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. 2000 Nov;83(3):F171–F176. doi: 10.1136/fn.83.3.F171

Long term outcome of twin-twin transfusion syndrome

R Cincotta, P Gray, G Phythian, Y Rogers, F Chan
PMCID: PMC1721175  PMID: 11040163

Abstract

AIMS—To compare the perinatal mortality and morbidity of infants with twin-twin transfusion syndrome (TTTS) with those of gestation matched twin controls and to assess the neurodevelopmental outcome of surviving twins with TTTS.
METHODS—A cohort of 17 consecutive pregnancies with TTTS was enrolled over three years together with gestation matched twin pregnancies unaffected by TTTS. Serial amnioreduction for the TTTS pregnancies was performed as appropriate. Perinatal death and neonatal morbidities were recorded for both the TTTS cohort and controls. The TTTS survivors had neurodevelopmental follow up to at least 2 years of age.
RESULTS—In 12 of the pregnancies, serial amniocenteses were performed, but, in five, the infants were born before intervention. The mean gestational age at delivery was 29.1 weeks (range 23-36). There were five intrauterine deaths in the TTTS cohort and six neonatal deaths (survival 68%). In the control group, there was one intrauterine death and five neonatal deaths (survival 82%). Infants in the TTTS group had a greater requirement for inotropes (p = 0.04) and a higher incidence of renal failure (p = 0.005). Periventricular leucomalacia and cerebral atrophy were seen in 17% of the TTTS group, but none of the controls (p = 0.03). The 23 surviving TTTS infants were all followed up, with 22% having significant neurological morbidity: cerebral palsy and global developmental delay.
CONCLUSIONS—Twins with TTTS have high perinatal mortality and neonatal morbidity, and long term neurodevelopmental morbidity in survivors is high. Further investigation into the pathogenesis and management of TTTS is required.



