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Yaniv Zipori, Karen Reidy, T Gilchrist, Lex W Doyle, Mark P Umstad
BACKGROUND: Monochorionic diamniotic (MCDA) twin pregnancies are associated with adverse perinatal outcome. Intertwin discordances at the time of nuchal translucency (NT) screening may have a value in the prediction of fetal loss or twin-to-twin transfusion syndrome. We aimed to determine the ability of intertwin NT and crown rump length (CRL) discordances among MCDA twins to predict adverse outcomes. MATERIAL AND METHODS: All MCDA twins with a documented routine ultrasound at 11 to 13+6 weeks' gestation, and known pregnancy outcome between August 2003 and August 2012 were included...
October 21, 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Liran Hiersch, Mayan Eitan, Eran Ashwal, Boaz Weisz, Benny Chayen, Shlomo Lipitz, Yoav Yinon
OBJECTIVE: To estimate the risk for twin anemia-polycythemia sequence (TAPS) and adverse perinatal outcome in monochorionic diamniotic (MCDA) twin pregnancies with amniotic fluid discordance (AFD). METHODS: Retrospective cohort study of 34 MCDA pregnancies with AFD (intertwin difference of ≥3 cm in maximal vertical pocket measurement) without meeting the criteria for twin to twin transfusion syndrome (TTTS) or selective intrauterine growth restriction (sIUGR)...
October 12, 2016: Prenatal Diagnosis
N V Nizyaeva, K V Kostyukov, K A Gladkova, G V Kulikova, A I Shchegolev
Monochorionic multiple pregnancy has a higher risk for obstetric complications, including those due to the development of twin-to-twin transfusion syndrome and reversed arterial perfusion syndrome (TRAP sequence). The latter occurs in 0.1% of all monochorionic pregnancies. The basis for TRAP sequence is a relationship between arterial and venous anastomoses from the appropriate placental areas, causing a recipient fetus to develop at the expense of a donor fetus. The presence of abnormal anastomoses is considered to be a main cause of acardia...
July 2016: Arkhiv Patologii
Fiona Cheong-See, Ewoud Schuit, David Arroyo-Manzano, Asma Khalil, Jon Barrett, K S Joseph, Elizabeth Asztalos, Karien Hack, Liesbeth Lewi, Arianne Lim, Sophie Liem, Jane E Norman, John Morrison, C Andrew Combs, Thomas J Garite, Kimberly Maurel, Vicente Serra, Alfredo Perales, Line Rode, Katharina Worda, Anwar Nassar, Mona Aboulghar, Dwight Rouse, Elizabeth Thom, Fionnuala Breathnach, Soichiro Nakayama, Francesca Maria Russo, Julian N Robinson, Jodie M Dodd, Roger B Newman, Sohinee Bhattacharya, Selphee Tang, Ben Willem J Mol, Javier Zamora, Basky Thilaganathan, Shakila Thangaratinam
OBJECTIVE: To determine the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, and Cochrane databases (until December 2015). REVIEW METHODS: Databases were searched without language restrictions for studies of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal outcomes at various gestational ages...
September 6, 2016: BMJ: British Medical Journal
Masahiko Nakata, Keisuke Ishii, Masahiro Sumie, Mayumi Takano, Hiroko Hirata, Susumu Murata, Yuichiro Takahashi, Takeshi Murakoshi, Haruhiko Sago
OBJECTIVE: The aim of this study is to clarify the feasibility and efficacy of fetoscopic laser photocoagulation of placental vascular communicating vessels (FLP) on twin-twin transfusion syndrome (TTTS) after 26 weeks of gestation. MATERIALS AND METHODS: This is a prospective pilot study investigating all cases of TTTS between 26 weeks and 27 weeks during 2012 and 2013 in Japan. The primary endpoints in this study were the feasibility of FLP and rate of harmful complications for the mother's health...
August 2016: Taiwanese Journal of Obstetrics & Gynecology
Rebecca McDonald, Ryan Hodges, Michelle Knight, Mark Teoh, Andrew Edwards, Peter Neil, Euan M Wallace, Philip DeKoninck
INTRODUCTION: Monochorionic-diamniotic (MCDA) twin pregnancies are high risk, due to twin-to-twin transfusion syndrome (TTTS), twin anaemia polycythaemia sequence (TAPS) and intrauterine growth restriction (IUGR). There is limited evidence to guide ultrasound surveillance protocols. Using a retrospective cohort, we aimed to provide insight into the optimal interval of ultrasound surveillance. METHODS: Retrospective cohort of women with MCDA pregnancies who received antenatal care at Monash Medical Centre (January 2011-October 2014)...
