2,558 results match your criteria Twin-to-Twin Transfusion Syndrome


Management of monochorionic twins discordant for structural fetal anomalies.

Prenat Diagn 2020 May 12. Epub 2020 May 12.

Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France.

Objective: To review the perinatal management and outcomes of monochorionic twin pregnancies (MC) discordant for congenital anomalies (DCA).

Methods: Retrospective study of all MC DCA cases referred to our tertiary referral center from 1997 to 2018. We excluded cases complicated with twin-to-twin transfusion syndrome, twin anemia-polycythemia sequence, twin reversed arterial perfusion sequence or selective intra-uterine growth restriction. Read More

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http://dx.doi.org/10.1002/pd.5734DOI Listing

Neurodevelopmental impairment at 3 years of age after fetoscopic laser surgery for twin-to-twin transfusion syndrome.

Prenat Diagn 2020 May 2. Epub 2020 May 2.

Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.

Background: Data on neurodevelopmental outcomes of children surviving after fetoscopic laser surgery (FLS) for twin-to-twin transfusion syndrome (TTTS) are scarce.

Methods: We retrospectively investigated children surviving after FLS for TTTS at 16 to 26 weeks' gestation between 2003 and 2014. Children were evaluated by standardized neurologic examinations using the Kyoto Scale 2001 at a corrected age of 3 years ± 6 months. Read More

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http://dx.doi.org/10.1002/pd.5726DOI Listing

Pregnancy outcomes associated with chorioamnion membrane separation severity following fetoscopic laser surgery for twin-twin transfusion syndrome.

Prenat Diagn 2020 May 2. Epub 2020 May 2.

Department of Obstetrics, Gynecology and Reproductive Sciences, The Fetal Center, Children's Memorial Hermann Hospital, UTHealth, McGovern School of Medicine, University of Texas, Houston, Texas, USA.

Objective: We tested the hypothesis that increasing severity of chorioamnion membrane separation (CAS) after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS) is associated with worse pregnancy outcomes.

Methods: Prospective cohort of patients undergoing FLS for TTTS between 2011 and 2018. CAS was defined as separation of fetal membranes from the uterine wall on post-operative ultrasound. Read More

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http://dx.doi.org/10.1002/pd.5725DOI Listing

Cause of intrauterine and neonatal Death in Twin Pregnancies (CoDiT): development of a novel classification system.

BJOG 2020 May 2. Epub 2020 May 2.

Institute of Metabolism & Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.

Objective: Twin pregnancies have a significantly higher perinatal mortality than singleton pregnancies and current classification systems for perinatal death lack twin-specific categories, potentially leading to loss of important information regarding cause of death. We introduce and test a classification system designed to assign a cause of death in twin pregnancies (CoDiT).

Design: Retrospective cross-sectional study. Read More

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http://dx.doi.org/10.1111/1471-0528.16291DOI Listing

Magnetic resonance imaging of the fetal brain in monochorionic diamniotic twin gestation: correlation of cerebral injury with ultrasound staging and survival outcomes.

Pediatr Radiol 2020 May 2. Epub 2020 May 2.

Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.

Background: The current staging system of twin-twin transfusion syndrome (TTTS) is based on the ultrasound criteria and does not consider the cerebral injury.

Objective: To assess the incidence of cerebral damage on fetal MRI and correlate abnormal cerebral diffusion-weighted imaging (DWI) findings with survival outcome and the ultrasound staging of TTTS.

Materials And Methods: We conducted a retrospective review of MRI/DWI of fetal brains and the electronic medical records in monochorionic diamniotic twin gestations. Read More

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http://dx.doi.org/10.1007/s00247-020-04661-wDOI Listing

Deep learning-based monocular placental pose estimation: towards collaborative robotics in fetoscopy.

Int J Comput Assist Radiol Surg 2020 Apr 30. Epub 2020 Apr 30.

Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.

Purpose: Twin-to-twin transfusion syndrome (TTTS) is a placental defect occurring in monochorionic twin pregnancies. It is associated with high risks of fetal loss and perinatal death. Fetoscopic elective laser ablation (ELA) of placental anastomoses has been established as the most effective therapy for TTTS. Read More

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http://dx.doi.org/10.1007/s11548-020-02166-3DOI Listing

FetNet: a recurrent convolutional network for occlusion identification in fetoscopic videos.

Int J Comput Assist Radiol Surg 2020 Apr 29. Epub 2020 Apr 29.

Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and Department of Computer Science, University College London, London, UK.

