Abstract
Twin to Twin Transfusion Syndrome is one of the most serious complications on multiple pregnancy which deserves a strict monitoring and appropriated treatment according to the characteristics of the pathology in each case presented. This pathology is presented as a condition in foetus from multiple monchorionic pregnancies which have identical genotypes, but they adopt discordant cardiovascular
phenotypes as a consequence of the disorder in the discharge due to multiple placental anastomoses usually developed between the foetuses. Perinatology experts have approached this topic and they have postulated different diagnostic and therapeutic alternatives, so it is fundamental to know the considerations to aboard patients with the above mentioned clinical condition and provide a timely
consultation to the affected mothers. Below, it is presented a revision on different literature about Twin to Twin Transfusion Syndrome focused on the characteristics of its presentation, epidemiological reviews, criteria and methods of diagnosis as well as the therapeutic alternatives developed for the management of its complications and a summary of progress regarding post intervention prospective
studies which demonstrate progress in terms of survival and neurological involvement in the twin survivors. MÉD.UIS. 2016;29(3):61-71.
Keywords: Fetofetal Transfusion. Blood Transfusion, Intrauterine. Pregnancy, twin.
References
Moise K, Johnson A. Pathogenesis and diagnosis of twin-twin transfusion syndrome. [Internet] UptoDate. [Citado en Mayo 2011]. Disponible en: www.uptodate.com
González Ocampo JE. Proyecto de ley número 289 de 2007
Cámara. Colombia.Bogota. [Citado Octubre 12 2011].
Redline R. Nonidentical Twins with a Single Placenta — Disproving Dogma in Perinatal Pathology. N Engl J Med 2003; 349:111-114.
Cincinnati Fetal Center. [Internet] cincinnati Children’s - Good Samaritan - University Hospital. Twin-Twin Transfusion Syndrome / TTTS. [Citado Octubre 10 2011] Disponible en: http://www.fetalcarecenter.org/conditions/ttts/default.htm
Gómez-Castro L, Parra G, Vergara F, Parra M, Gómez M, Cuellar R, et al. Síndrome de transfusión intergemelar estadio III, manejado
con fotocoagulación láser guiada por fetoscopia, complicado con síndrome de Ballantyne y RCIU selectivo del feto donante: reporte de caso y revisión de la literatura.Rev Colomb Obstet Ginecol.2010;61(4):341-7
Fetal Treatment Care. The Birthplace of Fetal Surgery.Universidad
de San Francisco, California. [Internet] Twin to Twin Transfusion
Syndrome. [Citado Octubre 12 2011] Disponible en: http://fetus.
ucsfmedicalcenter.org/twin/twin_twin_transfusion.asp
Chansen S, Chervenak F. Antepartum issues in management of
twin gestations. [Internet] UptoDate. [Citado en Mayo 24, 2011].
Disponible en: www.uptodate.com
Herrera León L, Martínez Barreiro L. El embarazo múltiple: ¿es
realmente un factor de alto riesgo obstétrico.PSM.2009;6(2):1-20.
Hernández Herrera RJ, Ochoa Torres M, Flores Santos R, Cortés
Flores R. Prevalencia de embarazos múltiples: incremento en la
última década. Ginecol Obstet Mex 2008;76(9):507-11.
Paulson R. Pregnancy outcome after assisted reproductive
technology. [Internet] UptoDate. [Citado en Mayo 2016].
Disponible en: http://www.uptodate.com/contents/pregnancyoutcome-after-assisted-reproductive-technology
Cañas Giraldo C, Cifuente B L, Fabio Montes H, Morbimortalidad
Del Embarazo Gemelar En El Hospital Universitario Del Valle.
Rev Colomb Obstet Ginecol.2000.50(3).
Sepulveda W, Dezerega V, Valle P, Gutierrez J, Corral E.
Determinación prenatal de la corionicidad en el embarazo gemelar. Rev. Ecuatoriana de Ultrasonido.2007;1(3):p47-53.
Nazario-redondo C, Ventura-laveriano J, Flores-molina E, Ventura
W. La importancia de la ecografía a las 11+0 a 13+6 semanas de
embarazo. actualización. An. Fac. Med. 2011; 72(3) p. 211-5.
Ayala-Méndez JA, Jiménez-Solís G, Fernández-Martínez LR,
López-Rangel JA. Determinación de corionicidad por ultrasonido
en embarazo gemelar. Ginecol Obstet Mex. 1997;65(3):111-3.
Fisk NM, Galea P. Twin–Twin Transfusion — As Good as It Gets?.
N Engl J Med 2004;351(2):182-4. Epub 2004 Jul 6.
Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK,
Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol.
;19(8 Pt 1):550-5.
Moise K, Johnson A. Management of twin-twin transfusion
syndrome. [Base de Datos en Internet] UptoDate. [Citado en Mayo
, 2011]. Disponible en www.uptodate.com
Valenzuela P, Becker J, Carvajal J. Pautas de manejo clínico en
embarazos gemelares. Rev Chil Obstet Ginecol. 2009;74(1):52-68.
Wagner MM, Lopriore E, Klumper FJ, Oepkes D, Vandenbussche
FP, Middeldorp JM. Short and long term outcome in stage 1 twin to twin transfusion syndrome treated with laser surgery compared with conservative management. Am J Obstet Gynecol. 2009; 201(3): 286. e1-6. Epub 2009 Jul 22.
Leung WC, Jouannic JM, Hyett J, Rodeck C, Jauniaux E. Procedurerelated complications of rapid amniodrainage in the treatment of polyhydramnios. Ultrasound Obstet Gynecol. 2004;23(2):154-8.
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.
Van den Wijngaard JP, Umur A, Ross MG, van Gemert MJ.
