Acute twin-to-twin transfusion in monochorionic multiple pregnancy

DOI

https://dx.doi.org/10.18565/aig.2022.259

Mikhailov A.V., Romanovsky A.N., Volchenkova V.E., Kuznetsov A.A., Kyanksep A.N., Saveleva A.A., Osipova A.V., Tcyganova M.K.
1) Maternity Hospital No. 17, Saint Petersburg, Russia; 2) Department of Obstetrics, Gynecology, and Reproductology, Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia; 3) S.N. Davydov Department of Obstetrics and Gynecology, I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia; 4) Department of Obstetrics, Gynecology, and Reproductology, Saint Petersburg State University, Saint Petersburg, Russia; 5) D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductology, Saint Petersburg, Russia

The paper provides an overview of modern concepts of different forms of twin-to-twin transfusion in monochorionic multiple pregnancy. It deals with diagnostic criteria for acute twin-to-twin transfusion during monochorionic twin delivery. The pathogenetic mechanisms of risk factors for acute twin-to-twin transfusion are considered. The differential diagnosis in chronic (twin-to-twin transfusion syndrome, twin anemia polycythemia sequence) and acute (single fetal death in twin pregnancy, placentofetal and acute twin-to-twin transfusions) forms of twin-to-twin transfusion is discussed in detail.
The possibility of predicting and preventing the development of acute twin-to-twin transfusion during childbirth has not been now defined; however, it is assumed that in some cases the changes in the cardiotocographic heart rate patterns may suspect specific disorders and make a timely delivery decision to minimize both antenatal losses and neonatal morbidity and mortality rates. The review gives possible approaches to postnatal correction for neonatal hematological disorders due to acute bypass surgery during monochorionic twin delivery.
Conclusion: Further investigations are needed to clarify diagnostic criteria and risk factors for acute twin-to-twin transfusion and optimal delivery tactics and to study long-term consequences for the health of children with this complication of monochorionic multiple pregnancy.

Authors’ contributions: Mikhailov A.V. – analyzing and generalizing the data available in the literature, editing and processing the manuscript; Romanovsky A.N., Osipova A.V., Kyanksep A.N., Volchenkova V.E. – collecting, analyzing, and generalizing the data available in the literature, writing the text of the article, executing the manuscript; Kuznetsov A.A., Tcyganova M.K., Saveleva A.A. – collecting, analyzing, and generalizing the data available in the literature, editing the manuscript.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The article has been prepared for publication without sponsorship.
For citation: Mikhailov A.V., Romanovsky A.N., Volchenkova V.E.,
Kuznetsov A.A., Kyanksep A.N., Saveleva A.A., Osipova A.V., Tcyganova M.K.
Acute twin-to-twin transfusion in monochorionic multiple pregnancy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (2): 5-11 (in Russian)
https://dx.doi.org/10.18565/aig.2022.259

monochorionic twin

acute twin-to-twin transfusion

twin-to-twin transfusion syndrome

twin anemia polycythemia sequence

Full text (in Russian)

