[Prenatal diagnosis and treatment of twin-to-twin transfusion syndrome]

Monochorionic twins originate of single placenta serving two twins, which potentionally could lead to unique complications including twin-to-twin transfusion syndrome, twin anemia--polycythemia sequence (TAPS), selective intrauterine growth restriction or twin reversed arterial perfusion sequence (TRAP). A shared placenta and fetoplacental circulation are responsible for significant discordance in amniotic fluid, fetoplacental hemodynamics, fetal size or fetal structural defects. All these complications pose high risk of fetal demise in one of the twins and therefore this could trigger death or neurological injury of the co-twin. The most severe complication of the monochorionic placenation is twin-to-twin transfusion syndrome.

Prenatal management of complicated monochorionic twin pregnancy with twin-to-twin transfusion syndrome exposed to the risk of losing one or two twins in utero justifies the endoscopic laser coagulation for placental anastomoses as a first line treatment.