Twin-to-twin transfusion syndrome (TTTS) pathogenesis, diagnostics, classification and treatment options
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Twin to twin transfusion syndrome (TTTS) belongs to the group of multiple monochorionic pregnancies complications. The pathogenesis of this syndrome is not entirely clear, however there is a correlation between the location of the placentas trailers of umbilical cord, and the tendency to its occurrence. Moreover it is characterized by the existence of vascular connections in common placenta. It results in hemodynamic disorders, which consist in full leakage from one fetus called a "donor" to another fetus called the "recipient". Hypotony, hypotrophy, hypovolemia, anemia and oliguria are being developed in donor’s as the result. Whereas the second fetus is under the risk of hypertrophy, hypertension, hypervolaemia, polycythemia and polyhydramnios. TTTS is a complication occurring in 10-15% of all monochorionic pregnancies. If no treatment is performed the fetal mortality occurs in 60-100% of cases. Diagnosis of twin-to-twin transfusion syndrome is based on ultrasound assessment of amniotic fluid volume. The conditions of diagnose are: the occurrence of common chorioid for both twins in the first trimester and measurement of the maximum fluid pocket. The main and preferred therapeutic method is fetoscopic laser coagulation of vascular connections. Treatment depends on the age of the fetus. The most important factor affecting prognosis is early diagnosis of TTTS and consultation at the reference center of fetal therapy.
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