Purpose: Fetoscopic laser photocoagulation is a minimally invasive surgery for the treatment of twin-to-twin transfusion syndrome (TTTS). By using a lens/fibre-optic scope, inserted into the amniotic cavity, the abnormal placental vascular anastomoses are identified and ablated to regulate blood flow to both fetuses. Limited field-of-view, occlusions due to fetus presence and low visibility make it difficult to identify all vascular anastomoses. Read More

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http://dx.doi.org/10.1007/s11548-020-02169-0DOI Listing

Combination of "Markers" and the Consequent Importance of Fetal Abdominal Circumference in the First Trimester for Predicting Complications Specific to Monochorionic Twin Pregnancies.

Fetal Diagn Ther 2020 Apr 28:1-7. Epub 2020 Apr 28.

Department of Fetal Medicine, Bangalore Fetal Medicine Centre, Bangalore, India.

Background: Multifetal pregnancies are considered high-risk pregnancies compared to singleton pregnancies. Monochorionic diamniotic (MCDA) twin pregnancies tend to have a more complicated intrauterine course than their dichorionic counterparts. The most common complications are twin-to-twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR), and unexplained intrauterine fetal demise (IUFD). Read More

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http://dx.doi.org/10.1159/000505812DOI Listing

Prevalence, risk factors and outcome of post-procedural amniotic band disruption sequence after fetoscopic laser surgery in twin-twin transfusion syndrome: a large single center case series.

Am J Obstet Gynecol 2020 Apr 23. Epub 2020 Apr 23.

Department of Pediatrics, Division of Neonatology.

Background: Post-procedural amniotic band disruption sequence (PABDS) is a condition following intra-uterine interventions, where fibrous strands constrict limbs or umbilical cord, leading to edema, amputation and fetal demise.

Objective: To evaluate the prevalence, risk factors and outcome of PABDS following fetoscopic laser surgery in twin-twin transfusion syndrome (TTTS).

Methods: All consecutive cases of TTTS treated with fetoscopic laser coagulation of the vascular anastomoses at our center between January 2002 and March 2019 were included in the study. Read More

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http://dx.doi.org/10.1016/j.ajog.2020.04.016DOI Listing

Outcome of twin-twin transfusion syndrome according to the Quintero stage of the disease: A systematic review and meta-analysis.

Ultrasound Obstet Gynecol 2020 Apr 24. Epub 2020 Apr 24.

Fetal Medicine and Cardiology Unit, Department of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University of Foggia, Italy.

Objectives: To report the outcomes of twin-twin transfusion syndrome (TTTS) according to Quintero staging system.

Methods: Medline, Embase and Cinahl databases were searched for studies reporting outcomes of TTTS stratified by Quintero staging (I-V). The primary outcome was the survival rate according to TTTS stage. Read More

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http://dx.doi.org/10.1002/uog.22054DOI Listing
April 2020
3.853 Impact Factor

Deep Q-CapsNet Reinforcement Learning Framework for Intrauterine Cavity Segmentation in TTTS Fetal Surgery Planning.

IEEE Trans Med Imaging 2020 Apr 14. Epub 2020 Apr 14.

Fetoscopic laser photocoagulation is the most effective treatment for Twin-to-Twin Transfusion Syndrome, a condition affecting twin pregnancies in which there is a deregulation of blood circulation through the placenta, that can be fatal to both babies. For the purposes of surgical planning, we design the first automatic approach to detect and segment the intrauterine cavity from axial, sagittal and coronal MRI stacks. Our methodology relies on the ability of capsule networks to successfully capture the part-whole interdependency of objects in the scene, particularly for unique class instances (i. Read More

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http://dx.doi.org/10.1109/TMI.2020.2987981DOI Listing

Cerebral oxygenation reflects fetal development in preterm monochorionic and dichorionic twins.

Early Hum Dev 2020 Apr 13;144:105025. Epub 2020 Apr 13.

Institute for the Care of Mother and Child - Neonatology, Podolské nábřeží 157/36, Prague 14700, Czech Republic; 3rd Faculty of Medicine - Charles University, Ruská 2411/87, Prague 10000, Czech Republic.

Background: Cerebral oxygenation (crSO) monitoring is increasingly used in high-risk infants. Monochorionic twins suffer from specific fetal pathologies that can affect cerebral hemodynamics. Limited data are available on crSO and blood flow patterns in this population after birth. Read More

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http://dx.doi.org/10.1016/j.earlhumdev.2020.105025DOI Listing

Monochorionic diamniotic twins: What do I tell the prospective parents?

Authors:
Liesbeth Lewi

Prenat Diagn 2020 Apr 12. Epub 2020 Apr 12.

