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Twin-Twin Transfusion Syndrome
Priyanka Jha, MBBS; Anne Kennedy, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Twin-twin transfusion syndrome (TTTS)
            • Synonyms

              • Twin oligohydramnios-polyhydramnios sequence (TOPS)
            • Definitions

              • Monochorionic (MC) twin complication caused by intrauterine transfusion of blood from donor (D) twin to recipient (R) twin via arteriovenous (AV) placental anastomoses

            IMAGING

            • Diagnostic Criteria

              • Ultrasonographic Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Staging, Grading, & Classification

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Corroenne R et al: Inter-twin differences in fetal echocardiographic findings are associated with decreased dual twin survival in twin-twin transfusion syndrome. J Matern Fetal Neonatal Med. 1-7, 2021
                                  2. Chmait HR et al: Child temperament outcomes after laser surgery for twin-twin transfusion syndrome. J Dev Behav Pediatr. 42(1):41-5, 2021
                                  3. Espinoza J et al: Umbilical artery doppler patterns and right ventricular outflow abnormalities in twin-twin transfusion syndrome. J Ultrasound Med. 40(1):71-8, 2021
                                  4. Bamberg C et al: Neither the differentiation between twin-twin transfusion syndrome stages I and II nor III and IV makes a difference regarding the probability of double survival after laser therapy. Ultrasound Obstet Gynecol. ePub, 2020
                                  5. Bergh EP et al: Pregnancy outcomes associated with chorioamnion membrane separation severity following fetoscopic laser surgery for twin-twin transfusion syndrome. Prenat Diagn. 40(8):1020-7, 2020
                                  6. Brock CO et al: Fortnightly surveillance of monochorionic diamniotic twins for twin to twin transfusion syndrome: compliance and effectiveness. Prenat Diagn. 40(12):1598-605, 2020
                                  7. De Zoysa MY et al: Membrane separation and perinatal outcomes after laser treatment for twin-twin transfusion syndrome. Fetal Diagn Ther. 47(4):307-14, 2020
                                  8. Donepudi R et al: Prediction of fetal death in selective growth restriction complicating twin-twin transfusion syndrome using standardized definitions. Ultrasound Obstet Gynecol. ePub, 2020
                                  9. Espinoza J et al: Early laser surgery is not associated with very preterm delivery or reduced neonatal survival in TTTS. Ultrasound Obstet Gynecol. ePub, 2020
                                  10. French A et al: Reproductive outcomes following laser surgery for twin-twin transfusion syndrome. Fetal Diagn Ther. 47(6):464-70, 2020
                                  11. Gabby LC et al: Risk factors for co-twin fetal demise following radiofrequency ablation in multifetal monochorionic gestations. Fetal Diagn Ther. 1-7, 2020
                                  12. Gijtenbeek M et al: Early postnatal cardiac follow-up of survivors of twin-twin transfusion syndrome treated with fetoscopic laser coagulation. J Perinatol. 40(9):1375-82, 2020
                                  13. Gijtenbeek M et al: Perioperative fetal hemodynamic changes in twin-twin transfusion syndrome and neurodevelopmental outcome at two years of age. Prenat Diagn. 40(7):825-30, 2020
                                  14. Gleeson EI et al: Monochorionic monoamniotic twin-twin transfusion syndrome treated with laser ablation. Eur J Obstet Gynecol Reprod Biol. 246:193-4, 2020
                                  15. Greimel P et al: Amniodrainage-induced circulatory dysfunction in women treated for twin-to-twin transfusion syndrome. J Clin Med. 9(7):2085, 2020
                                  16. Gulati N et al: Cause of intrauterine and neonatal death in twin pregnancies (CoDiT): development of a novel classification system. BJOG. 127(12):1507-15, 2020
                                  17. Harbison AL et al: Evaluation of cardiac function in the recipient twin in successfully treated twin to twin transfusion syndrome (TTTS) using a novel fetal speckle tracking analysis. Prenat Diagn. ePub, 2020
                                  18. Kim SM et al: The amniotic fluid proteome differs significantly between donor and recipient fetuses in pregnancies complicated by twin-to-twin transfusion syndrome. J Korean Med Sci. 35(10):e73, 2020
