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Updated: Mar 28 2020

Twin-Twin Transfusion Syndrome

  • Snapshot
    • A 24-year-old G2P0 woman presents to the obstetrician at 25 weeks gestation. She complains that her abdomen seems to have rapidly enlarged over the past 2 weeks. An ultrasound is performed and is notable for polyhydramnios in 1 sac, explaining her enlarged abdomen, and oligohydramnios in the other sac, causing it to be stuck to the anterior uterine wall (see image).
  • Introduction
    • Overview
      • twin-to-twin transfusion syndrome results when there is intrauterine blood transfusion from 1 twin (donor) to the other twin (recipient)
  • Epidemiology
    • Incidence
      • 3-5 per 1000 pregnancies
    • Pathophysiology
      • result of transfusion of blood from 1 fetal twin to another twin through placental vascular anastomoses
        • hypoperfusion of the donor twin and hyperperfusion of the recipient twin
          • donor twin becomes hypovolemic and oliguric
            • oligohydramnios develops in the amniotic sac
          • recipient twin becomes hypervolemic and polyuric
            • polyhydramnios develops in the amniotic sac
      • specific complication of monozygotic twins with monochorionic placentation
        • may be monoamniotic or diamniotic
  • Imaging
    • Ultrasound
      • indications
        • diagnosis of twin-to-twin transfusion syndrome
      • findings
        • significant discrepancy in size of same-sex fetuses
        • monochorionic placentation
        • disparity in amount of amniotic fluid between the fetuses
          • smaller twin has oligohydramnios
  • Treatment
    • Procedural
      • reduction amniocentesis
        • drains amniotic fluid from around the recipient twin to ↓ polyhydramnios
          • may improve circulation in the donor twin
      • laser photocoagulation of anastomotic vessels
        • reserved for more severe cases that do not respond to amnioreduction
        • decreases shunting of blood from one fetus to the other
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