Treatment of twin-twin transfusion syndrome

Obstet Gynecol. 1993 Nov;82(5):841-6.

Abstract

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.

Publication types

  • Review

MeSH terms

  • Adult
  • Amniocentesis*
  • Female
  • Fetofetal Transfusion / mortality
  • Fetofetal Transfusion / therapy*
  • Humans
  • Infant, Newborn
  • Infant, Newborn, Diseases / epidemiology
  • Oligohydramnios
  • Polyhydramnios
  • Pregnancy
  • Survival Rate