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Geburtshilfe Frauenheilkd 2019; 79(11): 1153-1156
DOI: 10.1055/a-0787-2256
GebFra Magazin
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Georg Thieme Verlag KG Stuttgart · New York

Zwillingstransfusionssyndrom

Christian Bamberg
,
Kurt Hecher
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Publication Date:
11 November 2019 (online)

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Das Zwillingstransfusionssyndrom oder Twin-Twin Transfusion Syndrome (TTTS) betrifft monochoriale Mehrlingsschwangerschaften. Monochorionizität bedeutet, dass sich die Feten eine Plazenta teilen, und in praktisch allen Fällen gibt es Gefäßverbindungen zwischen den umbilikalen Kreisläufen auf der Plazentaoberfläche. Drei verschiedene Anastomosentypen sind beschrieben: arteriovenös, arterioarteriell und venovenös. Daraus resultiert, dass eine Imbalance bezüglich der Blutvolumina beider Feten möglich ist. Derzeit ist nicht endgültig geklärt, warum ein TTTS entsteht, jedoch scheint die Anzahl, der Typ und das Kaliber der Anastomosen das Risiko zu bestimmen [1]. Etwa 10 – 15% der monochorialen Zwillinge zeigen ein TTTS [2], welches sich typischerweise zwischen der 16. und 26. SSW entwickelt.
 

