[Management of twin twin transfusion syndrome]

The diagnosis of twin twin transfusion syndrome is an emergency and is generally easily done by ultrasound. Once the diagnosis is established patients should be referred rapidly for counselling and treatment within a network that can offer fetoscopic laser surgery as first-line treatment. Invasive treatments should be proscribed until then since they may impair fetoscopic visualization and therefore the overall prognosis, should this treatment be required. Depending on the presentation, other options may be offered such as cord coagulation, expectant management or delivery. Other treatment modalities such as amnioreduction or septostomy have almost no indications. Post-operative follow-up will be oriented by secondary hemodynamical complications and fetal neurological damage. An MRI may be a useful adjunct for ischemic/haemorrhagic brain injuries. Moderate prematurity may be justified, regarding the incidence of severe delayed complications.