Perinatal and Long Term Outcome of Monochorionic Twins Complicated by Twin-Twin Transfusion Syndrome

Authors

  • D. Casati Fetal Therapy Unit "U.Nicolini", Department of Obstetrics and Gynecology, Buzzi Children's Hospital, University of Milan, Milan, Italy
  • A. Laoreti Fetal Therapy Unit "U.Nicolini", Department of Obstetrics and Gynecology, Buzzi Children's Hospital, University of Milan, Milan, Italy
  • S. Faiola Fetal Therapy Unit "U.Nicolini", Department of Obstetrics and Gynecology, Buzzi Children's Hospital, University of Milan, Milan, Italy
  • M. Lanna Fetal Therapy Unit "U.Nicolini", Department of Obstetrics and Gynecology, Buzzi Children's Hospital, University of Milan, Milan, Italy

DOI:

https://doi.org/10.12974/2311-8687.2021.09.3

Keywords:

Fetal therapy, High risk pregnancy, Neurodevelopmental impairment, Perinatal morbidity and mortality, Prematurity, Recipient twin cardiomyopathy, Twin pregnancy.

Abstract

Twin-twin transfusion syndrome (TTTS) is the most harmful complication of monochorionic twin pregnancies. Fetoscopic laser coagulation of placental vascular anastomoses represents the causative and first-line treatment for the disease. Substantial improvements in survival rates and long-term outcome have been achieved during the last 20 years of practice. This is due to improvements in antenatal detection of the condition, surgical skills and centralization in the referral fetal therapy unit, as well as postnatal intensive care and follow up programs. Major morbidity issues concern cardiologic, renal and cerebral functions and are mainly caused by intrauterine haemodynamic imbalances and prematurity. This review summarizes the current evidence on the prognosis of monochorionic twins survivors after TTTS treated by laser surgery, focusing on perinatal and long-term outcomes. 

References

Dubè J, Doddis L, Armson A. Does chorionicity or zygosity predict adverse perinatal outcome in twins? Am J Obstet and Gynecol 2002; 186: 579-83 https://doi.org/10.1067/mob.2002.121721 DOI: https://doi.org/10.1067/mob.2002.121721

Kristiansen MK, Joensen BS, Ekelund CK, Petersen OB, Sandager P, Danish Fetal Medicine Study Group Perinatal outcome after first-trimester risk assessment in monochorionic and dichorionic twin pregnancies: a population-based register study. BJOG. 2015; 122(10): 1362- 9. Epub 2015 Feb 25 https://doi.org/10.1111/1471-0528.13326 DOI: https://doi.org/10.1111/1471-0528.13326

Lewi L, Jani J, Blickstein I, Huber A, Gucciardo L, Van Mieghem T et al. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study Am J Obstet Gynecol, 2008; 199: 514e1-514e8. https://doi.org/10.1016/j.ajog.2008.03.050 DOI: https://doi.org/10.1016/j.ajog.2008.03.050

Lewi L, Deprest J, Hecher K. The vascular anastomoses in monochorionic twin pregnancies and their clinical consequences. AJOG Expert Reviews 2013b. https://doi.org/10.1016/j.ajog.2012.09.025 DOI: https://doi.org/10.1016/j.ajog.2012.09.025

Lanna MM, Consonni D, Faiola S, Schena V, Ratti M, Ferrazzi E et al. Color-dye injection of monochorionic placentas and correlation with pregnancy complications. Placenta. 2015; 36(10): 1095-9. Epub 2015 Jul 30. PMID: 26278056 https://doi.org/10.1016/j.placenta.2015.07.129 DOI: https://doi.org/10.1016/j.placenta.2015.07.129

Galea P, Barigye O, Wee L, Jain V, Sullivan M, Fisk NM. The placenta contributes to activation of the renin angiotensin system in twin-twin transfusion syndrome. Placenta. 2008; 29(8): 734-42. Epub 2008 Jun 16. PMID: 18558429. https://doi.org/10.1016/j.placenta.2008.04.010 DOI: https://doi.org/10.1016/j.placenta.2008.04.010

Lopriore E, Nagel HT, Vandenbussche FP, Walther FJ. Longterm neurodevelopmental outcome in twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2003; 189(5): 1314-9. PMID: 14634561. https://doi.org/10.1067/S0002-9378(03)00760-9 DOI: https://doi.org/10.1067/S0002-9378(03)00760-9