Department of Development and Regeneration, KULeuven, Leuven, Belgium.

Monochorionic diamniotic twins occur in about 1 in 300 pregnancies. Compared with dichorionic twins, they face increased risks because of the shared circulation. In about 15%, an imbalance in blood exchange occurs, such as twin-twin transfusion syndrome and twin anemia polycythemia sequence. Read More

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http://dx.doi.org/10.1002/pd.5705DOI Listing

Perioperative fetal hemodynamic changes in twin-twin transfusion syndrome and neurodevelopmental outcome at two years of age.

Prenat Diagn 2020 Apr 8. Epub 2020 Apr 8.

Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.

Objective: To investigate whether perioperative fetal hemodynamic changes in twin-to-twin transfusion syndrome (TTTS) are associated with neurodevelopmental impairment (NDI) at two years.

Methods: Doppler parameters of three sonograms (day before, first day after and 1 week after laser surgery for TTTS) were assessed for correlation with neurodevelopmental outcome at two years (2008-2016). NDI was defined as: cerebral palsy, deafness, blindness, and/or a Bayley-III cognitive/motor developmental test-score > 2SD below the mean. Read More

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http://dx.doi.org/10.1002/pd.5690DOI Listing

Effect of Chorionicity on Umbilical Cord Blood Acid-Base Analysis of the Second Twin.

Twin Res Hum Genet 2020 Apr 6:1-6. Epub 2020 Apr 6.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Southside Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Bay Shore, NY, USA.

Our objective was to determine whether chorionicity affects umbilical cord blood acid-base parameters of the second twin. This was a retrospective cohort of twin pregnancies delivered at ≥23 weeks of gestation at a tertiary hospital from 2010 to 2016. Patients were included if arterial and venous umbilical cord gas results were available for both newborns and chorionicity was confirmed histologically. Read More

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http://dx.doi.org/10.1017/thg.2020.10DOI Listing

Selective intrauterine growth restriction (SIUGR) type II: proposed subclassification to guide surgical management.

J Matern Fetal Neonatal Med 2020 Mar 31:1-8. Epub 2020 Mar 31.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Pasadena, CA, USA.

Optimal surgical management of monochorionic diamniotic twins complicated by selective intrauterine growth restriction (SIUGR) type II is unknown. Surgical management may involve selective laser photocoagulation of communicating vessels (SLPCV), which offers the possibility of dual twin survivors versus umbilical cord occlusion (UCO) of the SIUGR twin. To identify patient characteristics associated with SIUGR twin survival for those undergoing SLPCV. Read More

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http://dx.doi.org/10.1080/14767058.2020.1745177DOI Listing

Short- and long-term outcomes of preterm spontaneous twin anemia-polycythemia sequence.

J Perinat Med 2020 Mar 30. Epub 2020 Mar 30.

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.

Background In monochorionic twin pregnancy, placental anastomosis and inter-twin blood transfusion can result in specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). It is well established that adverse outcomes are increased in TTTS, but reports on the neonatal and long-term outcomes of TAPS are lacking. The objective of this study was to evaluate the neonatal and neurodevelopmental outcomes in spontaneous TAPS. Read More

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http://dx.doi.org/10.1515/jpm-2019-0437DOI Listing

Fetal therapies as standard prenatal care in Japan.

Obstet Gynecol Sci 2020 Mar 18;63(2):108-116. Epub 2020 Feb 18.

Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.

With recent advances in fetal medicine, various attempts have been made to save fetuses facing perinatal death or devastating consequences despite optimal management after birth. The concept of the fetus as a patient has been established through the application of treatments. This paper reviews fetal therapies in order to highlight the role of perinatal medicine as standard prenatal care. Read More

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http://dx.doi.org/10.5468/ogs.2020.63.2.108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073354PMC

The Amniotic Fluid Proteome Differs Significantly between Donor and Recipient Fetuses in Pregnancies Complicated by Twin-to-Twin Transfusion Syndrome.

J Korean Med Sci 2020 Mar 16;35(10):e73. Epub 2020 Mar 16.

Department of Obstetrics & Gynecology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Background: Twin-to-twin transfusion syndrome (TTTS) is a serious complication of monochorionic twin pregnancies. It results from disproportionate blood supply to each fetus caused by abnormal vascular anastomosis within the placenta. Amniotic fluid (AF) is an indicator reflecting the various conditions of the fetus, and an imbalance in AF volume is essential for the antenatal diagnosis of TTTS by ultrasound. Read More

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http://dx.doi.org/10.3346/jkms.2020.35.e73DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073317PMC

Perinatal outcomes of twin pregnancies affected by early twin-twin transfusion syndrome: A systematic review and meta-analysis.

