Abstract
Introduction: twin twin transfusion syndrome is one further complication in the 10-15% of all monochorionic-biamniotic pregnancies, it is known that part of its pathophysiology corresponds to the presence of placental anastomosis between two fetuses that lead to present an acute clinic and urgent intervention for anemia, restriction of intrauterine growth, oliguria and olgohydramnios in the donor twin, while the receiver becomes plethoric, polyuric, cardiomegaly, congestive heart failure and polyhydramnios appear. Objective: present a review about twin-twin transfusion syndrome, clinical features, complications and its treatment. Methodology: databases such as Pubmed and ScienceDirect were used to search for the information. Results: we found 41 articles with updated information, reviewing its pathophysiology, classification and treatment, highlighting the role of the renin angiotensin aldosterone system, the presence of placental anastomosis, the involvement of vasopressin levels and its present treatment. Conclusions: twin-twin transfusion syndrome is one of the most severe complications of the monochorionic-biamniotic pregnancies with a high rate of fetal and perinatal morbidity and mortality. It’s pathology is caused due to imbalance of lows between placental anastomoses, alterations in the axis renin angiotensin aldosterone, changes in the levels of vasopressin, among other factors. The current treatment is the therapy of laser ablation of placental anastomoses with a survival of 70% and a decrease of neurologic sequelae. We reiterate the importance of understanding this disease to make an assertive diagnosis and immediate treatment, inviting you to investigate it. MÉD.UIS. 2015;28(2):239-46.
Keywords: Fetofetal Transfusion. Pregnancy, Twin. Oligohydramnios, Polyhydramnios.
References
Skupski D. Twin-to-Twin Transfusion Syndrome. Londres: Jaypee Brothers Medical Publishers Ltd; 2013.
Rausen AR, Seki M, Strauss L. Twin transfusion syndrome: A review of 19 cases studied at one institution. J peatrics. 1965;66(3):613-28.
Tan KL, Tan R, Tan SH, Tan AM. The Twin Transfusion Syndrome: Clinical observations on 35 affected pairs. Clin Pediatr (Phila). 1979;18(2):111-4.
Golubovsky MD. Postzygotic diploidization of triploids as a source of unusual cases of mosaicism, chimerism and twinning. Hum Reprod. 2003;18(2):236-42.
Nygren KG, Sullivan E, Zegers-Hochschild F, Mansour R, Ishihara O, Adamson GD, et al. International Committee for Monitoring Assisted Reproductive Technology (ICMART) world report: assisted reproductive technology 2003. Fertil Steril. 2011;95(7):2209-22, 2222.e1-e17. Epub 11 May 2011.
Cameron AH, Edwards JH, Derom R, Thiery M, Boelaert R. The value of twin surveys in the study of malformations. Eur J Obstet Gynecol Reprod Biol. 1983;14(5):347-56.
Taylor MJ, Denbow ML, Tanawattanacharoen S, Gannon C, Cox PM, Fisk NM. Doppler detection of arterio-arterial anastomoses in monochorionic twins: feasibility and clinical application. Hum Reprod. 2000;15(7):1632-6.
Denbow M, Fogliani R, Kyle P, Letsky E, Nicolini U, Fisk N. Haematological indices at fetal blood sampling in monochorionic pregnancies complicated by feto-fetal transfusion syndrome. Prenat Diagn. 1998;18(9):941-6.
Lewi L, Jani J, Boes AS, Donne E, Van Mieghem T, Gucciardo L, et al. The natural history of monochorionic twins and the role of prenatal ultrasound scan. Ultrasound Obstet Gynecol. 2007;30:401-2.
Bajoria R, Ward S, Sooranna SR. Influence of vasopressin in the pathogenesis of oligohydramnios- polyhydramnios in monochorionic twins. Eur J Obstet Gynecol Reprod Biol. 2004;113(1):49-55.
Mahieu-Caputo D, Dommergues M, Delezoide AL, Lacoste M, Cai Y, Narcy F, et al. Twin-to-twin transfusion syndrome: Role of the fetal renin-angiotensin system. Am J Pathol. 2000;156(2):629-36.
Bermúdez C, Becerra CH, Bornick PW, Allen MH, Arroyo J, Quintero RA. Placental types and twin-twin transfusion syndrome. Am J Obstet Gynecol. 2002;187(2):489-94.
Bermúdez C, Becerra C, Bornick PW, Allen MH, Arroyo J, Quintero RA. Twin-twin transfusion syndrome with only superficial placental anastomoses: endoscopic and pathological evidence. J Matern Fetal Neonatal Med. 2002;12(2):138-40.
Bajoria R. Abundant vascular anastomoses in monoamniotic versus diamniotic monochorionic placentas. Am J Obstet Gynecol. 1998;179(3 Pt 1):788-93.
Denbow ML, Cox P, Talbert D, Fisk NM. Colour Doppler energy insonation of placental vasculature in monochorionic twins: absent arterio-arterial anastomoses in association with twin-to-twin transfusion syndrome. Br J Obstet Gynaecol. 1998;105(7):760-5.
Sebire NJ, Talbert D, Fisk NM. Twin-to-twin transfusion syndrome results from dynamic asymmetrical reduction in placental anastomoses: a hypothesis. Placenta. 2001;22(5):383-91.