                                  19. Knijnenburg PJC et al: Prevalence, risk factors and outcome of post-procedural amniotic band disruption sequence after fetoscopic laser surgery in twin-twin transfusion syndrome: a large single center case series. Am J Obstet Gynecol. 223(4):576.e1-8, 2020
                                  20. Kocaoglu M et al: Magnetic resonance imaging of the fetal brain in monochorionic diamniotic twin gestation: correlation of cerebral injury with ultrasound staging and survival outcomes. Pediatr Radiol. 50(8):1131-8, 2020
                                  21. Lewi L: Monochorionic diamniotic twins: what do I tell the prospective parents? Prenat Diagn. 40(7):766-75, 2020
                                  22. Mascio DD et al: Outcome of twin-twin transfusion syndrome according to the Quintero stage of the disease: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 56(6):811-20, 2020
                                  23. Mogra R et al: Prospective validation of first-trimester ultrasound characteristics as predictive tools for twin-twin transfusion syndrome and selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies. Fetal Diagn Ther. 47(4):321-7, 2020
                                  24. Murgano D et al: Outcome of twin-to-twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 55(3):310-7, 2020
                                  25. Pandya VM et al: Comparison of crown-rump length discordance and abnormal cord insertions as first-trimester predictors of poor outcome in monochorionic diamniotic twin pregnancies. J Matern Fetal Neonatal Med. 1-5, 2020
                                  26. Purnell ME et al: Percent absent end-diastolic velocity in the umbilical artery and donor twin demise after laser surgery for twin-twin transfusion syndrome. Fetal Diagn Ther. 47(7):572-9, 2020
                                  27. Radhakrishnan P et al: Combination of "markers" and the consequent importance of fetal abdominal circumference in the first trimester for predicting complications specific to monochorionic twin pregnancies. Fetal Diagn Ther. 47(7):580-6, 2020
                                  28. Rüegg L et al: Long-term outcome of monochorionic twins after fetoscopic laser therapy compared to matched dichorionic twins. Fetal Diagn Ther. 1-8, 2020
                                  29. Shanahan MA et al: Placental anatomy and function in twin gestations. Obstet Gynecol Clin North Am. 47(1):99-116, 2020
                                  30. Sommer J et al: Renal functional markers in extremely premature infants with and without twin-twin transfusion syndrome. J Perinatol. 40(2):256-62, 2020
                                  31. Takano M et al: Prediction of twin-to-twin transfusion syndrome using characteristic waveforms of ductus venosus in recipient twins. Twin Res Hum Genet. 1-6, 2020
                                  32. Tollenaar LSA et al: Post-laser twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 164 cases. J Clin Med. 9(6):1759, 2020
                                  33. Visser GL et al: Leukocyte counts and other hematological values in twin-twin transfusion syndrome and twin anemia-polycythemia sequence. Fetal Diagn Ther. 47(2):123-8, 2020
                                  34. Wang X et al: Study of the placental characteristics and time of onset of twin-to-twin transfusion syndrome. Placenta. 103:10-5, 2020
                                  35. Yamamoto R et al: Prevalence of extraplacental anastomoses in monochorionic twin pregnancies. Fetal Diagn Ther. 1-4, 2020
                                  36. Gijtenbeek M et al: Congenital heart defects in monochorionic twins: a systematic review and meta-analysis. J Clin Med. 8(6):902, 2019
                                  37. Greimel P et al: Maternal complications and hemodynamic changes following intrauterine interventions for twin-to-twin transfusion syndrome in monochorionic diamniotic twin pregnancies. J Clin Med. 8(5):605, 2019
                                  38. Groene SG et al: Twin-twin transfusion syndrome with and without selective fetal growth restriction prior to fetoscopic laser surgery: short and long-term outcome. J Clin Med. 8(7):969, 2019
                                  39. Jha P et al: US evaluation of twin pregnancies: importance of chorionicity and amnionicity. Radiographics. 39(7):2146-66, 2019
