Twin to Twin Transfusion Syndrome Treatment
The medical team works closely with the parents to create a plan of treatment that takes into consideration the TTTS stages, progression of condition, the babies’ gestational age and the parents’ wishes. The team explains all possible treatment options and what risks each carries. Support is available at every step of the diagnosis and treatment process.
Laser photocoagulation is a minimally invasive procedure that “disconnects” the abnormal vessels within the placenta, separating the babies’ circulation. It can be performed between 16 and 26 weeks of gestation. The mother is given local/spinal anesthesia and the surgeon makes a small incision through which a fetoscope (a small camera on a thin tube) is carefully placed into the uterus. The medical team then identifies the connecting vessels and disconnects (coagulates) them using a laser light in the fetoscope. This highly advanced procedure offers the best outcomes: an estimated 90 percent of patients have at least one twin survive after this procedure; 60-70 percent have two survivors.
Serial amniocentesis is a procedure to drain the excessive amniotic fluid around the recipient twin. The surgeon uses a needle passed through the mother’s abdomen to relieve the pressure. This technique often is performed in milder cases that occur later in the pregnancy. It is usually not recommended for more severe cases. It usually restores the balance of fluid between the two sacs, but because the twins are still connected, the transfusion process will continue.
Amniotic septostomy is a procedure using the same needle as the serial amniocentesis. In this procedure, however, the needle is used to create a hole in the thin wall that separates the babies’ amniotic sacs. This allows the fluid to move from the recipient’s sac to the donor’s sac, allowing balance to be restored. Because the hole can become larger, the babies are at risk to share a sac, which can lead to a very serious complication called umbilical cord entanglement.
Selective Cord Coagulation
In some cases, often when one of the twins is suffering from additional complications outside of TTTS or is very close to death, a selective cord coagulation may be performed. During this procedure, the umbilical cord is coagulated so that blood flow will stop to the fetus. The communication between the twins is ended, but it eliminates the chance of survival for one of the twins. Survival of the remaining fetus can be expected in 85 percent of cases.
While twin to twin transfusion is a very significant condition, there is hope for families facing the diagnosis. When the condition is discovered promptly and treatment or management action is taken, many families have successful outcomes for the pregnancy and both babies.