{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:38:13Z","timestamp":1791437893680,"version":"4.3.3"},"reference-count":95,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2016,5,20]],"date-time":"2016-05-20T00:00:00Z","timestamp":1463702400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Twin Res Hum Genet"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:p><jats:italic>Objective:<\/jats:italic> 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.<\/jats:p><jats:p><jats:italic>Materials and Methods:<\/jats:italic> 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.<\/jats:p><jats:p><jats:italic>Results:<\/jats:italic> From an etymologic and medical point of view, the term \u2018fetofetal transfusion\u2019 is more appropriate than \u2018TTTS\u2019. 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.<\/jats:p><jats:p><jats:italic>Conclusions:<\/jats:italic> The term \u2018TTTS\u2019 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.<\/jats:p>","DOI":"10.1017\/thg.2016.34","type":"journal-article","created":{"date-parts":[[2016,5,21]],"date-time":"2016-05-21T21:10:18Z","timestamp":1463865018000},"page":"175-183","source":"Crossref","is-referenced-by-count":43,"title":["Twin-to-Twin Transfusion Syndrome: Definition, Staging, and Ultrasound Assessment"],"prefix":"10.1017","volume":"19","author":[{"given":"Eftichia","family":"Kontopoulos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramen H.","family":"Chmait","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben A.","family":"Quintero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2016,5,20]]},"reference":[{"key":"S1832427416000347_ref092","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0095-5108(18)30721-8","article-title":"Incidence, morbidity and mortality, and diagnosis of twin gestations","volume":"15","author":"Wenstrom","year":"1988","journal-title":"Clinics in Perinatology"},{"key":"S1832427416000347_ref085","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.12.006"},{"key":"S1832427416000347_ref094","first-page":"123","article-title":"Antenatal diagnosis of twin transfusion syndrome by ultrasound","volume":"58","author":"Wittman","year":"1981","journal-title":"Obstetrics and Gynecology"},{"key":"S1832427416000347_ref086","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7488"},{"key":"S1832427416000347_ref079","doi-asserted-by":"publisher","DOI":"10.1159\/000263622"},{"key":"S1832427416000347_ref067","doi-asserted-by":"publisher","DOI":"10.3109\/15513811003615013"},{"key":"S1832427416000347_ref091","doi-asserted-by":"publisher","DOI":"10.1159\/000263949"},{"key":"S1832427416000347_ref070","first-page":"279","article-title":"Twin-twin transfusion syndrome in a dizygotic monochorionic-diamniotic twin pregnancy","volume":"14","author":"Quintero","year":"2003","journal-title":"Journal of Maternal-Fetal and Neonatal Medicine"},{"key":"S1832427416000347_ref038","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(97)70203-5"},{"key":"S1832427416000347_ref009","first-page":"714","article-title":"The twin-twin transfusion syndrome","volume":"76","author":"Blickstein","year":"1990","journal-title":"Obstetrics and Gynecology"},{"key":"S1832427416000347_ref039","doi-asserted-by":"publisher","DOI":"10.1016\/0143-4004(89)90006-4"},{"key":"S1832427416000347_ref061","doi-asserted-by":"publisher","DOI":"10.1016\/S0095-5108(03)00103-9"},{"key":"S1832427416000347_ref066","doi-asserted-by":"publisher","DOI":"10.1002\/uog.945"},{"key":"S1832427416000347_ref041","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.09.015"},{"key":"S1832427416000347_ref032","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.115119"},{"key":"S1832427416000347_ref046","doi-asserted-by":"publisher","DOI":"10.1046\/j.0004-8666.2003.00002.x"},{"key":"S1832427416000347_ref021","doi-asserted-by":"publisher","DOI":"10.1002\/uog.234"},{"key":"S1832427416000347_ref008","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-3557"},{"key":"S1832427416000347_ref023","doi-asserted-by":"publisher","DOI":"10.1002\/uog.6221"},{"key":"S1832427416000347_ref063","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.161.5.7506005"},{"key":"S1832427416000347_ref019","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.2000.00050.x"},{"key":"S1832427416000347_ref035","doi-asserted-by":"publisher","DOI":"10.1111\/j.1447-0756.1992.tb00327.x"},{"key":"S1832427416000347_ref026","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(85)90348-5"},{"key":"S1832427416000347_ref048","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.107440"},{"key":"S1832427416000347_ref030","first-page":"1097","article-title":"Doppler umbilical artery studies in the twin-twin transfusion syndrome","volume":"76","author":"Giles","year":"1990","journal-title":"Obstetrics