Acta Obstet Gynecol Scand 2020 Mar 11. Epub 2020 Mar 11.

Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK.

Introduction: Twin-to-twin transfusion syndrome (TTTS) is associated with a high risk of perinatal mortality and morbidity if not treated. However, the optimal timing and management in case of early (occurring < 18 weeks) TTTS has not been established yet.

Material And Methods: This is a systematic review and meta-analysis aiming at evaluating the outcomes of monochorionic diamniotic twin pregnancies complicated by early (ie before 18 weeks) TTTS according to different management options (expectant, laser therapy, amnioreduction or cord occlusion). Read More

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http://dx.doi.org/10.1111/aogs.13840DOI Listing

Early postnatal cardiac follow-up of survivors of twin-twin transfusion syndrome treated with fetoscopic laser coagulation.

J Perinatol 2020 Mar 9. Epub 2020 Mar 9.

Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.

Objective: To assess the cardiac function and prevalence of congenital heart defects (CHD) in twin-twin transfusion syndrome (TTTS) survivors.

Study Design: Prospective follow-up of TTTS pregnancies treated with laser surgery (2015-2018). Echocardiography was performed 1 day and 1 month after birth (corrected for prematurity). Read More

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http://dx.doi.org/10.1038/s41372-020-0645-xDOI Listing

Fetal cardiovascular alterations in twin-to-twin transfusion syndrome.

Med Pharm Rep 2020 Jan 31;93(1):5-11. Epub 2020 Jan 31.

1 Department of Obstetrics and Gynecology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

Twin-to-twin transfusion syndrome (TTTS) is the consequence of vascular anastomoses of the shared placenta of monochorionic twin pregnancies. Both circulating inter-twin blood flow and vasoactive mediators imbalance cause hypovolemia in the donor and hypervolemia in the recipient fetus. If left untreated, TTTS has a high perinatal mortality rate and adverse long-term outcomes mainly cardiovascular and neurological. Read More

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http://dx.doi.org/10.15386/mpr-1481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051825PMC
January 2020

Monozygotic twins discordant for low-level mosaic trisomy 17 at amniocentesis in a pregnancy with a favorable outcome and a literature review of heterokaryotypic monozygotic twins at amniocentesis.

Taiwan J Obstet Gynecol 2020 Mar;59(2):306-313

Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; Department of Bioengineering, Tatung University, Taipei, Taiwan.

Objective: We present a set of twins discordant for low-level mosaic trisomy 17 at amniocentesis, and we review the literature of heterokaryotypic monozygotic twins at amniocentesis.

Materials And Methods: We describe a monozygotic twin pregnancy with discordant karyotypes and structural abnormalities. A 22-year-old, primigravid woman underwent amniocentesis at 21 weeks of gestation because of an abnormal maternal serum screening result for Down syndrome. Read More

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http://dx.doi.org/10.1016/j.tjog.2020.01.022DOI Listing

Laser for twin-to-twin transfusion syndrome: a guide for endoscopic surgeons.

Facts Views Vis Obgyn 2019 Sep;11(3):197-205

Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, KULeuven and Clinical Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.

Twin-to-twin-transfusion syndrome (TTTS) is the most important cause of handicap and death in monochorionic twin pregnancies. It is caused by a certain pattern of anastomoses between the two fetal circulations leading to an unbalanced blood and fluid transfer. This leads to severe amniotic fluid discordance and variable degrees of cardiac dysfunction. Read More

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020942PMC
September 2019

Prenatal Sonographic Detection of Monochorionic Twins with Bipartite Placenta.

Fetal Pediatr Pathol 2020 Feb 12:1-6. Epub 2020 Feb 12.

Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey.

Determination of placentation and amnionicity is important for antenatal and intrapartum management in twin gestations. We present an typical monozygotic twin placenta and underscore the sonographic features and diagnostic pitfalls that may interfere with antenatal diagnosis. A 35-year-old G4P2 with a spontaneous pregnancy applied for routine second trimester anomaly screening. Read More

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http://dx.doi.org/10.1080/15513815.2020.1725938DOI Listing
February 2020

Percent Absent End-Diastolic Velocity in the Umbilical Artery and Donor Twin Demise after Laser Surgery for Twin-Twin Transfusion Syndrome.

Fetal Diagn Ther 2020 Feb 5:1-8. Epub 2020 Feb 5.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA,

Introduction: To examine the association of preoperative absent end-diastolic velocity (AEDV) and percent AEDV (%AEDV) in the umbilical artery (UA) with donor twin intrauterine fetal demise (IUFD) after laser surgery for twin-twin transfusion syndrome (TTTS).

