Twin to Twin Transfusion Syndrome in Discordance Twins: Diagnostic and Management Approach

I Gde Sastra Winata; William Alexander Setiawan; I Kadek Wahyu Putra Dyatmika; I Gede Agus Rastika; Shaalini Arjunan

doi:10.24018/ejmed.2023.5.2.1285

Review Article

I Gde Sastra Winata

Sanglah General Hospital, Indonesia

* Corresponding author

William Alexander Setiawan

Udayana University, Indonesia

I Kadek Wahyu Putra Dyatmika

Udayana University, Indonesia

I Gede Agus Rastika

Udayana University, Indonesia

Shaalini Arjunan

Udayana University, Indonesia

10.24018/ejmed.2023.5.2.1285

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Submitted 2022-03-18
Published 2023-04-24

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Abstract

Twin to twin tranfusion syndrome (TTTS) is a rare condition that affects the identical twin pregnancy or other multiples. TTTS occurs when there is an imbalance in blood flow between fetuses who share one placenta. This condition can cause one fetus to be dominant among other fetuses or is called discordant twins. The cause of discordant twins is still unclear. But one of the causes is Twin-to-Twin Tranfusion Syndrome. The incidence of discordant twin pregnancies is around 15-29% of total pregnancies. The chance of developing TTTS is estimated to be around 10-15% of monochorionic diamniotic. TTTS is diagnosed by ultrasonography with measuring the single deepest pocket (SDP). TTTS can be treated by fetoscopy laser ablation. The aim of this treatment is to close the connection of blood vessels. There are alternative treatments such as amnioreduction, selective fetal reduction, or termination of pregnancy.

Keywords: twin to twin transfusion syndrome discordant fetoscopy

References

Ashwal E, Hiersch L, Berger H, et al. Pathologic Basis for the Definition of Discordant Growth in Dichorionic Twins. Fetal Diagn Ther. 2021;48(4):279-287. doi:10.1159/000514328.
DOI | Google Scholar

D'Antonio F, Odibo AO, Prefumo F, et al. Weight discordance and perinatal mortality in twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;52(1):11-23. doi:10.1002/uog.18966.
DOI | Google Scholar

Miller JL. Twin to twin transfusion syndrome. Transl Pediatr. 2021;10(5):1518-1529. doi:10.21037/tp-20-264
DOI | Google Scholar

Rezende TMS, Weihermann V, Fachin CG, Bruns RF, Dias AIBS. Twin-twin transfusion syndrome - a University Hospital experience with intrauterine treatment. Rev Col Bras Cir. 2021;48:e20202671. Published 2021 Jan 20. doi:10.1590/0100-6991e-20202671.
DOI | Google Scholar

Bamberg C, Hecher K. Update on twin-to-twin transfusion syndrome. Best Pract Res Clin Obstet Gynaecol. 2019;58:55-65. doi:10.1016/j.bpobgyn.2018.12.011.
DOI | Google Scholar

Borse V, Shanks AL. Twin-To-Twin Transfusion Syndrome. [Updated 2022 Oct 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563133/
Google Scholar

Agrawal P, Vaidya A, Vaidya A, Phuyal S, Pandey A. Twin to Twin Transfusion Syndrome: A Case Report. JNMA J Nepal Med Assoc. 2022;60(256):1056-1058. Published 2022 Dec 1. doi:10.31729/jnma.5574.
DOI | Google Scholar

Couck I, Ponnet S, Thewissen L, et al. The Detection, Outcome, and Presentation of Twin-Twin Transfusion Syndrome in Monochorionic Diamniotic Twin Pregnancies Followed with a Protocol of Fortnightly Ultrasound Examination. Fetal Diagn Ther. 2021;48(5):353-360. doi:10.1159/000514575.
DOI | Google Scholar

Kim R, Lee MY, Won HS, et al. Perinatal outcomes and factors affecting the survival rate of fetuses with twin-to-twin transfusion syndrome treated with fetoscopic laser coagulation: a single-center seven-year experience. J Matern Fetal Neonatal Med. 2022;35(25):5595-5606. doi:10.1080/14767058.2021.1888286.
DOI | Google Scholar

Groene SG, Tollenaar LSA, van Klink JMM, et al. Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome. J Clin Med. 2019;8(7):969. Published 2019 Jul 3. doi:10.3390/jcm8070969.
DOI | Google Scholar

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Twin to Twin Transfusion Syndrome in Discordance Twins: Diagnostic and Management Approach. (2023). European Journal of Medical and Health Sciences, 5(2), 4-6. https://doi.org/10.24018/ejmed.2023.5.2.1285

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Vol. 5 No. 2 (2023)

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[1] Ashwal E, Hiersch L, Berger H, et al. Pathologic Basis for the Definition of Discordant Growth in Dichorionic Twins. Fetal Diagn Ther. 2021;48(4):279-287. doi:10.1159/000514328.
DOI | Google Scholar

[2] D'Antonio F, Odibo AO, Prefumo F, et al. Weight discordance and perinatal mortality in twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;52(1):11-23. doi:10.1002/uog.18966.
DOI | Google Scholar

[3] Miller JL. Twin to twin transfusion syndrome. Transl Pediatr. 2021;10(5):1518-1529. doi:10.21037/tp-20-264
DOI | Google Scholar

[4] Rezende TMS, Weihermann V, Fachin CG, Bruns RF, Dias AIBS. Twin-twin transfusion syndrome - a University Hospital experience with intrauterine treatment. Rev Col Bras Cir. 2021;48:e20202671. Published 2021 Jan 20. doi:10.1590/0100-6991e-20202671.
DOI | Google Scholar

[5] Bamberg C, Hecher K. Update on twin-to-twin transfusion syndrome. Best Pract Res Clin Obstet Gynaecol. 2019;58:55-65. doi:10.1016/j.bpobgyn.2018.12.011.
DOI | Google Scholar

[6] Borse V, Shanks AL. Twin-To-Twin Transfusion Syndrome. [Updated 2022 Oct 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563133/
Google Scholar

[7] Agrawal P, Vaidya A, Vaidya A, Phuyal S, Pandey A. Twin to Twin Transfusion Syndrome: A Case Report. JNMA J Nepal Med Assoc. 2022;60(256):1056-1058. Published 2022 Dec 1. doi:10.31729/jnma.5574.
DOI | Google Scholar

[8] Couck I, Ponnet S, Thewissen L, et al. The Detection, Outcome, and Presentation of Twin-Twin Transfusion Syndrome in Monochorionic Diamniotic Twin Pregnancies Followed with a Protocol of Fortnightly Ultrasound Examination. Fetal Diagn Ther. 2021;48(5):353-360. doi:10.1159/000514575.
DOI | Google Scholar

[9] Kim R, Lee MY, Won HS, et al. Perinatal outcomes and factors affecting the survival rate of fetuses with twin-to-twin transfusion syndrome treated with fetoscopic laser coagulation: a single-center seven-year experience. J Matern Fetal Neonatal Med. 2022;35(25):5595-5606. doi:10.1080/14767058.2021.1888286.
DOI | Google Scholar

[10] Groene SG, Tollenaar LSA, van Klink JMM, et al. Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome. J Clin Med. 2019;8(7):969. Published 2019 Jul 3. doi:10.3390/jcm8070969.
DOI | Google Scholar

Twin to Twin Transfusion Syndrome in Discordance Twins: Diagnostic and Management Approach

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