Twin-twin transfusion syndrome: neurodevelopment of infants treated with laser surgery.

OBJECTIVE: To assess the neurodevelopmental functions of survivors of twin-twin transfusion syndrome (TTTS) treated by fetoscopic laser coagulation (FLC), during the first year of life, comparing them to a control group; and to verify the influence of specific variables on neurodevelopment. METHOD: This was a prospective, longitudinal study. The sample comprised 33 monochorionic diamniotic twins who underwent FLC for treatment of TTTS and 22 full-term infants of single-fetus pregnancies. Bayley Scales of Infant and Toddler Development Screening Test were used for evaluation. Prenatal, perinatal and postnatal information were obtained. RESULTS: There was an increased frequency of infants in the TTTS group with inadequate performance compared to the control group. The identified variables (fetal donor, low economic income and cardiorespiratory disease) negatively impacted expressive communication and fine motor skills. CONCLUSION: Although through follow-up is recommended in all TTTS survivors, particular attention is required for the high-risk group as defined in this study.

Twin-twin transfusion syndrome: neurodevelopment of infants treated with laser surgery / Síndrome de transfusão feto-fetal: neurodesenvolvimento de lactentes tratados com cirurgia a laser

ABSTRACT Objective To assess the neurodevelopmental functions of survivors of twin-twin transfusion syndrome (TTTS) treated by fetoscopic laser coagulation (FLC), during the first year of life, comparing them to a control group; and to verify the influence of specific variables on neurodevelopment. Method This was a prospective, longitudinal study. The sample comprised 33 monochorionic diamniotic twins who underwent FLC for treatment of TTTS and 22 full-term infants of single-fetus pregnancies. Bayley Scales of Infant and Toddler Development Screening Test were used for evaluation. Prenatal, perinatal and postnatal information were obtained. Results There was an increased frequency of infants in the TTTS group with inadequate performance compared to the control group. The identified variables (fetal donor, low economic income and cardiorespiratory disease) negatively impacted expressive communication and fine motor skills. Conclusion Although through follow-up is recommended in all TTTS survivors, particular attention is required for the high-risk group as defined in this study.

RESUMO Objetivo Avaliar o desenvolvimento neurológico de sobreviventes da sindrome de transfusão feto-fetal (STFF) submetidos à coagulação a laser por fetoscopia (CLF), durante o primeiro ano de vida, comparando estes ao grupo controle; e verificar a influência de variáveis específicas no desenvolvimento. Método Tratou-se de estudo prospectivo, longitudinal. A amostra foi composta por 33 gêmeos diamnióticos monocoriônicos submetidos à CLF para tratamento da STFF e 22 lactentes a termo de gestação única. Bayley Scales of Infant and Toddler Development Screening Test foram utilizadas para avaliação. Informações pré-natal, perinatal e pós-natal foram coletadas. Resultados Houve maior número de lactentes com desempenho inadequado no grupo STFF do que no controle. As variáveis identificadas (feto doador, baixa renda econômica e doença cárdio-respiratória) influenciaram negativamente a comunicação expressiva e as habilidades motoras finas. Conclusão Embora o acompanhamento seja recomendado para todos lactentes com STFF, especial atenção deve ser dada àqueles que apresentam fatores de risco.

Rapid Resolution of Polyhydramnios Foretells Circulatory Collapse for the Donor Twin in Feto-Fetal Transfusion Syndrome.

Feto-fetal transfusion syndrome is a pathological process unique to diamniotic monochorionic pregnancies. It is the consequence of an unbalanced fetal blood flow through communicating vessels within a shared placenta. When it occurs, a polyuric, hypervolemic recipient twin co-exists with a hypovolemic oliguric donor. The presence of polyhydramnios or oligohydramnios is considered a poor prognostic indicator, whereas normal amniotic fluid volumes indicate a lack of clinically significant twintwin transfusion. In addition, the spontaneous normalization of amniotic fluid volume is usually seen as a favorable prognostic sign. Here, however, we present a case of feto-fetal transfusion in a 31 year-old primigravida at 19 week, in which the spontaneous normalization of amniotic fluid volume in the recipient twin preceded the death of the donor.

Twin-twin transfusion syndrome: neurodevelopmental screening test.

OBJECTIVE: To assess the neurodevelopmental functions (cognition, language and motor function) of survivors of twin-twin transfusion syndrome (TTTS). METHOD: Observational cross-sectional study of a total of 67 monochorionic diamniotic twins who underwent fetoscopic laser coagulation (FLC) for treatment of TTTS. The study was conducted at the Center for Investigation in Pediatrics (CIPED), Universidade Estadual de Campinas. Ages ranged from one month and four days to two years four months. Bayley Scales of Infant and Toddler Development Screening Test-III, were used for evaluation. RESULTS: Most children reached the competent category and were classified as having appropriate performance. The preterm children scored worse than term infants for gross motor subtest (p = 0.036). CONCLUSION: The majority of children reached the expected development according to their age. Despite the good neurodevelopment, children classified at risk should be monitored for development throughout childhood.