Methods: We performed a retrospective study of stage III/IV TTTS patients who underwent laser surgery from 2006 to 2016. Donors were classified as having preoperative persistent AEDV (yes/no). Read More

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http://dx.doi.org/10.1159/000505780DOI Listing
February 2020

Twin Anemia Polycythemia Sequence.

N Engl J Med 2020 Feb;382(6):e9

Unidade Local de Saude do Alto Minho, Viana do Castelo, Portugal

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http://dx.doi.org/10.1056/NEJMicm1905895DOI Listing
February 2020

Fetal cardiac function by three-dimensional ultrasound using 4D-STIC and VOCAL - an update.

J Ultrason 2019 12 31;19(79):287-294. Epub 2019 Dec 31.

Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.

Three- and four-dimensional (3D/4D) ultrasonography with spatio-temporal image correlation (4D-STIC) allows obtaining fetal cardiac volumes and their static and real-time analysis in multiplanar and rendering modes. Cardiac biometrics and Doppler-echocardiographic parameters for evaluation of fetal heart function, including cardiac output and stroke volume, can be analyzed using M-mode, two-dimensional (2D), and 3D/4D cardiac ultrasound. In recent years, functional echocardiography has been used to study fetuses without a structurally cardiac defect but who are at risk of heart failure due to the presence of extra-cardiac conditions, such as, fetal growth restriction, tumors/masses, twin-to-twin transfusion syndrome, fetal anemia (Rh alloimmunization), congenital infections, or maternal diabetes mellitus. Read More

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http://dx.doi.org/10.15557/JoU.2019.0043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988455PMC
December 2019

Placental Anatomy and Function in Twin Gestations.

Obstet Gynecol Clin North Am 2020 Mar;47(1):99-116

Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, Mailstop 8064-37-1005, St. Louis, MO 63110, USA. Electronic address:

With an increasing incidence of twin gestations, understanding the inherent risks associated with these pregnancies is essential in modern obstetrics. The unique differences in placentation in twins contribute to the increased risks. Monochorionic twins are susceptible to complications because of their unique placental architecture, including twin-to-twin transfusion syndrome, the twin anemia-polycythemia sequence, selective intrauterine growth restriction, and the twin reversed arterial perfusion sequence. Read More

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http://dx.doi.org/10.1016/j.ogc.2019.10.010DOI Listing

Novel Use of a Social-Media-Based Survey to Detect Regional Differences in Management of Monochorionic-Diamniotic Twins.

Am J Perinatol 2020 Jan 30. Epub 2020 Jan 30.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California Los Angeles, California.

Objective:  This study aims to evaluate the utility of social media to distribute a patient survey on differences in management and outcomes of monochorionic-diamniotic (MCDA) pregnancies.

Study Design:  A cross-sectional survey was posted to an English-language MCDA twins patient-centered support group within the social media site, Facebook from April 2, 2018 to June 26, 2018. Subjects were recruited through a technique called "snowballing," whereby individuals shared the survey to assist with recruiting. Read More

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http://dx.doi.org/10.1055/s-0039-1701027DOI Listing
January 2020

Effect of monochorionicity on perinatal outcomes and growth discordance in triplet pregnancies: a collaborative multicentre study in England, 2000-2013.

Ultrasound Obstet Gynecol 2020 Jan 29. Epub 2020 Jan 29.

Department of Fetal Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.

Objectives: To compare perinatal outcomes and growth discordance between trichorionic-triamniotic (TCTA) and dichorionic-triamniotic/monochorionic-triamniotic (DCTA/MCTA) triplets.

Methods: This multicentre cohort study used population-based data from 11 Northern Survey of Twin and Multiple Pregnancy (NorSTAMP) and the Southwest Thames Region of London Obstetric Research Collaborative (STORK) multiple pregnancy cohort for 2000-2013. Perinatal outcomes (from ≥ 24 weeks' gestation to the first 28 days of life), inter-triplet fetal growth and birth weight discordance, and neonatal morbidity were analysed in relation to chorionicity. Read More

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http://dx.doi.org/10.1002/uog.21987DOI Listing
January 2020

Risk Factors for Parenting Stress in Parents of Children Treated with Laser Surgery for Twin-Twin Transfusion Syndrome 2 Years Postpartum.

Am J Perinatol 2020 Jan 27. Epub 2020 Jan 27.

Department of Pediatrics, USC University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, Los Angeles, California.

