Update on twin-to-twin transfusion syndrome
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Update on twin-to-twin transfusion syndrome. / Bamberg, Christian; Hecher, Kurt.
In: Best practice & research. Clinical obstetrics & gynaecology, Vol. 58, 07.2019, p. 55-65.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Update on twin-to-twin transfusion syndrome
AU - Bamberg, Christian
AU - Hecher, Kurt
N1 - Copyright © 2019 Elsevier Ltd. All rights reserved.
PY - 2019/7
Y1 - 2019/7
N2 - Twin-to-twin transfusion syndrome (TTTS) is a serious complication that affects 10-15% of monochorionic multiple pregnancies. Communicating placental vessels on the chorionic plate between the donor and recipient twin are responsible for the imbalance of blood flow. There is evidence for the superiority of fetoscopic laser ablation over serial amnioreductions regarding survival and neurological outcome for stages II-IV TTTS. However, the optimal management of stage I is still debated. The "Solomon" technique showed a significant reduction in recurrent TTTS and post laser twin anemia-polycythemia sequence (TAPS) in comparison to the selective laser method without improvement in perinatal mortality or neonatal morbidity. Survival rates after fetoscopic laser surgery have significantly increased over the last 25 years. High volume centers report up to 70% double survival and at least one survivor in >90%. Long-term neurodevelopmental impairment occurs in about 10% of children after laser surgery. In this review we discuss the optimal management, innovations in laser technique, long-term neurodevelopmental outcome, and future aspects of TTTS treatment.
AB - Twin-to-twin transfusion syndrome (TTTS) is a serious complication that affects 10-15% of monochorionic multiple pregnancies. Communicating placental vessels on the chorionic plate between the donor and recipient twin are responsible for the imbalance of blood flow. There is evidence for the superiority of fetoscopic laser ablation over serial amnioreductions regarding survival and neurological outcome for stages II-IV TTTS. However, the optimal management of stage I is still debated. The "Solomon" technique showed a significant reduction in recurrent TTTS and post laser twin anemia-polycythemia sequence (TAPS) in comparison to the selective laser method without improvement in perinatal mortality or neonatal morbidity. Survival rates after fetoscopic laser surgery have significantly increased over the last 25 years. High volume centers report up to 70% double survival and at least one survivor in >90%. Long-term neurodevelopmental impairment occurs in about 10% of children after laser surgery. In this review we discuss the optimal management, innovations in laser technique, long-term neurodevelopmental outcome, and future aspects of TTTS treatment.
KW - Female
KW - Fetofetal Transfusion/diagnosis
KW - Fetoscopy/adverse effects
KW - Gestational Age
KW - Humans
KW - Laser Coagulation/adverse effects
KW - Placenta/physiopathology
KW - Pregnancy
KW - Pregnancy, Twin
KW - Ultrasonography, Doppler
KW - Ultrasonography, Prenatal
U2 - 10.1016/j.bpobgyn.2018.12.011
DO - 10.1016/j.bpobgyn.2018.12.011
M3 - SCORING: Review article
C2 - 30850326
VL - 58
SP - 55
EP - 65
JO - BEST PRACT RES CL OB
JF - BEST PRACT RES CL OB
SN - 1521-6934
ER -