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Chapter 6 - Twin-Twin Transfusion Syndrome

from Section 2

Published online by Cambridge University Press:  19 November 2021

By
Rupi Mavi Parikh  and
Jose L. Peiro
Edited by
Olutoyin A. Olutoye
Olutoyin A. Olutoye
Affiliation:
Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois
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Summary

Twin pregnancies, especially those in which the twins share one placenta but have separate amnion sacs (referred to monochorionic, diamniotic or Mo-di twins), are at risk for a number of complications. Most notable of these is twin-twin transfusion syndrome. This condition can result in fetal morbidity or intrauterine fetal demise but is also amenable to surgical intervention. Severe discordance in amniotic fluid volumes between each twin is the prenatal finding that highlights this diagnosis. Selective laser photocoagulation has greatly improved the survival of twins with this condition. With a posteriorly located placenta, laser ablation of the abnormal placenta vascular communications can be achieved with local anesthesia and maternal sedation. Anterior placenta location may present a challenge for uterine access that may require modification of the anesthetic technique.

Keywords

twin-twin transfusionplacental anastomoseshydropsrecipient twindonor twinlaser photocoagulationanemiapolycythemiamnioreduction
Type
Chapter
Information
Anesthesia for Maternal-Fetal Surgery
Concepts and Clinical Practice
 , pp. 83 - 94
Publisher: Cambridge University Press
Print publication year: 2021

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