TWIN-TO-TWIN TRANSFUSION SYNDROME - SELECTIVE FETICIDE BY EMBOLIZATION OF THE HYDROPIC FETUS

To improve the outcome of severe twin-to-twin transfusion syndrome wit h 1 hydropic fetus and to prevent ischemic sequelae in the survivor, w e developed a technique of selective feticide by vascular embolization of the most severely damaged twin. Acute second trimester polyhydramn ios occurred in 4 biamniotic monochorial twin pregnancies, with 1 fetu s normal on ultrasound but the other severely damaged by hydrops and h ypertrophic hypokinetic cardiomyopathy. The hydropic fetus underwent e mbolization using a bolus of histoacryl injected into the umbilical ve in and fetal heart under ultrasound guidance. In 1 triplet pregnancy w ith a set of monochorial fetuses, premature labor occurred at 26 weeks , 2 weeks after embolization, and there were 2 neonatal deaths. The 3 other cases resulted in the birth of a normal infant at 31-37 weeks of gestation. This suggests that in twin-to-twin transfusion syndrome wi th severe polyhydramnios and hydrops of 1 fetus, embolization may salv age the other twin.