Objective: Severe previable twin-to-twin transfusion syndrome (TTTS) is ass
ociated with a high fetal loss rate and is therefore usually treated. In th
is paper, serial amniodrainage and inter-twin septostomy are reviewed in te
rms of technical aspects and fetal outcome. Study design: A review of the l
iterature using a MEDLINE DATA search between 1990 and 2000 was done in ord
er to describe the mechanisms and technical aspects of both procedures with
their physiopathological consequences. In addition, data from our experien
ce with septostomy are given. Results: Amniodrainage increases survival rat
e, with outcome ranging :From 40 to 87% (mean: 56%). Inter-twin septostomy
is associated with a mean fetal survival rate ranging from 57 to 83% (mean:
70%). Conclusion: In severe TTTS, amniodrainage and septostomy are simple
therapeutic alternatives with a survival rate similar to what is currently
reported for laser coagulation of placental vessels. (C) 2000 Elsevier Scie
nce Ireland Ltd. All rights reserved.