Abstract
Twin to twin transfusion syndrome (TTTTS) accounts for approximately 10% of monochorionic twin pregnancies and, if left untreated, is associated with high morbidity and mortality rate. A net transfusion of blood flow from one fetus (donor twin) to the other (recipient twin) via placental vascular anastomoses has been supposed as the major etiology of TTTTS. The donor twin becomes hypovolemic and oliguria, oligohydramnios, and a variable degree of growth restriction develop, whereas the recipient twin manifests polyuria, polyhydramnios, and hydrops in response to hypervolemia. TTTTS can be treated by either serial amniocentesis or selective fetoscopic laser coagulation of the communicating vessels. The rationale for removal of large volumes of amniotic fluid is to prevent preterm delivery secondary to polyhydramnios and to improve fetal circulation by reducing pressure on the chorionic plate. On the other hand, the goal of laser therapy is to occlude vascular anastomoses, thereby interrupting intertwin blood exchange. Although laser treatment is associated with increased survival rate and reduced neurologic complications, compared with amnioreduction, it requires highly specialized centers, whereas serial amniocentesis has the advantage of being performed worldwide. Therefore, the optimal treatment for pregnancies complicated with TTTTS is still controversial.
Highlights
Twin to twin transfusion sindrom (TTTTS) se javlja u oko 10% svih monohorionskih blizanačkih trudnoća, i ako ne bude prepoznat i adekvatno tretiran, povezan je sa visokom stopom morbiditeta i mortaliteta
Anegdotalno se spominju slučajevi maternalnih komplikacija, kao što su edem pluća, adultni respiratorni distres sindrom i maternalna smrt, mada učinak lasera nije baš jasan [8]
Zvanično praćenje neurološkog razvoja 89 preživelih od TTTTS u periodu 14 do 33 meseca, od strane iste grupe, pokazalo je incidence od 22% neuroloških sekvela kod selektivne laserske grupe, uključujući i incidence cerebralne paralize od 11% [22]
Summary
Šulović N.1, Marjanović S.1, Šulović Lj., Jovanovic M.3, Lukač A.4 1 Klinika za Ginekologiju i Akušerstvo – Medicinski fakultet Priština 2 Klinika za Pedijatriju – Medicinski fakultet Priština 3 Zdravstveni centar Gnjilane 4 Zdravstveni centar Rozaje. Twin to twin transfusion sindrom (TTTTS) se javlja u oko 10% svih monohorionskih blizanačkih trudnoća, i ako ne bude prepoznat i adekvatno tretiran, povezan je sa visokom stopom morbiditeta i mortaliteta. Transfusija krvi iz jednog ploda (donor) ka drugom (recipijent) preko placentnih vaskularnih anastomoza je u osnovi čitave etiologije TTTTS. Pokazalo se da je laserska terapija povezana sa povećanjem stepena preživljavanja i redukcijim neuroloških komplikacija u komparaciji sa amnioredukcijom. Optimalna terapija trudnoća komplikovanih TTTTS je još uvek kontroverzna. Ključne reči: amniocenteza, septostomija, amnioredukcija, selektivni feticid, fetalno i neonatalno preživljavanje, laserska terapija, neurološki morbiditet, twin to twin transfuion sindrom. Povećanje stepena mortaliteta kod monohorionske placentacije uzrokovano je pojavom aberantne vaskularne komunikacije u placenti koja vodi razvoju twin to twin transfuzionog sindroma. U monoamnionskih blizanaca rizik je još veći zbog mogućnosti upetljavanja pupčane vrpce. Monohorionski blizanci su prema tome u većem riziku od prematuriteta, intrauterine smrti i neuroloških oštećenja praćeno komplikacijama usled transfuzijskog sindroma [3,4]
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