SERIAL AMNIOCENTESES IN THE MANAGEMENT OF TWIN-TWIN TRANSFUSION SYNDROME - WHEN IS IT VALUABLE

Serial decompressive amniocenteses were performed at 18-23 weeks of ge station in 23 pregnancies referred due to echographic signs typical of twin-twin transfusion syndrome. The procedures were repeated until de livery or permanent normalization of the amniotic fluid volume both in the donor and the recipient twin sac. The overall survival rate was 5 7%, but in only 39% of the pregnancies did both twins survive without handicaps. The absence of end diastolic flow in the umbilical artery o f the donor twin was associated with poor chances of survival for both fetuses; in contrast, the presence of hydrops or ascites in the recip ient twin did not worsen the prognosis. A policy of aggressive amnioti c fluid decompression may achieve permanent resolution of the fluid in over 50% of the pregnancies complicated by twin-twin transfusion synd rome.