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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Greenough, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Reiss, Irwin / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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1619-3997
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Volume 42, Issue 1 (Jan 2014)

Issues

The prevalence and clinical features of twin-twin transfusion syndrome with onset during the third trimester

Masaharu Murata
  • Corresponding author
  • Department of Maternal Fetal Medicine, Osaka Prefectural Hospital Organization, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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/ Keisuke Ishii
  • Department of Maternal Fetal Medicine, Osaka Prefectural Hospital Organization, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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/ Takako Taguchi
  • Department of Maternal Fetal Medicine, Osaka Prefectural Hospital Organization, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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/ Aki Mabuchi
  • Department of Maternal Fetal Medicine, Osaka Prefectural Hospital Organization, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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/ Haruna Kawaguchi
  • Department of Maternal Fetal Medicine, Osaka Prefectural Hospital Organization, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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/ Ryo Yamamoto
  • Department of Maternal Fetal Medicine, Osaka Prefectural Hospital Organization, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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/ Shusaku Hayashi
  • Department of Maternal Fetal Medicine, Osaka Prefectural Hospital Organization, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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/ Nobuaki Mitsuda
  • Department of Maternal Fetal Medicine, Osaka Prefectural Hospital Organization, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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Published Online: 2013-08-29 | DOI: https://doi.org/10.1515/jpm-2013-0101

Abstract

Objective: To describe the incidence and clinical features of twin-twin transfusion syndrome (TTTS) with third trimester onset.

Methods: We performed a retrospective chart review of monochorionic diamniotic (MD) twin pregnancies delivered during a recent 4-year period. The inclusion criterion was women who received prenatal care at our center from the first trimester onward. Serial ultrasound examinations were performed at least every 2 weeks until delivery to evaluate fetal growth as well as to estimate amniotic fluid volume. The prevalence of TTTS onset after 28 weeks of gestation and clinical features, including neonatal outcomes and placental findings, were elucidated.

Results: Meeting our inclusion criterion were 143 MD twin pregnancies, including 15 TTTS cases (10%). Five cases (4%) developed TTTS during the third trimester and underwent a cesarean section immediately after the diagnosis. All of these women exhibited either abdominal distension or uterine contractions. Recipient twins tended to require more intensive cardiopulmonary treatment than donors, however, neither a recipient nor a donor twin suffered neonatal death or neurological impairment. Placental arterio-arterial anastomoses were detected in three out of five cases. Arteriovenous anastomoses were present in all cases, however, venovenous anastomoses were not found in any case.

Conclusions: TTTS is a relatively rare complication during the third trimester. It is imperative to be observant for the development of TTTS in MD twin pregnancies with any abdominal symptoms, even if they appear insignificant.

Keywords: Monochorionic diamniotic twin pregnancy; perinatal outcome; third trimester; twin-twin transfusion syndrome

References

  • [1]

    Acosta-Rojas R, Becker J, Munoz-Abellana B, Ruiz C, Carreras E, Gratacos E. Twin chorionicity and the risk of adverse perinatal outcome. Int J Gynaecol Obstet. 2007;96:98–102.Google Scholar

  • [2]

    Bajoria R, Ward S, Chatterjee R. Brain natriuretic peptide and endothelin-1 in the pathogenesis of polyhydramnios-oligohydramnios in monochorionic twins. Am J Obstet Gynecol. 2003;189:189–94.CrossrefGoogle Scholar

  • [3]

    Baud D, Windrim R, Keunen J, Kelly EN, Shah P, van Mieghem T, et al. Fetoscopic laser therapy for twin-twin transfusion syndrome before 17 and after 26 weeks’ gestation. Am J Obstet Gynecol. 2013;208:197.e1–7.Google Scholar

  • [4]

    Bermudez C, Becerra CH, Bornick PW, Allen MH, Arroyo J, Quintero RA. Placental types and twin-twin transfusion syndrome. Am J Obstet Gynecol. 2002;187:489–94.Web of ScienceGoogle Scholar

  • [5]

    de Villiers SF, Slaghekke F, Middeldorp JM, Walther FJ, Oepkes D, Lopriore E. Arterio-arterial vascular anastomoses in monochorionic placentas with and without twin-twin transfusion syndrome. Placenta. 2012;33:652–4.Web of ScienceGoogle Scholar

  • [6]

    Denbow ML, Cox P, Taylor M, Hammal DM, Fisk NM. Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. Am J Obstet Gynecol. 2000;182:417–26.Google Scholar

  • [7]

    Galea P, Barigye O, Wee L, Jain V, Sullivan M, Fisk NM. The placenta contributes to activation of the renin angiotensin system in twin-twin transfusion syndrome. Placenta. 2008;29:734–42.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [8]

    Hack KE, Nikkels PG, Koopman-Esseboom C, Derks JB, Elias SG, van Gemert MJ, et al. Placental characteristics of monochorionic diamniotic twin pregnancies in relation to perinatal outcome. Placenta. 2008;29:976–81.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [9]

