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natural history of twin twin transfusion

Erin E Washburn, Teresa N Sparks, Kristen A Gosnell, Larry Rand, Juan M Gonzalez, Vickie A Feldstein
OBJECTIVE:  This article describes the natural history of stage I twin-twin transfusion syndrome (TTTS) including risk of progression to higher stage TTTS and pregnancy outcomes, and to identify risk factors for progression. STUDY DESIGN:  Retrospective cohort study of monochorionic diamniotic (MCDA) twin pregnancies from 2006 to 2016 with expectantly managed Quintero stage I TTTS. RESULTS:  A total of 30 MCDA twin pregnancies with expectantly managed stage I TTTS were identified...
February 8, 2018: American Journal of Perinatology
Fatiha Djaafri, Julien Stirnemann, Imen Mediouni, Claire Colmant, Yves Ville
Monochorionic twin pregnancies are at increased risk for adverse outcome compared to dichorionic twin pregnancies and singletons. Monochorionic-specific complications include twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence, single intrauterine fetal demise and its consequences on the co-twin, and selective intrauterine growth restriction. Whereas the natural history of monochorionic-specific complications carries a high risk of fetal death or severe neurologic disability, a framework now exists, based on well-designed clinical trials, for optimal treatment of these entities...
December 2017: Seminars in Fetal & Neonatal Medicine
Andrew H Chon, Lisa M Korst, Ryan D Assaf, Arlyn Llanes, Joseph G Ouzounian, Ramen H Chmait
OBJECTIVE: To describe the natural history and perinatal outcomes of monochorionic diamniotic twins with midtrimester isolated oligohydramnios (iOligo). MATERIALS AND METHODS: We performed a retrospective study of iOligo patients who were initially referred for the management of evolving twin-twin transfusion syndrome (TTTS) or selective intrauterine growth restriction (sIUGR). iOligo was defined as a maximum vertical pocket of amniotic fluid of ≤2 cm in the iOligo twin's sac and normal fluid level (>2 and <8 cm) in the co-twin's sac...
October 12, 2017: Journal of Maternal-fetal & Neonatal Medicine
Asma Khalil, Emily Cooper, Rosemary Townsend, Basky Thilaganathan
OBJECTIVES: The natural history of stage 1 Twin-to-twin transfusion syndrome (TTTS) remains unclear and its optimal management is yet to be established. The main aims of this meta-analysis were to quantify the incidence of progression in stage 1 TTTS and to ascertain survival in these pregnancies. METHODS: MEDLINE, EMBASE, and The Cochrane Library were searched. Reference lists within each article were hand-searched for additional reports. The outcomes included incidence of progression and survival in stage 1 TTTS...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Stephen P Emery, Steve K Hasley, Janet M Catov, Russell S Miller, Anita J Moon-Grady, Ahmet A Baschat, Anthony Johnson, Foong-Yen Lim, Alain L Gagnon, Richard W O'Shaughnessy, Tulin Ozcan, Francois I Luks
BACKGROUND: Stage I twin-twin transfusion syndrome presents a management dilemma. Intervention may lead to procedure-related complications while expectant management risks deterioration. Insufficient data exist to inform decision-making. OBJECTIVE: The aim of this retrospective observational study was to describe the natural history of stage I twin-twin transfusion syndrome, to assess for predictors of disease behavior, and to compare pregnancy outcomes after intervention at stage I vs expectant management...
September 2016: American Journal of Obstetrics and Gynecology
Naoto Yonetani, Keisuke Ishii, Hiroshi Kawamura, Aki Mabuchi, Shusaku Hayashi, Nobuaki Mitsuda
INTRODUCTION: The objective of this study was to evaluate the actual association between velamentous cord insertion (VCI) and twin-twin transfusion syndrome (TTTS) in the native cohort concerning the natural history of monochorionic twin pregnancies. MATERIAL AND METHODS: All monochorionic diamniotic twin pregnancies who received prenatal care from <16 weeks of gestation until delivery at our center between 2004 and 2013 were included in this retrospective cohort study...
2015: Fetal Diagnosis and Therapy
Mira Abdel-Sattar, Larry D Platt, Greggory DeVore, Manuel Porto, Kurt Benirschke, Ramen H Chmait
Monochorionic diamniotic twins share a single placenta and have intertwin vascular communications that link the circulatory systems of the twins together. Twin anemia-polycythemia sequence (TAPS) is an atypical form of twin-twin transfusion syndrome (TTTS) caused by net transfer of blood from one fetus to the other and is characterized by large intertwin hemoglobin differences in the absence of oligohydramnios and polyhydramnios. This condition may develop spontaneously (sTAPS) or as a result of residual vascular communications after prior laser surgery...
