Twin-to-twin transfusion: update on management options and outcomes.
OBJECTIVE
The diagnosis and treatment of twin-to-twin transfusion syndrome has progressed to a staging system to allow directed therapy with the addition of laser to traditional serial amnioreduction. The management options and outcomes are reviewed here.


RESULTS
In three observational and one randomized controlled trial, laser photocoagulation of chorionic plate vessels at the intertwin membrane improved perinatal survival of at least one fetus and reduced neurological morbidity. Cerebral palsy continues to be a major contributor to adverse outcome with rates of around 20% for survivors.


CONCLUSIONS
Treatment strategies for this condition have remained controversial, but two main approaches have been commonly used. Serial, aggressive amnioreduction and fetoscopic laser photocoagulation of the chorionic plate vascular anastomoses at the intertwin membrane. Using the former technique, survival rates of between 18 and 83% have been described. However, 5-58% neurological morbidity has been demonstrated in the surviving infants treated by serial amnioreduction alone. Laser photocoagulation has been advocated in a few specialist centres. Such treatment has been associated with survival rates of between 55 and 69% and potentially reduced neurological morbidity of between 5 and 11% in surviving infants.
Duncan
Keith R
KR
Chelsea and Westminster Hospital, London, UK. keith.duncan@chelwest.nhs.uk
D005260:Female; D005330:Fetofetal Transfusion / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome