Incidence and survival of MCDA twin pregnancies with TTTS presenting without amniotic fluid discordance due to spontaneous septostomy and treated with fetoscopy

Atypical twin–twin transfusion syndrome

“…without oligohydramniospolyhydramnios sequence, but in which there is a distended recipient bladder and the bladder of the suspected donor twin cannot be visualized (Figures 6 and 7 and Videoclip S2). Such sporadic cases may be explained by spontaneous septostomy due to the increased amniotic fluid pressure in the recipient's sac [39][40][41] . Other possible mechanisms include infection or developmental disturbance.…”

“…Laser therapy in these cases is technically challenging, as the free-floating membranes may obscure visualization of the vascular equator and anastomoses, necessitating passage of a fetoscope through the defect into the intertwin membrane to trace the anastomoses. Compared with TTTS with an intact intertwin membrane, TTTS with spontaneous septostomy is associated with an increased risk of adverse perinatal outcomes such as preterm prelabor rupture of the membrane, preterm labor, umbilical cord entanglement and overall lower survival rates 40 . TTTS generally presents after 16 weeks of gestation, when the implicated intertwin placental vascular anastomoses have developed, resulting in unbalanced vascular exchange, and subsequent hemodynamic imbalance and endocrine cascade.…”

Prenatal diagnosis of congenital anomalies in the era of fetal surgery in Mexico

“…We reported a prospective cohort of 248 TTTS cases treated with fetoscopic placental laser therapy at GA between 15 and 31 weeks showing survival of at least one twin in 87% of the cases and 53% of both twins. 13 In an attempt to foster lung growth and improve neonatal survival in CDH fetuses with severe pulmonary hypoplasia, Fetal Endoscopic Tracheal Occlusion (FETO) was performed in 25 isolated CDH fetuses at a mean GA of 29.3 (25.6 to 31.8) weeks. Our results showed a significantly higher neonatal survival in comparison with another 25 fetuses managed expectantly during pregnancy (32% vs. 0%, p<0.01 respectively).…”