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

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

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice, and high quality teaching and research related to diagnostic imaging in women's healthcare. The ISUOG Clinical Standards Com mittee (CSC) has a remit to develop Practice Gui delines and Consensus Statements as educational recommendations that provide healthcare practit ioners with a consensus based approach, from experts, for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or state ments issued by the CSC. The ISUOG CSC docu ments are not intended to establish a legal stan dard of care because interpretation of the eviden ce that underpins the Guidelines may be influen ced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG (info@isuog.org).

https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1002/uog.15821

ISUOG Practice Guidelines: role of ultrasound in twin pregnancy.

Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome.

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.

Selective laser photocoagulation of communicating vessels in severe twin-twin transfusion syndrome in women with an anterior placenta.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(00)05084-4.pdf

Patricia K Johnson

Papers

Staging of twin-twin transfusion syndrome.

Selective laser photocoagulation of communicating vessels in severe twin-twin transfusion syndrome in women with an anterior placenta.

In-utero treatment of fetal bladderoutlet obstruction by a ureterocele

Fetal hydrolaparoscopy and endoscopic cystotomy in complicated cases of lower urinary tract obstruction.