Treatment of twin-twin transfusion syndrome.

Abstract

To determine whether therapeutic amniocentesis may improve outcomes in patients with twin-twin transfusion syndrome. 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. 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. 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.