title: Management of Stage I twin-to-twin transfusion syndrome: an international survey.
abstract: OBJECTIVE
  To determine practice patterns for evaluation and treatment of Stage I twin-to-twin transfusion syndrome (TTTS) among international physicians.
  
  
  METHODS
  An e-mail cross-sectional survey of members from the IFMSS, NAFTNet and SMFM societies and participants at a Eurofoetus-sponsored TTTS meeting was undertaken between May 2008 and November 2008. Questionnaires consisted of physician demographics and their recommendations for managing Stage I TTTS. Alternative therapies to expectant management were assessed based on the following special circumstances of the patient: residence more than 200 miles from the center, severe symptoms, or a cervical length of </= 15 mm.
  
  
  RESULTS
  Eighty-one surveys were returned, giving a response rate of 84%. Five surveys were excluded as a result of duplication or missing data. Of the remaining 76 surveys, 48 were from North America, 20 were from Europe and eight were from other continents. Expectant management was the predominant recommendation (78%), followed by amnioreduction (11%), laser ablation (11%) and septostomy (1%). Recommendations for amnioreduction were exclusively from North American centers. Laser centers recommended expectant management more frequently than non-laser facilities (89% vs. 59%; P < 0.01). When examples of special patient circumstances were presented, North American centers changed their recommendation from expectant management to amnioreduction more often than did European centers. However, a greater proportion of European centers recommended laser surgery for special patient circumstances.
  
  
  CONCLUSIONS
  Expectant management remains the predominant management of Stage I TTTS. In some patient circumstances, North American centers are more likely to recommend amnioreduction while European centers are more likely to recommend laser therapy. A randomized controlled trial will be necessary to evaluate the most efficacious management strategy for Stage I TTTS.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and The Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX 77030, USA.
authors.forename: S
authors.initials: S
authors.lastname: Molina
authors.forename: R
authors.initials: R
authors.lastname: Papanna
authors.forename: K J
authors.initials: KJ
authors.lastname: Moise
authors.forename: A
authors.initials: A
authors.lastname: Johnson
mesh_terms: D003430:Cross-Sectional Studies; D034742:Electronic Mail; D005060:Europe; D005260:Female; D005330:Fetofetal Transfusion / Q000175:diagnosis / Q000628:therapy*; D005332:Fetoscopy / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D017075:Laser Coagulation / Q000706:statistics & numerical data*; D008297:Male; D009656:North America; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy