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
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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