Fetofetal Transfusion (Twin Transfusion Syndrome)

Passage of blood from one fetus to another via an arteriovenous communication or other shunt, in a monozygotic twin pregnancy. It results in anemia in one twin and polycythemia in the other. (Lee et al., Wintrobe's Clinical Hematology, 9th ed, p737-8)

Also Known As:

Twin Transfusion Syndrome; Fetal Transfusion Syndrome; Fetofetal Transfusion Syndrome; Twin Twin Transfusion Syndrome; Twin-to-Twin Transfusion Syndrome; Cross Transfusion, Intrauterine; Fetal Transfusion Syndromes; Fetofetal Transfusion Syndromes; Fetofetal Transfusions; Intrauterine Cross Transfusion; Intrauterine Cross-Transfusions; Syndrome, Fetal Transfusion; Syndrome, Fetofetal Transfusion; Syndrome, Twin Transfusion; Syndrome, Twin-to-Twin Transfusion; Transfusion Syndrome, Fetal; Transfusion Syndrome, Fetofetal; Transfusion Syndrome, Twin; Transfusion Syndrome, Twin-to-Twin; Transfusion, Fetofetal; Transfusion, Twin; Transfusion, Twin-to-Twin; Twin Transfusion Syndromes; Twin Transfusions; Twin to Twin Transfusion; Twin to Twin Transfusion Syndrome; Twin-to-Twin Transfusion Syndromes; Twin-to-Twin Transfusions; Cross-Transfusion, Intrauterine; Intrauterine Cross-Transfusion; Twin Transfusion; Twin-to-Twin Transfusion

Networked: 893 relevant articles (53 outcomes, 145 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Anemia
2.	Polycythemia (Erythrocytosis)
3.	Premature Birth (Birth, Premature)
4.	Cardiomyopathies (Cardiomyopathy)
5.	Fetal Death

Experts

1.	Chmait, Ramen H: 53 articles (02/2022 - 08/2006)
2.	Lopriore, Enrico: 37 articles (01/2022 - 11/2005)
3.	Oepkes, Dick: 32 articles (01/2021 - 11/2005)
4.	Middeldorp, Johanna M: 30 articles (01/2022 - 11/2005)
5.	Oepkes, D: 28 articles (01/2019 - 06/2004)
6.	Deprest, Jan: 26 articles (06/2022 - 07/2004)
7.	Lopriore, E: 26 articles (01/2019 - 06/2004)
8.	Korst, Lisa M: 24 articles (02/2022 - 07/2008)
9.	Llanes, Arlyn: 24 articles (02/2022 - 05/2011)
10.	Ville, Yves: 23 articles (11/2022 - 07/2004)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Fetofetal Transfusion:

