Ward Morgan A
C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
AANA J. 2013 Jun;81(3):222-4.
Twin-twin transfusion syndrome (TTTS) is a complication of multiple gestation in which arteriovenous vascular communications occur in a shared placenta. Due to these communications, there is an imbalance of blood flow between the developing fetuses. This results in 1 twin becoming the donor and the other becoming the recipient. In severe cases, the recipient may experience polycythemia, polyhydramnios, and hydrops fetalis, while in the donor oligohydramnios and severe anemia may develop. It has been reported that fetal mortality can reach as high as 60% to 80% if TTTS develops before 26 weeks' gestation and goes untreated. Therapeutic options available include decompression amniocentesis, amniotic septostomy, interruption of the placental vessel communications, and selective fetal reduction. Selective fetoscopic laser photocoagulation of abnormal vascular communications has shown to result in increasing survival rates and has become a definitive treatment option for severe TTTS. The case report presented involves a 32-year-old, gravida 5, para 2 patient at 19 weeks' estimated gestational age with a monochorionic diamniotic twin gestation with TTS diagnosed using ultrasonography presenting for an elective laparoscopic fetal laser photocoagulation.
双胎输血综合征（TTTS）是多胎妊娠的一种并发症，其中在共用胎盘中发生动静脉血管交通。由于这些交通，发育中的胎儿之间存在血流不平衡。这导致一个胎儿成为供血儿，另一个成为受血儿。在严重的情况下，受血儿可能会出现红细胞增多症、羊水过多和胎儿水肿，而供血儿可能会出现羊水过少和严重贫血。据报道，如果TTTS在妊娠26周前发生且未得到治疗，胎儿死亡率可高达60%至80%。可用的治疗选择包括减压羊膜穿刺术、羊膜隔造口术、胎盘血管交通中断和选择性减胎术。选择性胎儿镜激光凝固异常血管交通已显示可提高存活率，并已成为严重TTTS的确定性治疗选择。所呈现的病例报告涉及一名32岁、孕5产2的患者，估计孕周为19周，单绒毛膜双羊膜囊双胎妊娠，经超声检查诊断为TTTS，前来接受择期腹腔镜胎儿激光凝固治疗。
