AMNIOTIC-FLUID PRESSURE IN TWIN-TO-TWIN TRANSFUSION SYNDROME - AN OBJECTIVE PROGNOSTIC FACTOR

Severe twin-to-twin transfusion syndrome presenting before 28 weeks' g estation is associated with a high neonatal mortality and morbidity du e to polyhydramnios-related very premature delivery or intrauterine de ath of one or both twins, Management options include serial amniodrain ages or laser coagulation of the intertwin placental anastomoses; howe ver, early antenatal prognostic factors are lacking. Serial amniocente ses were performed in 9 pregnancies with twin-to-twin transfusion synd rome presenting with second-trimester polyhydramnios, and serial measu rements of amniotic fluid pressure were made, Although in 8 cases the pre-drainage pressure was above the 95th centile of the normal range f or singleton pregnancies, the pressures were lower in the pregnancies resulting in two livebirths than in the cases where one or both babies died. This study suggests that patients presenting with intraamniotic pressure >17 mm Hg cannot be safely managed by serial amniodrainages.