Stillbirth Risk'Twin Blood Transfusion Syndrome', Fetal Endoscopic Surgery to Give Birth to Health
Nov 06, 2024
#. Mr. A in his 30s, who was pregnant naturally with identical twins, felt uncomfortable because his stomach expanded due to a sudden increase in amniotic fluid in the 15th week of pregnancy. A, who visited the hospital, was diagnosed with twin blood transfusion syndrome and performed fetal endoscopy to give birth to a healthy child later.
Twin-to-Twin Transfusion Syndrome (TTTS) is a serious complication that can occur during identical twin pregnancy, and refers to a pathological condition that occurs when the fetus shares blood vessels with the placenta in the uterus. It is known to occur in 9-15% of identical twin pregnancies.
Twin blood transfusion syndrome, which occurs by sharing one placenta, is caused by the vascular connection between the twins causing problems.
It is characterized by a disproportionate blood flow between the two fetuses, i.e., circulatory disorders, and one fetus receives excessive blood from the other and widens, while the other fetus lacks blood, resulting in deterioration of both fetuses' physical conditions. If this imbalance persists, each fetus may suffer from problems such as heart burden, kidney dysfunction, and growth impairment, and in severe cases, the risk of leading to stillbirth increases. Early detection and treatment significantly improve fetal survival, but without treatment, both fetuses have a very poor prognosis that can die 73-100%.
The main symptom is abdominal bloating due to overamniotic fluid, which causes overamniotic fluid in one fetus and overamniotic fluid in the other due to the difference in amniotic fluid volume between the two fetuses. Through ultrasound examination, it is confirmed through comprehensive evaluation such as imbalance in amniotic fluid volume, difference in growth between fetuses, and abnormal fetal heart function.
The stage of twin transfusion syndrome is divided into five stages depending on the degree. The first stage shows a difference in the amount of amniotic fluid between the two fetuses, but it is normal in Doppler ultrasound, which can determine the flow of blood in the blood vessels. After that, the bladder of the donor fetus goes through the second stage, the third stage, which shows differences in amniotic fluid volume and abnormal blood flow patterns, and the fourth stage, where the unborn baby is still born.
Treatment methods require various approaches depending on the degree of progression. In the early stages of the first stage, the fetal condition is monitored through intensive observation and watched whether it naturally improves. However, for severe cases of stage 2 or higher, active treatment methods such as intrauterine fetal endoscopic laser treatment or early childbirth are required. Prenatal endoscopic laser treatment is recommended between 16 and 26 weeks of pregnancy as a way to resolve the imbalance in blood flow by blocking the blood vessels of two fetuses connected to the placenta. The average birth period after treatment is between 32 and 34 weeks of pregnancy, and most of them give birth prematurely.
"First of all, it is very important to accurately identify whether identical twins are identical twins early in pregnancy," said Kim Ho-yeon, director of the Center for Integrated Treatment of High-Risk Mothers and Births at Korea University Ansan Hospital. "The risk can be reduced through early detection of twin transfusion syndrome in identical twins, and periodic prenatal examinations and ultrasound examinations are important."
Professor Song Kwan-hyeop from the obstetrics and gynecology department said "In the case of fetal endoscopic laser treatment, the medical community has recently shown high success rates, giving healthier children a chance to be born.""We are also successfully performing fetal endoscopic surgery for twin transfusion syndrome at the Integrated Treatment Center for High-Risk Mother and Child at the Korea Advanced Institute of Obstetrics and Maternity.""
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Twin-to-Twin Transfusion Syndrome (TTTS) is a serious complication that can occur during identical twin pregnancy, and refers to a pathological condition that occurs when the fetus shares blood vessels with the placenta in the uterus. It is known to occur in 9-15% of identical twin pregnancies.
Twin blood transfusion syndrome, which occurs by sharing one placenta, is caused by the vascular connection between the twins causing problems.
It is characterized by a disproportionate blood flow between the two fetuses, i.e., circulatory disorders, and one fetus receives excessive blood from the other and widens, while the other fetus lacks blood, resulting in deterioration of both fetuses' physical conditions. If this imbalance persists, each fetus may suffer from problems such as heart burden, kidney dysfunction, and growth impairment, and in severe cases, the risk of leading to stillbirth increases. Early detection and treatment significantly improve fetal survival, but without treatment, both fetuses have a very poor prognosis that can die 73-100%.
The main symptom is abdominal bloating due to overamniotic fluid, which causes overamniotic fluid in one fetus and overamniotic fluid in the other due to the difference in amniotic fluid volume between the two fetuses. Through ultrasound examination, it is confirmed through comprehensive evaluation such as imbalance in amniotic fluid volume, difference in growth between fetuses, and abnormal fetal heart function.
The stage of twin transfusion syndrome is divided into five stages depending on the degree. The first stage shows a difference in the amount of amniotic fluid between the two fetuses, but it is normal in Doppler ultrasound, which can determine the flow of blood in the blood vessels. After that, the bladder of the donor fetus goes through the second stage, the third stage, which shows differences in amniotic fluid volume and abnormal blood flow patterns, and the fourth stage, where the unborn baby is still born.
Treatment methods require various approaches depending on the degree of progression. In the early stages of the first stage, the fetal condition is monitored through intensive observation and watched whether it naturally improves. However, for severe cases of stage 2 or higher, active treatment methods such as intrauterine fetal endoscopic laser treatment or early childbirth are required. Prenatal endoscopic laser treatment is recommended between 16 and 26 weeks of pregnancy as a way to resolve the imbalance in blood flow by blocking the blood vessels of two fetuses connected to the placenta. The average birth period after treatment is between 32 and 34 weeks of pregnancy, and most of them give birth prematurely.
"First of all, it is very important to accurately identify whether identical twins are identical twins early in pregnancy," said Kim Ho-yeon, director of the Center for Integrated Treatment of High-Risk Mothers and Births at Korea University Ansan Hospital. "The risk can be reduced through early detection of twin transfusion syndrome in identical twins, and periodic prenatal examinations and ultrasound examinations are important."
Professor Song Kwan-hyeop from the obstetrics and gynecology department said "In the case of fetal endoscopic laser treatment, the medical community has recently shown high success rates, giving healthier children a chance to be born.""We are also successfully performing fetal endoscopic surgery for twin transfusion syndrome at the Integrated Treatment Center for High-Risk Mother and Child at the Korea Advanced Institute of Obstetrics and Maternity.""
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