Management of Twin-to-Twin Transfusion Syndrome: A Systematic Review of Fetoscopic Laser Ablation versus Amnioreduction

Abstract

Introduction: Twin-to-twin transfusion syndrome (TTTS) is a serious complication of monochorionic twin pregnancies. This review compares the two primary treatment modalities: serial amnioreduction and fetoscopic laser ablation of placental anastomoses.

Methods: A search of MEDLINE and CENTRAL was conducted for RCTs comparing fetoscopic laser ablation to serial amnioreduction for the treatment of severe TTTS. The primary outcome was perinatal survival of at least one twin.

Results: The meta-analysis of several RCTs demonstrated that fetoscopic laser ablation was superior to serial amnioreduction, resulting in a significantly higher survival rate of at least one twin. Laser therapy was also associated with a lower incidence of severe neurological impairment in survivors.

Discussion: Fetoscopic laser ablation treats the underlying cause of TTTS by coagulating the inter-twin vascular anastomoses. This definitive treatment leads to better perinatal and neurological outcomes compared to the symptomatic management offered by amnioreduction.

Conclusion: Fetoscopic laser ablation is the superior treatment for severe twin-to-twin transfusion syndrome, improving both survival and neurological outcomes.