Twin-twin transfusion syndrome

摘要: Objective We sought to review the natural history, pathophysiology, diagnosis, and treatment options for twin-twin transfusion syndrome (TTTS). Methods A systematic was performed using MEDLINE database, PubMed, EMBASE, Cochrane Library. The search restricted English-language articles published from 1966 through July 2012. Priority given reporting original research, in particular randomized controlled trials, although commentaries also were consulted. Abstracts of research presented at symposia scientific conferences not considered adequate inclusion this document. Evidence reports guidelines by organizations or institutions such as National Institutes Health, Agency Health Research Quality, American College Obstetricians Gynecologists, Society Maternal-Fetal Medicine reviewed, additional studies located reviewing bibliographies identified articles. Consistent with US Preventive Task Force guidelines, references evaluated quality based on highest level evidence, recommendations graded accordingly. Results Recommendations TTTS is a serious condition that can complicate 8-10% twin pregnancies monochorionic diamniotic (MCDA) placentation. diagnosis requires 2 criteria: (1) presence MCDA pregnancy; (2) oligohydramnios (defined maximal vertical pocket 8 cm) other sac. Quintero staging system appears be useful tool describing severity standardized fashion. Serial sonographic evaluation should all twins placentation, usually beginning around 16 weeks continuing about every until delivery. Screening congenital heart disease warranted twins, those complicated TTTS. Extensive counseling provided patients including history disease, well management their risks benefits. stage I more than three-fourths cases remain stable regress without invasive intervention, perinatal survival 86%. Therefore, many may often managed expectantly. advanced (eg, ≥III) bleak, reported loss rate 70-100%, particularly when it presents