Background: Monochorionic twins have a risk of developing a Twin-to-twin transfusion syndrome (TTTS) between 10 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 diagnosis of TTTS is primarly ultrasonographic, through the identification of peculiar signs: no intertwin dividing membrane, same sex, 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 syndrome is 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 with its 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 management of twin-to-twin transfusion syndrome: fetoscopic laser coagulation of placental vascular anastomoses and serial amniodrainage; selective feticide by cord occlusion; septostomy with or without amniodrainage. Conclusions: Appropriately timed diagnosis of twin-to-twin transfusion syndrome is crucial because a delay in diagnosis may result in a delay in treatment and consequent increased perinatal mortality and morbidity. At the moment the best treatment seems to be fetoscopic laser coagulation of placental vessel anastomoses, which showed survival rates between 76-88%.

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

CARBONARO, Antonio;
2012

Abstract

Background: Monochorionic twins have a risk of developing a Twin-to-twin transfusion syndrome (TTTS) between 10 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 diagnosis of TTTS is primarly ultrasonographic, through the identification of peculiar signs: no intertwin dividing membrane, same sex, 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 syndrome is 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 with its 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 management of twin-to-twin transfusion syndrome: fetoscopic laser coagulation of placental vascular anastomoses and serial amniodrainage; selective feticide by cord occlusion; septostomy with or without amniodrainage. Conclusions: Appropriately timed diagnosis of twin-to-twin transfusion syndrome is crucial because a delay in diagnosis may result in a delay in treatment and consequent increased perinatal mortality and morbidity. At the moment the best treatment seems to be fetoscopic laser coagulation of placental vessel anastomoses, which showed survival rates between 76-88%.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11769/52419
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