Lewi L., Van Schoubroeck D., Gratacós E., Witters I., Timmerman D.,Deprest J. Monochorionic diamniotic twins: complications and management options. Curr. Opin. Obstet. Gynecol. 2003; 15(2): 177-94.https://dx.doi.org/10.1097/00001703-200304000-00013.
Lewi L., Gucciardo L., Van Mieghem T. Monochorionic diamniotic twin pregnancies: natural history and risk stratification. Fetal Diagn. Ther. 2010; 27(3): 121-33. https://dx.doi.org/10.1159/000313300.
Gratacós E., Ortiz J.U., Martinez J.M. A systematic approach to the differential diagnosis and management of the complications of monochorionic twin pregnancies. Fetal Diagn. Ther. 2012; 32(3): 145-55.https://dx.doi.org/10.1159/000342751.
Костюков К.В., Гладкова К.А. Диагностика фето-фетального трансфузионного синдрома, синдрома анемии-полицитемии при монохориальной многоплодной беременности. Акушерство и гинекология. 2016; 1: 10-5. [Kostyukov K.V., Gladkova K.A. Diagnosis of twin-to-twin transfusion syndrome and anemia-polycythemia syndrome in monochorionic multiple pregnancy. Obstetrics and Gynecology. 2016; (1): 10-5. (in Russian)].https://dx.doi.org/10.18565/aig.2016.1.10-15.
Костюков К.В., Сакало В.А., Гладкова К.А., Шакая М.Н., Ионов О.В., Тетруашвили Н.К. Перинатальные исходы монохориальной многоплодной беременности, осложненной фето-фетальным трансфузионным синдромом. Акушерство и гинекология. 2020; 8: 72-80. [Kostyukov K.V., Sakalo V.A., Gladkova K.A., Shakaya M.N., Ionov O.V., Tetruashvili N.K. Perinatal outcomes of monochorionic multiple pregnancies complicated by twin-to-twin transfusion syndrome. Obstetrics and Gynecology. 2020; (8): 72-80. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.8.72-80.
Михайлов А.В., Романовский А.Н., Шлыкова А.В., Кузнецов А.А., Каштанова Т.А., Новикова А.В., Потанин С.А. Применение лазерной коагуляции сосудистых анастомозов плаценты при фето-фетальном трансфузионном синдроме. Таврический медико-биологический вестник. 2016; 19(2): 167-71. [Mikhailov A.V., Romanovsky A.N., Shlykova A.V., Kuznetsov A.A., Kashtanova T.A., Novikov A.V., Potanin S.A. Laser coagulation of vascular placental anastomoses in twin-to-twin-transfusion syndrome. Taurian Medical and Biological Bulletin. 2016; 19(2): 167-71.(in Russian)].
Bajoria R., Wigglesworth J., Fisk N.M. Angioarchitecture of monochorionic placentas in relation to the twin-twin transfusion syndrome. Am. J. Obstet. Gynecol. 1995; 172(3): 856-63. https://dx.doi.org/10.1016/0002-9378(95)90011-x.
Кузнецов А.А., Романовский А.Н., Шлыкова А.В., Каштанова Т.А., Шман В.В., Кянксеп И.В., Мовчан В.Е., Державина Н.Е., Савельева А.А., Овсянников Ф.А., Михайлов А.В. Синдром гибели одного плода при многоплодной беременности. Трансляционная медицина. 2019; 6(5): 31-8. [Kuznetsov A.A., Romanovsky A.N., Shlykova A.V., Kashtanova T.A.,Shman V.V., Kyanksep I.V., Movchan V.E., Derzhavina N.E.,Savel’eva A.A., Ovsyannikov F.A., Mikhailov A.V. Single fetal demise in multiple pregnancy. Translational Medicine. 2019; 6(5): 31-8. (in Russian)]. https://dx.doi.org/10.18705/2311-4495-2019-6-5-.
Hillman S.C., Morris R K., Kilby M.D. Co-twin prognosis after single fetal death: a systematic review and meta-analysis. Obstet. Gynecol. 2011; 118(4): 928-940. https://dx.doi.org/10.1097/AOG.0b013e31822f129d.
Овсянников Ф.А., Романовский А.Н. Современные подходы к лечению фето-фетального трансфузионного синдрома. Трансляционная медицина. 2017; 4(4): 36-42. [Ovsyannikov F.A., Romanovsky A.N. Current treatment of twin-to-twin transfusion syndrome. Translational Medicine. 2017; 4(4): 36-42. (in Russian)]. https://dx.doi.org/10.18705/2311-4495-2017-4-4-36-42.
Benoit R.M., Baschat A.A. Twin-to-twin transfusion syndrome: prenatal diagnosis and treatment. Am. J. Perinatol. 2014; 31(7): 583-94.https://dx.doi.org/10.1055/s-0034-1372428.
Lopriore E., Middeldorp J.M., Sueters M. Twin-to-twin transfusion syndrome: from placental anastomoses to long-term neurodevelopmental outcome. Curr. Pediatr. Rev. 2005; 1(3): 191-203. https://dx.doi.org/10.2174/157339605774574999.