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(3):708-15.
Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol. 1999;19(8 Pt 1):550-5.
Leake RD, Ervin MG, Ross MG, Stegner H, Fisher DA. Fetal arginine vasopressin under basal and hypoosmolal conditions. Biol Neonate. 1987;51(4):204-11.
Talbert DG, Bajoria R, Sepulveda W, Bower S, Fisk NM. Hydrostatic and osmotic pressure gradients produce manifestations of fetofetal transfusion syndrome in a computerized model of monochorial twin pregnancy. Am J Obstet Gynecol. 1996;174(2):598-608.
Johnson RJ, Alpers CE, Yoshimura A, Lombardi D, Pritzl P, Floege J, et al. Renal injury from angiotensin II-mediated hypertension. Hypertension. 1992;19(5):464-74.
Baud O, Lebidois J, Van Peborgh P, Ville Y. Fetal and neonatal hypertension in twin-twin transfusion syndrome: a case report. Fetal Diagn Ther. 1998;13(4):223-6.
Wenstrom KD, Tessen JA, Zlatnik FJ, Sipes SL. Frequency, distribution, and theoretical mechanisms of hematologic and weight discordance in monochorionic twins. Obstet Gynecol. 1992;80(2):257-61.
Devlieger R, Millar LK, Bryant-Greenwood G, Lewi L, Deprest JA. Fetal membrane healing after spontaneous and iatrogenic membrane rupture: a review of current evidence. Am J Obstet Gynecol. 2006;195(6):1512- 20. Epub 8 May 2006.
Pérez-Borbón GM, Hernández-Andrade E, Benavides-Serralde JA, Guzmán-Huerta ME, Camargo-Marín L, López R, et al. Mortalidad perinatal y morbilidad materna asociada al síndrome de transfusión feto-feto sin tratamiento intrauterino: Necesidad de un programa de cirugía fetal. 2010;24(3):161-6.
Roberts D, Neilson JP, Kilby MD, Gates S. Interventions for the treatment of twin-twin transfusion syndrome. Cochrane Database Syst Rev. 2014;30(1):CD002073.
Saunders NJ, Snijders RJ, Nicolaides KH. Therapeutic amniocentesis in twin-twin transfusion syndrome appearing in the second trimester of pregnancy. Am J Obstet Gynecol. 1992;166(3):820-4.
Quintero RA, Dickinson JE, Morales WJ, Bornick PW, Bermúdez C, Cincotta R, et al. Stage-based treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2003;188(5):1333-40.
Sutcliffe AG, Sebire NJ, Pigott AJ, Taylor B, Edwards PR, Nicolaides KH. Outcome for children born after in utero laser ablation therapy for severe twin-to-twin transfusion syndrome. BJOG. 2001;108(12):1246-50.
Urig MA, Clewell WH, Elliott JP. Twin-twin transfusion syndrome. Am J Obstet Gynecol. 1990;163(5 Pt 1):1522-26.
De Lia JE, Cruikshank DP, Keye WR Jr. Fetoscopic neodymium: YAG laser occlusion of placental vessels in severe twin-twintransfusion syndrome. Obstet Gynecol. 1990;75(6):1046-53.
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(2):136-144.
Trespidi L, Boschetto C, Caravelli E, Villa L, Kustermann A, Nicolini U. Serial amniocenteses in the management of twintwin transfusion syndrome: when is it valuable? Fetal Diagn Ther. 1997;12(1):15-20.
Dickinson JE, Evans SF. Obstetric and perinatal outcomes from the australian and new zealand twin-twin transfusion syndrome registry. Am J Obstet Gynecol. 2000;182(3):706-12.
Mari G, Detti L, Oz U, Abuhamad AZ. Long-term outcome in twin-twin transfusion syndrome treated with serial aggressive amnioreduction. Am J Obstet Gynecol. 2000;183(1):211-7.
Mahony BS, Petty CN, Nyberg DA, Luthy DA, Hickok DE, Hirsch JH. The “stuck twin” phenomenon: ultrasonographic findings, pregnancy outcome, and management with serial amniocenteses. Am J Obstet Gynecol. 1990;163(5 pt 1):1513-22.
Gratacós E, Deprest J. Current experience with fetoscopy and the Eurofoetus registry for fetoscopic procedures. Eur J Obstet Gynecol Reprod Biol. 2000;92(1):151-9.
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;105(4):446-53.
Banek CS, Hecher K, Hackeloer BJ, Bartmann P. Long-term neurodevelopmental outcome after intrauterine laser treatment for severe twin-twin transfusion syndrome. Am J Obstet Gynecol. 2003;188(4):876-80.
Walsh CA, McAuliffe FM. Recurrent twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation: a systematic review of the literature. Ultrasound Obstet Gynecol. 2012;40(5):506-12.
Lewi L, Gratacos E, Ortibus E, Van Schoubroeck D, Carreras E, Higueras T, et al. Pregnancy and infant outcome of 80 consecutive cord coagulations in complicated monochorionic multiple pregnancies. Am J Obstet Gynecol. 2006;194(3):782-9.