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Twin-To-Twin Transfusion Syndrome



Twin-To-Twin Transfusion Syndrome Causes


The disease occurs in monozygotic, monochorionic twin pregnancies when an anastomosis between placental vasculature exists. The causes however remain unknown.


Twin-To-Twin Transfusion Syndrome Definition


Also known as Feto-Fetal Transfusion Syndrome, Twin-to-twin transfusion syndrome is a complication with high morbidity and mortality that can affect identical twins or higher multiple pregnancies where two or more fetuses share a common placenta. Severe cases have a 60-100% mortality rate.


Twin-To-Twin Transfusion Syndrome Diagnosis


A single placenta massive polyhydramnios in the sac of the recipient twin can help diagnose the disease in the most sever form. Milder forms are harder to diagnose due to the lack of uniform criteria. However, physicians should suspect TTTS if there is the presence of amniotic fluid discrepancies between the cavities, regardless of the amount of weight discordance between the twins.


Twin-To-Twin Transfusion Syndrome Symptoms and Signs


The donor twin, usually the smaller one, become hypovolemic and oliguric or anuric.


Twin-To-Twin Transfusion Syndrome Treatment


There are various therapies used to treat TTTS and each has varying rates of success. Serial amniocentesis is the oldest and most traditional treatment, which involves periodically draining amniotic fluid from around the recipient twin in an effort to reduce the pressure of the amniotic fluid. When performed early in pregnancy, it increases the risk of premature delivery and it has limited success. The disease can also be treated by surgery during pregnancy. Using fetoscopy, interconnectiong blood vessels find interconnecting blood vessels. A laser beam can also used to coagulate the blood in the vessels. The procedure is called tetoscopic laser ablation and is performed in a few hospitals all over the world. The outcome of different procedures widely varies from case to case and has an overall survival rate of 50-60 percent.


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