Modelling the influence of amnionicity on the severity of twintwin
transfusion syndrome in monochorionic twin pregnancies.
Phys Med Biol. 2004;49(6):57-64.
Moise KJ Jr, Dorman K, Lamvu G, Saade GR, Fisk NM, Dickinson
JE, et al. A randomized trial of amnioreduction versus septostomy
in the treatment of twin-twin transfusion syndrome. Am J Obstet
Gynecol. 2005;193(3 Pt 1):701-7.
Ramírez L, Carmona de Uzcátegui ML, Chacín B, Moreno F.
Síndrome de perfusión arterial retrógrada en gemelos (trap):
feto acardio. Reporte de un caso. Rev Obstet Ginecol Venez.
;69(3):193-203.
Lee H, Wagner A, Robert B, Feldstein V, Farmer D, Kerilyn N, et
al. Radiofrequency ablation for trap sequence: 39. Am J Obstet
Gynecol. 2004;191:S18
Sepúlveda W, Wong A, Pons A, Gutierrez J, Corral E. Secuencia de perfusión arterial reversa (gemelo acárdico): Evaluación prenatal
y tratamiento. Rev Chil Ultrasonog. 2005;8:118-130.
Ville Y, Hyett J, Vandenbussche FPHA, Nicolaides KH. Endoscopic
laser coagulation of umbilical cord vessels in twin reversed arterial perfusion sequence. Obstet Gynecol. 1994;(4):396-8.
Taylor MJ, Shalev E, Tanawattanacharoen S, Jolly M, Kumar S,
Weiner E, et al. Ultrasound-guided umbilical cord occlusion
using bipolar diathermy for Stage III/IV twin-twin transfusion syndrome. Prenat Diagn. 2002 Jan;22(1):70-6.
Arias F, Sunderji S, Gimpelson R, Colton E. Treatment of acardiac twinning. Obstet Gynecol. 1998;(91):818-21.
Hasbun J, Sepúlveda W, Parra M. Vía Del Nacimiento En Gemelar
Monocoriónico Con Transfusión Intergemelar Y Terapia In Útero.
Rev Chil Obstet Ginecol. 2004; 69(6):451-9.
Persico N, Fabietti I, D`Ambrosi F, Ricardi M, Boito S, Fedele
L. Posnatal survival after endoscopic equatorial laser for the
treatment of twin-to-twin transfusion syndrome. Am J Obstet
Gynecol. 2016 Apr;214(4): 533.e1-7.
Senat M, 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;
:136-44.
Yamamoto M, Ville Y. Laser tratament in twin-to-twin transfusion
syndrome. Semin Fetal Neonatal Med. 2007;(12):450-7.
Poblete A, Pomes C, Figueroa J, Soto J, Gana A, Montaña R, et
al. Cirugía láser endoscópica de la placenta en el tratamiento
del síndrome de transfusión feto-fetal. Rev chil obstet ginecol
[Internet]. 2003;68(6):503-7. [citado 2011 noviembre 01],
Disponible en: http://www.scielo.cl/scielo.php?script=sci_
arttext&pid=S0717-75262003000600009&lng=es.
Zhao DP, Cambiaso O, Otaño L, Lewi L, Deprest J, Sun L.M, et al.
Veno-venous anastomoses in twin-twin transfusion Syndrome: A
multiccenter study. Placenta. 2015;36(8):911-4.
Chang YL. Fetoscopic guide laser therapy for twin-twin
transfusion syndrome. Gynecology and Minimally Invasive
Therapy. 2013;2(1):8-12.
Bebbington M. Twin-to-twin transfusion syndrome: current
understanding of pathophysiology, in-utero therapy and
impact for future development. Semin Fetal Neonatal Med.
;15(1):15-20.
Van Klink J, Koopman H, Van Zwet E, Middeldorp JM, Walther F,
Oepkes D, et al. Improvement in neurodevelopmental outcome in
survivors of twin-twin transfusion syndrome with laser surgery.
Am J Obstet Gynecol. 2014;210(6):540.e1-7.
Mclntosh J, Meriki N, Joshi A, Biggs V, Welsh AW, Challis D, et
al. Long term developmental outcomes of pre-school age children
following laser surgery for twin-to-twin transfusion syndrome.
Early Hum Dev. 2014;90(12):837-42.
Sueters M, Oepkes D. Diagnosis of twin-to-twin transfusion
syndrome, selective fetal growth restriction, twin anaemia polycythaemia sequence, and twin reversed arterial perfusion
sequence. Best Pract Res Clin Obstet Gynaecol. 2014 Feb;28(2):215-26.
Parra M, Bascuñán J, Valencia C, Rencoret G, Caballero R,
Quezada S. Complicaciones tardías de la terapia láser como
tratamiento de la transfusión feto-fetal: caso clínico. Rev chil
obstet ginecol. 2011;76(1):42-6.
Lombardo ML, Watson-Smith DJ, Muratore CS, Carr SR, O’Brien
BM, Luks FI. Laser ablation of placental vessels in twin-to-twin
transfusion syndrome: a paradigm for endoscopic fetal surgery. J
Laparoendosc Adv Surg Tech A. 2011 Nov;21(9):869-72.
Bermúdez C, Pérez-Wulff J, Rojas J, González F, Uzcátegui G, Plata P. Fetoscopia operatoria: fotocoagulación láser selectiva en el
síndrome de transfusión intergemelar. Rev Obstet Ginecol Venez.
Jun;63(2):101-6.
Chmait RH, Chon AH, Schrager SM, Kontopoulos EV, Quintero
RA, Vanderbilt DL. Donor catch-up growth after laser surgery
for twin-twin transfusion syndrome. Early Hum Dev. 2015
Dec;91(12):751-4.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2016 Revista Médicas UIS