![]() This can be determined in the first trimester by ultrasound identification of a single placental mass with a thin dividing membrane that inserts directly into the placental surface (T-sign) and absence of placental tissue extending in between the intertwin membrane (λ-sign) with a sensitivity and specificity of up to 98–100% ( Figure 2) ( 4- 7). Chorionicity refers to the number of placentas in the pregnancy. The timing of the split is related to the observed number of placentas and amniotic sacs, with earlier division leading to more complete separation ( Figure 1) ( 1, 3). Monozygotic twins are classically considered the result of division of a single embryo and account for approximately 30% of all twin pairs worldwide ( 1, 2). This unique features of the monochorionic placenta that contribute to the TTTS, as well as diagnosis, treatment and anticipated outcomes are reviewed. The current technique allows >70% survival of at least one twin but preterm birth is a common consequence of the intervention. Diagnosis of monochorionicity in the first trimester and adherence to international guidelines for close surveillance of these pregnancies at least every 2 weeks after 16 weeks provides the best opportunity and early diagnosis and definitive treatment with fetoscopic laser surgery. Twin to twin transfusion syndrome (TTTS) is a disease that occurs in 10−15% of monochorionic twins as a result of volume imbalance across the vascular anastomoses between the twins and is the largest contributor to previable pregnancy loss for this type of twins. Keywords: Fetoscopy placental diseases, pregnancy, twin twin to twin transfusion syndrome (TTTS) Strategies to minimize preterm birth after treatment and standardized reporting by laser centers are important considerations to improve overall outcomes and understand the long-term impacts of TTTS. Long term outcomes of TTTS survivors indicate that up to 11% of children may show signs of neurologic impairment. However, preterm birth remains a significant contributor to postnatal morbidity and mortality. Contemporary outcome data after laser surgery suggests survival for both fetuses can be anticipated in up to 65% of cases and survival of a single fetus in up to 88% of cases. It aims to cure the condition by interrupting the link between their circulations and making them independent of one another. Fetoscopic laser ablation of the communicating vascular anastomoses between the twins is the standard treatment for TTTS. Assessment of fetal cardiac function also provides additional insight into the fetal cardiovascular impacts of the disease as well as help identify fetuses that may require postnatal follow up. Assessment of bladder filling as well as arterial and venous Doppler patterns are required for staging disease severity. The diagnosis of TTTS is made by ultrasound with the findings of polyhydramnios due to volume overload and polyuria in one twin and oligohydramnios due to oliguria of the co-twin. ![]() Ultrasound diagnosis of monochorionicity is most reliable in the first trimester and sets the monitoring strategy for this type of twins. Without recognition and treatment, TTTS is the greatest contributor to fetal loss prior to viability in 90–100% of advanced cases. Interviews with Outstanding Guest EditorsĪbstract: Twin to twin transfusion syndrome (TTTS) is a common complication that typically presents in the second trimester of pregnancy in 10–15% of monochorionic twins due to net transfer of volume and hormonal substances from one twin to the other across vascular anastomoses on the placenta.Policy of Dealing with Allegations of Research Misconduct. ![]() Policy of Screening for Plagiarism Process.
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