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KEY FACTS
Terminology
Imaging
Pathology
Clinical Issues
TERMINOLOGY
Abbreviations
- Twin-twin transfusion syndrome (TTTS)
Synonyms
- Twin oligohydramnios polyhydramnios sequence (TOPS)
Definitions
- Monochorionic twin complication caused by intrauterine transfusion of blood from donor twin (D) to recipient twin (R) via arteriovenous (AV) placental anastomoses
- Staging based on fluid volume, bladder size, Doppler findings, presence of hydrops
IMAGING
Diagnostic Criteria
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
Selected References
- Behrendt N et al: Twin-twin transfusion and laser therapy. Curr Opin Obstet Gynecol. 28(2):79-85, 2016
- 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
- Duryea EL et al: The natural history of twin-twin transfusion syndrome stratified by Quintero stage. J Matern Fetal Neonatal Med. 1-5, 2016
- Van Winden KR et al: Decreased Total Placental Mass Found in Twin-Twin Transfusion Syndrome Gestations with Selective Growth Restriction. Fetal Diagn Ther. ePub, 2016
- Ashwal E et al: Twin Anemia-Polycythemia Sequence: Perinatal Management and Outcome. Fetal Diagn Ther. ePub, 2015
- Ben-Ami I et al: Monochorionic diamniotic in vitro fertilization twins have a decreased incidence of twin-to-twin transfusion syndrome. Fertil Steril. ePub, 2015
- Boyle M et al: Postnatal MRI Brain in Infants Treated for Twin-Twin Transfusion Syndrome. Ir Med J. 108(8):240-3, 2015
- 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
- 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
- Persico N et al: Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome. Am J Obstet Gynecol. ePub, 2015
- Benoit RM et al: Twin-to-twin transfusion syndrome: prenatal diagnosis and treatment. Am J Perinatol. 31(7):583-94, 2014
- Diehl W et al: Twin-twin transfusion syndrome: treatment and outcome. Best Pract Res Clin Obstet Gynaecol. 28(2):227-38, 2014
- Moon-Grady AJ: Fetal echocardiography in twin-twin transfusion syndrome. Am J Perinatol. 31 Suppl 1:S31-8, 2014
- Roberts D et al: Interventions for the treatment of twin-twin transfusion syndrome. Cochrane Database Syst Rev. 1:CD002073, 2014
- Oostveen MP et al: Congenital anomalies presenting in utero as TTTS: a case series report and review of literature. J Obstet Gynaecol. 33(8):901-3, 2013
- Gray PH et al: Cardiac outcomes of hydrops as a result of twin-twin transfusion syndrome treated with laser surgery. J Paediatr Child Health. 45(1-2):48-52, 2009
- Habli M et al: Twin-to-twin transfusion syndrome: a comprehensive update. Clin Perinatol. 36(2):391-416, x, 2009
- Kontopoulos EV et al: Assessment of the peak systolic velocity of the middle cerebral artery in twin-twin transfusion syndrome. Part I: preoperative assessment. Am J Obstet Gynecol. 200(1):61, 2009
- Lopriore E et al: Risk factors for neurodevelopment impairment in twin-twin transfusion syndrome treated with fetoscopic laser surgery. Obstet Gynecol. 113(2 Pt 1):361-6, 2009
- Rossi AC et al: Comparison of donor and recipient outcomes following laser therapy performed for twin-twin transfusion syndrome: a meta-analysis and review of literature. Am J Perinatol. 26(1):27-32, 2009
- Rossi AC et al: Twin-twin transfusion syndrome. Minerva Ginecol. 61(2):153-65, 2009
- Chmait RH et al: Fetal growth after laser therapy for twin-twin transfusion syndrome. Am J Obstet Gynecol. 199(1):47, 2008
- Gungor S et al: Umbilical venous volume flow in twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 32(6):800-6, 2008
- Habli M et al: Acute effects of selective fetoscopic laser photocoagulation on recipient cardiac function in twin-twin transfusion syndrome. Am J Obstet Gynecol. 199(4):412, 2008
- Habli M et al: The outcome of twin-twin transfusion syndrome complicated with placental insufficiency. Am J Obstet Gynecol. 199(4):424, 2008
