İkizden İkize Transfüzyon Sendromu (TTTS)
Özet
İkizden İkize Transfüzyon Sendromu (TTTS), monokoryonik ikiz gebeliklerde plasentadaki derin arteriovenöz anastomozlar nedeniyle bir fetüsten diğerine dengesiz kan akışı sonucu gelişen ciddi bir komplikasyondur. Bu durum verici ikizde oligohidramniyos ve büyüme geriliğine yol açarken, alıcı ikizde hipervolemi, polihidramniyos ve kardiyak anomalilere neden olur. Tedavi edilmediğinde %80-100 mortalite riski taşıyan bu sendrom, genellikle 15-26. gebelik haftalarında ortaya çıkar. Antenatal tanısı ultrasonografi ile konulan hastalık için en yaygın kullanılan sınıflandırma Quintero evreleme sistemidir. Tedavi ve yönetim seçenekleri arasında rutin gebelik takibi, selektif terminasyon, septostomi, seri amniyoredüksiyon ve fetoskopik lazer fotokoagülasyonu yer almaktadır. Özellikle 26. gebelik haftasından önce tanı alan Evre 2 ve üzeri şiddetli vakalarda, patofizyolojiyi düzelten ve vasküler anastomozları ortadan kaldıran fetoskopik lazer ablasyon tedavisi altın standart olarak kabul edilmektedir. Lazer tedavisi, seri amniyoredüksiyona kıyasla bebeklerin sağ kalım oranını ve neonatal dönemdeki nörolojik prognozu anlamlı derecede iyileştirir. Ancak her türlü optimal tedaviye rağmen TTTS, yüksek perinatal mortalite ve uzun dönemde nörolojik morbidite riski taşımaya devam eden yüksek riskli bir klinik tablodur.
Twin-to-Twin Transfusion Syndrome (TTTS) is a severe complication occurring in monochorionic twin pregnancies, characterized by an imbalanced blood flow from one fetus to another due to deep arteriovenous anastomoses in the placenta. This condition leads to oligohydramnios and growth restriction in the donor twin, while causing hypervolemia, polyhydramnios, and cardiac anomalies in the recipient. Carrying an 80-100% mortality risk if left untreated, the syndrome typically manifests between the 15th and 26th gestational weeks. Calculated through ultrasonography for antenatal diagnosis, the Quintero staging system remains the most widely accepted classification method. Management and treatment options include routine surveillance, selective termination, septostomy, serial amnioreduction, and fetoscopic laser photocoagulation. Particularly for severe cases at Stage 2 or beyond diagnosed before the 26th week of gestation, fetoscopic laser ablation, which corrects the underlying pathophysiology by coagulating vascular connections, is considered the gold standard approach. Compared to serial amnioreduction, laser therapy significantly improves the survival rate of at least one twin and enhances neurological outcomes in newborns. Nevertheless, despite optimal laser interventions, TTTS remains a highly critical condition with a perinatal mortality rate between 20% and 50% and potential long-term neurological complications.
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