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. PMID: 10645517. https://doi.org/10.1038/sj.jp.7200292 DOI: https://doi.org/10.1038/sj.jp.7200292

Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 2016; 47: 247-263 https://doi.org/10.1002/uog.15821 DOI: https://doi.org/10.1002/uog.15821

Fichera A, Lanna M, Fratelli N, Rustico M, Frusca T. Twin-totwin transfusion syndrome presenting at early stages: is there still a possible role for amnioreduction? Prenat Diagn. 2010; 30(2): 144-8. https://doi.org/10.1002/pd.2430 DOI: https://doi.org/10.1002/pd.2430

De Lia JE, Cruikshank DP, Keye WR Jr. Fetoscopic neodymium: YAG laser occlusion of placental vessels in severe twin-twin transfusion syndrome. Obstet Gynecol. 1990 Jun; 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): 136-44. PMID: 15238624. https://doi.org/10.1056/NEJMoa032597 DOI: https://doi.org/10.1056/NEJMoa032597

Lenclen R, Ciarlo G, Paupe A, Bussieres L, Ville Y. Neurodevelopmental outcome at 2 years in children born preterm treated by amnioreduction or fetoscopic laser surgery for twin-to-twin transfusion syndrome: comparison with dichorionic twins. Am J Obstet Gynecol. 2009; 201(3): 291.e1-5. PMID: 19608152. https://doi.org/10.1016/j.ajog.2009.05.036 DOI: https://doi.org/10.1016/j.ajog.2009.05.036

Lewi L, Jani J, Cannie M, Robyr R, Ville Y, Hecher K et al. Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome: is there more than meets the eye? Am J Obstet Gynecol. 2006; 194(3): 790-5. PMID: 16522414. https://doi.org/10.1016/j.ajog.2005.08.062 DOI: https://doi.org/10.1016/j.ajog.2005.08.062

Slaghekke F, Lopriore E, Lewi L, Middeldorp JM, van Zwet EW, Weingertner AS et al. Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-totwin transfusion syndrome: an open-label randomised controlled trial. Lancet. 2014; 383(9935): 2144-51. PMID: 24613024. https://doi.org/10.1016/S0140-6736(13)62419-8 DOI: https://doi.org/10.1016/S0140-6736(13)62419-8

Lanna MM, Faiola S, Consonni D, Rustico MA. Increased risk of placental abruption after Solomon laser treatment of twintwin transfusion syndrome. Placenta. 2017; 53: 54-56. PMID: 28487021. https://doi.org/10.1016/j.placenta.2017.03.018 DOI: https://doi.org/10.1016/j.placenta.2017.03.018

Stirnemann J, Djaafri F, Kim A, Mediouni I, Bussieres L, Spaggiari E et al. Preterm premature rupture of membranes is a collateral effect of improvement in perinatal outcomes following fetoscopic coagulation of chorionic vessels for twintwin transfusion syndrome: a retrospective observational study of 1092 cases. BJOG. 2018; 125(9): 1154-1162. PMID: 29380497. https://doi.org/10.1111/1471-0528.15147 DOI: https://doi.org/10.1111/1471-0528.15147

Stirnemann J, Slaghekke F, Khalek N, Winer N, Johnson A, Lewi L et al., Intrauterine fetoscopic laser surgery versus expectant management in stage 1 twin-to-twin transfusion syndrome: an international randomized trial. Am J Obstet Gynecol. 2020: S0002-9378(20): 31330-2. PMID: 33248135.

Akkermans J, Peeters SH, Klumper FJ, Lopriore E, Middeldorp JM, Oepkes D. Twenty-Five Years of Fetoscopic Laser Coagulation in Twin-Twin Transfusion Syndrome: A Systematic Review. Fetal Diagn Ther. 2015; 38(4): 241-53. PMID: 26278319. https://doi.org/10.1159/000437053 DOI: https://doi.org/10.1159/000437053

Rustico MA, Lanna MM, Faiola S, Schena V, Dell'avanzo M, Mantegazza V et al., Fetal and maternal complications after selective fetoscopic laser surgery for twin-to-twin transfusion syndrome: a single-center experience. Fetal Diagn Ther. 2012; 31(3): 170-8. PMID: 22456330. https://doi.org/10.1159/000336227 DOI: https://doi.org/10.1159/000336227

Spruijt MS, Lopriore E, J Steggerda S, Slaghekke F, Van Klink JMM. Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond. Expert Rev Hematol. 2020; 13(3): 259- 267. https://doi.org/10.1080/17474086.2020.1720643 DOI: https://doi.org/10.1080/17474086.2020.1720643

