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Acute peripartum twin–twin transfusion syndrome: Incidence, risk factors, placental characteristics and neonatal outcome

Authors

  • Enrico Lopriore,

    Corresponding author
    1. Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
    • Reprint request to: Dr Enrico Lopriore, Division of Neonatology, Department of Pediatrics, J6-S, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. Email: e.lopriore@lumc.nl

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  • Nanneke Holtkamp,

    1. Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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  • Marieke Sueters,

    1. Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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  • Johanna M. Middeldorp,

    1. Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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  • Frans J. Walther,

    1. Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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  • Dick Oepkes

    1. Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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Abstract

Aim

The aim of this study was to examine the incidence, placental characteristics and outcome in acute peripartum twin–twin transfusion syndrome (TTTS).

Material and Methods

All consecutive cases of monochorionic (MC) twins admitted to our center were included in the study. We excluded cases with chronic TTTS or twin anemia polycythemia sequence. Acute peripartum TTTS was defined when the inter-twin hemoglobin difference at birth was >8 g/dL.

Results

A total of 241 MC twin pregnancies were included in the study. Acute peripartum TTTS was detected in six cases (2.5%, 6/241). Vaginal delivery occurred more often in the acute peripartum TTTS group compared to the control group of uncomplicated MC pregnancies, 100% (6/6) versus 57% (135/235) (P = 0.002), respectively. Acute anemia was detected only in firstborn twins. Placental angioarchitecture in acute peripartum TTTS was similar to the placentas in the control group.

Conclusions

The incidence of acute peripartum TTTS is low (2.5%). Birth order and mode of delivery appear to be associated with increased risk of acute peripartum TTTS.

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