Twin-to-twin transfusion syndrome: aggressive therapeutic amniocentesis

Untreated twin-to-twin transfusion syndrome reportedly carries nearly a 100% mortality rate. Over the last decade a number of therapeutic modalities have been attempted, including aggressive amniocentesis. This study was a retrospective evaluation of a series of 22 patients with twin-to-twin transfusion syndrome referred to our prenatal diagnostic center to determine the effectiveness in treating twin-to-twin transfusion syndrome with aggressive therapeutic amniocentesis.

In this study three patients did not meet diagnostic criteria. For various reasons six patients did not have therapeutic amniocentesis done. One patient chose to terminate the pregnancy after three amniocenteses. Another patient chose to discontinue therapy after removal of just 100 ml of amniotic fluid. Of the 11 treated patients, the mean gestational age at diagnosis was 22 weeks 4 days (range 15 weeks 4 days to 26 weeks 4 days).

The mean number of amniocenteses done was 5.5 (range 1 to 12). The mean total of amniotic fluid removed over the course of the pregnancy was 8.0 L (range 1100 to 24,200 ml). The mean number of days gained in these pregnancies was 56 (range 9 to 125) compared with 54 days for the untreated women. Eighty-two percent of the treated fetuses survived compared with 50% in the untreated group. Newborns in the treated group were delivered at a later gestational age and weighed more than those in the untreated group.

Spontaneous resolution of twin-to-twin transfusion syndrome does occur. Therapeutic amniocentesis offers a simple, effective method of therapy for twin-to-twin transfusion syndrome.