Objective:  Twin-twin transfusion syndrome (TTTS) is a rare but serious condition that can occur in monochorionic and diamniotic twin pregnancies. Research indicates almost half of postpartum mothers with TTTS may have clinically significant levels of stress. However, no studies have measured the levels of parenting stress at 2 years postpartum, and little research has been conducted on sources of stress. Read More

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http://dx.doi.org/10.1055/s-0040-1701194DOI Listing
January 2020

Utility of chromosomal microarray for diagnosis in cases of nonimmune hydrops fetalis.

Prenat Diagn 2020 Mar 11;40(4):492-496. Epub 2020 Feb 11.

Division of Maternal Fetal Medicine, University of California, San Francisco, San Francisco, California, USA.

Purpose: Chromosomal microarray (CMA) is recommended in the diagnostic evaluation of cases with fetal structural anomalies when invasive testing is pursued. However, the utility of CMA for nonimmune hydrops fetalis (NIHF) specifically is not well known. Our objective was to describe the overall yield of CMA in the diagnostic evaluation of NIHF, comparing isolated cases to those with concurrent structural anomalies. Read More

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http://dx.doi.org/10.1002/pd.5617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7153803PMC

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond.

Expert Rev Hematol 2020 Mar 31;13(3):259-267. Epub 2020 Jan 31.

Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.

: Twin-twin transfusion syndrome (TTTS) is a devastating complication of monochorionic twin pregnancy and remains a major challenge for worldwide fetal medicine specialists. In TTTS, intertwin transfusion through vascular anastomoses in the shared placenta leads to severe hemodynamic imbalance. This review summarizes the current knowledge of TTTS. Read More

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http://dx.doi.org/10.1080/17474086.2020.1720643DOI Listing

Prospective Validation of First-Trimester Ultrasound Characteristics as Predictive Tools for Twin-Twin Transfusion Syndrome and Selective Intrauterine Growth Restriction in Monochorionic Diamniotic Twin Pregnancies.

Fetal Diagn Ther 2020 21;47(4):321-327. Epub 2020 Jan 21.

Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, New South Wales, Australia.

Objective: Monochorionic diamniotic (MCDA) twins are at increased risk of adverse outcome due to unequal placental sharing and placental vascular communications between the fetal circulations. Most centres perform ultrasound examination every 2-3 weeks to identify these complications. Identifying a high-risk cohort of MCDA twins in the first trimester would allow more efficient surveillance. Read More

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http://dx.doi.org/10.1159/000504049DOI Listing
January 2020

Additional benefits of three-dimensional ultrasound for prenatal assessment of twins.

J Perinat Med 2020 Feb;48(2):102-114

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

Three-dimensional ultrasound (3DUS) may provide additional information for prenatal assessment of twins. It may improve the diagnostic confidence of dating, nuchal translucency (NT) and chorionicity assignment in twin pregnancies. The "virtual 3DUS placentoscopy" can guide selective fetoscopic laser photocoagulation (SFLP) to treat twin-twin transfusion syndrome (TTTS). Read More

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http://dx.doi.org/10.1515/jpm-2019-0409DOI Listing
February 2020

The outcomes of transient elevation of maternal liver enzymes preceding laser treatment for twin-twin transfusion syndrome.

Biomed J 2019 12 23;42(6):417-421. Epub 2019 Dec 23.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Background: A proportion of twin-twin transfusion syndrome (TTTS) patients may have elevated liver enzymes (ELEzs) before fetoscopic laser therapy, but the incidence of ELEzs before laser therapy and the association with the perinatal outcomes after laser therapy remain unclear.

Methods: From October 2008 to April 2015, 93 patients with TTTS who received fetoscopic laser therapy at our hospital were included in this study, and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were measured within 24 h before therapy. If ELEzs (AST > 34 U/L or ALT > 36 U/L) were observed before therapy, the AST and ALT levels were evaluated within 24 h after therapy. Read More

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http://dx.doi.org/10.1016/j.bj.2019.05.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962711PMC
December 2019

The body's integrated repair kit: Studying mesenchymal stem cells for better ligament repair.

Biomed J 2019 12;42(6):365-370

University of Copenhagen, BRIC Biotech Research & Innovation Centre, Anders Lund Group, Copenhagen, Denmark. Electronic address:

In this issue of the Biomedical Journal, we learn that the sport injury-prone knee ligaments might harbour their own repair kit in the form of mesenchymal stem cells, and that TERT transformation helps to keep these cells longer in culture for more extensive studies. In addition, we get a demonstration that diffusion tensor imaging can reliably show the activity of specific neural circuits, that rheumatoid arthritis patients are more prone to insulin resistance, and that platelet-enriched plasma gels significantly improve wound healing after pilonidal sinus surgery. Furthermore, two procreation-related articles inform us that growth hormone treatment improves endometrial receptivity in older women, and that elevated maternal liver enzymes do not impact on the outcome of laser therapy for twin-twin transfusion syndrome. Read More

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http://dx.doi.org/10.1016/j.bj.2019.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962754PMC
December 2019

Vision Based Robot Assistance in TTTS Fetal Surgery.

