Controlled Amnioreduction for Twin-to-Twin Transfusion Syndrome:
Perinatal and Long-Term Neurodevelopmental Outcome
Abstract
Objectives: Twin-to-twin transfusion syndrome (TTTS) is a severe
condition causing preterm delivery, fetal death, and neurodevelopmental
disorders. The aim of this study was to develop a simple procedure for
amnioreduction that would be controlled by the amniotic pressure and
volume removed. Design: Prospective study of cases diagnosed with TTTS.
Setting: Lis Maternity and Women’s Hospital, Israel. Population: Eleven
patients with severe TTTS at stages II and III of Quintero
classification were enrolled in the study. Methods: The amniotic
pressure was measured along with the removed volume of the amniotic
pressure between 17-34 weeks of gestation. The umbilical artery
systolic/diastolic ratio for each twin was measured at the beginning and
after every 500cc of removed amniotic fluid. Long-term
neurodevelopmental outcome of infants with TTTS was performed. Main
Outcome Measures: The survival rate was 86.4% although 91% of all
twins were Quintero stage III. Results: 18 procedures were performed in
this study without any maternal complications. The pattern of amniotic
pressure versus the volume removed demonstrated an exponential
relationship with a plateau. No tendency in the systolic/diastolic ratio
variations was observed during the procedure. Of the 19 surviving twins,
13(59.1%) were considered neurologically normal, 5 (22.73%)
neurologically subnormal and 1 (4.55%) abnormal. Results were compared
to classical amnioreduction and laser technique procedures. Conclusions:
The procedure resulted in a high rate of twin survival. The amniotic
pressure was reduced towards normal values. The new procedure seems to
be more efficient in terms of twin survival and positive long-term
outcomes. Clinical trial ID: NCT04148