTTS as follows: fetal urinary bladder visualization, urinary bladder volume measurements, edema of subcutaneous and/or generalized tissue edema, Doppler flow velocity waves, and cardiac evaluation.

  • It is physicians' responsibility to accurately assess severity, therapeutic possibilities, and prognosis of patients with MCTP and diagnosis of TTTS.

Keywords

twin-twin transfusion syndrome - twin pregnancy - prenatal diagnosis - ultrasound - complications


Publikationsverlauf

Eingereicht: 01. Mai 2021

Angenommen: 26. Januar 2022

Artikel online veröffentlicht:
09. März 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Briceño-Pérez C, Briceño-Sanabria L. Twin pregnancy at Chiquinquirá Hospital in Maracaibo. 1991–2000. Rev Obstet Ginecol Venez 2004; 64 (01) 3-13
    PubMedGoogle Scholar
  • 2 Briceño-Pérez C, Briceño-Sanabria L. Fetal and neonatal morbidity and mortality in twin pregnancy. Chiquinquirá Hospital in Maracaibo. 1991–2000. Rev Obstet Ginecol Venez 2005; 65 (01) 1-8
    PubMedGoogle Scholar
  • 3 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 (07) 965-971
    CrossrefPubMedGoogle Scholar
  • 4 Tollenaar LSA, Lopriore E, Faiola S. et al. Post-laser twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 164 cases. J Clin Med 2020; 9 (06) 1759
    CrossrefPubMedGoogle Scholar
  • 5 Murgano D, Khalil A, Prefumo F. et al. Outcome of twin-to-twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2020; 55 (03) 310-317
    CrossrefPubMedGoogle Scholar
  • 6 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 (08) 815-820
    CrossrefPubMedGoogle Scholar
  • 7 Bolch C, Fahey M, Reddihough D. et al. Twin-to-twin transfusion syndrome neurodevelopmental follow-up study (neurodevelopmental outcomes for children whose twin-to-twin transfusion syndrome was treated with placental laser photocoagulation). BMC Pediatr 2018; 18 (01) 256
    CrossrefPubMedGoogle Scholar
  • 8 Morris RK, Mackie F, Garces AT, Knight M, Kilby MD. The incidence, maternal, fetal and neonatal consequences of single intrauterine fetal death in monochorionic twins: A prospective observational UKOSS study. PLoS One 2020; 15 (09) e0239477
    CrossrefPubMedGoogle Scholar
  • 9 Seravalli V, Maoloni L, Pasquini L. et al. The impact of assisted reproductive technology on prenatally diagnosed fetal growth restriction in dichorionic twin pregnancies. PLoS One 2020; 15 (04) e0231028
    CrossrefPubMedGoogle Scholar
  • 10 Townsend R, Khalil A. Ultrasound screening for complications in twin pregnancy. Semin Fetal Neonatal Med 2018; 23 (02) 133-141
    CrossrefPubMedGoogle Scholar
  • 11 Mackie FL, Morris RK, Kilby MD. The prediction, diagnosis and management of complications in monochorionic twin pregnancies: the OMMIT (Optimal Management of Monochorionic Twins) study. BMC Pregnancy Childbirth 2017; 17 (01) 153
    CrossrefPubMedGoogle Scholar
  • 12 Allaf MB, Campbell WA, Vintzileos AM. et al. Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies?. J Ultrasound Med 2014; 33 (09) 1573-1578
    CrossrefPubMedGoogle Scholar
  • 13 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 (05) 573-582
    CrossrefPubMedGoogle Scholar
  • 14 Khalil A, Rodgers M, Baschat A. et al. ISUOG practice guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 2016; 47 (02) 247-263
    CrossrefPubMedGoogle Scholar
  • 15 Santos-Bolívar J, Reyna-Villasmil E, Torres-Cepeda D. Ultrasound usefulness in twin pregnancies diagnosis. Rev Latinoam Perinatol 2016; 19 (02) 117-130
