Dangerous Findings in a Multifetal Gestation

LaRae Brown, MD

Disclosures

June 05, 2012

Management

Reduction amniocentesis is the most widely accepted and common procedure used to treat TTTS. By removing excess amniotic fluid from the recipient twin, some of the downstream effects of this syndrome may be ameliorated in both the recipient and the donor twin. Relieving the pressure by reducing the amniotic fluid volume may improve uteroplacental perfusion. As in the case of this patient, however, this procedure does not always prevent the disease from worsening.

Laser photocoagulation (ablation) of placental vessels along the chorionic plate has become an accepted therapy for TTTS. It is generally reserved for the most severe cases, particularly those that do not respond to amnioreduction. In pregnancies treated with fetoscopic procedures, the overall survival is 75%, with survival of at least 1 fetus in 85%.[2]

Unfortunately, a few days before this patient's scheduled fetoscopic laser ablation, fetus B (the recipient twin) died.

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