Twin-to-Twin Transfusion Syndrome: Definition, Staging, and Ultrasound Assessment

Twin Res Hum Genet. 2016 Jun;19(3):175-83. doi: 10.1017/thg.2016.34.


Objective: The purpose of this article is to review the definition of twin-to-twin transfusion syndrome (TTTS) and the sonographic diagnostic assessment of these cases prior to therapy.

Materials and methods: The article addresses the terminology used to refer to the condition and describes the systematic ultrasound assessment of the condition, including the ultrasound diagnosis, the staging of the disease, cervical assessment and pre-operative mapping.

Results: From an etymologic and medical point of view, the term 'fetofetal transfusion' is more appropriate than 'TTTS'. However, as the latter, and its attendant acronym TTTS, have been widely adopted in the English language, it is impractical to change at this point. TTTS is defined sonographically in the combined presence of a maximum vertical pocket (MVP) of 8 cm or greater in one sac and 2 cm or less in the other sac, regardless of the gestational age at diagnosis. Staging of the condition using the Quintero staging system is practical, reproducible, and accepted. Transvaginal cervical length assessment should be an integral part of the ultrasound evaluation. Pre-operative mapping to anticipate the location of the placental vascular anastomoses and avoid injuring the dividing membrane is also discussed.

Conclusions: The term 'TTTS' can continue to be used in the English medical literature. The condition can be diagnosed and assessed following a systematic ultrasound methodology. The use of such ultrasound methodology breaks the examination into a distinct set of components, assuring a comprehensive examination and proper communication among caregivers.

Keywords: Ultrasound; monochorionic twins; twin-twin transfusion syndrome.

Publication types

  • Review

MeSH terms

  • Female
  • Fetofetal Transfusion / diagnosis*
  • Fetofetal Transfusion / diagnostic imaging
  • Fetofetal Transfusion / physiopathology
  • Fetofetal Transfusion / surgery
  • Gestational Age
  • Humans
  • Laser Coagulation
  • Placenta / blood supply
  • Placenta / diagnostic imaging*
  • Placenta / physiopathology
  • Pregnancy
  • Pregnancy, Twin*
  • Ultrasonography