Early twin-to-twin transfusion syndrome: From early gestational physiology to diagnosis and management

Authors

Ali Javinani, Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA. Electronic address: javinaniali@gmail.com.
Asma Khalil, Obstetrics and Maternal Fetal Medicine - Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, City St George's University of London, London, UK; Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, UK. Electronic address: akhalil@sgul.ac.uk.
Eyal Krispin, Gynecology and Reproductive Biology - Fetal Care and Surgery Center (FCSC), Division of Fetal Medicine and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: eyal.krispin@childrens.harvard.edu.

Document Type

Journal Article

Publication Date

12-1-2025

Journal

Best practice & research. Clinical obstetrics & gynaecology

Volume

103

DOI

10.1016/j.bpobgyn.2025.102675

Keywords

Early twin-twin transfusion syndrome; Fetofetal transfusion [Mesh]; Fetoscopic laser photocoagulation; Fetoscopy [Mesh]; Monozygotic [Mesh]; Selective termination; Twins

Abstract

Twin-to-Twin Transfusion Syndrome (TTTS) occurs in about 15 % of monochorionic twin pregnancies, less frequently does it occur prior to 18 weeks of gestation. When occurring early, this severe complication presents unique diagnostic and management challenges. In this review we will focus on the pathophysiological mechanisms underlying early TTTS. We will be emphasizing the role of placental vascular anastomoses and hemodynamic imbalances in disease progression. Advances in imaging techniques allow early diagnosis of the disease, impacting on consultation and clinical decision-making. Current treatment strategies, specifically including fetoscopic laser photocoagulation, are reviewed with a focus on optimizing perinatal outcomes. By integrating insights from fetal physiology, diagnostic innovations, and therapeutic advancements, this review aims to refine clinical management approaches to improve survival and morbidity outcomes for monochorionic twin pregnancies complicated by early TTTS.

APA Citation

Javinani, Ali; Khalil, Asma; and Krispin, Eyal, "Early twin-to-twin transfusion syndrome: From early gestational physiology to diagnosis and management" (2025). GW Authored Works. Paper 8481.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8481

Department

School of Medicine and Health Sciences Resident Works