Where is twin transfusion syndrome treated?

summary

Twin transfusion syndrome (TTTS) is a serious complication of twin pregnancy. If patients feel unwell, they should go to the hospital immediately for diagnosis and treatment. The perinatal mortality rate is very high, and the untreated mortality rate is 70% - 100%. At present, the treatment of TTTS by laser coagulation of placental communicating vessels under fetal endoscopy has become the first choice in many fetal medical centers in the world, and the survival rate of at least one fetus can reach 75% - 80%. Today, let me learn from you where twin transfusion syndrome is treated?.

Where is twin transfusion syndrome treated?

First: selective laser electrocoagulation under the fetoscope: laser cauterizes the anastomotic branches of placental vessels under the fetoscope to block the blood flow. Theoretically, it can fundamentally treat the disease. This is an effective method for each stage, but it needs professional technology and sufficient equipment. So far, selective laser electrocoagulation of placental anastomotic vessels is the first choice for TTTS before 26 weeks. Compared with continuous amniotic fluid reduction, laser coagulation can improve the perinatal survival rate and reduce the incidence rate of nervous system.

Second: amniotic fluid reduction is one of the main treatment methods at present. In acute TTTS after 26 weeks, amniotic fluid reduction is the first choice. Although amniocentesis can not interrupt the blood transfusion between twins, it can reduce the fluid venous pressure of placental vascular bed and improve the blood flow of umbilical cord and uterus. After the reduction of amniotic fluid, the waveform of inferior vena cava can be monitored by echocardiography to accurately predict the changes of cardiac function in the recipient infants. Compared with electrocoagulation, this method is simple and easy to popularize, but repeated operation will increase the chance of infection.

Third, amniostomy is made on the separating membrane to balance the amniotic fluid flow in the two amniotic sacs, so as to improve the placental circulation. Amniotic ostomy and amniotic fluid reduction have no significant difference in improving the survival rate and reducing the incidence rate of neurological diseases. But compared with amniotic fluid reduction, it only needs one operation, so it is easier to be accepted.

matters needing attention

The earlier TTTS appear, the worse the prognosis. The perinatal mortality rate is almost 100% in the early cases without treatment. In general, the perinatal mortality rate is still 20% - 45% after diagnosis and treatment before 28 weeks of gestation, which is significantly higher than that of twin amniotic sac twin chorionic twins.