2015: Fetal Diagnosis and Therapy
Lynn L Simpson
OBJECTIVE: We sought to review the natural history, pathophysiology, diagnosis, and treatment options for twin-twin transfusion syndrome (TTTS). METHODS: A systematic review was performed using MEDLINE database, PubMed, EMBASE, and Cochrane Library. The search was restricted to English-language articles published from 1966 through July 2012. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries also were consulted...
January 2013: American Journal of Obstetrics and Gynecology
Tim van Mieghem, David Baud, Roland Devlieger, Liesbeth Lewi, Greg Ryan, Luc De Catte, Jan Deprest
The implementation of systematic pregnancy screening programmes, and the increased use and improving quality of medical imaging techniques, have lead to earlier detection and better understanding of the natural history of fetal anomalies. Where most fetal conditions are adequately treatable after birth, some disorders progress during fetal life and can lead to severe morbidity or fetal and neonatal demise. This inherently raises the question of prenatal therapy. Some fetal conditions are amenable for fetal surgical intervention, part of them by minimal access...
October 2012: Best Practice & Research. Clinical Obstetrics & Gynaecology
Liesbeth Lewi, Leonardo Gucciardo, Tim Van Mieghem, Philippe de Koninck, Veronika Beck, Helga Medek, Dominique Van Schoubroeck, Roland Devlieger, Luc De Catte, Jan Deprest
About 30% of monochorionic twin pregnancies are complicated by twin-to-twin transfusion syndrome (TTTS), isolated discordant growth, twin anemia-polycythemia sequence, congenital defects or intrauterine demise. About 15% will be eligible for invasive fetal therapy, either fetoscopic laser treatment for TTTS or fetoscopic or ultrasound-guided umbilical cord coagulation for a severe congenital defect in one twin or severe discordant growth with imminent demise of the growth-restricted twin. Ultrasound examination in the first and early second trimester can differentiate the monochorionic twins at high risk for adverse outcome from those likely to be uneventful, which may be useful for patient counselling and planning of care...
2010: Fetal Diagnosis and Therapy
Lourenço Sbragia
About 1% of all pregnancies present structural anomalies. During the last three decades, various experimental studies in large animals, associated with the technological advance of diagnostic imaging and fetoscopy equipment, have led to great progress in the knowledge of the pathophysiology of various congenital defects. Such knowledge applied to intrauterine correction of abnormalities has transformed the natural history of several previously fatal diseases, leading to a considerable number of survivors. Fetal intervention, such as open fetal surgery, may be indicated in meningomyelocele or in congenital cystic adenomatoid malformation, and in sacrococcygeal teratoma, which lead to secondary fetal hydropsy...
January 2010: Revista Brasileira de Ginecologia e Obstetrícia
Angela C Rossi
PURPOSE OF REVIEW: Although the efficacy of intrauterine intervention has been clearly demonstrated for some conditions, such as twin to twin transfusion syndrome and twin reversal arterial perfusion, it is still to be determined as treatment of congenital diaphragmatic hernia, cardiac defects, lower urinary tract obstruction and sacrococcygeal teratoma. The aim of the present study was to review literature concerning the benefits and outcomes of fetal intervention for these anomalies together with its limitations and controversies...
April 2010: Current Opinion in Obstetrics & Gynecology
Cleisson Fábio Andrioli Peralta, Luciana Emy Ishikawa, Renato Passini Júnior, João Renato Bennini Júnior, Marcelo Luiz Nomura, Izilda Rodrigues Machado Rosa, Ricardo Barini
PURPOSE: to evaluate the evolution of monochorionic-diamniotic twin pregnancies with and without the twin-twin transfusion syndrome (TTTS), followed up in an expectant way. METHODS: retrospective study in which the pregnancies with and without TTTS and with mild (Quintero's stage I) and severe (Quintero's stages II, III, IV and V) disease manifestations were compared according to extreme preterm delivery, neurological impairment and the twins' nursery discharge...
