title: Controlled fetal blood-letting of the recipient twin as a new method for the treatment of severe twin-twin transfusion syndrome: preliminary results.
abstract: OBJECTIVE
  To investigate the feasibility of withdrawal of blood from the recipient twin as a new method for the treatment of severe twin-twin transfusion syndrome.
  
  
  METHODS
  Seven consecutive monozygotic monochorionic twin pregnancies affected by severe twin-twin transfusion syndrome were treated. Fetal blood was withdrawn from the recipient twin using cordocentesis. The volume of blood to be removed was determined using the formula for intrauterine blood transfusion of anemic fetuses. Fetal outcome was evaluated in relation to changes in the amniotic fluid and in growth curves (comparing the differences between the centiles of the estimated fetal weight before the procedure and the centiles of weight at birth), fetal mortality, gestational age at delivery, neonatal weight and neurological damage.
  
  
  RESULTS
  Overall, seven of the 14 (50%) fetuses survived; at least one fetus survived in five (71%) pregnancies, both fetuses survived in two (29%) pregnancies, while in two (29%) pregnancies there were no survivors. No maternal complications were observed. At follow-up, one (14%) baby had minor neurological damage.
  
  
  CONCLUSIONS
  Withdrawal of blood from the recipient twin in the treatment of severe twin-twin transfusion syndrome was associated with survival similar to that of the alternative techniques of serial amniodrainage and fetoscopic laser surgery, with some possible advantages such as reduced neurological damage compared with serial amniodrainage. It is also less invasive compared with fetoscopic laser surgery.
authors.affiliation: Department of Obstetrics and Gynecology, DMSD San Paolo, Via di Rudini 8, 20142 Milan, Italy. bellotti.m@libero.it
authors.forename: M
authors.initials: M
authors.lastname: Bellotti
authors.forename: G
authors.initials: G
authors.lastname: Rognoni
authors.forename: C
authors.initials: C
authors.lastname: de Gasperi
authors.forename: M
authors.initials: M
authors.lastname: Panteghini
authors.forename: N
authors.initials: N
authors.lastname: Berlanda
authors.forename: E
authors.initials: E
authors.lastname: Ferrazzi
authors.forename: M
authors.initials: M
authors.lastname: Buscaglia
mesh_terms: D017218:Cordocentesis; D005240:Feasibility Studies; D005260:Female; D005330:Fetofetal Transfusion / Q000401:mortality / Q000628:therapy*; D006801:Humans; D011247:Pregnancy; D015996:Survival Rate