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3 results

  • Chapter 12 - Monochorionic Twin Pregnancy

  • from Section 1 - Obstetric Aspects of Antenatal Care
  • Edited by Amira El-Messidi, McGill University, Montréal, Alan D. Cameron, University of Glasgow
  • Book:
    OSCEs in Obstetrics and Maternal-Fetal Medicine
    Published online:
    23 February 2023
    Print publication:
    16 February 2023, pp 158-172

  • Summary

    A 34-year-old primigravida is referred by her primary care provider to your hospital center’s high-risk obstetrics unit after sonographic imaging confirmed viable intrauterine spontaneous monochorionic diamniotic (MCDA) twins with crown–rump lengths (CRL) of 47 mm and 44 mm, consistent for 12+4 weeks’ gestation by CRL of the larger twin. Twin A’s and twin B’s nuchal translucency (NT) measurements are 1.5 mm and 1.0 mm, respectively, with normal-appearing first-trimester fetal morphologies.

  • The History of Treatment of Twin-to-Twin Transfusion Syndrome

  • Chelsea L. Glennon, Scott A. Shemer, Ricardo Palma-Dias, Mark P. Umstad
  • Journal:
    Twin Research and Human Genetics / Volume 19 / Issue 3 / June 2016
    Published online by Cambridge University Press:
    20 May 2016, pp. 168-174
    • Article
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  • Historical suggestions of twin-to-twin transfusion syndrome (TTTS) date back to the early 17th century. Placental anastomoses were first reported in 1687; however, it was Schatz who first identified their importance in 1875. He recognized ‘the area of transfusion’ within the ‘villous district’ of the placenta, which he named the ‘third circulation’. This article describes how the management of TTTS has evolved as we have gained a more sophisticated understanding and appreciation of the complex vascular anastomoses that exist in monochorionic twin placentae. Currently, fetosopic laser occlusion is the preferred treatment option for TTTS.

  • Chapter 11.4 - Twin-to-twin transfusion syndrome

  • from Section 2 - Fetal disease
  • Edited by Mark D. Kilby, Anthony Johnson, Baylor College of Medicine, Texas, Dick Oepkes
  • Book:
    Fetal Therapy
    Published online:
    05 February 2013
    Print publication:
    13 December 2012, pp 173-183

  • Summary

    This chapter discusses the twin-to-twin transfusion syndrome (TTTS) treatment options focusing on fetoscopic laser ablation of anastomoses. It also explains the benefits and risks associated with this treatment. Fetoscopic laser coagulation of placental vessels (FLCPV) is the only treatment addressing the pathophysiology of the syndrome as proven through a randomized controlled study against amnioreduction. Septostomy is based on a deliberate opening of the intertwin membrane with the needle in order to let the amniotic fluid flow freely between the two amniotic sacs. Even though two randomized trials have yielded similar survival rates between amnioreduction and septostomy, it has been abandoned by most teams. The superiority of laser treatment over amnioreduction was established through a randomized controlled study. The type of anesthesia has also evolved with time since the first interventions. Some teams still operate under general anesthesia although it is significantly associated with significant maternal morbidity.