and Gynecology"},{"key":"S1832427416000347_ref014","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.02.063"},{"key":"S1832427416000347_ref015","first-page":"393.e391","article-title":"Stage-based outcomes of 682 consecutive cases of twin-twin transfusion syndrome treated with laser surgery: The USFetus experience","volume":"204","author":"Chmait","year":"2011","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"S1832427416000347_ref006","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000168435.17200.53"},{"key":"S1832427416000347_ref005","doi-asserted-by":"publisher","DOI":"10.1071\/RD01037"},{"key":"S1832427416000347_ref025","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1944.tb07378.x"},{"key":"S1832427416000347_ref055","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.117188"},{"key":"S1832427416000347_ref062","doi-asserted-by":"publisher","DOI":"10.7863\/ultra.33.7.1147"},{"key":"S1832427416000347_ref027","doi-asserted-by":"publisher","DOI":"10.7863\/jum.1992.11.11.571"},{"key":"S1832427416000347_ref049","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(03)00859-7"},{"key":"S1832427416000347_ref043","doi-asserted-by":"publisher","DOI":"10.1375\/twin.4.3.150"},{"key":"S1832427416000347_ref012","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2009.28.5.633"},{"key":"S1832427416000347_ref054","first-page":"399","article-title":"\u2018Pseudo\u2019 twin-to-twin transfusion syndrome and fetal outcome","volume":"18","author":"Mari","year":"1998","journal-title":"Journal of Perinatology"},{"key":"S1832427416000347_ref059","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(94)70291-8"},{"key":"S1832427416000347_ref058","first-page":"476","article-title":"Second- and third-trimester ultrasound evaluation of chorionicity and amnionicity in twin pregnancy. A simple algorithm","volume":"45","author":"Monteagudo","year":"2000","journal-title":"Journal of Reproductive Medicine"},{"key":"S1832427416000347_ref075","doi-asserted-by":"publisher","DOI":"10.1016\/S0037-198X(99)80017-0"},{"key":"S1832427416000347_ref004","doi-asserted-by":"publisher","DOI":"10.1016\/S0146-0005(05)80012-6"},{"key":"S1832427416000347_ref047","doi-asserted-by":"publisher","DOI":"10.1177\/107155769500200405"},{"key":"S1832427416000347_ref018","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.02.064"},{"key":"S1832427416000347_ref045","first-page":"737","article-title":"Amniotic fluid index and single deepest pocket: Weak indicators of abnormal amniotic volumes","volume":"96","author":"Magann","year":"2000","journal-title":"Obstetrics and Gynecology"},{"key":"S1832427416000347_ref082","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1996.07060421.x"},{"key":"S1832427416000347_ref088","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.107368"},{"key":"S1832427416000347_ref073","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(93)90041-G"},{"key":"S1832427416000347_ref013","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.35957"},{"key":"S1832427416000347_ref095","doi-asserted-by":"publisher","DOI":"10.1016\/0029-7844(96)00094-4"},{"key":"S1832427416000347_ref034","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1104"},{"key":"S1832427416000347_ref051","doi-asserted-by":"publisher","DOI":"10.1016\/0029-7844(95)00054-U"},{"key":"S1832427416000347_ref036","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-999882"},{"key":"S1832427416000347_ref011","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2803"},{"key":"S1832427416000347_ref087","doi-asserted-by":"publisher","DOI":"10.1177\/000992287901800206"},{"key":"S1832427416000347_ref069","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7200292"},{"key":"S1832427416000347_ref071","first-page":"84","article-title":"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","volume":"5","author":"Quintero","year":"2000","journal-title":"Prenatal and Neonatal Medicine"},{"key":"S1832427416000347_ref084","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-2011.2012.00209.x"},{"key":"S1832427416000347_ref050","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8545(05)70100-5"},{"key":"S1832427416000347_ref064","doi-asserted-by":"publisher","DOI":"10.1016\/S0095-5108(03)00051-4"},{"key":"S1832427416000347_ref037","doi-asserted-by":"publisher","DOI":"10.3109\/9780203696576-12"},{"key":"S1832427416000347_ref078","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.06.055"},{"key":"S1832427416000347_ref089","first-page":"1257","article-title":"Validation of the Quintero staging system for twin-twin transfusion syndrome","volume":"100","author":"Taylor","year":"2002","journal-title":"Obstetrics and