Conf Proc IEEE Eng Med Biol Soc 2019 Jul;2019:5855-5861

This paper presents an accurate and robust tracking vision algorithm for Fetoscopic Laser Photo-coagulation (FLP) surgery for Twin-Twin Transfusion Syndrome (TTTS). The aim of the proposed method is to assist surgeons during anastomosis localization, coagulation and review using a tele-operated robotic system. The algorithm computes the relative position of the fetoscope tool tip with respect to the placenta, via local vascular structure registration. Read More

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http://dx.doi.org/10.1109/EMBC.2019.8856402DOI Listing

Is computerized cardiotocography useful in monochorionic twins with selective intrauterine growth restriction?

J Matern Fetal Neonatal Med 2020 Jan 12:1-6. Epub 2020 Jan 12.

Department of Obstetrics and Gynaecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

To assess the value of using computerized cardiotocography (cCTG) short-term variation (STV) for intrapartum monitoring in monochorionic twins (MC) complicated by selective intrauterine growth restriction (sIUGR). All available cCTGs retrieved from computerized medical records of MC with sIUGR were retrospectively studied regarding the behavior of the STV. sIUGR was defined as intertwin estimated fetal weight (EFW) discordance of ≥20% with the abdominal circumference (AC) below the fifth percentile and/or the EFW of the smaller twin below the 10th percentile. Read More

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http://dx.doi.org/10.1080/14767058.2020.1712708DOI Listing
January 2020

Monochorionic twins after in-vitro fertilization: do they have poorer outcomes? A retrospective cohort study.

Ultrasound Obstet Gynecol 2020 Jan 7. Epub 2020 Jan 7.

Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium; Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KULeuven, 3000, Leuven, Belgium.

Objective: To compare the outcome of monochorionic diamniotic (MCDA) twin pregnancies after in vitro fertilisation with or without intracytoplasmic sperm injection (IVF/ICSI) with spontaneously conceived MCDA twins.

Methods: Retrospective cohort study in MCDA twin pregnancies conceived after IVF/ICSI (N=80) or spontaneously (N=574), followed from the first trimester onward between January 2002 and September 2018 at a single centre. The primary outcome was survival per fetus from the first trimester until 28 days after birth. Read More

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http://dx.doi.org/10.1002/uog.21973DOI Listing
January 2020

Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study.

BMC Pregnancy Childbirth 2019 Dec 31;20(1). Epub 2019 Dec 31.

Centre for Women's & Children's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK.

Background: Twin-twin transfusion syndrome (TTTS) is a highly morbid condition in which treatment exists, but the pregnancy remains high-risk until delivery. It may have serious sequelae, including fetal death, and in the longer term, neurodevelopmental problems. The aim of this study is to assess antenatal and postnatal parental attachment and depressive symptoms in those with pregnancies affected by TTTS. Read More

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http://dx.doi.org/10.1186/s12884-019-2679-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938629PMC
December 2019

Steroid Hormone Levels in Recipient Amniotic Fluid in Twin-Twin Transfusion Syndrome and Their Association with Preterm Delivery.

Am J Perinatol 2020 May 31;37(6):562-569. Epub 2019 Dec 31.

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, UTHealth, The University of Texas Health Science Center at Houston, Houston, Texas.

Objective:  Preterm delivery following fetoscopic laser surgery (FLS) of twin-twin transfusion syndrome (TTTS) is associated with severe perinatal morbidity and mortality. The role of steroid hormones in amniotic fluid (AF) after FLS remains unknown.

Study Design:  A prospective cohort study of consecutive case series of FLS for TTTS was performed from April 2012 to February 2017. Read More

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http://dx.doi.org/10.1055/s-0039-1700862DOI Listing

Subchorionic Hematomas and Adverse Pregnancy Outcomes among Twin Pregnancies.

Am J Perinatol 2019 Dec 30. Epub 2019 Dec 30.

Maternal Fetal Medicine Associates, PLLC, New York, New York.

Objective:  This study estimates the association of a first trimester finding of subchorionic hematoma (SCH) with third trimester adverse pregnancy outcomes in women with twin pregnancies.

