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Systolic (A) and diastolic (B) blood pressure of recipient twins with cardiac failure (CF group) and with isolated high systolic blood pressure (HighBP group). All data are presented as median values with 1st and 3rd quartiles.
Source publication
Background:
This paper's intent is to describe the neonatal hemodynamic characteristics of recipient twins of monochorionic pregnancies complicated with twin-to-twin transfusion syndrome (TTTS), born without prenatal fetoscopic selective laser coagulation (FSLC).
Methods:
Retrospective analysis of hemodynamic characteristics was performed during...
Contexts in source publication
Context 1
... of the other two groups (i.e., HighBP and CF groups) showed that they had similar clinical characteristics at birth (gestational age, birth weight, blood pressure, ventricular hypertrophy) ( Table 2). During the first 12 h of life, systolic blood pressure was higher than the 95th percentile in both groups, and diastolic blood pressure was within the normal range (Figure 2). High blood pressure was treated with nicardipine in both groups, with no significant difference between the two groups in age at onset and maximal nicardipine dose (Table 2). ...
Context 2
... output was similar in both groups at 12 h of life but decreased to less than 1 mL/kg/h between 18 and 36 h of life in the CF group, whereas it remained above 2 to 3 mL/kg/h in the HighBP group (Figure 3). Blood urea nitrogen and serum creatinine increased significantly in the CF group and were significantly higher than in the HighBP group between day 1 and day 4 and at day 1 and 2, respectively (Table 2, Supplementary Figure S2). (Table 3) Search for associated factors of CF was performed by comparing the characteristics of the CF group with those of the NoHI and the HighBP groups combined (Table 3). ...
Similar publications
Objective:
To describe the perinatal and neonatal outcomes of fetal laser ablation (FLA) for the treatment of twin-twin transfusion syndrome (TTTS) in our single center institution.
Study design:
Retrospective study of 76 treated pregnant women. Procedural complications, perinatal and neonatal outcomes analyzed. Differences in outcomes between t...
Citations
... High blood pressure is a common occurrence in recipients, often observed alongside cardiac overload. Multiple factors are responsible for this phenomenon, such as dysregulation in the renin-angiotensin system and changes in endothelin production [4]. When TTTS is left untreated, mortality rates are as high as 80-90% [5]. ...
The distinct placental angioarchitecture in monochorionic (MC) pregnancies increases the risk of complications such as twin–twin transfusion syndrome (TTTS), twin anemia polycythemia sequence (TAPS), and selective fetal growth restriction (sFGR). The aim of this systematic review was to evaluate the incidence, type, and severity of cerebral injury and structural brain development on fetal and/or neonatal cerebral magnetic resonance imaging (MRI) in MC twins with or without complications. Twenty-three studies were included, covering a wide range of complications observed during MC pregnancies, with studies involving sIUFD (n = 12), TTTS (n = 7), mixed complications (n = 2), TAPS (n = 1), and uncomplicated MC pregnancy (n = 1). TAPS and sFGR were largely underrepresented in the current literature. The included studies reported that MC pregnancies with single intrauterine fetal demise (sIUFD) are most at risk for cerebral injury during the fetal period. The overall median incidence of cerebral injury after sIUFD was 28.3% (0–55%). Severe antenatal cerebral injury after sIUFD was detected antenatally in 6.5% (0–36%) of the cases. Three of the included studies described the incidence, type, and severity of cerebral injury on neonatal MRI in MC twins. Structural brain development based on cerebral biometry was only assessed in two studies, revealing significantly smaller biometric measurements of the cerebrum in cases of single sIUFD or smaller twins compared to singleton pregnancies. To enhance our understanding of the potential risks and pathophysiological mechanisms associated with cerebral injury and structural brain development in MC twins, there is a need for future studies and standardized protocols using serial fetal and neonatal MRI imaging in addition to routine ultrasound imaging.
To characterize the neonatal hemodynamic profiles in recipients born after twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic selective laser coagulation (FSLC). Retrospective analysis during the first month of life of recipient twins. Of the 480 newborns born during an 11-year period, 138 recipient twins with prenatal FSLC were classified into four groups: no hemodynamic impairment (NoHI, n = 102, 74%), isolated high blood pressure (HighBP, n = 18, 13%), right ventricular outflow tract obstruction (RVOTO, n = 10, 7%), and cardiac failure (CF, n = 8, 6%). The time (median (IQR)) between FSLC and birth was significantly shorter in the HighBP (36 days (23–54)) and CF (44 days (18–54)) groups than in the RVOTO (91 days (68–112)) and NoHi (82 days (62–104)) groups (p < 0.001).
Conclusion: Four distinct and well-characterized groups of recipients were identified based on their hemodynamics. High blood pressure and heart failure occurred in approximately 20% of the infants and were associated with a time between laser coagulation and birth of less than 2 months.
What is Known:
• Twin-to-twin transfusion syndrome (TTTS) is characterized by a hemodynamic imbalance that leads to high fetal and neonatal mortality if left untreated. One-third of recipient twins born without prenatal fetoscopic laser coagulation (FSLC) develop a life-threatening cardiac failure.
What is New:
• Four distinct groups of recipient twins with prenatal FSLC have been identified based on their hemodynamics. High blood pressure and cardiac failure occurred in 20% of the infants and were associated with an interval between FSLC and birth of less than 2 months.