Diehl W, Diemert A, Grasso D, Sehner S, Wegscheider K, Hecher K. Fetoscopic laser coagulation in 1020 pregnancies with twin-twin transfusion syndrome demonstrates improvement in double-twin survival rate. Ultrasound Obstet Gynecol. 2017; 50(6): 728-735. PMID: 28477345. https://doi.org/10.1002/uog.17520 DOI: https://doi.org/10.1002/uog.17520

Lopriore E, Oepkes D, Walther FJ. Neonatal morbidity in twin-twin transfusion syndrome. Early Hum Dev. 2011; 87(9): 595-599. PubMed PMID: 21784588. https://doi.org/10.1016/j.earlhumdev.2011.07.006 DOI: https://doi.org/10.1016/j.earlhumdev.2011.07.006

Hecher K, Gardiner HM, Diemert A, Bartmann P. Long-term outcomes for monochorionic twins after laser therapy in twinto- twin transfusion syndrome. Lancet Child Adolesc Health. 2018; 2(7): 525-535. PMID: 30169324. https://doi.org/10.1016/S2352-4642(18)30127-5 DOI: https://doi.org/10.1016/S2352-4642(18)30127-5

Gijtenbeek M, Shirzada MR, Ten Harkel ADJ, Oepkes D, Haak M. Congenital heart defects in monochorionic twins: A systematic review and meta-analysis. J. Clin. Med. 2019; 8: 902. https://doi.org/10.3390/jcm8060902 DOI: https://doi.org/10.3390/jcm8060902

Manning N, Archer N. Cardiac Manifestations of Twin-to-Twin Transfusion Syndrome. Twin Res Hum Genet. 2016; 19(3): 246-54. PMID: 27087122. https://doi.org/10.1017/thg.2016.20 DOI: https://doi.org/10.1017/thg.2016.20

Rustico MA, Lanna M, Faiola S, Casati D, Spaccini L, Righini A et al. Major Discordant Structural Anomalies in Monochorionic Twins: Spectrum and Outcomes. Twin Res Hum Genet. 2018; 21(6): 546-555. https://doi.org/10.1017/thg.2018.58 DOI: https://doi.org/10.1017/thg.2018.58

Eschbach SJ, Ten Harkel ADJ, Middeldorp JM, Klumper FJCM, Oepkes D, Lopriore E et al. Acquired right ventricular outflow tract obstruction in twin-to-twin transfusion syndrome; a prospective longitudinal study. Prenat Diagn. 2018; 38(13): 1013-1019. PMID: 30365169. https://doi.org/10.1002/pd.5378 DOI: https://doi.org/10.1002/pd.5378

van den Boom J, Battin M, Hornung T. Twin-twin transfusion syndrome, coarctation of the aorta and hypoplastic aortic arch: A case series report. J. Paediatr. Child Health 2010; 46: 76-79. https://doi.org/10.1111/j.1440-1754.2009.01641.x DOI: https://doi.org/10.1111/j.1440-1754.2009.01641.x

Chiang MC, Lien R, Chao AS, Chou YH, En Chen YJ. Clinical consequences of twin-to-twin transfusion. Eur J Pediatr. 2003; 162(2): 68-71. PMID: 12548380. https://doi.org/10.1007/s00431-002-1107-5 DOI: https://doi.org/10.1007/s00431-002-1107-5

Christensen AM, Daouk GH, Norling LL, Catlin EA, Ingelfinger JR. Postnatal transient renal insufficiency in the feto-fetal transfusion syndrome. Pediatr Nephrol. 1999; 13(2): 117-20. PMID: 10228996. https://doi.org/10.1007/s004670050575 DOI: https://doi.org/10.1007/s004670050575

Verbeek L, Joemmanbaks FA, Quak JME, Sukhai RN, Middeldorp JM, Oepkes D et al. Renal function in neonates with twin-twin transfusion syndrome treated with or without fetoscopic laser surgery. Eur J Pediatr. 2017; 176(9): 1209- 1215. PMID: 28730318; PMCID: PMC5563331. https://doi.org/10.1007/s00431-017-2964-2 DOI: https://doi.org/10.1007/s00431-017-2964-2

Sutton D, Miller R. Neurologic Outcomes After Prenatal Treatment of Twin-Twin Transfusion Syndrome. Clin Perinatol. 2020; 47(4): 719-731. PMID: 33153657. https://doi.org/10.1016/j.clp.2020.08.002 DOI: https://doi.org/10.1016/j.clp.2020.08.002