  • Literatur

  • 1 Benirschke K, Masliah E. The placenta in multiple pregnancy: outstanding issues. Reprod Fertil Dev 2001; 13: 615-622
    CrossrefPubMedSearch in Google Scholar
  • 2 Lewi L, Jani J, Blickstein I. 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: 514.e1-514.e8
    CrossrefPubMedSearch in Google Scholar
  • 3 Khalil A, Rodgers M, Baschat A. et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 2016; 47: 247-263
    CrossrefPubMedSearch in Google Scholar
  • 4 Oepkes D, Sueters M. Antenatal fetal surveillance in multiple pregnancies. Best Pract Res Clin Obstet Gynaecol 2016; 38: 59-70
    PubMedSearch in Google Scholar
  • 5 Simpson LL. Twin-twin transfusion syndrome. Am J Obstet Gynecol 2013; 208: 3-18
    CrossrefPubMedSearch in Google Scholar
  • 6 Baxi LV, Walsh CA. Monoamniotic twins in contemporary practice: a single-center study of perinatal outcomes. J Matern Fetal Neonatal Med 2010; 23: 506-510
    CrossrefPubMedSearch in Google Scholar
  • 7 Quintero RA, Morales WJ, Allen MH. et al. Staging of twin-twin transfusion syndrome. J Perinatol 1999; 19 (8 Pt 1): 550-555
    CrossrefPubMedSearch in Google Scholar
  • 8 Yamamoto M, Essaoui M, Nasr B. et al. Three-dimensional sonographic assessment of fetal urine production before and after laser surgery in twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol 2007; 30: 972-976
    CrossrefPubMedSearch in Google Scholar
  • 9 Michelfelder E, Gottliebson W, Border W. et al. Early manifestations and spectrum of recipient twin cardiomyopathy in twin-twin transfusion syndrome: relation to Quintero stage. Ultrasound Obstet Gynecol 2007; 30: 965-971
    CrossrefPubMedSearch in Google Scholar
  • 10 Rychik J, Tian Z, Bebbington M. 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 2007; 197: 392.e1-392.e8
    CrossrefPubMedSearch in Google Scholar
  • 11 Wohlmuth C, Gardiner HM, Diehl W. et al. Fetal cardiovascular hemodynamics in twin-twin transfusion syndrome. Acta Obstet Gynecol Scand 2016; 95: 664-671
    CrossrefPubMedSearch in Google Scholar
  • 12 Berghella V, Kaufmann M. Natural history of twin-twin transfusion syndrome. J Reprod Med 2001; 46: 480-484
    PubMedSearch in Google Scholar
  • 13 Senat MV, Deprest J, Boulvain M. et al. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med 2004; 351: 136-144
    CrossrefPubMedSearch in Google Scholar
  • 14 Khalil A, Cooper E, Townsend R. et al. Evolution of stage 1 twin-to-twin transfusion syndrome (TTTS): systematic review and meta-analysis. Twin Res Hum Genet 2016; 19: 207-216
    CrossrefPubMedSearch in Google Scholar
  • 15 Lewi L, Jani J, Cannie M. 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: 790-795
    CrossrefPubMedSearch in Google Scholar
  • 16 Lopriore E, Middeldorp JM, Oepkes D. et al. Residual anastomoses after fetoscopic laser surgery in twin-to-twin transfusion syndrome: frequency, associated risks and outcome. Placenta 2007; 28: 204-208
    CrossrefPubMedSearch in Google Scholar
  • 17 Slaghekke F, Lopriore E, Lewi L. et al. Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: an open-label randomised controlled trial. Lancet 2014; 383: 2144-2151
    CrossrefPubMedSearch in Google Scholar
  • 18 Slaghekke F, Lewi L, Middeldorp JM. et al. Residual anastomoses in twin-twin transfusion syndrome after laser: the Solomon randomized trial. Am J Obstet Gynecol 2014; 211: 285.e1-285.e7
    CrossrefPubMedSearch in Google Scholar
  • 19 Lanna MM, Faiola S, Consonni D. et al. Increased risk of placental abruption after solomon laser treatment of twin-twin transfusion syndrome. Placenta 2017; 53: 54-56
    CrossrefPubMedSearch in Google Scholar
  • 20 Akkermans J, Peeters SH, Klumper FJ. et al. Twenty-five years of fetoscopic laser coagulation in twin-twin transfusion syndrome: a systematic review. Fetal Diagn Ther 2015; 38: 241-253
    CrossrefPubMedSearch in Google Scholar
  • 21 Diehl W, Diemert A, Grasso D. et al. Fetoscopic laser coagulation in 1020 pregnancies with twin-twin transfusion syndrome demonstrates improvement in double-twin survival rate. Ultrasound Obstet Gynecol 2017; 50: 728-735
    CrossrefPubMedSearch in Google Scholar
  • 22 Stirnemann J, Chalouhi G, Essaoui M. et al. Fetal brain imaging following laser surgery in twin-to-twin surgery. BJOG 2016; 125: 1186-1191
    PubMedSearch in Google Scholar
  • 23 Schou KV, Lando AV, Ekelund CK. et al. Long-term neurodevelopmental outcome of monochorionic twins after laser therapy or umbilical cord occlusion for twin-twin transfusion syndrome. Fetal Diagn Ther 2018;
    CrossrefPubMedSearch in Google Scholar
  • 24 van Klink JM, Koopman HM, Rijken M. et al. Long-term neurodevelopmental outcome in survivors of twin-to-twin transfusion syndrome. Twin Res Hum Genet 2016; 19: 255-261
    CrossrefPubMedSearch in Google Scholar
  • 25 Herberg U, Bolay J, Graeve P. et al. Intertwin cardiac status at 10-year follow-up after intrauterine laser coagulation therapy of severe twin-twin transfusion syndrome: comparison of donor, recipient and normal values. Arch Dis Child Fetal Neonatal Ed 2014; 99: F380-F385
    CrossrefPubMedSearch in Google Scholar
  • 26 Hecher K, Gardiner HM, Diemert A. et al. Long-term outcomes for monochorionic twins after laser therapy in twin-to-twin transfusion syndrome. Lancet Child Adolesc Health 2018; 2: 525-535
    CrossrefPubMedSearch in Google Scholar
  • 27 Chmait RH, Chon AH, Korst LM. et al. Risks of preterm premature rupture of membranes and preterm birth post fetoscopy based on location of trocar insertion site. Am J Perinatol 2018; 35: 801-808
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Petersen SG, Gibbons KS, Luks FI. et al. The impact of entry technique and access diameter on prelabour rupture of membranes following primary fetoscopic laser treatment for twin-twin transfusion syndrome. Fetal Diagn Ther 2016; 40: 100-109
    CrossrefPubMedSearch in Google Scholar
  • 29 Shaw CJ, Civale J, Botting KJ. et al. Noninvasive high-intensity focused ultrasound treatment of twin-twin transfusion syndrome: a preliminary in vivo study. Sci Transl Med 2016; 8: 347ra395
    PubMedSearch in Google Scholar
  • 30 Mackie FL, Hall MJ, Morris RK. et al. Early prognostic factors of outcomes in monochorionic twin pregnancy: systematic review and meta-analysis. Am J Obstet Gynecol 2018; 219: 436-446
    CrossrefPubMedSearch in Google Scholar
  • 31 Stagnati V, Zanardini C, Fichera A. et al. Early prediction of twin-to-twin transfusion syndrome: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2017; 49: 573-582
    CrossrefPubMedSearch in Google Scholar
  • 32 Bamberg C, Diemert A, Glosemeyer P. et al. Discordance of umbilical coiling index between recipients and donors in twin-twin transfusion syndrome. Placenta 2019; 76: 19-22
    CrossrefPubMedSearch in Google Scholar