Leiden University Scholarly Publications

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Knijnenburg, P.J.C. (2024)

Twin-twin transfusion syndrome: antenatal complications and postnatal outcome after fetoscopic laser therapy

Doctoral Thesis
The blood circulations of monochorionic twins are connected through vascular anastomoses on the shared placenta. In about 10% of the monochorionic twin pregnancies, a disbalance occurs in blood flow from the placenta to the children: one child, the recipient, receives more blood than the other child, the donor. This situation is called twin-twin transfusion syndrome (TTTS) and is often lethal for both twins. Fetoscopic laser therapy is the preferred and only causal treatment for TTTS and since the introduction in the 90’s, has improved survival rates from 65 to 90%. However, fetoscopic laser therapy is not always successful and residual anastomoses can persist, which can cause recurrence of TTTS or TAPS. In addition, fetoscopic laser therapy can induce pregnancy complications. In this thesis rates and risk factors for complications as intertwin membrane rupture, placental abruption and post-procedural amniotic band syndrome are investigated. We studied short-term and long-term...Show moreThe blood circulations of monochorionic twins are connected through vascular anastomoses on the shared placenta. In about 10% of the monochorionic twin pregnancies, a disbalance occurs in blood flow from the placenta to the children: one child, the recipient, receives more blood than the other child, the donor. This situation is called twin-twin transfusion syndrome (TTTS) and is often lethal for both twins. Fetoscopic laser therapy is the preferred and only causal treatment for TTTS and since the introduction in the 90’s, has improved survival rates from 65 to 90%. However, fetoscopic laser therapy is not always successful and residual anastomoses can persist, which can cause recurrence of TTTS or TAPS. In addition, fetoscopic laser therapy can induce pregnancy complications. In this thesis rates and risk factors for complications as intertwin membrane rupture, placental abruption and post-procedural amniotic band syndrome are investigated. We studied short-term and long-term outcomes and evaluated neurodevelopmental impairment at age 2 and 5 years.
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Monochorionic twin pregnancy
Fetoscopic laser surgery
Residual anastomoses
Placental abruption
Amniotic band syndrome
Iatrogenic monoamniotic twin pregnancy
Cord entanglement
Neurodevelopmental impairment
All authors
Knijnenburg, P.J.C.
Supervisor
Lopriore, E.
Co-supervisor
Klink, J.M.M. van; Slaghekke, F.
Committee
Haak, M.C.; Devlieger, R.; Oudijk, M.A.; Reiss, I.
Qualification
Doctor (dr.)
Awarding Institution
Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
Date
2024-02-06

Funding

Sponsorship
Sponsoring drukkosten: The publication of this thesis was financially supported by: J.G. Knijnenburg en A.C.T. Knijnenburg - van Adrichem, de Nederlandse Vereniging voor Ouders van Meerlingen (NVOM), the TAPS Support Foundation, Chiesi Pharmaceuticals B.V. en Canon Medical Systems Nederland