- Murakoshi T et al: Validation of Quintero stage III sub-classification for twin-twin transfusion syndrome based on visibility of donor bladder: characteristic differences in pathophysiology and prognosis. Ultrasound Obstet Gynecol. 32(6):813-8, 2008
- Roberts D et al: Interventions for twin-twin transfusion syndrome: a Cochrane review. Ultrasound Obstet Gynecol. 31(6):701-11, 2008
- Rossi AC et al: Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature. Am J Obstet Gynecol. 198(2):147-52, 2008
- Russell Z et al: What is the definition of pulsatile umbilical venous flow in twin-twin transfusion syndrome? Am J Obstet Gynecol. 199(6):634, 2008
- Shah AD et al: Initial fetal cardiovascular profile score predicts recipient twin outcome in twin-twin transfusion syndrome. J Am Soc Echocardiogr. 21(10):1105-8, 2008
- Crombleholme TM et al: A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome. Am J Obstet Gynecol. 197(4):396, 2007
- Kagan KO et al: Discordance in nuchal translucency thickness in the prediction of severe twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol. 29(5):527-32, 2007
- Kline-Fath BM et al: Twin-twin transfusion syndrome: cerebral ischemia is not the only fetal MR imaging finding. Pediatr Radiol. 37(1):47-56, 2007
- Kontopoulos EV et al: Percent absent end-diastolic velocity in the umbilical artery waveform as a predictor of intrauterine fetal demise of the donor twin after selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 30(1):35-9, 2007
- Lopriore E et al: Neurodevelopmental outcome after laser therapy for twin-twin transfusion syndrome. Am J Obstet Gynecol. 196(1):e20; author reply e20-1, 2007
- Michelfelder E et al: Early manifestations and spectrum of recipient twin cardiomyopathy in twin-twin transfusion syndrome: relation to Quintero stage. Ultrasound Obstet Gynecol. 30(7):965-71, 2007
- Norton ME: Evaluation and management of twin-twin transfusion syndrome: still a challenge. Am J Obstet Gynecol. 196(5):419-20, 2007
- Quintero RA et al: Sequential selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. J Matern Fetal Neonatal Med. 20(10):763-8, 2007
- Rychik J et al: The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol. 197(4):392, 2007
- Graef C et al: Long-term neurodevelopmental outcome of 167 children after intrauterine laser treatment for severe twin-twin transfusion syndrome. Am J Obstet Gynecol. 194(2):303-8, 2006
- Huber A et al: Stage-related outcome in twin-twin transfusion syndrome treated by fetoscopic laser coagulation. Obstet Gynecol. 108(2):333-7, 2006
- Moise KJ Jr: Neurodevelopmental outcome after laser therapy for twin-twin transfusion syndrome. Am J Obstet Gynecol. 194(5):1208-10, 2006
- Ozcan T et al: Use of middle cerebral artery peak systolic velocity and intrauterine transfusion for management of twin-twin transfusion and single fetal intrauterine demise. J Matern Fetal Neonatal Med. 19(12):807-9, 2006
- Beck M et al: Long-term outcome of kidney function after twin-twin transfusion syndrome treated by intrauterine laser coagulation. Pediatr Nephrol. 20(11):1657-9, 2005
- Cromi A et al: Sonographic umbilical cord morphometry and coiling patterns in twin-twin transfusion syndrome. Prenat Diagn. 25(9):851-5, 2005
- Matias A et al: Search for hemodynamic compromise at 11-14 weeks in monochorionic twin pregnancy: is abnormal flow in the ductus venosus predictive of twin-twin transfusion syndrome? J Matern Fetal Neonatal Med. 18(2):79-86, 2005
- Moise KJ Jr et al: A randomized trial of amnioreduction versus septostomy in the treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2005 Sep;193(3 Pt 1):701-7. Erratum in: Am J Obstet Gynecol. 193(6):2183, 2005
- Senat MV et al: Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 351(2):136-44, 2004
- Lougheed J et al: Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome. J Am Coll Cardiol. 38(5):1533-8, 2001
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References
