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... 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. Show less
Knijnenburg, P.J.C.; Lopriore, E.; Slaghekke, F.; Klink, J.M.M. van 2022
Monochorionic twin pregnancies have an increased risk of morbidity and mortality. Due to the advancements in screening and treatment strategies, mortality rates have decreased. Improving survival... Show moreMonochorionic twin pregnancies have an increased risk of morbidity and mortality. Due to the advancements in screening and treatment strategies, mortality rates have decreased. Improving survival rates demands a shift in scope toward long-term outcomes. In this review, we focus on neurodevelopmental outcome in survivors from complicated monochorionic twin pregnancies, including twinetwin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), acute peripartum TTTS, acute perimortem TTTS, selective fetal growth restriction (sFGR) and monoamnionicity. Our aim is to provide an overview of the current knowledge on the long-term outcome in survivors, including psychomotor development and quality of life, and provide recommendations for future research and follow-up programs. (c) 2022 Published by Elsevier Ltd. Show less
Monochorionc twin pregnancies carry a high risk for adverse pregnancy outcome. The unique placenta angioarchitecture in monochorionic twin pregnancies might cause specific complications such as... Show moreMonochorionc twin pregnancies carry a high risk for adverse pregnancy outcome. The unique placenta angioarchitecture in monochorionic twin pregnancies might cause specific complications such as twin-to-twin transfusion syndrome (TTTS) and selective intrauterine growth restriction (sIUGR). The hemodynamic challenges in these complications require specific adaptation of the fetal heart. Subsequently, a higher risk for fetal demise and acquired cardiac abnormalities is present in these cases.In part one of this thesis we focused on the risk for fetal demise. We investigated possible predictors for fetal demise after laser therapy for TTTS, and found that abnormal Doppler profiles and the presence and absence of certain anastomoses are associated with this complication. Beside this, we investigated the possible relation between proximate cord insertion and fetal deterioration.In part two we investigated possible predictors for the development of right ventricular outflow tract obstruction (RVOTO), and found that an early gestational age at onset of TTTS and cardiac dysfunction are associated with this complication. We described that postnatal RVOTO is not only found in recipients, but also in donors and sIUGR cases. We described the spectrum of prenatal RVOTO in relation to postnatal RVOTO. Lastly we introduced a new modality to detect fetal cardiac dysfunction. Show less
Gijtenbeek, M.; Haak, M.C.; Harkel, D.J. ten; Pas, A.B. te; Middeldorp, J.M.; Klumper, F.J.C.M.; ... ; Lopriore, E. 2017