                                  40. Kawaguchi H et al: The incidence of unexpected critical complications in monochorionic diamniotic twin pregnancies according to the interval period between ultrasonographic evaluations. J Obstet Gynaecol Res. 45(2):318-24, 2019
                                  41. Knijnenburg PJC et al: Incidence of and risk factors for residual anastomoses in twin-twin transfusion syndrome treated with laser surgery: a 15-year single-center experience. Fetal Diagn Ther. 45(1):13-20, 2019
                                  42. Konno H et al: The roles of superficial anastomoses in twin-twin transfusion syndrome. Placenta. 82:5-9, 2019
                                  43. Melhem NZ et al: Chronic kidney disease following twin-to-twin transfusion syndrome-long-term outcomes. Pediatr Nephrol. 34(5):883-8, 2019
                                  44. Perry H et al: Core outcome set for research studies evaluating treatments for twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 54(2):255-61, 2019
                                  45. Schou KV et al: Long-term neurodevelopmental outcome of monochorionic twins after laser therapy or umbilical cord occlusion for twin-twin transfusion syndrome. Fetal Diagn Ther. 46(1):20-7, 2019
                                  46. Zaretsky MV et al: North American Fetal Therapy Network: Timing of and indications for delivery following laser ablation for twin-twin transfusion syndrome. Am J Obstet Gynecol MFM. 1(1):74-81, 2019
                                  47. Delabaere A et al: Factors associated to early intrauterine fetal demise after laser for TTTS by preoperative fetal heart and Doppler ultrasound. Prenat Diagn. 38(7):523-30, 2018
                                  48. Eschbach SJ et al: Acquired right ventricular outflow tract obstruction in twin-to-twin transfusion syndrome; a prospective longitudinal study. Prenat Diagn. 38(13):1013-9, 2018
                                  49. Fischbein R et al: Twin-twin transfusion syndrome screening and diagnosis in the United States: a triangulation design of patient experiences. PLoS One. 13(7):e0200087, 2018
                                  50. Gordon BJ et al: Incidental septostomy after laser surgery for twin-twin transfusion syndrome: perinatal outcomes and antenatal management. Fetal Diagn Ther. 44(4):285-90, 2018
                                  51. Hecher K et al: Long-term outcomes for monochorionic twins after laser therapy in twin-to-twin transfusion syndrome. Lancet Child Adolesc Health. 2(7):525-35, 2018
                                  52. Washburn EE et al: Polyhydramnios affecting a recipient-like twin: risk of progression to twin-twin transfusion syndrome and outcomes. Am J Perinatol. 35(4):317-23, 2018
                                  53. Washburn EE et al: Stage I twin-twin transfusion syndrome: outcomes of expectant management and prognostic features. Am J Perinatol. 35(14):1352-7, 2018
                                  54. Behrendt N et al: Twin-twin transfusion and laser therapy. Curr Opin Obstet Gynecol. 28(2):79-85, 2016
                                  55. Chmait RH et al: Fetal brain-sparing after laser surgery for twin-twin transfusion syndrome appears associated with two-year neurodevelopmental outcomes. Prenat Diagn. 36(1):63-7, 2016
                                  56. Duryea EL et al: The natural history of twin-twin transfusion syndrome stratified by Quintero stage. J Matern Fetal Neonatal Med. 1-5, 2016
                                  57. Persico N et al: Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 214(4):533.e1-7, 2016
                                  58. Bahtiyar MO et al: The North American Fetal Therapy Network consensus statement: prenatal surveillance of uncomplicated monochorionic gestations. Obstet Gynecol. 125(1):118-23, 2015
                                  59. Dhillon RK et al: Comparison of Solomon technique with selective laser ablation for twin-twin transfusion syndrome: a systematic review. Ultrasound Obstet Gynecol. 46(5):526-33, 2015
                                  60. Emery SP et al: The North American Fetal Therapy Network consensus statement: prenatal management of uncomplicated monochorionic gestations. Obstet Gynecol. 125(5):1236-43, 2015
                                  61. Benoit RM et al: Twin-to-twin transfusion syndrome: prenatal diagnosis and treatment. Am J Perinatol. 31(7):583-94, 2014
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Pathology