Gynecology"},{"key":"S1832427416000347_ref060","doi-asserted-by":"publisher","DOI":"10.1007\/BF02390673"},{"key":"S1832427416000347_ref017","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.05.025"},{"key":"S1832427416000347_ref029","doi-asserted-by":"publisher","DOI":"10.1097\/01.PGP.0000070848.25718.3A"},{"key":"S1832427416000347_ref083","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2004.09.001"},{"key":"S1832427416000347_ref080","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032597"},{"key":"S1832427416000347_ref096","first-page":"1058","article-title":"Antenatal diagnosis of twin-twin transfusion syndrome by Doppler ultrasound","volume":"78","author":"Yamada","year":"1991","journal-title":"Obstetrics and Gynecology"},{"key":"S1832427416000347_ref020","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(89)90521-8"},{"key":"S1832427416000347_ref042","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000143828.41271.6c"},{"key":"S1832427416000347_ref031","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2008.08.019"},{"key":"S1832427416000347_ref053","doi-asserted-by":"publisher","DOI":"10.1203\/01.PDR.0000180558.03164.E8"},{"key":"S1832427416000347_ref077","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.05.025"},{"key":"S1832427416000347_ref093","doi-asserted-by":"publisher","DOI":"10.1159\/000263655"},{"key":"S1832427416000347_ref052","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9440(10)64767-0"},{"key":"S1832427416000347_ref033","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2012.657278"},{"key":"S1832427416000347_ref090","first-page":"708","article-title":"Twin-twin transfusion syndrome. Three possible pathophysiologic mechanisms","volume":"42","author":"van Gemert","year":"1997","journal-title":"Journal of Reproductive Medicine"},{"key":"S1832427416000347_ref065","doi-asserted-by":"publisher","DOI":"10.3109\/9780203696576"},{"key":"S1832427416000347_ref003","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0223(199712)17:13<1207::AID-PD295>3.0.CO;2-F"},{"key":"S1832427416000347_ref044","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(97)00351-7"},{"key":"S1832427416000347_ref072","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(65)80125-1"},{"key":"S1832427416000347_ref022","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.170.5.9574605"},{"key":"S1832427416000347_ref056","first-page":"1","article-title":"Infant mortality statistics from the 2007 period linked birth\/infant death data set","volume":"59","author":"Mathews","year":"2011","journal-title":"National Vital Statistics Reports"},{"key":"S1832427416000347_ref028","doi-asserted-by":"publisher","DOI":"10.1136\/adc.65.7_Spec_No.657"},{"key":"S1832427416000347_ref076","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.2002.00645.x"},{"key":"S1832427416000347_ref024","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.1870110807"},{"key":"S1832427416000347_ref016","first-page":"47.e41","article-title":"Fetal growth after laser therapy for twin-twin transfusion syndrome","volume":"199","author":"Chmait","year":"2008","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"S1832427416000347_ref002","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(98)70084-5"},{"key":"S1832427416000347_ref074","first-page":"978","article-title":"Uterine artery doppler velocity waveforms in twin pregnancies","volume":"82","author":"Rizzo","year":"1993","journal-title":"Obstetrics and Gynecology"},{"key":"S1832427416000347_ref010","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1992.02050317.x"},{"key":"S1832427416000347_ref040","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1998.12030211.x"},{"key":"S1832427416000347_ref001","doi-asserted-by":"publisher","DOI":"10.1177\/000992286700600711"},{"key":"S1832427416000347_ref057","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5211"},{"key":"S1832427416000347_ref081","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(97)85858-9"},{"key":"S1832427416000347_ref007","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(95)90469-7"}],"container-title":["Twin Research and Human Genetics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1832427416000347","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,4,19]],"date-time":"2019-04-19T04:13:12Z","timestamp":1555647192000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1832427416000347\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5,20]]},"references-count":95,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2016,6]]}},"alternative-id":["S1832427416000347"],"URL":"https:\/\/doi.org\/10.1017\/thg.2016.34","relation":{},"ISSN":["1832-4274","1839-2628"],"issn-type":[{"value":"1832-4274","type":"print"},{"value":"1839-2628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5,20]]}}}