Tvilling-tvilling transfusjon syndrom. Årsak og behandling.

Abstract

Objective: The aim of this review was to present different treatment options for pregnancies diagnosed with twin to twin transfusion syndrome (TTTS) and compare them to each other. Background: Twin to twin transfusion syndrome is a rare and serious complication affecting 5,5-17% of all monozygotic, monochorionic, diamniotic twin pregnancies. Without treatment TTTS is associated with a high risk of fetal and neonatal mortality and morbidity. Treatment options include expectant management, amnionreduction, septostomy, selective feticide, fetoscopic laser ablation, preterm delivery (after week 35) and medications. Amnionreduction and fetoscopic laser ablation are the treatment options most used and discussed. Method: Literature searches in Cochrane library, Ovid, Up-to-date and Pubmed were performed in the period March 2010 – August 2011. We chose to include articles from 1990-2011 using relevant key words concentrating on pathogenesis, treatment and prognosis. A total of 26 articles were reviewed. Result and Conclusion: TTTS is a complex and unpredictable syndrome and choice of treatment must be taken after determining at what stage TTTS is present and how far the pregnancy has proceeded. There is an ongoing discussion about what the treatment of choice should be, as the knowledge of the syndrome and longterm prognosis is increasing and the surgical techniques developes. Laser ablation, being the only curative treatment, is widely accepted as the treatment of choice for women with stage II-IV TTTS between week 16-26.