Treatment of Twin-Twin Transfusion Syndrome

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 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 interfetal blood flow, possibly as a result of changes in intravascular pressure, which are related to changes in intra-amniotic pressure.