Objective The purpose of this study was to evaluate the prognostic value of sonographic and clinical parameters to develop a staging classification of twin-twin transfusion syndrome (TTTS). Study design Severe TTTS was defined as the presence of polyhydramnios (maximum vertical pocket of > or = 8 cm) and oligohydramnios (maximum vertical pocket of Results A total of 80 of 108 referred patients met criteria for surgery, but only 65 were treated surgically: 48 with LPCV and 17 with umbilical cord ligation. Complete Doppler data were obtainable in 41 of 48 LPCV patients. Survival rates by stage for one or two fetuses were statistically different (chi-squared analysis = 12.9, df = 6, p = 0.044). Neither percent size discordance nor gestational age at diagnosis were predictive of outcome. Conclusion Staging of TTTS using the proposed criteria has prognostic significance. This staging system may allow comparison of outcome data of TTTS with different treatment modalities.

Staging of twin-twin transfusion syndrome.

Background Monochorionic twin pregnancies complicated by severe twin-to-twin transfusion syndrome at midgestation can be treated by either serial amnioreduction (removal of large volumes of amniotic fluid) or selective fetoscopic laser coagulation of the communicating vessels on the chorionic plate. We conducted a randomized trial to compare the efficacy and safety of these two treatments. Methods Pregnant women with severe twin-to-twin transfusion syndrome before 26 weeks of gestation were randomly assigned to laser therapy or amnioreduction. We assessed perinatal survival of at least one twin (a prespecified primary outcome), survival of at least one twin at six months of age, and survival without neurologic complications at six months of age on the basis of the number of pregnancies or the number of fetuses or infants, as appropriate. Results The study was concluded early, after 72 women had been assigned to the laser group and 70 to the amnioreduction group, because a planned interim analysis demonstr...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa032597

Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome

Background—The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and manage...

/pdf/diagnosis-and-treatment-of-fetal-cardiac-disease-a-1komqhwbxf.pdf

Diagnosis and Treatment of Fetal Cardiac Disease A Scientific Statement From the American Heart Association

Preterm premature rupture of the membranes.

The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study.

pdf/quintero-et-al-2003-stage-based-treatment-of-twin-twin-1v6gaobr7b.pdf

Stage-based treatment of twin-twin transfusion syndrome

Selective photocoagulation of placental vessels in twin-twin transfusion syndrome: evolution of a surgical technique.

Selective photocoagulation of communicating vessels in the treatment of monochorionic twins with selective growth retardation

Objective. We have previously described the selective laser photocoagulation of communicating vessels (SLPCV) technique for the treatment of twin–twin transfusion syndrome (TTTS). Because TTTS is thought to result from a net transfer of blood from the donor twin to the recipient twin, we hypothesized that lasering the arteriovenous anastomoses from the donor to the recipient (AVDRs) first (sequential SLPCV or SQLPCV) would result in an improved hemodynamic status and decreased likelihood of intrauterine fetal demise of the donor twin (IUFD-D).Materials and methods. The diagnosis of TTTS was made by ultrasound showing the combined presence of a maximum vertical pocket ≥ 8 cm in one sac and ≤2 cm in the other in a monochorionic/diamniotic twin pregnancy. Triplet pregnancies and monoamniotic pregnancies were excluded. Severity of TTTS was assessed using the Quintero staging system. All vascular anastomoses were endoscopically identified and classified as AVDR (AV from donor to recipient), AVRD (AV from recip...

Mary H. Allen

Papers

Staging of twin-twin transfusion syndrome.

Stage-based treatment of twin-twin transfusion syndrome

Selective photocoagulation of placental vessels in twin-twin transfusion syndrome: evolution of a surgical technique.

Selective photocoagulation of communicating vessels in the treatment of monochorionic twins with selective growth retardation

Sequential selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome.