Brain matters in twin-twin transfusion syndrome

Abstract

Twin-twin transfusion syndrome (TTTS) is a complication of monochorionic twin pregnancies, caused by imbalanced blood flow between twins through shared placental vessels. Fetoscopic laser coagulation of placental vessels, introduced in the Netherlands in the year 2000, has significantly improved outcomes.

This thesis investigates brain injury and neurodevelopmental outcomes in TTTS fetuses, neonates and children treated with laser surgery. Studies revealed that risk factors for brain injury include post-laser twin anemia-polycythemia sequence (TAPS) or recurrent TTTS, and lower gestational age. Severe neurodevelopmental impairment is uncommon after TTTS and remains linked to low birth weight, SGA, and cerebral injury. Mild impairment at 2 years of age is a common finding (23%), affecting cognition and motor outcomes. Behavioral problems were seen in 8% of survivors, comparable to the general population, but may have been underestimated. Early intervention is crucial for children affected by behavioral problems. Intentional demise (termination of pregnancy, selective fetal reduction or withdrawal of neonatal intensive care treatment) occurred in 17% of pregnancies due to complications, including severe brain injury.

The thesis highlights the need for long-term follow-up, improved imaging, and specialized care to optimize TTTS outcomes.