Twin-twin transfusion syndrome: a review of treatment option

The twin-twin transfusion syndrome (TTTS) is a complication of monozygotic-monochorionic twinning and is a direct result of transplacental communication between the circulations of twins. When acute TTTS occurs in the second trimester, the perinatal mortality can be as high as 95% in the absence of treatment. For this reason, several aggressive, even desperate treatment modalities have been attempted including selective fetocide, umbilical cord ligation, maternal digoxin therapy. None have gained wide acceptance. Serial drainage amniocentesis or amnioreduction is actually the most widely used therapy. More recently, laser ablation under fetoscopic guidance of placental vessel has been reported in an attempt to improve survival. The objective of this review was to evaluate the impact of treatment modalities in TTTS. STUDY DESIGN: Reports of prospective and retrospective trials and other study designs in English identified from searches of MEDLINE, EMBASE, specialized databases, bibliographies of review articles. Study on twin pregnancies affected by TTTS between 1990 and 2003 that met our inclusion criteria were included. RESULTS AND CONCLUSIONS: No single therapy is associated with a uniformly improved outcome for the involved twins and success is primarily related to gestational age and severity at diagnosis. Standard therapy has commonly been serial amnioreduction, which appears to improve the overall outcome. Intertwin sepstostomy similary improves outcome but has no survival advantage over serial amnioreduction. Selective fetoscopic laser photocoagualtion has emerged as an alternative treatment strategy in TTTS with at least comparable if not superior survival to serial amnioreduction. TTTS diagnosed before 26 weeks' gestation has significantly better survival rates and fewer neurological sequelae after laser therapy than amnioreduction.