How Is Twin-Twin Transfusion Syndrome Treated?
The treatment plan we recommend depends on the severity of the condition and how far along the pregnancy is. Referring doctors can participate in this meeting, in person or by phone. We give them information about all parts of our evaluation, treatment and follow-up recommendations.
Expectant Management (Monitoring the Pregnancy)
In less severe cases, surgery may not be needed. If that is the case, we will use ultrasound and fetal echocardiography to monitor the fetuses during the pregnancy. If their condition worsens, our team will work with the patient, the patient’s family and referring doctor to decide what treatment is best. Sometimes, early delivery is the best option.
Amnioreduction (Draining Excess Amniotic Fluid)
When the fetuses are only mildly affected by TTTS, we may recommend amnioreduction to drain the excess amniotic fluid from the recipient twin’s sac. If amnioreduction does not work, patients may be given the option to move forward with selective fetoscopic laser photocoagulation (SFLP), known as laser surgery.
Selective Fetoscopic Laser Photocoagulation (Laser Surgery)
When the pregnancy is more severely affected by TTTS, the team may recommend selective fetoscopic laser photocoagulation, or laser surgery. This procedure involves making a small incision in the mother’s abdomen and inserting a trocar, or small metal tube, into the uterus. The surgeon then passes a fetoscope (a kind of medical telescope) through the metal tube to see all the blood vessel connections on the surface of the placenta shared by the twins.
After all the abnormal blood vessel connections are found, the laser is used to treat these vessels. The laser disconnects them permanently. Afterward, the surgeon drains the extra amniotic fluid around the recipient fetus through the trocar. The surgery is then complete.
The location of the placenta will help decide the type of anesthesia used for the laser surgery. If the placenta is “posterior,” or located on the back wall of the uterus, we recommend intravenous (IV) sedation and a local anesthetic. However, if the placenta is “anterior,” or located on the front wall of the uterus, we recommend IV sedation, a local anesthetic and possibly an epidural.
After laser surgery, most patients stay in the hospital for one day. Post-operative ultrasound and fetal echocardiography are then repeated five days after the laser surgery to reassess the fetal condition. We will work with the patient's maternal-fetal medicine specialist and obstetrician to make sure they have follow-up care at home.
