OBJECTIVE: To determine whether therapeutic amniocentesis may improve outcomes in patients with twin-twin transfusion syndrome. METHODS: Thirteen patients with possible twin-twin transfusion syndrome were evaluated for treatment. Therapeutic amniocenteses were performed on nine, and four patients were managed conservatively depending on the clinical severity of the twin-twin transfusion syndrome. RESULTS: Therapeutic amniocenteses resolved the syndrome in three of nine cases, with an overall neonatal survival rate of 83.3% (15 of 18) and neonatal morbidity of 53.3% (eight of 15) among the survivors. The survival rate in patients with expectant management was 75% (six of eight), with a neonatal morbidity of 33.3% (two of six). An association between amniotic fluid status and fetal outcomes was observed. Patients with normalization of polyhydramniosoligohydramnios had the best outcomes. CONCLUSION: Early, aggressive amniocentesis may be an effective therapy for twin-twin transfusion syndrome. Therapeutic amniocentesis may have the capability to alter inter-fetal blood flow, possibly as a result of changes in intravascular pressure, which are related to changes in intra-amniotic pressure.
OBJECTIVE: To determine whether therapeutic amniocentesis may improve outcomes in patients with twin-twin transfusion syndrome. METHODS: Thirteen patients with possible twin-twin transfusion syndrome were evaluated for treatment. Therapeutic amniocenteses were performed on nine, and four patients were managed conservatively depending on the clinical severity of the twin-twin transfusion syndrome. RESULTS: Therapeutic amniocenteses resolved the syndrome in three of nine cases, with an overall neonatal survival rate of 83.3% (15 of 18) and neonatal morbidity of 53.3% (eight of 15) among the survivors. The survival rate in patients with expectant management was 75% (six of eight), with a neonatal morbidity of 33.3% (two of six). An association between amniotic fluid status and fetal outcomes was observed. Patients with normalization of polyhydramniosoligohydramnios had the best outcomes. CONCLUSION: Early, aggressive amniocentesis may be an effective therapy for twin-twin transfusion syndrome. Therapeutic amniocentesis may have the capability to alter inter-fetal blood flow, possibly as a result of changes in intravascular pressure, which are related to changes in intra-amniotic pressure.
Authors: Timothy M Crombleholme; David Shera; Hanmin Lee; Mark Johnson; Mary D'Alton; Flint Porter; Jacquelyn Chyu; Richard Silver; Alfred Abuhamad; George Saade; Laurence Shields; David Kauffman; Joanne Stone; Craig T Albanese; Ray Bahado-Singh; Robert H Ball; Larissa Bilaniuk; Beverly Coleman; Diana Farmer; Vickie Feldstein; Michael R Harrison; Holly Hedrick; Jeffrey Livingston; Robert P Lorenz; David A Miller; Mary E Norton; William J Polzin; Julian N Robinson; Jack Rychik; Per L Sandberg; Istvan Seri; Erin Simon; Lynn L Simpson; Larisa Yedigarova; R Douglas Wilson; Bruce Young Journal: Am J Obstet Gynecol Date: 2007-10 Impact factor: 8.661