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Tables
KEY FACTS
Terminology
Imaging
Pathology
Clinical Issues
TERMINOLOGY
Abbreviations
- Twin-twin transfusion syndrome (TTTS)
Synonyms
- Twin oligohydramnios polyhydramnios sequence (TOPS)
Definitions
- Monochorionic twin complication caused by intrauterine transfusion of blood from donor twin (D) to recipient twin (R) via arteriovenous (AV) placental anastomoses
- Staging based on fluid volume, bladder size, Doppler findings, presence of hydrops
IMAGING
Diagnostic Criteria
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
Selected References
- Behrendt N et al: Twin-twin transfusion and laser therapy. Curr Opin Obstet Gynecol. 28(2):79-85, 2016
- 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
- Duryea EL et al: The natural history of twin-twin transfusion syndrome stratified by Quintero stage. J Matern Fetal Neonatal Med. 1-5, 2016
- Van Winden KR et al: Decreased Total Placental Mass Found in Twin-Twin Transfusion Syndrome Gestations with Selective Growth Restriction. Fetal Diagn Ther. ePub, 2016
- Ashwal E et al: Twin Anemia-Polycythemia Sequence: Perinatal Management and Outcome. Fetal Diagn Ther. ePub, 2015
- Ben-Ami I et al: Monochorionic diamniotic in vitro fertilization twins have a decreased incidence of twin-to-twin transfusion syndrome. Fertil Steril. ePub, 2015
- Boyle M et al: Postnatal MRI Brain in Infants Treated for Twin-Twin Transfusion Syndrome. Ir Med J. 108(8):240-3, 2015
- 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
- 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
- Persico N et al: Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome. Am J Obstet Gynecol. ePub, 2015
- Benoit RM et al: Twin-to-twin transfusion syndrome: prenatal diagnosis and treatment. Am J Perinatol. 31(7):583-94, 2014
- Diehl W et al: Twin-twin transfusion syndrome: treatment and outcome. Best Pract Res Clin Obstet Gynaecol. 28(2):227-38, 2014
- Moon-Grady AJ: Fetal echocardiography in twin-twin transfusion syndrome. Am J Perinatol. 31 Suppl 1:S31-8, 2014
- Roberts D et al: Interventions for the treatment of twin-twin transfusion syndrome. Cochrane Database Syst Rev. 1:CD002073, 2014
- Oostveen MP et al: Congenital anomalies presenting in utero as TTTS: a case series report and review of literature. J Obstet Gynaecol. 33(8):901-3, 2013
- Gray PH et al: Cardiac outcomes of hydrops as a result of twin-twin transfusion syndrome treated with laser surgery. J Paediatr Child Health. 45(1-2):48-52, 2009
- Habli M et al: Twin-to-twin transfusion syndrome: a comprehensive update. Clin Perinatol. 36(2):391-416, x, 2009
- Kontopoulos EV et al: Assessment of the peak systolic velocity of the middle cerebral artery in twin-twin transfusion syndrome. Part I: preoperative assessment. Am J Obstet Gynecol. 200(1):61, 2009
- Lopriore E et al: Risk factors for neurodevelopment impairment in twin-twin transfusion syndrome treated with fetoscopic laser surgery. Obstet Gynecol. 113(2 Pt 1):361-6, 2009
- Rossi AC et al: Comparison of donor and recipient outcomes following laser therapy performed for twin-twin transfusion syndrome: a meta-analysis and review of literature. Am J Perinatol. 26(1):27-32, 2009
- Rossi AC et al: Twin-twin transfusion syndrome. Minerva Ginecol. 61(2):153-65, 2009
- Chmait RH et al: Fetal growth after laser therapy for twin-twin transfusion syndrome. Am J Obstet Gynecol. 199(1):47, 2008
- Gungor S et al: Umbilical venous volume flow in twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 32(6):800-6, 2008
- Habli M et al: Acute effects of selective fetoscopic laser photocoagulation on recipient cardiac function in twin-twin transfusion syndrome. Am J Obstet Gynecol. 199(4):412, 2008
- Habli M et al: The outcome of twin-twin transfusion syndrome complicated with placental insufficiency. Am J Obstet Gynecol. 199(4):424, 2008
