Abstract
BackgroundAmnioreduction remains a treatment option for pregnancies with twin-to-twin transfusion syndrome (TTTS) not meeting criteria for laser surgery or those in which it is not feasible. Amnioreduction is a relatively simple treatment which does not require sophisticated technical equipment. Previous reports of conservative management have indicated that major neurodevelopmental impairment occurs in 14.3-26% of survivors. The purpose of this study was to investigate long-term neurodevelopmental outcome in conservatively treated TTTS.MethodsDuring the nine-year study period from January 1996 to December 2004, all pregnancies with TTTS who were admitted to our center were investigated. TTTS was diagnosed by using standard prenatal ultrasound criteria, and staged according to the criteria of Quintero et al. We reviewed gestational age at diagnosis, gestational age at delivery, the stage of TTTS at diagnosis, and diagnosis to delivery interval. Neonatal cranial ultrasound findings were reviewed and the neurodevelopmental outcomes were evaluated.ResultsTwenty-one pregnancies with TTTS were included. Thirteen pregnancies (62%) were treated with serial amnioreduction. The mean gestational age at delivery was 28 weeks (22 - 34 weeks). The perinatal mortality rate was 42.9%. Twenty survivors were followed up until at least 3 years of age. The mean age at follow-up was 6.3 years (3 - 12 years). Six children (30%) had neurodevelopmental impairment. Four children (20%) had major neurodevelopmental impairment and two children (10%) had minor neurodevelopmental impairment. Children with neurodevelopmental impairment were delivered before 29 weeks of gestation.ConclusionsOur study showed a high rate of perinatal mortality and a high rate of major neurodevelopmental impairment in conservatively treated TTTS. The long-term outcomes for the survivors with TTTS were good when survivors were delivered after 29 weeks of gestation.
Highlights
Amnioreduction remains a treatment option for pregnancies with twin-to-twin transfusion syndrome (TTTS) not meeting criteria for laser surgery or those in which it is not feasible
Several studies have reported that the incidence of neurodevelopmental impairment in TTTS survivors treated with laser surgery is still high [5,6]
During the nine-year study, 21 pregnancies with TTTS were admitted to our center
Summary
Amnioreduction remains a treatment option for pregnancies with twin-to-twin transfusion syndrome (TTTS) not meeting criteria for laser surgery or those in which it is not feasible. Twin-to-twin transfusion syndrome (TTTS) complicates 9% of monochorionic twin pregnancies, and if untreated, is associated with a perinatal loss rate of over 80% [1,2]. Fetal interventions, such as repeated serial amnioreduction and laser surgery may reduce the perinatal mortality rate. Endoscopic laser surgery has been adopted as the first-line treatment for TTTS diagnosed before 26 weeks [4] As this technique interrupts placental vascular communication, it can potentially reduce neurodevelopmental impairment. Several studies have reported that the incidence of neurodevelopmental impairment in TTTS survivors treated with laser surgery is still high [5,6]
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