Contemporary treatments for twin-twin transfusion syndrome

OBJECTIVE: To undertake a systematic review to determine the effects of fetal therapy interventions compared with amniodrainage for twin-twin transfusion syndrome on perinatal survival and outcome. METHODS: Searching MEDLINE (1966-2004), ENEBASE (1988-2004), a hand search of specialist journals, and the Cochrane library (2004:2) identified relevant articles. Studies were selected if the effects of fetal therapeutic interventions for twin-twin transfusion syndrome (laser photocoagulation, serial amnioreduction, septostomy, and selective feticide) on perinatal survival, complications, and morbidity were compared. Study selection, quality assessment, and data abstraction were performed independently and in duplicate. RESULTS: Only 3 controlled observational studies (comparing treatment in 306 twins) and 1 randomized controlled trial (of 142 twins) were identified. Laser photocoagulation significantly improved perinatal survival of at least 1 fetus and reduced neurologic morbidity compared with serial amnioreduction. No such differences were observed in the comparison of serial amnioreduction with septostomy. CONCLUSION: In a systematic review of observational and randomized controlled studies, laser photocoagulation of chorionic plate vessels at the intertwin membrane seems to be more effective than serial amnioreduction in the treatment of twin-twin transfusion syndrome with less associated perinatal morbidity and mortality. However, septostomy and selective feticide have not been robustly evaluated. (c) 2005 by The American College of Obstetricians and Gynecologists.