[Pathophysiology and therapeutic possibilities in twin-to-twin transfusion syndrome]

Abstract

Introduction: Twin-to-twin transfusion syndrome is a threatening consequence of monochorionicity. Without therapeutic intervention it has approximately a 100% mortality rate, but due to therapeutic efforts it improved dramatically to about 20-50% mortality. It is caused by arteriovenosus anastomoses within the placenta, that causes hormonal changes, polyhydramnios, hypertension of the recipient and weight discordance.

Aims: Detection of ultrasonographic and pathologic consequences of twin-to-twin transfusion syndrome.

Patients and methods: Ultrasonographic and pathologic findings of six twin pairs were analysed with the common feature of twin-to-twin transfusion syndrome.

Results: Ultrasonographic and pathologic results were suggestive for fetal hypertension in all recipients and pulmonary stenosis in four of them.

Conclusion: The prognosis of twin-to-twin transfusion syndrome can be improved significantly with serial amnioreduction, amniotic fenestration, laser ablation of connecting vessels or selective fetocidium. Proper therapy prevents the development of the serious clinical and pathological consequences of twin-to-twin transfusion syndrome.