Published online by Cambridge University Press: 11 October 2022
Twin-twin transfusion syndrome (TTTS) is a severe complication that affects 10-15% of monochorionic multiple pregnancies. It is caused by an imbalanced blood flow through communicating placental vessels on the chorionic surface between the donor and recipient twin circulations. Regarding treatment, evidence demonstrates that fetoscopic laser ablation is superior to serial amnioreductions in terms of survival and neurological outcome for stage II-IV TTTS. However, the optimal management of stage I TTTS remains controversial. It is well established that all chorionic plate anastomoses should be closed by laser. Compared to the selective laser method, the Solomon technique yields a significant reduction of recurrent TTTS and post-laser twin anemia-polycythemia sequence (TAPS). Over the past 25 years, survival rates after fetoscopic laser surgery have significantly increased. High-volume centers report up to 70% double survival, and >90% survival of at least one twin after laser treatment of TTTS. About 10% of laser surgery survivors exhibit long-term neurodevelopmental delay. In this chapter, we discuss TTTS pathophysiology, diagnosis, and optimal treatment, as well as long-term outcomes after laser intervention.
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