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Selected References

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  1. BAX M. C. TERMINOLOGY AND CLASSIFICATION OF CEREBRAL PALSY. Dev Med Child Neurol. 1964 Jun;6:295–297. doi: 10.1111/j.1469-8749.1964.tb10791.x. [DOI] [PubMed] [Google Scholar]
  2. Cincotta R. B., Fisk N. M. Current thoughts on twin-twin transfusion syndrome. Clin Obstet Gynecol. 1997 Jun;40(2):290–302. doi: 10.1097/00003081-199706000-00006. [DOI] [PubMed] [Google Scholar]
  3. Cincotta R., Oldham J., Sampson A. Antepartum and postpartum complications of twin-twin transfusion. Aust N Z J Obstet Gynaecol. 1996 Aug;36(3):303–308. doi: 10.1111/j.1479-828x.1996.tb02716.x. [DOI] [PubMed] [Google Scholar]
  4. De Lia J. E., Kuhlmann R. S., Harstad T. W., Cruikshank D. P. Fetoscopic laser ablation of placental vessels in severe previable twin-twin transfusion syndrome. Am J Obstet Gynecol. 1995 Apr;172(4 Pt 1):1202–1211. doi: 10.1016/0002-9378(95)91480-3. [DOI] [PubMed] [Google Scholar]
  5. De Lia J. E., Kuhlmann R. S., Lopez K. P. Treating previable twin-twin transfusion syndrome with fetoscopic laser surgery: outcomes following the learning curve. J Perinat Med. 1999;27(1):61–67. doi: 10.1515/JPM.1999.007. [DOI] [PubMed] [Google Scholar]
  6. Denbow M. L., Battin M. R., Cowan F., Azzopardi D., Edwards A. D., Fisk N. M. Neonatal cranial ultrasonographic findings in preterm twins complicated by severe fetofetal transfusion syndrome. Am J Obstet Gynecol. 1998 Mar;178(3):479–483. doi: 10.1016/s0002-9378(98)70424-7. [DOI] [PubMed] [Google Scholar]
  7. Dennis L. G., Winkler C. L. Twin-to-twin transfusion syndrome: aggressive therapeutic amniocentesis. Am J Obstet Gynecol. 1997 Aug;177(2):342–349. doi: 10.1016/s0002-9378(97)70196-0. [DOI] [PubMed] [Google Scholar]
  8. Dickinson J. E., Evans S. F. Obstetric and perinatal outcomes from the australian and new zealand twin-twin transfusion syndrome registry. Am J Obstet Gynecol. 2000 Mar;182(3):706–712. doi: 10.1067/mob.2000.104236. [DOI] [PubMed] [Google Scholar]
  9. Elliott J. P., Urig M. A., Clewell W. H. Aggressive therapeutic amniocentesis for treatment of twin-twin transfusion syndrome. Obstet Gynecol. 1991 Apr;77(4):537–540. [PubMed] [Google Scholar]
  10. Fisk N. M., Bajoria R., Wigglesworth J. Twin-twin transfusion syndrome. N Engl J Med. 1995 Aug 10;333(6):388–389. [PubMed] [Google Scholar]
  11. Gray P. H., Hurley T. M., Rogers Y. M., O'Callaghan M. J., Tudehope D. I., Burns Y. R., Phty M., Mohay H. A. Survival and neonatal and neurodevelopmental outcome of 24-29 week gestation infants according to primary cause of preterm delivery. Aust N Z J Obstet Gynaecol. 1997 May;37(2):161–168. doi: 10.1111/j.1479-828x.1997.tb02245.x. [DOI] [PubMed] [Google Scholar]
  12. Hecher K., Plath H., Bregenzer T., Hansmann M., Hackelöer B. J. Endoscopic laser surgery versus serial amniocenteses in the treatment of severe twin-twin transfusion syndrome. Am J Obstet Gynecol. 1999 Mar;180(3 Pt 1):717–724. doi: 10.1016/s0002-9378(99)70278-4. [DOI] [PubMed] [Google Scholar]
  13. Inder T., Huppi P. S., Zientara G. P., Maier S. E., Jolesz F. A., di Salvo D., Robertson R., Barnes P. D., Volpe J. J. Early detection of periventricular leukomalacia by diffusion-weighted magnetic resonance imaging techniques. J Pediatr. 1999 May;134(5):631–634. doi: 10.1016/s0022-3476(99)70251-9. [DOI] [PubMed] [Google Scholar]
  14. Pinette M. G., Pan Y., Pinette S. G., Stubblefield P. G. Treatment of twin-twin transfusion syndrome. Obstet Gynecol. 1993 Nov;82(5):841–846. [PubMed] [Google Scholar]
  15. Quintero R. A., Morales W. J., Mendoza G., Allen M., Kalter C. S., Giannina G., Angel J. L. Selective photocoagulation of placental vessels in twin-twin transfusion syndrome: evolution of a surgical technique. Obstet Gynecol Surv. 1998 Dec;53(12 Suppl):S97–103. doi: 10.1097/00006254-199812010-00001. [DOI] [PubMed] [Google Scholar]
  16. Rehan V. K., Menticoglou S. M. Mechanism of visceral damage in fetofetal transfusion syndrome. Arch Dis Child Fetal Neonatal Ed. 1995 Jul;73(1):F48–F50. doi: 10.1136/fn.73.1.f48. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Reisner D. P., Mahony B. S., Petty C. N., Nyberg D. A., Porter T. F., Zingheim R. W., Williams M. A., Luthy D. A. Stuck twin syndrome: outcome in thirty-seven consecutive cases. Am J Obstet Gynecol. 1993 Oct;169(4):991–995. doi: 10.1016/0002-9378(93)90041-g. [DOI] [PubMed] [Google Scholar]
  18. Sebire N. J., D'Ercole C., Carvelho M., Sepulveda W., Nicolaides K. H. Inter-twin membrane folding in monochorionic pregnancies. Ultrasound Obstet Gynecol. 1998 May;11(5):324–327. doi: 10.1046/j.1469-0705.1998.11050324.x. [DOI] [PubMed] [Google Scholar]
  19. Simpson L. L., Marx G. R., Elkadry E. A., D'Alton M. E. Cardiac dysfunction in twin-twin transfusion syndrome: a prospective, longitudinal study. Obstet Gynecol. 1998 Oct;92(4 Pt 1):557–562. doi: 10.1016/s0029-7844(98)00220-8. [DOI] [PubMed] [Google Scholar]
  20. Trespidi L., Boschetto C., Caravelli E., Villa L., Kustermann A., Nicolini U. Serial amniocenteses in the management of twin-twin transfusion syndrome: when is it valuable? Fetal Diagn Ther. 1997 Jan-Feb;12(1):15–20. [PubMed] [Google Scholar]
  21. Tudehope D. I., Masel J., Mohay H., O'Callaghan M., Burns Y., Rogers Y., Williams G. Neonatal cranial ultrasonography as predictor of 2 year outcome of very low birthweight infants. Aust Paediatr J. 1989 Apr;25(2):66–71. doi: 10.1111/j.1440-1754.1989.tb01418.x. [DOI] [PubMed] [Google Scholar]
  22. Ville Y., Hecher K., Gagnon A., Sebire N., Hyett J., Nicolaides K. Endoscopic laser coagulation in the management of severe twin-to-twin transfusion syndrome. Br J Obstet Gynaecol. 1998 Apr;105(4):446–453. doi: 10.1111/j.1471-0528.1998.tb10132.x. [DOI] [PubMed] [Google Scholar]
  23. Ville Y., Hyett J., Hecher K., Nicolaides K. Preliminary experience with endoscopic laser surgery for severe twin-twin transfusion syndrome. N Engl J Med. 1995 Jan 26;332(4):224–227. doi: 10.1056/NEJM199501263320404. [DOI] [PubMed] [Google Scholar]
  24. Weir P. E., Ratten G. J., Beischer N. A. Acute polyhydramnios--a complication of monozygous twin pregnancy. Br J Obstet Gynaecol. 1979 Nov;86(11):849–853. doi: 10.1111/j.1471-0528.1979.tb10710.x. [DOI] [PubMed] [Google Scholar]
  25. Zosmer N., Bajoria R., Weiner E., Rigby M., Vaughan J., Fisk N. M. Clinical and echographic features of in utero cardiac dysfunction in the recipient twin in twin-twin transfusion syndrome. Br Heart J. 1994 Jul;72(1):74–79. doi: 10.1136/hrt.72.1.74. [DOI] [PMC free article] [PubMed] [Google Scholar]

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