    PubMedGoogle Scholar
  • 16 Moise Jr KJ. Toward consistent terminology: assessment and reporting of amniotic fluid volume. Semin Perinatol 2013; 37 (05) 370-374
    CrossrefPubMedGoogle Scholar
  • 17 Glennon CL, Shemer SA, Palma-Dias R, Umstad MP. The history of treatment of twin-to-twin transfusion syndrome. Twin Res Hum Genet 2016; 19 (03) 168-174
    CrossrefPubMedGoogle Scholar
  • 18 Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol 1999; 19 (8 pt. 1): 550-555
    CrossrefPubMedGoogle Scholar
  • 19 Rotar IC, Zaharie G, Staicu A, Preda A, Mureşan D. Fetal cardiovascular alterations in twin-to-twin transfusion syndrome. Med Pharm Rep 2020; 93 (01) 5-11
    PubMedGoogle Scholar
  • 20 Marwan AI, Zaretsky M, Feltis B. Complex multigestational anomalies. Semin Pediatr Surg 2019; 28 (04) 150825
    CrossrefPubMedGoogle Scholar
  • 21 Yoda H. Fetal and neonatal circulatory disorders in twin to twin transfusion syndrome (The Secondary Publication). J Nippon Med Sch 2019; 86 (04) 192-200
    CrossrefPubMedGoogle Scholar
  • 22 Wohlmuth C, Gardiner HM, Diehl W, Hecher K. Fetal cardiovascular hemodynamics in twin-twin transfusion syndrome. Acta Obstet Gynecol Scand 2016; 95 (06) 664-671
    CrossrefPubMedGoogle Scholar
  • 23 Djaafri F, Stirnemann J, Mediouni I, Colmant C, Ville Y. Twin-twin transfusion syndrome - what we have learned from clinical trials. Semin Fetal Neonatal Med 2017; 22 (06) 367-375
    CrossrefPubMedGoogle Scholar
  • 24 Zanardini C, Prefumo F, Fichera A, Botteri E, Frusca T. Fetal cardiac parameters for prediction of twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol 2014; 44 (04) 434-440
    CrossrefPubMedGoogle Scholar
  • 25 Leszczynska K, Meyer-Szary J, Chojnicki M. et al. Assessment of cardiac function in donor and recipient fetuses during a 7-day follow-up after selective laser photocoagulation of communicating vessels due to TTTS. Ginekol Pol 2019; 90 (04) 189-194
    CrossrefPubMedGoogle Scholar
  • 26 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 (07) 972-976
    CrossrefPubMedGoogle Scholar
  • 27 Kist WJ, Slaghekke F, Papanna R. et al. Sonography-based Automated Volume Count to estimate fetal urine production in twin-to-twin transfusion syndrome: comparison with Virtual Organ Computer-aided AnaLysis. Am J Obstet Gynecol 2011; 205 (06) 574.e1-574.e5
    CrossrefPubMedGoogle Scholar
  • 28 Akkermans J, Peeters SH, Klumper FJ, Lopriore E, Middeldorp JM, Oepkes D. Twenty-five years of fetoscopic laser coagulation in twin-twin transfusion syndrome: a systematic review. Fetal Diagn Ther 2015; 38 (04) 241-253
    CrossrefPubMedGoogle Scholar
  • 29 Huber A, Diehl W, Bregenzer T, Hackelöer BJ, Hecher K. Stage-related outcome in twin-twin transfusion syndrome treated by fetoscopic laser coagulation. Obstet Gynecol 2006; 108 (02) 333-337
    CrossrefPubMedGoogle Scholar
  • 30 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 (04) 392.e1-392.e8
    CrossrefPubMedGoogle Scholar
  • 31 Khalil A, Perry H, Duffy J. et al; International Collaboration to Harmonise Outcomes for Twin-Twin Transfusion Syndrome (CHOOSE). Twin-Twin Transfusion Syndrome: study protocol for developing, disseminating, and implementing a core outcome set. Trials 2017; 18 (01) -3 25
    CrossrefPubMedGoogle Scholar
  • 32 Bamberg C, Hecher K. Update on twin-to-twin transfusion syndrome. Best Pract Res Clin Obstet Gynaecol 2019; 58: 55-65
    CrossrefPubMedGoogle Scholar