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Treatment of twin-twin transfusion syndrome
M G Pinette1, Y Pan, S G Pinette
1Department of Obstetrics and Gynecology, Maine Medical Center, Scarborough.
Objective:
To determine whether therapeutic amniocentesis may improve outcomes in patients with twin-twin transfusion syndrome.
Methods:
Thirteen patients with possible twin-twin transfusion syndrome were evaluated for treatment. Therapeutic amniocenteses were performed on nine, and four patients were managed conservatively depending on the clinical severity of the twin-twin transfusion syndrome.
Results:
Therapeutic amniocenteses resolved the syndrome in three of nine cases, with an overall neonatal survival rate of 83.3% (15 of 18) and neonatal morbidity of 53.3% (eight of 15) among the survivors. The survival rate in patients with expectant management was 75% (six of eight), with a neonatal morbidity of 33.3% (two of six). An association between amniotic fluid status and fetal outcomes was observed. Patients with normalization of polyhydramniosoligohydramnios had the best outcomes.
Conclusion:
Early, aggressive amniocentesis may be an effective therapy for twin-twin transfusion syndrome. Therapeutic amniocentesis may have the capability to alter inter-fetal blood flow, possibly as a result of changes in intravascular pressure, which are related to changes in intra-amniotic pressure.