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Twin-twin transfusion syndrome (TTTS)
                                            • Synonyms

                                              • Twin oligohydramnios-polyhydramnios sequence (TOPS)
                                            • Definitions

                                              • Monochorionic (MC) twin complication caused by intrauterine transfusion of blood from donor (D) twin to recipient (R) twin via arteriovenous (AV) placental anastomoses

                                            IMAGING

                                            • Diagnostic Criteria

                                              • Ultrasonographic Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      • Staging, Grading, & Classification

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Corroenne R et al: Inter-twin differences in fetal echocardiographic findings are associated with decreased dual twin survival in twin-twin transfusion syndrome. J Matern Fetal Neonatal Med. 1-7, 2021
                                                                  2. Chmait HR et al: Child temperament outcomes after laser surgery for twin-twin transfusion syndrome. J Dev Behav Pediatr. 42(1):41-5, 2021
                                                                  3. Espinoza J et al: Umbilical artery doppler patterns and right ventricular outflow abnormalities in twin-twin transfusion syndrome. J Ultrasound Med. 40(1):71-8, 2021
                                                                  4. Bamberg C et al: Neither the differentiation between twin-twin transfusion syndrome stages I and II nor III and IV makes a difference regarding the probability of double survival after laser therapy. Ultrasound Obstet Gynecol. ePub, 2020
                                                                  5. Bergh EP et al: Pregnancy outcomes associated with chorioamnion membrane separation severity following fetoscopic laser surgery for twin-twin transfusion syndrome. Prenat Diagn. 40(8):1020-7, 2020
                                                                  6. Brock CO et al: Fortnightly surveillance of monochorionic diamniotic twins for twin to twin transfusion syndrome: compliance and effectiveness. Prenat Diagn. 40(12):1598-605, 2020
                                                                  7. De Zoysa MY et al: Membrane separation and perinatal outcomes after laser treatment for twin-twin transfusion syndrome. Fetal Diagn Ther. 47(4):307-14, 2020
                                                                  8. Donepudi R et al: Prediction of fetal death in selective growth restriction complicating twin-twin transfusion syndrome using standardized definitions. Ultrasound Obstet Gynecol. ePub, 2020
                                                                  9. Espinoza J et al: Early laser surgery is not associated with very preterm delivery or reduced neonatal survival in TTTS. Ultrasound Obstet Gynecol. ePub, 2020
                                                                  10. French A et al: Reproductive outcomes following laser surgery for twin-twin transfusion syndrome. Fetal Diagn Ther. 47(6):464-70, 2020
                                                                  11. Gabby LC et al: Risk factors for co-twin fetal demise following radiofrequency ablation in multifetal monochorionic gestations. Fetal Diagn Ther. 1-7, 2020
                                                                  12. Gijtenbeek M et al: Early postnatal cardiac follow-up of survivors of twin-twin transfusion syndrome treated with fetoscopic laser coagulation. J Perinatol. 40(9):1375-82, 2020
                                                                  13. Gijtenbeek M et al: Perioperative fetal hemodynamic changes in twin-twin transfusion syndrome and neurodevelopmental outcome at two years of age. Prenat Diagn. 40(7):825-30, 2020
                                                                  14. Gleeson EI et al: Monochorionic monoamniotic twin-twin transfusion syndrome treated with laser ablation. Eur J Obstet Gynecol Reprod Biol. 246:193-4, 2020
                                                                  15. Greimel P et al: Amniodrainage-induced circulatory dysfunction in women treated for twin-to-twin transfusion syndrome. J Clin Med. 9(7):2085, 2020
                                                                  16. Gulati N et al: Cause of intrauterine and neonatal death in twin pregnancies (CoDiT): development of a novel classification system. BJOG. 127(12):1507-15, 2020
                                                                  17. Harbison AL et al: Evaluation of cardiac function in the recipient twin in successfully treated twin to twin transfusion syndrome (TTTS) using a novel fetal speckle tracking analysis. Prenat Diagn. ePub, 2020
                                                                  18. Kim SM et al: The amniotic fluid proteome differs significantly between donor and recipient fetuses in pregnancies complicated by twin-to-twin transfusion syndrome. J Korean Med Sci. 35(10):e73, 2020