Quintero R.A., Morales W.J., Allen M.H., Bornick P.W., Johnson P.K., Kruger M. Staging of twin-twin transfusion syndrome. J. Perinatol. 1999; 19(8, Pt. 1): 550-5. https://dx.doi.org/10.1038/sj.jp.7200292.
WAPM Consensus Group on Twin-to-Twin Transfusion. Twin to-twin transfusion syndrome (TTTS). J. Perinat. Med. 2011; 39(2): 107-12.https://dx.doi.org/10.1515/jpm.2010.147.
Acosta-Rojas R., Becker J., Munoz-Abellana B., Ruiz C., Carreras E., Gratacos E. Twin chorionicity and the risk of adverse perinatal outcome. Int. J. Gynecol. Obstet. 2007; 96(2): 98-102. https://dx.doi.org/10.1016/j.ijgo.2006.11.002.
Faye-Petersen O.M., Crombleholme T.M. Twin-to-Twin transfusion syndrome Part 2. Infant anomalies, clinical interventions, and placental examination. Neo Reviews. 2008; 9(9): e380-92.
Михайлов А.В., Романовский А.Н., Каштанова Т.А., Кузнецов А.А., Кянксеп И.В., Волчёнкова В.Е., Савельева А.А. Синдром анемии-полицитемии – современные подходы к диагностике и антенатальной коррекции. Вопросы гинекологии, акушерства и перинатологии. 2021; 20(2): 134-40. [Mikhailov A.V., Romanovsky A.N., Kashtanova T.A., Kuznetsov A.A., Kyanksep I.V., Volchenkova V.E., Savel’eva A.A. Twin anemia polycythemia sequence – modern approaches to diagnosis and antenatal correction. Issues of Gynecology, Obstetrics and Perinatology. 2021; 20(2): 134-40. (in Russian)]. https://dx.doi.org/10.20953/1726-1678-2021-2-134-140.
Slaghekke F., Kist W.J., Oepkes D., Pasman S.A., Middeldorp J.M., Klumper F.J. et al. Twin anemia-polycythemia sequence: diagnostic criteria, classification, perinatal management and outcome. Fetal Diagn. Ther. 2010; 27(4): 181-90. https://dx.doi.org/10.1159/000304512.
Российское общество акушеров-гинекологов (РОАГ), ООО «Ассоциация анестезиологов-реаниматологов (ААР)», Ассоциация акушерских анестезиологов-реаниматологов. Клинические рекомендации. Многоплодная беременность. 2020. [Russian Society of Obstetricians and Gynecologists (ROAG), Association of Anesthesiologists-Resuscitators (AAR), Association of Obstetric Anesthesiologists-Resuscitators. Clinical Guidelines. Multiple pregnancy. 2020. (in Russian)].
Костюков К.В., Гладкова К.А. Диагностика синдрома селективной задержки роста плода, синдрома обратной артериальной перфузии при монохориальной многоплодной беременности. Акушерство и гинекология. 2016; 2: 14-8. [Kostyukov K.V., Gladkova K.A. Diagnosis of selective fetal growth restriction syndrome and reversed arterial perfusion in monochorionic multiple pregnancy. Obstetrics and Gynecology. 2016; (2): 14-8. (in Russian)].https://dx.doi.org/10.18565/aig.2016.2.14-18.
Михайлов А.В., Романовский А.Н., Кузнецов А.А., Каштанова Т.А., Шлыкова А.В., Кянксеп И.В. Синдром обратной артериальной перфузии: патофизиологические аспекты и принципы диагностики. Таврический медико-биологический вестник. 2018; 21(2-2): 195-201. [Mikhailov A.V., Romanovsky A.N., Kuznetsov A.A., Kashtanova T.A., Shlykova A.V., Kyanksep I.V. Pathophysiological aspects and diagnostic principles of twin reversed arterial perfusion. Taurian Medical and Biological Bulletin. 2018;21(2-2): 195-201. (in Russian)].
Костюков К.В., Павлов К.А., Дубова Е.А., Стыгар А.М., Гус А.И., Щёголев А.И. Синдром обратной артериальной перфузии (клинические наблюдения и обзор литературы). Медицинская визуализация. 2012; 6: 120-6. [Kostukov K.V., Pavlov K.A., Dubova E.A., Stygar A.M., Gus A.I., Shchegolev A.I. Twin reversed arterial perfusion syndrome (Case report and literature review). Medical Imaging. 2012; (6): 120-6. (in Russian)].
Костюков К.В., Гладкова К.А., Тетруашвили Н.К. Тактика ведения беременности при синдроме обратной артериальной перфузии. Акушерство и гинекология. 2018; 11: 44-9 [Kostyukov K.V., Gladkova K.A., Tetruashvili N.K. Pregnancy management tactics in reversed arterial perfusion syndrome. Obstetrics and Gynecology. 2018; (11): 44-9. (in Russian)].https://dx.doi.org/10.18565/aig.2018.11.44-49.
van Gemert M.J.C., van den Wijngaard J.P.H.M., Vandenbussche F.P.H.A. Twin reversed arterial perfusion sequence is more common than generally accepted. Birth Defects Res. A Clin. Mol. Teratol. 2015; 103(7): 641-3.https://dx.doi.org/10.1002/bdra.23405.