Síndrome de transfusão feto-fetal / Twin-twin transfusion syndrome

A síndrome de transfusão feto-fetal (STFF) é uma das complicações mais graves que pode ocorrer em gestações gemelares monocoriônicas. Sua incidência varia de 1:40 a 1:60 em gestações gemelares e de 10 a 20 das gemelares monocoriônicas. Sua fisiopatologia é explicada pelo desequilíbrio das anastomoses vasculares placentárias e a resposta cardiovascular a essa alteração. A taxa de mortalidade sem tratamento é de 70 a 100 para pelo menos um dos gêmeos e não existe consenso bem definido sobre qual o melhor momento para se realizar o tratamento nem sobre a técnica a ser utilizada.

Twin-twin transfusion syndrome (TTTS) is one of the most serious complications that can occur in monochorionic twin pregnancies. The incidence of TTTS ranges from 1:40 to 1:60 in twin pregnancies and 10-20 in monochorionic twin pregnancies. The pathophysiology of the disease is explained by the imbalance of placental vascular anastomoses and the cardiovascular response to this alteration. The mortality rate without treatment is 70-100 for at least one of the twins and there is no clear consensus about the best time to perform the treatment or wich technique shoud be used.

Síndrome de transfusäo feto-fetal / Twin-twin transfusion syndrome

Os autores relatam um caso de síndrome de transfusão feto-fetal ocorrido em uma paciente do Ambulatório de Ginecologia e Obstetrícia do Hospital Universitário São Francisco. A paciente procurou o serviço com diagnóstico de gemelaridade e aumento excessivo de volume abdominal. A ultra-sonografia obstétrica evidenciou gestação gemelar com um dos fetos apresentando polidrâmnio acentuado e o outro com oligoâmio. Instalou-se a terapêutica a fim de melhorar as condições fetais e postergar o término da gravidez, porém sem sucesso, evoluindo ambos para óbito

Gemelo acardiaco-acefálico, manifestación extrema del síndrome de transfusión feto-feto. Presentación de un caso / Acardiac-acephalic twin, an extreme manifestation fetus-fetus transfusion syndrome. A case presentation

Se presenta el caso clínico de un gemelo acardico-acefálico, la forma circunstancial en que se diagnóstico y se revisan los diferentes aspectos del diagnóstico temprano y modalidades terapéuticas

Síndrome de transfusión feto-feto: Un punto de vista actual / Twin-twin transfusion syndrome: a present overview

El síndrome de transfusión feto-feto es una complicación de los embarazos gemelares monocigóticos-monocoriónicos, que se presenta en el segundo trimestre, con una mortalidad perinatal mayor del 60 por ciento. La presencia de anastomosis vasculares dentro de la placenta es la responsable del síndrome. El diagnóstico requiere la comprobación ultrasonográfica de monocorionicidad, de la secuencia oligohidramnios-polihidramnios, de discordancia en el crecimiento fetal y valores divergentes de hemoglobina y hematócrito. La indometacina, la amniocentesis y la cirugía endoscópica fetal pueden disminuir la elevada tasa de mortalidad perinatal. Si bien el pronóstico perinatal parece estar relacionado con la morbimortalidad a corto plazo, es recomendable realizar segumiento a largo plazo

Anomalia acardíaca e síndrome de transfusäo feto-fetal: relato de um caso e revisäo bibliográfica / Acardiac anomalie and feto-fetal transfusion syndrome: report of a case and review of the literature

Caso de anomalia acardíaca que é condiçäo encontrada em gestaçöes múltiplas. Essa alteraçäo, na maioria dos casos, poderia ser considerada a manifestaçäo mais extrema da síndrome de transfusäo feto-fetal. Dessa maneira, os dois temas foram revisados. Os autores também discutem a formaçäo embriológica das membranas em gestaçäo gamelar, o que se faz necessário para o reconhecimento precoce e diferenciaçäo desses tipos de anomalia

Placental characteristics in twin transfusion syndrome.

The authors describe the histological features of the placenta in a typical case of twin-to-twin transfusion, with particular attention focused on the stereologic aspects. Villi from the anemic placental portion were slightly edematous, with small and inconspicuous vessels. The stereologic characteristics of this portion were nearer values of normal placentas. The plethoric region appears as a postmature organ, with a very thin trophoblast layer and numerous vasculo-syncytial membranes. The most dramatic alterations of this region were mainly related to the foetal capillary. According to the stereologic results, the consecutive circulatory alterations would facilitate the maternal-fetal exchanges in the plethoric placental territory, thus justifying the greater development of this twin.