                                                                  19. Knijnenburg PJC et al: Prevalence, risk factors and outcome of post-procedural amniotic band disruption sequence after fetoscopic laser surgery in twin-twin transfusion syndrome: a large single center case series. Am J Obstet Gynecol. 223(4):576.e1-8, 2020
                                                                  20. Kocaoglu M et al: Magnetic resonance imaging of the fetal brain in monochorionic diamniotic twin gestation: correlation of cerebral injury with ultrasound staging and survival outcomes. Pediatr Radiol. 50(8):1131-8, 2020
                                                                  21. Lewi L: Monochorionic diamniotic twins: what do I tell the prospective parents? Prenat Diagn. 40(7):766-75, 2020
                                                                  22. Mascio DD et al: Outcome of twin-twin transfusion syndrome according to the Quintero stage of the disease: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 56(6):811-20, 2020
                                                                  23. Mogra R et al: Prospective validation of first-trimester ultrasound characteristics as predictive tools for twin-twin transfusion syndrome and selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies. Fetal Diagn Ther. 47(4):321-7, 2020
                                                                  24. Murgano D et al: Outcome of twin-to-twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 55(3):310-7, 2020
                                                                  25. Pandya VM et al: Comparison of crown-rump length discordance and abnormal cord insertions as first-trimester predictors of poor outcome in monochorionic diamniotic twin pregnancies. J Matern Fetal Neonatal Med. 1-5, 2020
                                                                  26. Purnell ME et al: Percent absent end-diastolic velocity in the umbilical artery and donor twin demise after laser surgery for twin-twin transfusion syndrome. Fetal Diagn Ther. 47(7):572-9, 2020
                                                                  27. Radhakrishnan P et al: Combination of "markers" and the consequent importance of fetal abdominal circumference in the first trimester for predicting complications specific to monochorionic twin pregnancies. Fetal Diagn Ther. 47(7):580-6, 2020
                                                                  28. Rüegg L et al: Long-term outcome of monochorionic twins after fetoscopic laser therapy compared to matched dichorionic twins. Fetal Diagn Ther. 1-8, 2020
                                                                  29. Shanahan MA et al: Placental anatomy and function in twin gestations. Obstet Gynecol Clin North Am. 47(1):99-116, 2020
                                                                  30. Sommer J et al: Renal functional markers in extremely premature infants with and without twin-twin transfusion syndrome. J Perinatol. 40(2):256-62, 2020
                                                                  31. Takano M et al: Prediction of twin-to-twin transfusion syndrome using characteristic waveforms of ductus venosus in recipient twins. Twin Res Hum Genet. 1-6, 2020
                                                                  32. Tollenaar LSA et al: Post-laser twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 164 cases. J Clin Med. 9(6):1759, 2020
                                                                  33. Visser GL et al: Leukocyte counts and other hematological values in twin-twin transfusion syndrome and twin anemia-polycythemia sequence. Fetal Diagn Ther. 47(2):123-8, 2020
                                                                  34. Wang X et al: Study of the placental characteristics and time of onset of twin-to-twin transfusion syndrome. Placenta. 103:10-5, 2020
                                                                  35. Yamamoto R et al: Prevalence of extraplacental anastomoses in monochorionic twin pregnancies. Fetal Diagn Ther. 1-4, 2020
                                                                  36. Gijtenbeek M et al: Congenital heart defects in monochorionic twins: a systematic review and meta-analysis. J Clin Med. 8(6):902, 2019
                                                                  37. Greimel P et al: Maternal complications and hemodynamic changes following intrauterine interventions for twin-to-twin transfusion syndrome in monochorionic diamniotic twin pregnancies. J Clin Med. 8(5):605, 2019
                                                                  38. Groene SG et al: Twin-twin transfusion syndrome with and without selective fetal growth restriction prior to fetoscopic laser surgery: short and long-term outcome. J Clin Med. 8(7):969, 2019
                                                                  39. Jha P et al: US evaluation of twin pregnancies: importance of chorionicity and amnionicity. Radiographics. 39(7):2146-66, 2019
