Fetal Treatment Program
Treatment of Twin-to-Twin Transfusion Syndrome (TTTS)
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TTTS and its treatment
Note the absence of amniotic fluid around the donor twin (left), who is wrapped in the amniotic membrane. In contrast, the recipient twin (right) is floating in excess fluid. The laser, introduced through a very thin telescope, blocks the vessels on the placenta that cross from one twin to the other.
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Laser Coagulation of the Communicating Placental Vessels
This technique is a form of fetal surgery first used in 1995 by Julian DeLia, MD. It is the only known treatment for TTTS that targets the actual cause of the condition. A laser fiber enclosed in a long, thin telescope is inserted into the uterus to separate the blood vessels that run from one twin to the other.
Thus far, the results of laser fetal surgery are better than those of other treatments. The Fetal Treatment Program in Providence was the only North-American center in a landmark study that demonstrated a significant survival advantage of laser surgery over amnioreduction (New England Journal of Medicine, July 2004). There are fewer complications and fewer cases of severe heart and brain damage in the twins. In addition, separating the twins’ blood vessels protects a fetus from the damaging effects of the other twin’s death. However, there is still a risk that the invasive procedure itself may cause premature rupture of the membrane and premature labor.
It is important to note that this form of fetal surgery is the most aggressive treatment option for TTTS. Risks, although reduced to a minimum, still exist for the mother and the fetuses. While the procedure aims at separating the linked blood vessels, some of the effects of TTTS, such as heart failure, may persist, or even be permanent.
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