Woo H.H., Sin S.Y., Tang L.C. Single foetal death in twin pregnancies: review of the maternal and neonatal outcomes and management. Hong Kong Med. J. 2000; 6(3): 293-300.
De Villiers S.F., Slaghekke F., Middeldorp J.M., Walther F.J., Oepkes D., Lopriore E. Arterio-arterial vascular anastomoses in monochorionic placentas with and without twin–twin transfusion syndrome. Placenta. 2012; 33(8): 652-4. https://dx.doi.org/10.1016/j.placenta.2012.05.003.
Lewi L., Deprest J., Hecher K. The vascular anastomoses in monochorionic twin pregnancies and their clinical consequences. Am. J. Obstet. Gynecol. 2013; 208(1): 19-30. https://dx.doi.org/10.1016/j.ajog.2012.09.025.
Lopriore E., Holtkamp N., Sueters M., Middeldorp J.M., Walther F.J., Oepkes D. Acute peripartum twin–twin transfusion syndrome: Incidence, risk factors, placental characteristics and neonatal outcome. J. Obstet. Gynaecol. Res. 2014; 40(1): 18-24. https://dx.doi.org/10.1111/jog.12114.
Lopriore E., Oepkes D. Fetal and neonatal haematological complications in monochorionic twins. Semin. Fetal Neonatal Med. 2008; 13(4): 231-8.https://dx.doi.org/10.1016/j.siny.2008.02.002.
Skupski D.W., Sylvestre G., Di Renzo G.C., Grunebaum A. Acute twin-twin transfusion syndrome in labor: pathophysiology and associated factors. J. Matern. Fetal Neonatal Med. 2012; 25(5): 456-60. https://dx.doi.org/10.3109/14767058.2011.637146.
Verbeek L., Zhao D.P., Middeldorp J.M., Oepkes D., Hooper S.B., Te Pas A.B., Lopriore E. Haemoglobin discordances in twins: due to differences in timing of cord clamping? Arch. Dis. Child Fetal Neonatal Ed. 2017; 102(4): 324-8. https://dx.doi.org/10.1136/archdischild-2016-311822.
Tan T.Y.T., Denbow M.L., Cox P.M., Talbert D., Fisk N.M. Occlusion of arterio-arterial anastomosis manifesting as acute twin–twin transfusion syndrome. Placenta. 2004; 25(2-3): 238-42. https://dx.doi.org/10.1016/j.placenta.2003.08.018.
Suzuki S., Iwasaki N., Ono S., Igarashi M., Murata T. Fetal heart rate patterns in monochorionic twins following acute twin-twin transfusion. Obstet. Gynecol. Int. 2009; 2009: 498530. https://dx.doi.org/10.1155/2009/49853.
Общероссийская общественная организация содействия развитию неонатологии «Российское общество неонатологов» (РОН). Клинические рекомендации. Врожденная анемия вследствие кровопотери у плода. 2021. [All-Russian Public Organization for Promoting the Development of Neonatology "Russian Society of Neonatologists" (RSN). Clinical guidelines. Congenital anemia due to fetal blood loss. 2021. (in Russian)].
Общероссийская общественная организация содействия развитию неонатологии «Российское общество неонатологов» (РОН), Общественная организация «Российская ассоциация специалистов перинатальной медицины» (РАСПМ). Клинические рекомендации. Диагностика и лечение полицитемии новорожденных. 2015. [All-Russian Public Organization for Promoting the Development of Neonatology "Russian Society of Neonatologists" (RSN), Public Organization "Russian Association of Perinatal Medicine Specialists" (RAPMS). Clinical guidelines. Diagnosis and treatment of polycythemia in newborns. 2015. (in Russian)].
Aviram A., Lipworth H., Asztalos E.V., Mei-Dan E., Melamed N., Cao X. et al. Delivery of monochorionic twins: lessons learned from the Twin Birth Study. Am. J. Obstet. Gynecol. 2020; 223(6): 916.e1-916.e9.https://dx.doi.org/10.1016/j.ajog.2020.06.048.
Melka S., Miller J., Fox N.S. Labor and delivery of twin pregnancies. Obstet. Gynecol. Clin. 2017; 44(4): 645-54. https://dx.doi.org/10.1016/j.ogc.2017.08.004.
Pestana I., Loureiro T., Almeida A., Rocha I., Rodrigues R.M., Rodrigues T. Effect of mode of delivery on neonatal outcome of monochorionic diamniotic twin pregnancies: a retrospective cohort study. J. Reprod. Med. 2013; 58(1-2): 15-8.
Weisz B., Hogen L., Yinon Y., Mazaki S., Gindes L., Schiff E. et al. Mode of delivery and neonatal outcome in uncomplicated monochorionic twin pregnancies. J. Matern. Fetal Neonatal Med. 2012; 25(12): 2721-4.https://dx.doi.org/10.3109/14767058.2012.712560.

