A case series of pre-viable severe twin-twin transfusion syndrome

We present a case series of pre-viable severe twin-twin transfusion syndrome (TTTS).

In year 2000, there were 16,688 deliveries in KK Women's and Children's Hospital. Four cases that presented before 24 weeks gestation satisfied the sonographic criteria for severe TTTS: same-sex fetuses, absence of twin peak sign, thin intertwine membrane, polyhydramnios associated with large bladder in recipient twin, and oligohydramnios and small or absent bladder in donor twin.

Amnioreduction, septostomy and termination of pregnancy were offered.

In 1 case abortion was chosen. The follow-up was at least 18 months postnatal. There was 1 intrauterine death, 2 with severe neurological handicap and 3 with normal outcome.

Pre-viable severe TTTS is associated with significant mortality and morbidity rates and should be diagnosed promptly and managed in a tertiary fetal medicine unit with multi-disciplinary input.