Lanna MM, Consonni D, Faiola S, Izzo G, Scelsa B, Cetin I et al. Incidence of Cerebral Injury in Monochorionic Twin Survivors after Spontaneous Single Demise: Long-Term Outcome of a Large Cohort. Fetal Diagn Ther. 2020; 47(1): 66-73. https://doi.org/10.1159/000500774 DOI: https://doi.org/10.1159/000500774

van Klink JM, Koopman HM, van Zwet EW, Oepkes D, Walther FJ, Lopriore E. Cerebral injury and neurodevelopmental impairment after amnioreduction versus laser surgery in twin-twin transfusion syndrome: a systematic review and meta-analysis. Fetal Diagn Ther. 2013; 33(2): 81- 9. PMID: 22922370. https://doi.org/10.1159/000341814 DOI: https://doi.org/10.1159/000341814

Spruijt M, Steggerda S, Rath M, van Zwet E, Oepkes D, Walther F et al. Cerebral injury in twin-twin transfusion syndrome treated with fetoscopic laser surgery. Obstet Gynecol. 2012; 120(1): 15-20. PMID: 22914388. https://doi.org/10.1097/AOG.0b013e31825b9841 DOI: https://doi.org/10.1097/AOG.0b013e31825b9841

Conte G, Righini A, Griffiths PD, Rustico M, Lanna M, Mackie FL et al. Brain-injured Survivors of Monochorionic Twin pregnancies Complicated by Single Intrauterine Death: MR Findings in a Multicenter Study. Radiology. 2018; 288(2): 582-590. https://doi.org/10.1148/radiol.2018171267 DOI: https://doi.org/10.1148/radiol.2018171267

Stirnemann J, Chalouhi G, Essaoui M, Bahi-Buisson N, Sonigo P, Millischer AE, et al. Fetal brain imaging following laser surgery in twin-to-twin surgery. BJOG 2016; 125: 1186e91. https://doi.org/10.1111/1471-0528.14162 DOI: https://doi.org/10.1111/1471-0528.14162

van Klink JM, Slaghekke F, Balestriero MA, Scelsa B, Introvini P, Rustico M, et al. Neurodevelopmental outcome at 2 years in twin-twin transfusion syndrome survivors randomized for the Solomon trial. Am J Obstet Gynecol. 2016; 214(1): 113, 7. https://doi.org/10.1016/j.ajog.2015.08.033 DOI: https://doi.org/10.1016/j.ajog.2015.08.033

Rüegg L, Hüsler M, Krähenmann F, Zimmermann R, Natalucci G, Ochsenbein-Kölble N. Long-Term Outcome of Monochorionic Twins after Fetoscopic Laser Therapy Compared to Matched Dichorionic Twins. Fetal Diagn Ther. 2020; 2: 1-8. PMID: 32877900. https://doi.org/10.1055/s-0040-1717965 DOI: https://doi.org/10.1055/s-0040-1717965

Spruijt MS, Lopriore E, Tan RNG, Slaghekke F, Klumper FJC, Middeldorp JM et al. Long-term neurodevelopmental outcome in twin-to-twin transfusion syndrome: Is there still room for improvement? J Clin Med. 2019; 8(8): 1226. PMID: 31443258; PMCID: PMC6723379. https://doi.org/10.3390/jcm8081226 DOI: https://doi.org/10.3390/jcm8081226

Lopriore E, Ortibus E, Acosta-Rojas R, Le Cessie S, Middeldorp JM, Oepkes D et al. Risk factors for neurodevelopment impairment in twin-twin transfusion syndrome treated with fetoscopic laser surgery. Obstet Gynecol. 2009; 113(2 Pt 1): 361-6. PMID: 19155907. https://doi.org/10.1097/AOG.0b013e318195873e DOI: https://doi.org/10.1097/AOG.0b013e318195873e

Rossi AC, D'Addario V. 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 2009; 26(1): 27-32. https://doi.org/10.1055/s-0028-1091397 DOI: https://doi.org/10.1055/s-0029-1224869

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2021-06-02

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Casati, D., Laoreti, A., Faiola, S., & Lanna, M. (2021). Perinatal and Long Term Outcome of Monochorionic Twins Complicated by Twin-Twin Transfusion Syndrome. International Journal of Pediatrics and Child Health, 9, 23–30. https://doi.org/10.12974/2311-8687.2021.09.3

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