title: Simulation of therapy in a model of a nonhydropic and hydropic recipient in twin-twin transfusion syndrome.
abstract: OBJECTIVE
  This study was undertaken to model the sequence of events that occurs after amnioreduction, laser therapy, and digoxin administration in twin-twin transfusion syndrome (TTTS) with and without a hydropic recipient twin.
  
  
  METHODS
  We added amnioreduction, laser therapy, and digoxin administration to our mathematical TTTS model and simulated combinations of these therapies.
  
  
  RESULTS
  With a nonhydropic recipient, simulated amnioreduction delays the onset of hydrops. Conversely, with a hydropic recipient, amnioreduction aggravates the degree of hydrops. Furthermore, amnioreduction increases the transplacental fluid flow and may temporarily cause a hydropic donor. Laser therapy terminates the cause of recipient hydrops. Digoxin reduces the degree of recipient hydrops, but increases arteriovenous fetofetal transfusion.
  
  
  CONCLUSIONS
  Laser therapy is superior in TTTS with a hydropic recipient, because simulated amnioreduction aggravates the recipient's cardiovascular status. Digoxin benefits a hydropic recipient but slightly worsens the donor's condition. Therefore, TTTS presenting with a hydropic recipient prior to fetal viability (approximately 26 weeks) may be best treated with laser therapy, whereas more advanced gestations may be offered digoxin administration plus amnioreduction, to delay the progression of TTTS.
authors.affiliation: Laser Center, Department of Obstetrics and Gynecology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jeroen P H M
authors.initials: JP
authors.lastname: van den Wijngaard
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ross
authors.forename: Jos A P
authors.initials: JA
authors.lastname: van der Sloot
authors.forename: Yves
authors.initials: Y
authors.lastname: Ville
authors.forename: Martin J C
authors.initials: MJ
authors.lastname: van Gemert
mesh_terms: D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use*; D005260:Female; D005330:Fetofetal Transfusion / Q000503:physiopathology / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000209:etiology / Q000628:therapy; D053685:Laser Therapy; D008954:Models, Biological; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000379:methods
chemical_list: D002316:Cardiotonic Agents; D004077:Digoxin