1.	Indomethacin (Indometacin)FDA LinkGeneric 09/01/2018 - "Several reports of fetal ductal constriction have been described after indomethacin use in the literature; however, there are no previously documented reports describing an association between Twin-Twin Transfusion syndrome and a constrictor effect of indomethacin on the ductus arteriosus. " 05/01/1995 - "Indomethacin for treatment of fetofetal transfusion syndrome." 01/01/1993 - "Because of our experience with these three cases, we conclude that indomethacin does not prevent perinatal mortality in patients with severe twin-to-twin transfusion syndrome." 01/01/1993 - "We report the use of indomethacin in three cases of severe twin-to-twin transfusion syndrome in the second trimester. " 01/01/1993 - "Indomethacin in severe twin-to-twin transfusion syndrome."
2.	Hemoglobins (Hemoglobin)IBA 01/01/1998 - "The sonographic criteria seem to be very useful in diagnosis of twin-to-twin transfusion syndrome, especially in cases where the measurement of hemoglobin level is impossible. " 01/01/2010 - "The objective of the study was to develop a noninvasive technique to determine hemoglobin (Hb) content through spectral analysis of diffusely reflected broadband visible illumination from individual blood vessels during endoscopic fetal surgery for twin-to-twin transfusion syndrome (TTTS). " 01/01/1998 - "The aim of this study was to show the diagnostic possibilities of ultrasound in twin-to-twin transfusion syndrome (TTTS), to demonstrate its usefulness in cases of hemoglobin difference < 5 g/dL in neonates as well as in cases complicated by intrauterine death of one or both twins. " 11/01/2014 - "TAPS is an uncommon form of chronic fetofetal transfusion, characterized by large intertwin hemoglobin (Hb) differences in the absence of amniotic fluid discordances. " 08/01/2014 - "In cases of TAPS following twin-to-twin transfusion, the mean hemoglobin level was higher in donors than in anemic twins with isolated TAPS (P = 0.029) and similar between recipients and polycythemic twins with isolated TAPS (P = 0.135). "
3.	ReninIBA 03/01/2001 - "Renin gene expression in fetal kidneys of pregnancies complicated by twin-twin transfusion syndrome." 07/01/2012 - "Renin is activated in monochorionic diamniotic twins with birthweight discordance who do not have twin-to-twin transfusion syndrome." 07/01/2012 - "To assess renin, aldosterone, human atrial natriuretic peptide (hANP) and brain natriuretic peptide (BNP) levels in cord blood from monochorionic diamniotic (MD) twins with a birthweight (BW) discordance that do not satisfy the criteria of twin-to-twin transfusion syndrome (TTTS). " 01/01/2014 - "Inherited RTD is genetically heterogeneous and linked to mutations in the genes encoding the major components of the renin-angiotensin system (RAS): angiotensinogen, renin, angiotensin-converting enzyme or angiotensin II receptor type 1. Mutations result in either the absence of production or lack of efficacy of angiotensin II. Secondary RTD has been observed in various situations, particularly in the donor twin of severe twin-to-twin transfusion syndrome, in foetuses affected with congenital haemochromatosis or in foetuses exposed to RAS blockers. "
4.	Ritodrine (Yutopar)FDA Link 04/01/1995 - "This was a case of twin-to-twin transfusion syndrome and the arrhythmia was caused by ritodrine therapy. " 01/01/1995 - "We present a case of agranulocytosis after prolonged intravenous infusion of ritodrine hydrochloride and additional administration of indomethacin suppositories, effectively treated using recombinant human granulocyte colony stimulating factor without any infection in a mother with twin-to-twin transfusion syndrome. "
5.	Peptidyl-Dipeptidase A (Angiotensin Converting Enzyme)IBA 01/01/1994 - "A similar tubular lesion due to antenatal tubular atrophy has been reported for conjoined twins with twin-twin transfusion syndrome or acardia and in infants of mothers given antihypertensive agents, including angiotensin-converting enzyme (ACE) inhibitors, during pregnancy, and it has been seen as a unilateral lesion in young infants with renal artery stenosis due to arteritis or medial arterial calcinosis. " 01/01/2014 - "Inherited RTD is genetically heterogeneous and linked to mutations in the genes encoding the major components of the renin-angiotensin system (RAS): angiotensinogen, renin, angiotensin-converting enzyme or angiotensin II receptor type 1. Mutations result in either the absence of production or lack of efficacy of angiotensin II. Secondary RTD has been observed in various situations, particularly in the donor twin of severe twin-to-twin transfusion syndrome, in foetuses affected with congenital haemochromatosis or in foetuses exposed to RAS blockers. "
6.	Granulocyte Colony-Stimulating Factor (G-CSF)IBA 01/01/1995 - "We present a case of agranulocytosis after prolonged intravenous infusion of ritodrine hydrochloride and additional administration of indomethacin suppositories, effectively treated using recombinant human granulocyte colony stimulating factor without any infection in a mother with twin-to-twin transfusion syndrome. "
7.	Suppositories (Vaginal Suppositories)IBA 01/01/1995 - "We present a case of agranulocytosis after prolonged intravenous infusion of ritodrine hydrochloride and additional administration of indomethacin suppositories, effectively treated using recombinant human granulocyte colony stimulating factor without any infection in a mother with twin-to-twin transfusion syndrome. "
8.	Angiotensin Receptors (Angiotensin II Receptor)IBA 01/01/2014 - "Inherited RTD is genetically heterogeneous and linked to mutations in the genes encoding the major components of the renin-angiotensin system (RAS): angiotensinogen, renin, angiotensin-converting enzyme or angiotensin II receptor type 1. Mutations result in either the absence of production or lack of efficacy of angiotensin II. Secondary RTD has been observed in various situations, particularly in the donor twin of severe twin-to-twin transfusion syndrome, in foetuses affected with congenital haemochromatosis or in foetuses exposed to RAS blockers. "
9.	Nifedipine (Adalat)FDA LinkGeneric 10/01/2010 - "We conducted a case control study of consecutive cases of twin-twin transfusion syndrome (TTTS) in which TTTS cardiomyopathy was treated with maternal nifedipine 24-48 hours before SFLP, compared with gestational age and stage-matched control cases. " 10/01/2010 - "Improved recipient survival with maternal nifedipine in twin-twin transfusion syndrome complicated by TTTS cardiomyopathy undergoing selective fetoscopic laser photocoagulation."
10.	Heparin (Liquaemin)FDA LinkGeneric 02/05/2007 - "Severe preeclampsia cured by heparin in a patient with twin-twin transfusion syndrome."

