Twin-twin transfusion syndrome - a University Hospital experience with intrauterine treatment

Abstract

Introduction: twin-to-twin transfusion syndrome (TTTS), defined by combination of polyhydramnios-oligohydramnios, is the most prevalent (5%-35%) of the abnormalities due to placental vascular anastomoses and the most lethal (80%-100% mortality) if untreated. Fetoscopic laser ablation of abnormal vasculature using the Solomon technique is the gold standard approach. It consists of interrupting the intertwin blood flow. Objectives: to present our initial experience at the Fetal Surgery Service of the Hospital de Clinicas of the Federal University of Parana (HC-UFPR) and to compare our results with those reported in the literature. Methods: we conducted a retrospective analysis of pregnancies who had undergone laser ablation, assessing data on Quintero’s staging, gestational age at diagnosis and at the time of the procedure, placental position, immediate post-procedure survival, and survival after the neonatal period. We then compared these data with the most recent data available in the literature. Results: we analyzed ten TTTS cases. The diagnosis was performed before the 26th week of pregnancy (median 20.8 weeks) and treatment occurred in a median of 9.5 days later. The distribution by the Quintero’s staging was of three cases in stage II, five in stage III, and two in stage IV. In 50% of the gestations, at least one of the fetuses survived through the neonatal period. Conclusion: the treatment of TTTS in the HC-UFPR had a positive impact in the survival of the affected fetuses, although the results were worse than the ones reported in the literature, probably due to the delay in referencing the patients to our service, leading to a prolonged interval between diagnosis and treatment.

Controlled amnioreduction for twin-to-twin transfusion syndrome

“…[1][2][3][4] Numerous reports on the outcome of both AR and FLA interventions revealed very high rates of survival for either one or both twins and significant reduction of postnatal impairments, especially neurodevelopment. [5][6][7][8][9][10][11][12][13][14][15] The FLA procedure is the recommended procedure for stage II through IV of TTTS diagnosed before the 26th week of gestation based on clinical trials. 8 However, some concerns were debated regarding the comparison analyses between FLA and AR outcomes.…”