Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug 30;22(4):286-294.
doi: 10.1002/ajum.12176. eCollection 2019 Nov.

Early-onset twin-twin transfusion syndrome: Case series and systematic review

Bronacha Mylrea-Foley  1 , Caroline J Shaw  2 , Nirupama Harikumar  2 , Sophie Legg  2 , Shireen Meher  3 , Christoph C Lees  2   4
Affiliations

Early-onset twin-twin transfusion syndrome: Case series and systematic review

Bronacha Mylrea-Foley et al. Australas J Ultrasound Med. .

Abstract

Introduction: Data on the outcomes of early-onset twin-twin transfusion syndrome (TTTS), diagnosed before 18 weeks gestational age (GA), are sparse. We aimed to review the diagnosis, management and outcomes of early-onset TTTS.

Material and methods: Pregnancy records at a single referral unit 2010-6 were reviewed. In early-onset TTTS cases, data for pregnancy characteristics, interventions and outcomes were collected. PubMed and Scopus databases were searched for studies including pregnant women with early-onset TTTS. The primary outcome measure was livebirths.

Results: Case series: 58 cases of early-onset TTTS 2010-6, with full outcome data in 44. Diagnostic criteria were variable. Median GA at intervention was 17+4 (range 15+0-28+1); 67% of patients had laser therapy (39/58). Overall survival: 60% (53/88). At least one livebirth: 86% (38/44), Two livebirths: 34% (15/44); No survivors: 14% (6/44). GA at delivery was 32+1.5 (range 16+2-37+4). Systematic review: 16 studies included (n = 171 pregnancies). Diagnostic criteria varied widely: 79% of studies used Quintero staging. Most offered laser (89%) at median 17+0 weeks (range 16+0-21+6). GA at delivery was 23+0-39+5 weeks. Overall survival: 69% (129/186). At least one livebirth: 74% (127/171). Two livebirths: 59% (55/93). No survivors: 26% (44/171).

Conclusions: In comparison with the commonly accepted overall survival for TTTS treated after 18 weeks of 60-90%, outcomes in early-onset TTTS were at the lower bound of this range. Gestational age at intervention is similar to that of later onset TTTS, indicating a lack of therapeutic options when a diagnosis is made before 18 weeks.

Keywords: diagnostic imaging criteria; fetal therapies; multiple pregnancy; pregnancy outcome; twin–twin transfusion syndrome.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests, financial or otherwise.

Figures

Figure 1
Figure 1
Studies Included in Systematic Review. Schema Detailing the Identification and Inclusion Process for Studies in the Review.
Figure 2
Figure 2
Comparison of Survival in Early‐Onset TTTS. The Graph Shows the Proportions of Overall Survival, Double Twin Survival, Survival of at Least One Twin, and No Twin Survival Following a Diagnosis of Early‐Onset TTTS Compared Between Our Case Series and The Data Derived from the Systematic Review. Proportions were Compared Using a Chi‐Squared Test and * Denotes P < 0.05.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Simpson LL. Twin‐twin transfusion syndrome. Am J Obstet Gynecol 2013; 208(1): 3–18. - PubMed
    1. Lewi L, Gucciardo L, Van Mieghem T, de Koninck P, Beck V, Medek H, et al. Monochorionic diamniotic twin pregnancies: natural history and risk stratification. Fetal Diagn Ther 2010; 27(3): 121–33. - PubMed
    1. Acosta‐Rojas R, Becker J, Munoz‐Abellana B, Ruiz C, Carreras E, Gratacos E. Twin chorionicity and the risk of adverse perinatal outcome. Int J Gynaecol Obstet 2007; 96(2): 98–102. - PubMed
    1. Baud D, Windrim R, Keunen J, Kelly EN, Shah P, van Mieghem T, et al. Fetoscopic laser therapy for twin‐twin transfusion syndrome before 17 and after 26 weeks' gestation. Am J Obstet Gynecol 2013; 208(3): 197.e1‐7. - PubMed
    1. Lecointre L, Sananes N, Weingertner AS, Kohler M, Guerra F, Fritz G, et al. Fetoscopic laser coagulation for twin‐twin transfusion syndrome before 17 weeks' gestation: laser data, complications and neonatal outcome. Ultrasound Obstet Gynecol 2014; 44(3): 299–303. - PubMed

LinkOut - more resources