Received 03.11.2022

Accepted 13.01.2023

Anton V. Mikhailov, Dr. Med. Sci., Director and Chief of the Maternity Hospital No. 17, 4-1 Lesnozavodskaya str., St. Petersburg, 192174, Russia;
Professor at the Department of Obstetrics, Gynecology and Reproduction, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia,
6-8 L'va Tolstogo str., St. Petersburg, 197022, Russia; Professor at the Department of Obstetrics and Gynecology, I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, 47, Piskarevsky Ave., St. Petersburg, 195067, Russia; Chief Researcher, D.O. Ott Institute of Obstetrics, Gynecology and Reproductology,
3 Mendeleevskaya line, St. Petersburg, 199034, Russia, mav080960@gmail.com
Artem N. Romanovsky, PhD, obstetrician-gynecologist, ultrasound diagnostician, Maternity Hospital No. 17, 4-1 Lesnozavodskaya str., St. Petersburg, 192174, Russia;
Associate Professor at the Department of Obstetrics, Gynecology and Reproductology, St. Petersburg State University, 8а, 21-line, St. Petersburg, 199004, Russia.
Veronika E. Volchenkova, obstetrician-gynecologist, ultrasound diagnostician, Maternity Hospital No. 17, 4-1 Lesnozavodskaya str., St. Petersburg, 192174, Russia;
postgraduate of the Department of Obstetrics and Gynecology, I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia,
47, Piskarevskiy Ave., St. Petersburg, 195067, Russia.
Alexandr A. Kuznetsov, PhD, obstetrician-gynecologist, Maternity Hospital No. 17, 4-1 Lesnozavodskaya str., St. Petersburg, 192174, Russia;
assistant of the Department of Obstetrics, Gynecology and Reproduction, Pavlov First St. Petersburg State Medical University, Ministry of Health of Russia,
6-8, L'va Tolstogo str., St. Petersburg, 197022, Russia.
Alexey N. Kyanksep, Head of Neonatology, Maternity Hospital No. 17, Lesnozavodskaya str. 4-1, St. Petersburg, 192174, Russia.
Anna A. Saveleva, ultrasound diagnostician, Maternity Hospital No. 17, 4-1 Lesnozavodskaya str., St. Petersburg, 192174, Russia.
Anastasia V. Osipova, resident at the Department of Obstetrics, Gynecology and Reproductology, St. Petersburg State University, 8а, 21-line, St. Petersburg, 199004, Russia.
Maria K. Tcyganova, resident at the Department of Obstetrics, Gynecology and Reproductology, St. Petersburg State University, 8а, 21-line, St. Petersburg, 199004, Russia.
Corresponding author: Anton V. Mikhailov, mav080960@gmail.com

Acute twin-to-twin transfusion in monochorionic multiple pregnancy

Mikhailov A.V., Romanovsky A.N., Volchenkova V.E., Kuznetsov A.A., Kyanksep A.N., Saveleva A.A., Osipova A.V., Tcyganova M.K.

Keywords

References

About the Authors

Similar Articles