ANTEPARTUM AND POSTPARTUM COMPLICATIONS OF TWIN-TWIN TRANSFUSION

Twin-twin transfusion is a condition that was previously associated wi th close to a 100% perinatal mortality. Recent reports suggest that a survival rate of about 60% can be achieved with serial amniocentesis a nd modern neonatal care. However, it is now apparent that the survivor s of this condition have multisystem complications that can result in neonatal mortality and long-term morbidity. Fourteen cases of twin-twi n transfusion were examined to determine the antenatal findings that m ay predict the postnatal outcomes of these infants, The overall surviv al was 61% (17 of 28), The mean gestation at diagnosis was 23.0 weeks (range 18-34 weeks) and the mean gestation at delivery was 29.0 weeks (range 23-37 weeks). The mean number of amniocenteses was 2.9 and the average total volume of amniotic fluid removed was 6,114 mL. Different patterns of complications were seen in the donor and recipient twins, Hypertrophic cardiomyopathy affected 9 of the recipient twins. Anuria /oliguria was found in 4 of the donor twins and none of the recipients , Periventricular leukomalacia was found in 8 twins and 7 also had mil d ventriculomegaly; of the surviving 17 twins, 5 had either periventri cular leukomalacia, mild ventriculomegaly or both. Amniotic fluid leak age and perforation of the intervening membrane subsequent to serial a mniocentesis were seen in 5 cases. Severe intrauterine growth retardat ion and abnormal cardiotocographs were a common feature, These complic ations directly resulted in neonatal mortality and long-term morbidity in the survivors. Not all complications were detected antenatally and the severity was not able to be anticipated.