                                                                  40. Kawaguchi H et al: The incidence of unexpected critical complications in monochorionic diamniotic twin pregnancies according to the interval period between ultrasonographic evaluations. J Obstet Gynaecol Res. 45(2):318-24, 2019
                                                                  41. Knijnenburg PJC et al: Incidence of and risk factors for residual anastomoses in twin-twin transfusion syndrome treated with laser surgery: a 15-year single-center experience. Fetal Diagn Ther. 45(1):13-20, 2019
                                                                  42. Konno H et al: The roles of superficial anastomoses in twin-twin transfusion syndrome. Placenta. 82:5-9, 2019
                                                                  43. Melhem NZ et al: Chronic kidney disease following twin-to-twin transfusion syndrome-long-term outcomes. Pediatr Nephrol. 34(5):883-8, 2019
                                                                  44. Perry H et al: Core outcome set for research studies evaluating treatments for twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 54(2):255-61, 2019
                                                                  45. Schou KV et al: Long-term neurodevelopmental outcome of monochorionic twins after laser therapy or umbilical cord occlusion for twin-twin transfusion syndrome. Fetal Diagn Ther. 46(1):20-7, 2019
                                                                  46. Zaretsky MV et al: North American Fetal Therapy Network: Timing of and indications for delivery following laser ablation for twin-twin transfusion syndrome. Am J Obstet Gynecol MFM. 1(1):74-81, 2019
                                                                  47. Delabaere A et al: Factors associated to early intrauterine fetal demise after laser for TTTS by preoperative fetal heart and Doppler ultrasound. Prenat Diagn. 38(7):523-30, 2018
                                                                  48. Eschbach SJ et al: Acquired right ventricular outflow tract obstruction in twin-to-twin transfusion syndrome; a prospective longitudinal study. Prenat Diagn. 38(13):1013-9, 2018
                                                                  49. Fischbein R et al: Twin-twin transfusion syndrome screening and diagnosis in the United States: a triangulation design of patient experiences. PLoS One. 13(7):e0200087, 2018
                                                                  50. Gordon BJ et al: Incidental septostomy after laser surgery for twin-twin transfusion syndrome: perinatal outcomes and antenatal management. Fetal Diagn Ther. 44(4):285-90, 2018
                                                                  51. Hecher K et al: Long-term outcomes for monochorionic twins after laser therapy in twin-to-twin transfusion syndrome. Lancet Child Adolesc Health. 2(7):525-35, 2018
                                                                  52. Washburn EE et al: Polyhydramnios affecting a recipient-like twin: risk of progression to twin-twin transfusion syndrome and outcomes. Am J Perinatol. 35(4):317-23, 2018
                                                                  53. Washburn EE et al: Stage I twin-twin transfusion syndrome: outcomes of expectant management and prognostic features. Am J Perinatol. 35(14):1352-7, 2018
                                                                  54. Behrendt N et al: Twin-twin transfusion and laser therapy. Curr Opin Obstet Gynecol. 28(2):79-85, 2016
                                                                  55. Chmait RH et al: Fetal brain-sparing after laser surgery for twin-twin transfusion syndrome appears associated with two-year neurodevelopmental outcomes. Prenat Diagn. 36(1):63-7, 2016
                                                                  56. Duryea EL et al: The natural history of twin-twin transfusion syndrome stratified by Quintero stage. J Matern Fetal Neonatal Med. 1-5, 2016
                                                                  57. Persico N et al: Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 214(4):533.e1-7, 2016
                                                                  58. Bahtiyar MO et al: The North American Fetal Therapy Network consensus statement: prenatal surveillance of uncomplicated monochorionic gestations. Obstet Gynecol. 125(1):118-23, 2015
                                                                  59. Dhillon RK et al: Comparison of Solomon technique with selective laser ablation for twin-twin transfusion syndrome: a systematic review. Ultrasound Obstet Gynecol. 46(5):526-33, 2015
                                                                  60. Emery SP et al: The North American Fetal Therapy Network consensus statement: prenatal management of uncomplicated monochorionic gestations. Obstet Gynecol. 125(5):1236-43, 2015
                                                                  61. Benoit RM et al: Twin-to-twin transfusion syndrome: prenatal diagnosis and treatment. Am J Perinatol. 31(7):583-94, 2014