Rapid and radical amniodrainage in the treatment of severe twin-twin transfusion syndrome.
We have evaluated the role of a rapid and radical method of amniodrainage in the treatment of severe twin-twin transfusion. The outcome of 15 patients with severe twin-twin transfusion for which a amniodrainage was performed by means of a vacuum bottle system was compared with the outcome of 15 patients with a similar condition, matched for gestational age at the time of the initial procedure and drained using a standard procedure. In the study group the amniodrainage ended when no amniotic fluid could be aspirated, whereas the women in the standard group were drained with a syringe system and the fluid was removed until the deepest amniotic fluid pool was <8 cm. At the initial procedure, the mean volume of amniotic fluid drained was significantly (p<0.05) higher (3252 vs 2153 ml) and the length of the procedure significantly (p<0.001) shorter (21 vs 41 min) in the study group than in the standard group. The mean post-procedure amniotic fluid index was significantly (p<0.001) smaller (2.9 vs 7.7 cm) after radical amniodrainage than after the standard amniodrainage. The mean number of procedures was significantly (p<0.001) lower (1.5 vs 5.6) in the study group compared to the standard group. In the study group the mean placental thickness increased significantly (p<0.001) from 9 mm before the procedure to 49 mm after, and the overall perinatal survival rate was 80% and the proportion of pregnancies with at least one survivor was 93%. The present data indicate that early, rapid and radical amniodrainage is an effective and low-cost therapy for severe twin-twin transfusion syndrome. Compared to the standard amniodrainage technique it also appears to reduce the need for multiple procedures.
Jauniaux
E
E
Academic Department of Obstetrics, Royal Free and University College London Medical School, London, UK. e.jauniaux@ucl.ac.uk
Holmes
A
A
Hyett
J
J
Yates
R
R
Rodeck
C
C
D000650:Amnion; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008499:Medical Records; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D013396:Suction; D016896:Treatment Outcome; D014427:Twins; D014463:Ultrasonography