- Murakoshi T et al: Validation of Quintero stage III sub-classification for twin-twin transfusion syndrome based on visibility of donor bladder: characteristic differences in pathophysiology and prognosis. Ultrasound Obstet Gynecol. 32(6):813-8, 2008
- Roberts D et al: Interventions for twin-twin transfusion syndrome: a Cochrane review. Ultrasound Obstet Gynecol. 31(6):701-11, 2008
- Rossi AC et al: Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature. Am J Obstet Gynecol. 198(2):147-52, 2008
- Russell Z et al: What is the definition of pulsatile umbilical venous flow in twin-twin transfusion syndrome? Am J Obstet Gynecol. 199(6):634, 2008
- Shah AD et al: Initial fetal cardiovascular profile score predicts recipient twin outcome in twin-twin transfusion syndrome. J Am Soc Echocardiogr. 21(10):1105-8, 2008
- Crombleholme TM et al: A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome. Am J Obstet Gynecol. 197(4):396, 2007
- Kagan KO et al: Discordance in nuchal translucency thickness in the prediction of severe twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol. 29(5):527-32, 2007
- Kline-Fath BM et al: Twin-twin transfusion syndrome: cerebral ischemia is not the only fetal MR imaging finding. Pediatr Radiol. 37(1):47-56, 2007
- Kontopoulos EV et al: Percent absent end-diastolic velocity in the umbilical artery waveform as a predictor of intrauterine fetal demise of the donor twin after selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 30(1):35-9, 2007
- Lopriore E et al: Neurodevelopmental outcome after laser therapy for twin-twin transfusion syndrome. Am J Obstet Gynecol. 196(1):e20; author reply e20-1, 2007
- Michelfelder E et al: Early manifestations and spectrum of recipient twin cardiomyopathy in twin-twin transfusion syndrome: relation to Quintero stage. Ultrasound Obstet Gynecol. 30(7):965-71, 2007
- Norton ME: Evaluation and management of twin-twin transfusion syndrome: still a challenge. Am J Obstet Gynecol. 196(5):419-20, 2007
- Quintero RA et al: Sequential selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. J Matern Fetal Neonatal Med. 20(10):763-8, 2007
- Rychik J et al: The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol. 197(4):392, 2007
- Graef C et al: Long-term neurodevelopmental outcome of 167 children after intrauterine laser treatment for severe twin-twin transfusion syndrome. Am J Obstet Gynecol. 194(2):303-8, 2006
- Huber A et al: Stage-related outcome in twin-twin transfusion syndrome treated by fetoscopic laser coagulation. Obstet Gynecol. 108(2):333-7, 2006
- Moise KJ Jr: Neurodevelopmental outcome after laser therapy for twin-twin transfusion syndrome. Am J Obstet Gynecol. 194(5):1208-10, 2006
- Ozcan T et al: Use of middle cerebral artery peak systolic velocity and intrauterine transfusion for management of twin-twin transfusion and single fetal intrauterine demise. J Matern Fetal Neonatal Med. 19(12):807-9, 2006
- Beck M et al: Long-term outcome of kidney function after twin-twin transfusion syndrome treated by intrauterine laser coagulation. Pediatr Nephrol. 20(11):1657-9, 2005
- Cromi A et al: Sonographic umbilical cord morphometry and coiling patterns in twin-twin transfusion syndrome. Prenat Diagn. 25(9):851-5, 2005
- Matias A et al: Search for hemodynamic compromise at 11-14 weeks in monochorionic twin pregnancy: is abnormal flow in the ductus venosus predictive of twin-twin transfusion syndrome? J Matern Fetal Neonatal Med. 18(2):79-86, 2005
- Moise KJ Jr et al: A randomized trial of amnioreduction versus septostomy in the treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2005 Sep;193(3 Pt 1):701-7. Erratum in: Am J Obstet Gynecol. 193(6):2183, 2005
- Senat MV et al: Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 351(2):136-44, 2004
- Lougheed J et al: Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome. J Am Coll Cardiol. 38(5):1533-8, 2001