June 2009: Revista Brasileira de Ginecologia e Obstetrícia
Jose L Peiró, Elena Carreras, Gabriela Guillén, Silvia Arévalo, M Angeles Sánchez-Durán, Teresa Higueras, Felix Castillo, Claudia Marhuenda, Josep Lloret, Vicenç Martínez-Ibáñez
BACKGROUND: Prenatal ultrasound study allows the detection of fetal malformations. Intrauterine interventions are now contemplated to correct, or interfere with, the natural history of these anomalies. Minimally invasive techniques, such as the so-called "Fetendo" (fetal endoscopy), are now therapeutic possibilities. METHODS: From 2002 to 2007, 205 fetoscopies were performed in our hospital's fetal surgery program. Fetoscopic interventions were carried out under epidural anesthesia, accessing the uterine cavity with a fetoscope containing a 1...
April 2009: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
A C Rossi, V D'addario
Twin-twin transfusion syndrome (TTTS) is a condition unique to monochorionic pregnancies, although very few case reports described the syndrome in dichorionic placentas. The aetiology of TTTS relies in the presence of at least 1 arterio-venous placental anastomosis, through which unequal blood exchange from one twin (donor) to the co-twin (recipient) occurs. The diagnosis of TTTS relies on the sonographic detection of oligohydramnios in the donor's sac and polyhydramnios in the recipient's sac in the second trimester, although signs of TTTS are present since the first trimester...
April 2009: Minerva Ginecologica
A Huber, W Diehl, L Zikulnig, T Bregenzer, B J Hackelöer, K Hecher
OBJECTIVES: To assess the natural history and perinatal outcome in monochorionic diamniotic twin pregnancies with discordant amniotic fluid volume without signs of severe twin-twin transfusion syndrome (TTTS). METHODS: This was an observational study of 84 consecutive monochorionic twin pregnancies which did not meet the criteria for severe TTTS and endoscopic laser coagulation of placental anastomoses at initial presentation. The population was subdivided into two groups...
January 2006: Ultrasound in Obstetrics & Gynecology
Romaine Robyr, Masami Yamamoto, Yves Ville
OBJECTIVE: To review our experience with selective feticide in complicated monochorionic (MC) twin pregnancies, using ultrasound-guided cord coagulation with a bipolar forceps. DESIGN: Retrospective analysis. SETTING: All consecutive umbilical cord coagulations performed at our institution in the second trimester of pregnancy between November 1999 and 2003. POPULATION: Consecutive cases of complicated MC pregnancies with an indication for selective termination...
October 2005: BJOG: An International Journal of Obstetrics and Gynaecology
D H Rumsey, S J Nance, M Rubino, S G Sandler
Anti-Jka was detected by solid-phase red cell adherence (SPRCA) antibody detection and identification tests in the plasma of a 9-month-old female infant during a routine presurgical evaluation. The patient and her nonidentical twin sister, who also had anti-Jka in her plasma, were products of an uncomplicated in vitro fertilization, full-term pregnancy, and vaginal delivery. Neither twin had been transfused, recently infected, or treated with medication. Their mother had no prior pregnancies or transfusions...
1999: Immunohematology
Holly L Hedrick, Alan W Flake, Timothy M Crombleholme, Lori J Howell, Mark P Johnson, R Douglas Wilson, N Scott Adzick
PURPOSE: To understand the natural history and define indications for fetal intervention in sacrococcygeal teratoma (SCT), the authors reviewed all cases of fetal SCT presenting for evaluation. METHODS: Prenatal diagnostic studies including ultrasound scan, magnetic resonance imaging (MRI), echocardiography and pre- and postnatal outcomes were reviewed in 30 cases of SCT that presented between September 1995 and January 2003. RESULTS: The mean gestational age (GA) at presentation was 23...
March 2004: Journal of Pediatric Surgery
Ahmet Gul, Halil Aslan, Ibrahim Polat, Altan Cebeci, Hasan Bulut, Ozturk Sahin, Yavuz Ceylan
The natural history of 11 cases of twin-twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twin pregnancies has been reviewed. Seven cases before 28 weeks and four pregnancies after 28 weeks had been followed up without intervention. Eight cases had premature uterine contractions. All seven pregnancies before 28 weeks aborted, leading to a 100% mortality rate. After 28 weeks all mothers delivered live births. The diagnosis of TTTS before 28 weeks, and with premature uterine contraction, seems to be a poor prognostic sign...
August 2003: Twin Research: the Official Journal of the International Society for Twin Studies
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