title: A randomized trial of amnioreduction versus septostomy in the treatment of twin-twin transfusion syndrome.
abstract: OBJECTIVE
  Left untreated, severe twin-to-twin transfusion syndrome (TTTS) presenting in the early second trimester of pregnancy is often associated with significant maternal morbidity and almost universal perinatal loss. Removal of excessive amounts of amniotic fluid through serial amniocenteses (amnioreduction) has been the mainstay of therapy. We sought to compare amnioreduction to intentional perforation of the intervening twin membrane (septostomy).
  
  
  METHODS
  Pregnant women with TTTS before 24 weeks' gestation were randomly assigned to serial amnioreduction or septostomy. A single puncture technique under ultrasound guidance was used for the septostomy. The primary outcome measure was survival to neonatal discharge, and was assessed based on the number of pregnancies or the number of fetuses as appropriate.
  
  
  RESULTS
  The study was terminated at the planned interim analysis stage after 73 women were enrolled. This was because the rate of survival of at least 1 infant was similar in the amnioreduction group compared to the septostomy group (78% vs 80% of pregnancies, respectively; RR=0.94, 95%CI 0.55-1.61; P=.82). Patient undergoing septostomy were more likely to require a single procedure for treatment (64% vs 46%; P=.04).
  
  
  CONCLUSIONS
  Although overall perinatal survival is not enhanced, septostomy offers the advantage of often requiring a single procedure compared to serial amnioreduction in the treatment of severe twin-to-twin transfusion syndrome.
authors.affiliation: Department of Obstetrics and Gynecology of the University of North Carolina School of Medicine, Chapel Hill, NC, USA. kmoisejr@med.unc.edu
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Moise
authors.forename: Karen
authors.initials: K
authors.lastname: Dorman
authors.forename: Georgine
authors.initials: G
authors.lastname: Lamvu
authors.forename: George R
authors.initials: GR
authors.lastname: Saade
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Fisk
authors.forename: Jan E
authors.initials: JE
authors.lastname: Dickinson
authors.forename: R D
authors.initials: RD
authors.lastname: Wilson
authors.forename: Alain
authors.initials: A
authors.lastname: Gagnon
authors.forename: Michael A
authors.initials: MA
authors.lastname: Belfort
authors.forename: Richard O
authors.initials: RO
authors.lastname: O'Shaughnessy
authors.forename: Usha
authors.initials: U
authors.lastname: Chitkara
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Hassan
authors.forename: Anthony
authors.initials: A
authors.lastname: Johnson
authors.forename: Anthony
authors.initials: A
authors.lastname: Sciscione
authors.forename: Daniel
authors.initials: D
authors.lastname: Skupski
mesh_terms: D000653:Amniotic Fluid; D005321:Extraembryonic Membranes / Q000601:surgery*; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery / Q000628:therapy*; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D019233:Retreatment