Twin-to-twin transfusion syndrome presenting at early stages: is there still a possible role for amnioreduction?

OBJECTIVE: To assess the rate of resolution or progression after first line treatment with amnioreduction and related outcome of pregnancies with twin-to-twin transfusion syndrome (TTTS) diagnosed at stages I-II. METHOD: Data on 34 monochorionic diamniotic twin pregnancies presenting with TTTS at stage I-II before 26 weeks of gestation were collected retrospectively (1999-2006). All patients underwent at least one amnioreduction. The outcome and the results of neurological follow-up of surviving twins were analysed in relation to the regression or progression of the disease after treatment. RESULTS: Fourteen cases (41%) resolved after treatment while 18 cases (53%) progressed. In two patients immediate complications occurred within one week after amnioreduction; at least one infant survived in 85.3% of cases and there was double survival in 58.8%. Double survival was significantly better in cases that regressed (85.7%) compared with those cases that progressed (44.4%). None of the surviving infants in the group of cases with regression showed major neurological abnormalities. CONCLUSION: In our study, one-third of patients with stage I-II TTTS regressed after a single amnioreduction, and pregnancies with resolution of TTTS usually had a favourable outcome.