    Lewi L, Jani J, Blickstein I, Huber A, Gucciardo L, Van Mieghem T, et al. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. Am J Obstet Gynecol. 2008;199:514.e1–8.Web of ScienceGoogle Scholar

  • [10]

    Li X, Morokuma S, Fukushima K, Otera Y, Yumoto Y, Tsukimori K, et al. Prognosis and long-term neurodevelopmental outcome in conservatively treated twin-to-twin transfusion syndrome. BMC Pregnancy Childbirth. 2011;11:32.PubMedWeb of ScienceGoogle Scholar

  • [11]

    Lopriore E, Oepkes D, Walther FJ. Neonatal morbidity in twin-twin transfusion syndrome. Early Hum Dev. 2011;87:595–9.Web of ScienceGoogle Scholar

  • [12]

    Mahieu-Caputo D, Muller F, Joly D, Gubler MC, Lebidois J, Fermont L, et al. Pathogenesis of twin-twin transfusion syndrome: the renin-angiotensin system hypothesis. Fetal Diagn Ther. 2001;16:241–4.CrossrefGoogle Scholar

  • [13]

    Mari G, Roberts A, Detti L, Kovanci E, Stefos T, Bahado-Singh RO, et al. Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome: results of the International Amnioreduction Registry. Am J Obstet Gynecol. 2001;185:708–15.Google Scholar

  • [14]

    Middeldorp JM, Lopriore E, Sueters M, Klumper FJ, Kanhai HH, Vandenbussche FP, et al. Twin-to-twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery? Br J Obstet Gynecol. 2007;114:694–8.Google Scholar

  • [15]

    Nakayama S, Ishii K, Kawaguchi H, Hayashi S, Hidaka N, Murakoshi T, et al. Perinatal outcome of monochorionic diamniotic twin pregnancies managed from early gestation at a single center. J Obstet Gynaecol Res. 2012;38:692–7.Web of ScienceGoogle Scholar

  • [16]

    Nikkels PG, van Gemert MJ, Sollie-Szarynska KM, Molendijk H, Timmer B, Machin GA. Rapid onset of severe twin-twin transfusion syndrome caused by placental venous thrombosis. Pediatr Dev Pathol. 2002;5:310–4.CrossrefPubMedGoogle Scholar

  • [17]

    Quintero RA, Dickinson JE, Morales WJ, Bornick PW, Bermudez C, Cincotta R, et al. Stage-based treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2003;188:1333–40.Google Scholar

  • [18]

    Roberts D, Gates S, Kilby M, Neilson JP. Interventions for twin-twin transfusion syndrome: a Cochrane review. Ultrasound Obstet Gynecol. 2008;31:701–11.Google Scholar

  • [19]

    Sago H, Hayashi S, Saito M, Hasegawa H, Kawamoto H, Kato N, et al. The outcome and prognostic factors of twin-twin transfusion syndrome following fetoscopic laser surgery. Prenat Diagn. 2010;30:1185–91.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [20]

    Senat MV, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004;351:136–44.Google Scholar

  • [21]

    Shields LE, Brace RA. Fetal vascular pressure responses to nonlabor uterine contractions: dependence on amniotic fluid volume in the ovine fetus. Am J Obstet Gynecol. 1994;171:84–9.Google Scholar

  • [22]

    Takahashi Y, Iwagaki S, Nakagawa Y, Kawabata I, Tamaya T. Uterine contractions increase fetal heart preload. Ultrasound Obstet Gynecol. 2003;22:53–6.CrossrefPubMedGoogle Scholar

  • [23]

    Takahashi Y, Iwagaki S, Nakagawa Y, Kawabata I, Tamaya T. Uterine contractions might increase heart preload in the recipient fetus in early-onset twin-twin transfusion syndrome: an ultrasound assessment. Prenat Diagn. 2004;24:977–80.CrossrefPubMedGoogle Scholar

  • [24]

    Tan TY, Denbow ML, Cox PM, Talbert D, Fisk NM. Occlusion of arterio-arterial anastomosis manifesting as acute twin-twin transfusion syndrome. Placenta. 2004;25:238–42.CrossrefPubMedGoogle Scholar

  • [25]

    Thorson HL, Ramaeker DM, Emery SP. Optimal interval for ultrasound surveillance in monochorionic twin gestations. Obstet Gynecol. 2011;117:1227.Google Scholar

  • [26]

    Valsky DV, Eixarch E, Martinez-Crespo JM, Acosta ER, Lewi L, Deprest J, et al. Fetoscopic laser surgery for twin-to-twin transfusion syndrome after 26 weeks of gestation. Fetal Diagn Ther. 2012;31:30–4.Web of ScienceGoogle Scholar

About the article

Corresponding author: Masaharu Murata, MD, PhD, Department of Maternal Fetal Medicine, Osaka Prefectural Hospital Organization, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan, Tel.: +81-752-56-1220, Fax: +81-725-57-3207, E-mail:


Received: 2013-05-10

Accepted: 2013-07-26

Published Online: 2013-08-29

Published in Print: 2014-01-01


Citation Information: Journal of Perinatal Medicine, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2013-0101.

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