August 25, 2016: Fetal Diagnosis and Therapy
Nancy L Segal
The 2016 Satellite Meeting of the International Society of Twin Studies took place on June 20 in Brisbane, Australia. The host institution was the QIMR Berghofer Medical Research Institute. An overview of selected presentations and activities is provided. This synopsis is followed by a brief tribute to the recent passing of our esteemed colleague, Dr Irving I. Gottesman. Next, there are summaries of research on monozygotic twinning after single embryo transfer, a twin study of mononucleosis susceptibility, cerebral injury following twin-to-twin transfusion syndrome surgery, and a correction and clarification regarding an article by Segal (2016) on the Brazilian Twin Registry...
October 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Rebecca Fischbein, James Meeker, Julia R Saling, Michelle Chyatte, Lauren Nicholas
BACKGROUND: Twin-to-twin transfusion syndrome (TTTS) affects 10-20 % of monochorionic diamniotic (MCDA) births and accounts for 50 % of fetal loss in MCDA pregnancies. This exploratory qualitative study identified shared experiences, including potential emotional and psychosocial impacts, of this serious disease. METHODS: Forty-five publicly accessible, online stories posted by families who experienced TTTS were analyzed using grounded theory. RESULTS: Shared TTTS experiences included a common trajectory: early pregnancy experiences, diagnostic experiences, making decisions, interventions and variable outcomes...
2016: BMC Pregnancy and Childbirth
S J Eschbach, L S T M Boons, E van Zwet, J M Middeldorp, F J C M Klumper, E Lopriore, A K K Teunissen, M E Rijlaarsdam, D Oepkes, A D J Ten Harkel, M C Haak
OBJECTIVE: Severe right Ventricular Outflow Tract Obstruction (RVOTO) is a complication in recipient twins in Twin-to-Twin-Transfusion Syndrome (TTTS), which requires post-partum follow-up or treatment. The objective of our study was to evaluate pregnancy characteristics of neonates with RVOTO in complicated monochorionic twin pregnancies. In the TTTS cases we aimed to determine the incidence and to construct a prediction model for the development of RVOTO. METHODS: An observational cohort study of all complicated monochorionic twin pregnancies with a post-partum neonatal diagnosis of RVOTO was performed...
July 1, 2016: Ultrasound in Obstetrics & Gynecology
J Stirnemann, G Chalouhi, M Essaoui, N Bahi-Buisson, P Sonigo, A-E Millischer, A Lapillonne, V Guigue, L J Salomon, Y Ville
OBJECTIVE: To describe the incidence and nature of prenatal brain damage following fetoscopic laser selective coagulation (FLSC) of placental vessels for twin-to-twin transfusion syndrome (TTTS). DESIGN: Retrospective observational study. SETTING: Single center cohort. POPULATION: All consecutive cases referred for TTTS treated by FLSC between 2003 and 2015. METHODS: After the FLSC, patients were followed weekly by ultrasound...
June 27, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Valentina Stagnati, Cristina Zanardini, Anna Fichera, Giorgio Pagani, Ruben A Quintero, Rino Bellocco, Federico Prefumo
OBJECTIVE: The aim of this systematic review and meta-analysis was to assess the role of first trimester and early second trimester markers for the prediction of twin-to-twin transfusion syndrome (TTTS) in monochorionic twin pregnancies. METHODS: MEDLINE, EMBASE and were searched from inception to April 2014. The MeSH term "fetofetal transfusion" was searched in combination with the phrases "predictive value", "sensitivity", "specificity", "false positive", "false negative", "screening", "accuracy" and "ROC"...
