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.
As the pregnancy comes closer to term, it may be best to 'wait and see,' and to plan early delivery if either twin shows signs of distress.
If TTTS occurs during the third trimester, conservative measures and early delivery are usually recommended. As the pregnancy comes closer to term, it may be best to 'wait and see,' and to plan early delivery if either twin shows signs of distress.
In this situation, the risks associated with delivering prematurely may be less than the risk of an intervention in the womb.
Amnioreduction is the removal, through a fine needle, of the excess amniotic fluid from around the recipient twin. This procedure may help decrease the risk of rupture of the membranes and premature labor. It may also temporarily relieve pressure on the umbilical cord.
Amnioreduction does not treat the cause of twin-to-twin transfusion syndrome, only one of its effects. The fluid is likely to accumulate again and the procedure may have to be repeated. With each amnioreduction, the risk of bleeding or infection increases, as does the risk of injury to the membranes.
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.
The Fetal Treatment Program specializes in treating Twin-to-Twin Transfusion Syndrome.
Contact us by phone at 401-228-0559 or by e-mail at firstname.lastname@example.org.