Rossi A C, D'addario V
IV Clinic of Obstetrics and Gynecology, University of Bari, Bari, Italy.
Minerva Ginecol. 2009 Apr;61(2):153-65.
Twin-twin transfusion syndrome (TTTS) is a condition unique to monochorionic pregnancies, although very few case reports described the syndrome in dichorionic placentas. The aetiology of TTTS relies in the presence of at least 1 arterio-venous placental anastomosis, through which unequal blood exchange from one twin (donor) to the co-twin (recipient) occurs. The diagnosis of TTTS relies on the sonographic detection of oligohydramnios in the donor's sac and polyhydramnios in the recipient's sac in the second trimester, although signs of TTTS are present since the first trimester. Treatment options for TTTS include serial amnioreduction, septostomy, selective feticide of the apparently sick twin, and selective photocoagulation of placental vessels (SLPCV). Because of the growing evidence that SLPCV is the most efficacious therapy compared to amnioreduction with/without septostomy, the authors reviewed in details the effects of SLPCV on fetal growth and circulation. The authors further explore literature with regard to the prognostic factors. Finally, because Quintero staging system is actually under debate, they discuss the most recent findings on this topic and propose a new staging system to assess severity of TTTS at presentation (Rossi staging system). New topics for future research, which would probably further clarify the natural history of TTTS, are also proposed.
双胎输血综合征（TTTS）是单绒毛膜妊娠特有的一种情况，尽管极少数病例报告描述了双绒毛膜胎盘的该综合征。TTTS的病因在于至少存在1个胎盘动静脉吻合支，通过该吻合支发生了从一个胎儿（供血儿）到另一胎儿（受血儿）的不等量血液交换。TTTS的诊断依赖于孕中期超声检测到供血儿羊膜腔内羊水过少和受血儿羊膜腔内羊水过多，尽管TTTS的迹象自孕早期就已存在。TTTS的治疗选择包括反复羊膜腔穿刺减压、隔膜造口术、对明显患病胎儿进行选择性减胎术以及胎盘血管选择性激光凝固术（SLPCV）。由于越来越多的证据表明，与有/无隔膜造口术的羊膜腔穿刺减压相比，SLPCV是最有效的治疗方法，作者详细回顾了SLPCV对胎儿生长和循环的影响。作者进一步探讨了有关预后因素的文献。最后，由于Quintero分期系统实际上仍存在争议，他们讨论了该主题的最新研究结果，并提出了一种新的分期系统，以评估TTTS初诊时的严重程度（Rossi分期系统）。还提出了未来研究的新课题，这可能会进一步阐明TTTS的自然病程。