Study Design:  Retrospective cohort study of twin pregnancies prior to 14 weeks at a single institution from 2005 to 2019, all of whom had a first trimester ultrasound. We excluded monoamniotic twins, fetal anomalies, history of fetal reduction or spontaneous reduction, and twin-to-twin transfusion syndrome. Read More

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http://dx.doi.org/10.1055/s-0039-3401852DOI Listing
December 2019

Impact of first trimester determination of abnormal cord insertion on twin-to-twin transfusion syndrome and other adverse outcomes in monochorionic diamniotic twins: A retrospective cohort study.

Prenat Diagn 2020 Mar 24;40(4):507-513. Epub 2020 Jan 24.

Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.

Objective: To assess the influence of abnormal cord insertion (CI) detected by first trimester ultrasonography on the development of twin-to-twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twins.

Method: In this retrospective cohort study, consecutive patients with MCDA twins who underwent fetal ultrasound screening in the first trimester between January 2011 and January 2017 were enrolled. The CI sites were evaluated between 11 + 0 and 13 + 6 weeks' gestation. Read More

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http://dx.doi.org/10.1002/pd.5633DOI Listing

Antenatal course of referred monochorionic diamniotic twins complicated by selective intrauterine growth restriction (SIUGR) type III.

J Matern Fetal Neonatal Med 2019 Dec 16:1-7. Epub 2019 Dec 16.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

To describe the antenatal course of selective intrauterine growth restriction (SIUGR) type III patients. Retrospective study of monochorionic diamniotic twins with SIUGR type III. Patients were divided into those who did and did not progress to SIUGR type II or twin-twin transfusion syndrome (TTTS) (Groups A and B, respectively). Read More

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http://dx.doi.org/10.1080/14767058.2019.1701648DOI Listing
December 2019

Monochorionic monoamniotic twin-twin transfusion syndrome treated with laser ablation.

Eur J Obstet Gynecol Reprod Biol 2020 Mar 28;246:193-194. Epub 2019 Nov 28.

Baylor College of Medicine and Texas Children's Hospital, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 6651 Main St, Houston, TX 77030, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ejogrb.2019.11.029DOI Listing

Membrane Separation and Perinatal Outcomes after Laser Treatment for Twin-Twin Transfusion Syndrome.

Fetal Diagn Ther 2020 10;47(4):307-314. Epub 2019 Dec 10.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Pasadena, California, USA,

Introduction: Postoperative membrane separation is a complication of selective laser photocoagulation of communicating vessels (SLPCV) for the treatment of twin-twin transfusion syndrome (TTTS).

Objective: The aim of this work was to determine whether a quantitative grading system of membrane separation following SLPCV was associated with preterm premature rupture of membranes (PPROM) and preterm delivery (PTD).

Methods: Patients with membrane separation after SLPCV on postoperative day 1 were stratified into greatest width of separation <1 cm (Group A) or ≥1 cm (Group B) and compared to patients without separation by the following outcomes: PPROM ≤21 postoperative days, PTD <28 gestational weeks, and PTD <32 gestational weeks. Read More

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http://dx.doi.org/10.1159/000504361DOI Listing
December 2019

Twin gestation and the burden of adult cardio-renal disease.

Pediatr Nephrol 2019 Dec 6. Epub 2019 Dec 6.

Division of Pediatric Nephrology, University of Miami/Holtz Children's Hospital, P.O. Box 016960 (M714), Miami, FL, 33130, USA.

The rate of twin births has increased by nearly 80% in recent decades largely due to advanced reproductive technologies. Twins are often born preterm and/or growth restricted which are independently associated with impaired renal and vascular development. Many preterm and twin infants are surviving into adulthood, albeit with an increased burden of chronic health conditions. Read More

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http://dx.doi.org/10.1007/s00467-019-04418-0DOI Listing
December 2019

Early postnatal cardiac manifestations are associated with perinatal brain injury in preterm infants with twin to twin transfusion syndrome.

Sci Rep 2019 12 6;9(1):18505. Epub 2019 Dec 6.

Seoul National University College of Medicine, Department of Pediatrics, Seoul, 110-769, Republic of Korea.

Altered hemodynamics associated with twin to twin transfusion syndrome (TTTS) can be manifested in the fetal and neonatal heart. This study evaluated the association between cardiac manifestations immediately after birth and brain injury in preterm infants with TTTS. Medical records of preterm infants who were born at <35 weeks of gestation with TTTS and admitted to the neonatal intensive care unit at Seoul National University Children's Hospital between January 2011 and January 2018 were reviewed. Read More

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http://dx.doi.org/10.1038/s41598-019-54951-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898644PMC
December 2019