Therapies and Procedures

1.	Laser Therapy (Surgery, Laser) 12/01/2009 - "Fetoscopic laser therapy with selective coagulation of placental intertwin anastomoses is the best option in the treatment of twin-to-twin transfusion syndrome. " 01/01/2014 - "Despite improved perinatal survival following fetoscopic laser ablation (FLA) for twin-twin transfusion syndrome (TTTS), prematurity remains an important contributor to perinatal mortality and morbidity. " 02/01/2016 - "The introduction of fetoscopic laser surgery of placental anastomoses has led to a significant improvement of perinatal outcome of twin pregnancies affected by twin-to-twin-transfusion syndrome (TTTS). " 05/19/2002 - "The prognosis of twin-to-twin transfusion syndrome can be improved significantly with serial amnioreduction, amniotic fenestration, laser ablation of connecting vessels or selective fetocidium. " 09/01/2000 - "Fetoscopic laser ablation is a safe and effective form of treatment in the management of severe twin-to-twin transfusion syndrome. "
2.	Lasers (Laser) 09/01/2019 - "Fetoscopic laser has been shown to be the best first line treatment, which aims to dichorionise the placenta therefore arresting the inter-twin transfusion. " 02/25/2019 - "For non-severe structural malformation in MCDA patients with twin transfusion syndrome, fetoscopic laser occlusion is safe and effective. " 04/01/2016 - "Background Placental laser equatorialization or "solomonization" during treatment for twin-twin transfusion syndrome (TTTS) is associated with improved pregnancy outcomes. " 04/01/2006 - "Early predictors of laser efficacy in twin-to-twin transfusion syndrome treatment, such as improvement in the umbilical vein flow imbalance and urine production, are being evaluated, because they are earlier predictors of outcome than amniotic fluid discordance. " 04/01/1995 - "We undertook a pilot study to determine the feasibility and efficacy of fetoscopic laser occlusion of chorioangiopagous vessels in severe previable twin-twin transfusion syndrome. "
3.	Laser Coagulation 02/01/2006 - "With a high rate (86.8%) of normal neurodevelopmental outcome and an incidence of only 6.0% of major neurologic deficiencies, intrauterine laser coagulation seems to be the best treatment option for severe twin-twin transfusion syndrome." 03/01/2005 - "As such, fetoscopic laser coagulation is currently the best first-line treatment for severe twin-to-twin transfusion syndrome. " 07/08/2004 - "Endoscopic laser coagulation of anastomoses is a more effective first-line treatment than serial amnioreduction for severe twin-to-twin transfusion syndrome diagnosed before 26 weeks of gestation." 06/01/2008 - "The fetoscopic laser coagulation of the vascular anastomoses on the monochorianic placenta for twin-to-twin transfusion syndrome (TTTS) has recently been shown to be effective. " 01/01/2021 - "Selective fetoscopic laser coagulation of the intertwin anastomotic chorionic vessels is the first-line treatment for twin-twin transfusion syndrome. "
4.	Light Coagulation 04/01/2005 - "The objective of this study was to assess the percentage of individual placental mass (individual placental territory) that is associated with fetal survival in twin-twin transfusion syndrome after selective photocoagulation of communicating vessels. " 01/01/2016 - "The narrow fetoscopic field of views and the vast vascular network on the placenta make examination and photocoagulation treatment of twin-to-twin transfusion syndrome challenging. " 10/01/2015 - "Image guidance plays a central role in minimally invasive fetal surgery such as photocoagulation of inter-twin placental anastomosing vessels to treat twin-to-twin transfusion syndrome (TTTS). " 10/01/2013 - "To document perinatal outcomes following use of the 'Solomon technique' in the selective photocoagulation of placental anastomoses for severe twin-twin transfusion syndrome (TTTS). " 05/01/2010 - "Successful photocoagulation on both sides of inter-twin membrane for twin-twin transfusion syndrome in a case of iatrogenic septostomy after an amnioreduction."
5.	Therapeutics 04/01/2001 - "We sought to review the available information on the etiology of twin-twin transfusion syndrome, to identify parameters that contribute to the severity of the syndrome, and propose a rational management plan based on pathophysiology, clinical presentation and the efficacy of therapies. " 06/01/1998 - "Chorionic plate vascular anatomy determines the efficacy of amnioreduction therapy for twin-twin transfusion syndrome." 10/01/2023 - "Feasibility of continuous intra-uterine pressure measurements during amnioreduction in twin-to-twin transfusion syndrome therapy." 09/01/2019 - "Beta blocker therapy in recipients of twin-to-twin transfusion syndrome." 01/01/2019 - "High-intensity focused ultrasound (HIFU) is a non-invasive method of selective placental vascular occlusion, providing a potential therapy for conditions such as twin-twin transfusion syndrome. "