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NeoReviews Vol.9 No.9 2008 e370
© 2008 American Academy of Pediatrics

Twin-to-Twin Transfusion Syndrome

Part 1. Types and Pathogenesis

Ona M. Faye-Petersen, MD^*
Timothy M. Crombleholme, MD

^* Associate Professor of Pathology and Obstetrics and Gynecology; Head, Microdissection Laboratory, Division of Anatomic Pathology, The University of Alabama at Birmingham, Birmingham, Ala
Director, Fetal Care Center of Cincinnati; Professor of Surgery, Pediatrics, and Obstetrics and Gynecology, University of Cincinnati College of Medicine; Division of Pediatric General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Twin-to-twin transfusion syndrome (TTTS) may be acute or chronic, but chronic TTTS complicates 10% to 20% of monochorionic twin gestations and has an 80% to 100% mortality rate if severe and left untreated. Both types are due to the presence of placental anastomoses between the two twins, but the mechanisms involved in the development of chronic TTTS are particularly complex and incompletely understood. Many of the apparent pathogenic mechanisms have implications for the appearances and cardiovascular and physiologic disturbances of neonates born following this intrauterine condition and their response to treatment. We present an update in the pathogenesis of TTTS that includes an overview of the placental features, fetal adaptive and maladaptive responses, and molecular mechanisms involved in the development of TTTS.