Twin-to-twin transfusion syndrome presenting at early stages: is there still a possible role for amnioreduction?
OBJECTIVE
To assess the rate of resolution or progression after first line treatment with amnioreduction and related outcome of pregnancies with twin-to-twin transfusion syndrome (TTTS) diagnosed at stages I-II.


METHODS
Data on 34 monochorionic diamniotic twin pregnancies presenting with TTTS at stage I-II before 26 weeks of gestation were collected retrospectively (1999-2006). All patients underwent at least one amnioreduction. The outcome and the results of neurological follow-up of surviving twins were analysed in relation to the regression or progression of the disease after treatment.


RESULTS
Fourteen cases (41%) resolved after treatment while 18 cases (53%) progressed. In two patients immediate complications occurred within one week after amnioreduction; at least one infant survived in 85.3% of cases and there was double survival in 58.8%. Double survival was significantly better in cases that regressed (85.7%) compared with those cases that progressed (44.4%). None of the surviving infants in the group of cases with regression showed major neurological abnormalities.


CONCLUSIONS
In our study, one-third of patients with stage I-II TTTS regressed after a single amnioreduction, and pregnancies with resolution of TTTS usually had a favourable outcome.
Fichera
Anna
A
Feto-Maternal Unit, Spedali Civili, University of Brescia, Brescia, Italy. afichera@med.unibs.it
Lanna
Mariano
M
Fratelli
Nicola
N
Rustico
Mariangela
M
Frusca
Tiziana
T
D018450:Disease Progression; D005260:Female; D005330:Fetofetal Transfusion / Q000175:diagnosis* / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal