Twin-to-twin transfusion syndrome: treatment by amniodrainage and septostomy

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.