Twin-to-twin transfusion syndrome: Controversies in the diagnosis and management
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Twin-to-twin transfusion syndrome: Controversies in the diagnosis and management. / Bamberg, Christian; Hecher, Kurt.
In: BEST PRACT RES CL OB, Vol. 84, 11.2022, p. 143-154.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Twin-to-twin transfusion syndrome: Controversies in the diagnosis and management
AU - Bamberg, Christian
AU - Hecher, Kurt
N1 - Copyright © 2022. Published by Elsevier Ltd.
PY - 2022/11
Y1 - 2022/11
N2 - In twin-to-twin transfusion syndrome (TTTS) communicating placental vessels on the chorionic plate between the donor and recipient twins are responsible for the chronic imbalance of blood flow. Evidence demonstrates that fetoscopic laser ablation is superior to serial amnioreductions in terms of survival and neurological outcome for stages II-IV TTTS. However, the optimal management of stage I TTTS remains poorly understood. It is well established that all chorionic plate anastomoses should be closed by laser ablation. Compared to the selective laser method, the Solomon technique yields a significant reduction of recurrent TTTS and post-laser twin anemia polycythemia sequence (TAPS). Over the past 25 years, survival rates after fetoscopic laser surgery have significantly increased. High volume centers report up to 70% double survival and at least one survivor in >90% cases. In this review, we discuss the controversies in the diagnosis and management of TTTS, especially, the optimal management in stage I cases, very early or late diagnosis, and the optimal laser technique. Furthermore, we will discuss a stage-related outcome after laser surgery and examine whether it is necessary at all to distinguish between stages I and II. Finally, the optimal timing as well as mode of delivery after TTTS laser treatment will be discussed.
AB - In twin-to-twin transfusion syndrome (TTTS) communicating placental vessels on the chorionic plate between the donor and recipient twins are responsible for the chronic imbalance of blood flow. Evidence demonstrates that fetoscopic laser ablation is superior to serial amnioreductions in terms of survival and neurological outcome for stages II-IV TTTS. However, the optimal management of stage I TTTS remains poorly understood. It is well established that all chorionic plate anastomoses should be closed by laser ablation. Compared to the selective laser method, the Solomon technique yields a significant reduction of recurrent TTTS and post-laser twin anemia polycythemia sequence (TAPS). Over the past 25 years, survival rates after fetoscopic laser surgery have significantly increased. High volume centers report up to 70% double survival and at least one survivor in >90% cases. In this review, we discuss the controversies in the diagnosis and management of TTTS, especially, the optimal management in stage I cases, very early or late diagnosis, and the optimal laser technique. Furthermore, we will discuss a stage-related outcome after laser surgery and examine whether it is necessary at all to distinguish between stages I and II. Finally, the optimal timing as well as mode of delivery after TTTS laser treatment will be discussed.
KW - Female
KW - Pregnancy
KW - Humans
KW - Fetofetal Transfusion/diagnosis
KW - Placenta
KW - Pregnancy, Twin
KW - Fetoscopy/methods
KW - Polycythemia/diagnosis
U2 - 10.1016/j.bpobgyn.2022.03.013
DO - 10.1016/j.bpobgyn.2022.03.013
M3 - SCORING: Review article
C2 - 35589537
VL - 84
SP - 143
EP - 154
JO - BEST PRACT RES CL OB
JF - BEST PRACT RES CL OB
SN - 1521-6934
ER -