June 7, 2016: Ultrasound in Obstetrics & Gynecology
Fiona L Mackie, R Katie Morris, Mark D Kilby
Perinatal mortality is increased considerably in multiple pregnancies compared to singleton pregnancies, with single intrauterine fetal demise (sIUFD) presenting a rare but unique perinatal problem. Monochorionic pregnancies are at particular risk of sIUFD due to bidirectional inter-twin placental vascular anastomoses. The resulting inter-twin blood flow can become unbalanced, causing acute and chronic inter-twin transfusion and profound anemia secondary to fetal exsanguination into the low-pressure circulation of the dead fetus...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Femke Slaghekke, Dick Oepkes
Monochorionic twin pregnancies can be complicated by twin-to-twin transfusion syndrome (TTTS). The best treatment option for TTTS is fetoscopic laser coagulation of the vascular anastomoses between donor and recipient. After laser therapy, up to 33% residual anastomoses were seen. These residual anastomoses can cause twin anemia polycythemia sequence (TAPS) and recurrent TTTS. In order to reduce the number of residual anastomoses and their complications, a new technique, the Solomon technique, where the whole vascular equator will be coagulated, was introduced...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Rubén A Quintero, Eftichia Kontopoulos, Ramen H Chmait
OBJECTIVE: Laser ablation of all placental vascular anastomoses is the optimal treatment for twin-twin transfusion syndrome (TTTS). However, two important controversies are apparent in the literature: (a) a gap between concept and performance, and (b) controversy regarding whether all the anastomoses can be identified endoscopically and whether blind lasering of healthy placenta is justified. The purpose of this article is: (a) to address the potential source of the gap between concept and performance by analyzing the fundamental steps needed to successfully accomplish the surgery, and (b) to discuss the resulting competency benchmarks reported with the different surgical techniques...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Eftichia Kontopoulos, Ramen H Chmait, Ruben A Quintero
OBJECTIVE: The purpose of this article is to review the definition of twin-to-twin transfusion syndrome (TTTS) and the sonographic diagnostic assessment of these cases prior to therapy. MATERIALS AND METHODS: The article addresses the terminology used to refer to the condition and describes the systematic ultrasound assessment of the condition, including the ultrasound diagnosis, the staging of the disease, cervical assessment and pre-operative mapping. RESULTS: From an etymologic and medical point of view, the term 'fetofetal transfusion' is more appropriate than 'TTTS'...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Chelsea L Glennon, Scott A Shemer, Ricardo Palma-Dias, Mark P Umstad
Historical suggestions of twin-to-twin transfusion syndrome (TTTS) date back to the early 17th century. Placental anastomoses were first reported in 1687; however, it was Schatz who first identified their importance in 1875. He recognized 'the area of transfusion' within the 'villous district' of the placenta, which he named the 'third circulation'. This article describes how the management of TTTS has evolved as we have gained a more sophisticated understanding and appreciation of the complex vascular anastomoses that exist in monochorionic twin placentae...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
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
Jeanine M M van Klink, Hendrik M Koopman, Monique Rijken, Johanna M Middeldorp, Dick Oepkes, Enrico Lopriore
Twin-twin transfusion syndrome (TTTS) is a severe complication of monochorionic (MC) twin pregnancies associated with high perinatal mortality and morbidity rates. Management in TTTS is a major challenge for obstetricians and neonatologists. Twins with TTTS are often born prematurely after an extremely distressing and highly hazardous fetal period. Follow-up studies report varying rates of cerebral palsy (CP) and long-term neurodevelopmental impairment (NDI). This review discusses the latest findings on the long-term outcome of TTTS survivors, possible risk factors for long-term impairment, and provides recommendations for future research...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Liselotte E M van Kempen, Depeng Zhao, Sylke J Steggerda, Vincent Bekker, Johanna M Middeldorp, Dick Oepkes, Enrico Lopriore
OBJECTIVE: To investigate the occurrence of early-onset neonatal sepsis (EOS) in twin-twin transfusion syndrome (TTTS) managed with laser surgery. STUDY DESIGN: We performed a prospective cohort study of all consecutive TTTS cases treated with laser surgery (TTTS group) delivered at the Leiden University Medical Center. We recorded the occurrence of EOS, defined as a positive blood culture ≤72 hours postpartum (proven sepsis) or administration of a full course of antibiotics due to risk factors or signs of sepsis, in the absence of a positive blood culture (suspected sepsis)...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Robert Cincotta, Sailesh Kumar
Twin-to-twin transfusion syndrome (TTTS) is the major complication of monochorionic (MC) pregnancy. The outcomes of this condition have been significantly improved after the introduction and widespread uptake of fetoscopic laser ablation over the last decade. However, there is still a significant fetal loss rate and morbidity associated with this condition. Improvements in the management of TTTS will require improvements in many areas. They are likely to involve refinements in the prediction of the disease and clarification of the optimum frequency of surveillance and monitoring...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
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