The donor-recipient (D-R) score: In vivo endoscopic evidence to support the hypothesis of a net transfer of blood from donor to recipient in twin- twin transfusion syndrome

R. A. Quintero, L. F. Quintero, P. W. Bornick, A. Pivatelli, M. H. Allen, P. K. Johnson

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Objective: Twin-twin transfusion syndrome (TTTS) is thought to result from an uneven exchange of blood between two monochorionic fetuses through placental anastomoses. This theory, however, has thus far eluded confirmation. The purpose of this study was to estimate the direction of net transfer of blood in patients undergoing laser therapy for TTTS by assessing the diameter, direction and number of deep vascular anastomoses present. Materials and methods: All vascular anastomoses were systematically assessed in 24 patients undergoing laser therapy for severe TTTS. The direction of arteriovenous (AV) anastomoses was determined by noting the origin of the artery (AVDR, from donor to recipient; AVRD, from recipient to donor). A negative value was assigned to AVDRs. Vessel diameters were measured off-line with a computer graphics program and were assigned a relative diameter of x 1 (small), x 2.1 (medium) and x 3.6 (large). The net direction of blood flow was estimated by adding the blood flow through each anastomosis (D-R score) using Poiseuille's equation for capillary flow. Results: An average of 4.1 AV anastomoses (range 1-8) were found. Four of the 24 patients (16.6%) had superficial anastomoses in addition to deep AV anastomoses and were excluded from analysis. Concomitant AVDRs and AVRDs were noted in 90% (18/20) of cases, and a single AVDR was present in 2/20 (10%) cases. A negative D-R score, suggestive of net flow from donor to recipient, was found in 80% (16/20) of cases. Conclusion: Our data provide endoscopic evidence that TTTS may result from a net transfer of blood from donor to recipient, owing to an uneven design of deep vascular placental anastomoses.

Original languageEnglish (US)
Pages (from-to)84-91
Number of pages8
JournalPrenatal and Neonatal Medicine
Volume5
Issue number2
StatePublished - Jan 1 2000

Keywords

  • Fetal therapy
  • Fetoscopy
  • Twin-twin transfusion syndrome
  • Ultrasound

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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