A Twin-to-Twin Transfusion Syndrome (V Quintero’s stage): A Case Report and Literature’s Review

Background: Monochorionic twins have a risk of developing a Twin-to-twin transfusion syndrome (TTTS) between10 and 15%. The pathogenesis of the twin-to-twin transfusion syndrome is still unknown, and the mortality reaches 80-90% if not treated. TTTS is characterized by the presence of multiple vascular placental anastomoses. The diagnosisof TTTS is primarly ultrasonographic, through the identification of peculiar signs: no intertwin dividing membrane, samesex, polyhydramnios of the recipient, oligo/anhydramnios of the donor, donor Intra-Uterine Growth Restriction (IUGR),permanently filled bladder in the recipient and slightly filled or empty bladder in the donor. The severity of the syndromeis established using the Quintero’s staging system.Case: We report the case of a 36 year old patient with one set of monochorionic female twins and a male fetus withits own placenta. The one set of female twins was complicated by Quintero stage V twin-to-twin transfusion syndrome,with death of the donor twin.Methods: Review of the literature based mainly on PubMed search using specific keywords.Results: TTTS should be treated in specialized centers. There are several treatment options for the managementof twin-to-twin transfusion syndrome: fetoscopic laser coagulation of placental vascular anastomoses and serialamniodrainage; selective feticide by cord occlusion; septostomy with or without amniodrainage.Conclusions: Appropriately timed diagnosis of twin-to-twin transfusion syndrome is crucial because a delayin diagnosis may result in a delay in treatment and consequent increased perinatal mortality and morbidity. At themoment the best treatment seems to be fetoscopic laser coagulation of placental vessel anastomoses, which showedsurvival rates between 76-88%.