Twin-to-twin transfusion syndrome

Jump to navigation Jump to search
File:TTTS babypic.jpeg
A pair of newborn twins affected by TTTS. Both the donor (right) and recipient (left) survived.

For patient information, click here

Template:DiseaseDisorder infobox

WikiDoc Resources for Twin-to-twin transfusion syndrome

Articles

Most recent articles on Twin-to-twin transfusion syndrome

Most cited articles on Twin-to-twin transfusion syndrome

Review articles on Twin-to-twin transfusion syndrome

Articles on Twin-to-twin transfusion syndrome in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Twin-to-twin transfusion syndrome

Images of Twin-to-twin transfusion syndrome

Photos of Twin-to-twin transfusion syndrome

Podcasts & MP3s on Twin-to-twin transfusion syndrome

Videos on Twin-to-twin transfusion syndrome

Evidence Based Medicine

Cochrane Collaboration on Twin-to-twin transfusion syndrome

Bandolier on Twin-to-twin transfusion syndrome

TRIP on Twin-to-twin transfusion syndrome

Clinical Trials

Ongoing Trials on Twin-to-twin transfusion syndrome at Clinical Trials.gov

Trial results on Twin-to-twin transfusion syndrome

Clinical Trials on Twin-to-twin transfusion syndrome at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Twin-to-twin transfusion syndrome

NICE Guidance on Twin-to-twin transfusion syndrome

NHS PRODIGY Guidance

FDA on Twin-to-twin transfusion syndrome

CDC on Twin-to-twin transfusion syndrome

Books

Books on Twin-to-twin transfusion syndrome

News

Twin-to-twin transfusion syndrome in the news

Be alerted to news on Twin-to-twin transfusion syndrome

News trends on Twin-to-twin transfusion syndrome

Commentary

Blogs on Twin-to-twin transfusion syndrome

Definitions

Definitions of Twin-to-twin transfusion syndrome

Patient Resources / Community

Patient resources on Twin-to-twin transfusion syndrome

Discussion groups on Twin-to-twin transfusion syndrome

Patient Handouts on Twin-to-twin transfusion syndrome

Directions to Hospitals Treating Twin-to-twin transfusion syndrome

Risk calculators and risk factors for Twin-to-twin transfusion syndrome

Healthcare Provider Resources

Symptoms of Twin-to-twin transfusion syndrome

Causes & Risk Factors for Twin-to-twin transfusion syndrome

Diagnostic studies for Twin-to-twin transfusion syndrome

Treatment of Twin-to-twin transfusion syndrome

Continuing Medical Education (CME)

CME Programs on Twin-to-twin transfusion syndrome

International

Twin-to-twin transfusion syndrome en Espanol

Twin-to-twin transfusion syndrome en Francais

Business

Twin-to-twin transfusion syndrome in the Marketplace

Patents on Twin-to-twin transfusion syndrome

Experimental / Informatics

List of terms related to Twin-to-twin transfusion syndrome

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Twin-to-twin transfusion syndrome (TTTS, also known as Feto-Fetal Transfusion Syndrome (FFTS) and Twin Oligohydramnios-Polyhydramnios Sequence (TOPS)) is a complication with high morbidity and mortality that can affect identical twin or higher multiple pregnancies where two or more fetuses share a common (monochorionic) placenta. Severe TTTS has a 60-100% mortality rate.[1]

Prevalence

TTTS is believed to affect roughly 1 in 1000 pregnancies.

Etiology

As a result of sharing a single placenta, the blood supplies of monochorionic twin fetuses can become connected, so that they share blood circulation: although each fetus uses its side of the placenta, the blood vessels connecting the twins allow blood to pass from one twin to the other. Depending on the number, type and direction of the interconnecting blood vessels (anastomoses), blood can be transferred disproportionately from one twin (the "donor") to the other (the "recipient"). The transfusion causes the donor twin to have decreased blood volume, retarding the donor's development and growth, and also decreased urinary output, leading to a lower than normal level of amniotic fluid (becoming oligohydramnios). The blood volume of the recipient is increased, which can strain the fetus's heart and eventually lead to heart failure, and also higher than normal urinary output, which can lead to excess amniotic fluid (becoming polyhydramnios).

In early pregnancy (before 26 weeks), TTTS can cause both fetuses to die, or lead to severe disabilities. If TTTS develops after 26 weeks, the babies can usually be delivered and have a greater chance of survival without disability.

Other than requiring a monochorionic-diamniotic twin (or higher multiple) pregnancy, the causes of TTTS are not known. It is not known to be hereditary or genetic.

Imbalance in development

Some doctors recommend complete bed-rest for the mother coupled with massive intakes of protein (generally in the form of "protein shakes" such as Boost or Ensure) as a therapy to try to counteract the syndrome. Theories for why this would be effective vary, but some doctors claim to have seen it help. There are, however, no formal clinical trials indicating that the bed rest / high-protein diet is effective.

Research into TTTS is ongoing and best medical practices change quickly with respect to this condition. For the most up-to-date information, consult with a maternal-fetal medicine specialist.

Treatment

There are a number of different therapies used to treat TTTS, with varying rates of success. The oldest, most traditional treatment is through serial amniocentesis, which involves periodically draining amniotic fluid from around the recipient twin in an effort to reduce the pressure of the amniotic fluid. Because serial amniocentesis increases the risk of premature delivery, it has limited success when performed early in pregnancy, especially before fetal viability. TTTS can also be treated by surgery during pregnancy, using fetoscopy to find the interconnecting blood vessels, and a laser beam to coagulate the blood in these vessels, blocking them. This is called fetoscopic laser ablation, and is only performed in a few hospitals worldwide. Outcomes vary widely from case to case, but as of this writing overall statistics of fetoscopic laser ablation indicate a 75% chance that at least one twin will survive. The overall survival rate is 50 - 60%.

History

TTTS was first described by a German obstetrician, Friedrich Schatz, in 1875.

TTTS in art

File:De Wikkellkinderen.jpeg
De Wikkellkinderen (The Swaddled Children), 1617, by an unknown artist, is thought to depict TTTS.

A painting known as the De Wikkellkinderen (The Swaddled Children), from 1617, is thought to represent a depiction of TTTS.[2] The drawing shows twins that appear to be identical, but one is pale (possibly anemic), while the other is ruddy (possibly polycythemic). Analysis of the family histories of the owners of the painting suggests that the twins did not survive to adulthood, although whether that is due to TTTS is uncertain.

References

  1. Zach T, Ford SP. Twin-to-Twin Transfusion Syndrome. eMedicine.com. URL:http://www.emedicine.com/med/topic3410.htm. Accessed July 22, 2006.
  2. Berger H, de Waard F, Molenaar Y (2000). "A case of twin-to-twin transfusion in 1617". Lancet. 356 (9232): 847–8. PMID 11022944.

See also

de:Fetofetales Transfusionssyndrom


Template:WH Template:WS