Arefeh Gholamhosseini,1,*Saman Hakimian,2
1. Bachelor Student Microbiology Islamic Azad University Borujerd Iran 2. M.sc Student of Pathogenic Microbes Islamic Azad University Central Tehran Branch
Introduction: Twin-to-twin blood transfusion syndrome
Embryos are monochorionic, which are unequally nourished and oxygenated by common blood vessels. Vascular grafts and superficial and deep anastomosis are formed, which cause arterial-venous flow imbalance. The donor is wrinkled with an empty and small bladder And the recipient is edematous and the bladder is dilated, causing the amnion to increase. types of anastomosis There are 3 types 1-Artery to artery (AA): There are 37% pairs of ttts, it has less resistance, and they correct the balance (AA and VV are bilateral and by creating an intertwined pressure gradient, they transfer blood in two directions) 2-Venous to venous (VV): It is seen in 32% of TTTS pairs.And it may have a special role in creating this syndrome.
They are flexible and located deep in the tissue. AA anastomoses can compensate for unbalanced flow through AV.
Methods: TTTS staging In general, TTTS is divided into 5 stages based on the findings of two-dimensional ultrasound and Doppler velocimetry in the umbilical artery, as well as QUINTERO criteria: • First stage: Evidence of oligohydramnios/polyhydramnios sequence in sonography • Second stage: lack of visualization of the bladder of the donor embryo • Third stage: Abnormal Doppler of umbilical artery or venosus in one or both twins • The fourth stage: presence of hydrops In the first stage, pathological symptoms are not shown. The first and second stages are related to the evaluation of the donor (not the evaluation of the recipient). Because if the recipient with hydrops (stage 4) and the donor with visible edema (stage 1) are presented according to this classification, we will have a confusion syndrome (treatment of the recipient with the most invasive method, treatment of the donor with the least invasive method)
Results: Solomon's method In this method, to eliminate the remaining anastomosis, the entire equator of the vessels is destroyed. In addition to coagulating all the vessels and creating a cannula, a thin line of tissue is coagulated on the surface of the placenta, to connect the selected erosion sites from edge to edge. Complications )Grade 2 necrotizing enterocolitis, stage 3 retinopathy of prematurity, amniotic band syndrome ( are reduced by 8% with Solomon's method. However, a small percentage of remaining anastomosIs may reappear as recurrent TTTS and TAPS. In Solomon's method, the rate of separation of the placenta is higher, but survival is better,And the probability of premature rupture of the membrane is higher. Solomon's method needs more studies. Solomon's neonatal outcomes: intraventricular hemorrhage, dysplasia, bronchopulmonary (BPD), transient tachypnea of the newborn (TTN) BMI was measured at the start of treatment. It probably increases due to polyhydramnios and deserves to be considered as a risk factor. Septostomy This method creates a hole with a balloon so that the amniotic fluid is evenly distributed between the twins.
Conclusion: Twin anemia polycythemia sequence (TAPS) In two fetuses with a common placenta on the surface, their blood circulation is connected. The imbalance of blood exchange is due to TTTS and TAPS. TAPS: It happens after the 26th week. Occurs in 50% of monochorionic pregnancies. Appears 1 to 5 weeks after laser treatment It is associated with the development of chronic anemia in the donor and chronic polycythemia involved. in 2-13% of TTTS pregnancies occur after laser treatment. Neutropenia and decreased levels of hemoglobin, albumin and total protein have been reported in the donor. The absolute leukocyte level does not differ between the recipient and the donor, but there are fewer neutrophils in the donor. Reticulocytosis and increased erythropoiesis in TAPS donors are more than TTTS, therefore TAPS is associated with intrauterine growth restriction. TTTS and TAPS both have blood imbalances But in TTTS, a volume change is seen, which is to correct the incompatibility of hemoglobin. TTTS and TAPS are two distinct pathologies We expect TTTS to start with TAPS first. IATROGENIC MONOAMNIOTIC TWINS (IMAT) Iatrogenic perforation of the membrane occurs after laser treatment with a probability of 20%.