Controlled Amnioreduction for Twin-to-Twin Transfusion Syndrome: Perinatal and Long-Term Neurodevelopmental Outcome

Abstract

Objectives: Twin-to-twin transfusion syndrome (TTTS) is a severe condition causing preterm delivery, fetal death, and neurodevelopmental disorders. The aim of this study was to develop a simple procedure for amnioreduction that would be controlled by the amniotic pressure and volume removed. Design: Prospective study of cases diagnosed with TTTS. Setting: Lis Maternity and Women's Hospital, Israel. Population: Eleven patients with severe TTTS at stages II and III of Quintero classification were enrolled in the study. Methods: The amniotic pressure was measured along with the removed volume of the amniotic pressure between 17-34 weeks of gestation. The umbilical artery systolic/diastolic ratio for each twin was measured at the beginning and after every 500cc of removed amniotic fluid. Long-term neurodevelopmental outcome of infants with TTTS was performed. Main Outcome Measures: The survival rate was 86.4% although 91% of all twins were Quintero stage III. Results: 18 procedures were performed in this study without any maternal complications. The pattern of amniotic pressure versus the volume removed demonstrated an exponential relationship with a plateau. No tendency in the systolic/diastolic ratio variations was observed during the procedure. Of the 19 surviving twins, 13(59.1%) were considered neurologically normal, 5 (22.73%) neurologically subnormal and 1 (4.55%) abnormal. Results were compared to classical amnioreduction and laser technique procedures. Conclusions: The procedure resulted in a high rate of twin survival. The amniotic pressure was reduced towards normal values. The new procedure seems to be more efficient in terms of twin survival and positive long-term outcomes. Clinical trial ID: NCT04148 'Tweetable abstract' The efficiency of the controlled amnioreduction procedure has the potential to increase survival rates and wellness of both TTTS fetuses.