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Reversal of twin–twin transfusion syndrome: frequency, vascular anatomy, associated anomalies and outcome
Author(s) -
Wee Ling Y.,
Taylor Myles J. O.,
Vanderheyden Tina,
Wimalasundera Ruwan,
Gardiner Helena M.,
Fisk Nicholas M.
Publication year - 2004
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.799
Subject(s) - aneuploidy , twin twin transfusion syndrome , anastomosis , medicine , fetus , monochorionic twins , obstetrics , pregnancy , pediatrics , surgery , biology , chromosome , genetics , gene
Objective To determine the frequency of reversal of transfusional gradient and phenotype in a large cohort of prospectively studied cases of twin–twin transfusion syndrome (TTTS) and seek evidence of clinical or placental anastomotic associations. Methods Consecutive cases of TTTS seen over an eight‐year period with serial documentation of ultrasonic growth, liquor volume and fetal and placental Doppler studies were reviewed. Postnatal injection studies were inspected. Results Reversal of TTTS occurred in 5 of 96 affected pregnancies (5%). Two of the five cases had underlying aneuploidy or genetic syndrome, higher than the 2% frequency found in cases without reversal of TTTS ( p < 0.05). Placental anastomotic configurations provided no consistent explanation for reversal of phenotype. Conclusion This study documents the frequency of reversal of the direction of TTTS, and suggests that it is a heterogeneous condition. Reversal of donor–recipient phenotype may be explained by haemodynamic changes secondary to underlying aneuploidy/genetic syndromes, to the presence of multiple anastomoses in either direction or following laser ablation. This series together with previous case reports argues for a high level of suspicion for underlying aneuploidy, genetic syndrome or structural defects where there is reversal of the donor–recipient phenotype. Copyright © 2004 John Wiley & Sons, Ltd.