Twin-To-Twin Transfusion Syndrome in Dichorionic-Triamniotic Triplets Successfully Managed Without Fetoscopic Laser:
Ammir Abuzahra1, Safwat Jabari1, Mohammad Rabaee1
1Department of Obstetrics & Gynecology, College of Medicine Hebron University Hebron Palestine.
Clinical Case Reports
|July 8, 2026
Summary
Triplet pregnancies are rare and can be complicated by twin-to-twin transfusion syndrome (TTTS). This case shows conservative management with amnioreduction and early delivery can lead to favorable outcomes in selected cases.
Area of Science:
- Maternal-fetal medicine
- High-risk pregnancies
- Neonatal outcomes
Background:
- Triplet pregnancies occur in approximately 0.1% of births and carry a higher risk of complications, including prematurity.
- Monochorionic placentation within a triplet pregnancy increases the risk of twin-to-twin transfusion syndrome (TTTS), a serious condition characterized by vascular imbalance.
- Twin-to-twin transfusion syndrome (TTTS) is a severe complication affecting monochorionic gestations, potentially leading to significant fetal morbidity and mortality.
Purpose of the Study:
- To report a case of dichorionic-triamniotic triplet pregnancy complicated by Quintero stage II TTTS.
- To evaluate the effectiveness of conservative management strategies for TTTS in a triplet pregnancy.
- To highlight potential management alternatives when advanced interventions are not feasible.
Main Methods:
- Close surveillance of the dichorionic-triamniotic triplet pregnancy.
- Serial amnioreductions to manage amniotic fluid imbalance.
- Administration of antenatal corticosteroids to promote fetal lung maturity.
- Planned preterm delivery via cesarean section at 32 weeks' gestation.
Main Results:
- The triplet pregnancy was complicated by Quintero stage II TTTS affecting the monochorionic twin pair.
- Conservative management including serial amnioreductions and antenatal corticosteroids was implemented.
- Three male infants were delivered at 32 + 6 weeks' gestation.
- All neonates had favorable outcomes following admission to the neonatal intensive care unit.
Conclusions:
- Conservative management, including amnioreduction and planned preterm delivery, can be a viable option for selected late-gestation triplet pregnancies with TTTS.
- This approach may be considered when interventions like fetoscopic laser therapy are not feasible.
- Successful management resulted in favorable neonatal outcomes, demonstrating the potential efficacy of this conservative strategy.
