title: [Are in-utero interventions justified? Perspective of neonatologists. Part III. Twin to Twin Transfusion Syndrome and Congenital Heart Defects].
abstract: BACKGROUND
  TTTS complicates from 10 to 15% of monochorionic diamniotic pregnancies. Expectant management is associated with 80 - 100% mortality First in-utero intervention in the fetus with CHD was performed in 1991. However only recently have they attained wider acceptance of cardiologists and perinatologists.
  
  
  OBJECTIVE
  Our main objective was to analyze the studies evaluating prenatal interventions in pregnancies complicated by TTTS or CHD, and to determine whether given the available data, those interventions are justified.
  
  
  METHODS
  Pubmed and Cochrane database were searched for all studies related to in-utero interventions in fetuses with TTTS or CHD. Emphasis was placed on randomized controlled trials.
  
  
  RESULTS
  Meta-analysis published in Cochrane database concludes that laser photocoagulation of communicating vessels improves outcome in all stages of TTTS. Additional studies are required to elucidate the role of amnioreduction. For interventions in fetuses with CHD published data is limited to the case series. Potentially selected patients with CHD would benefit from in-utero intervention, but additional studies are required.
  
  
  CONCLUSIONS
  Prenatal interventions in TTTS improve the outcome. Further studies are required to define their role in patients with CHD. For all procedures selection criteria and indications for interventions need to be clarified. More precise prenatal diagnosis and improvements in the area of fetal monitoring during the procedure might positively impact survival Preterm birth and premature rapture of membranes remain significant adverse outcomes. Complications associated with prematurity might counteract the positive effect of fetal intervention. Most cases of in-utero interventions should only be performed in specialized centers as a part of a clinical trial protocol.
authors.affiliation: Instytut Centrum Zdrawia Matki Polki, Klinika Neonatologii, Łódź, Polska.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Dabrowska
authors.forename: Janusz
authors.initials: J
authors.lastname: Gadzinowski
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D005315:Fetal Diseases / Q000473:pathology / Q000601:surgery*; D005330:Fetofetal Transfusion / Q000473:pathology / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000473:pathology / Q000601:surgery*; D006801:Humans; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods