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What are the alternative treatment options?
 
Serial amniocentesis  
Serial amniocentesis is the removal of the excessive fluid from around the recipient twin using a needle. This procedure may temporarily restore the balance in the amniotic fluid volumes of both. This technique may be useful for milder cases of TTTS, and is often recommended in these cases, but is generally not effective for severe cases. Generally, the need for many amniocentesis procedures has been shown to result in a 40-60% survival rate of one of at least the twins, with approximately 25% of the survivors mentally handicapped.
 
Septostomy  
Septostomy is the creation of a hole in the membrane between the babies using a needle.  This causes fluid to move towards the donor’s side and balance the fluid levels.  Septostomy has not been shown to be a successful therapy, especially in stage 2-5 cases and may create complications such as amniotic bands and cord entanglement.
 
Cord Coagulation
Cord coagulation is a technique that involves sealing thecord of one of the twins to stop its heart from beating, stopping the communication between the fetuses.  This is done using similar instruments to the fetoscope. This procedure is used when one of the twins is so close to death that laser ablation is not possible, and is done to protect the other twin from the consequences of that death. The communication between the fetuses is definitively ended, however, this eliminates the chance of survival for one of the twins.
 
Pregnancy termination 
Given the poor prognosis of this condition, when severe, and the need for complicated treatment plans, before 24 weeks, TTTS may be treated with pregnancy termination, generally by labor induction.

 

What are the alternative treatment options?
 
Serial amniocentesis  
Serial amniocentesis is the removal of the excessive fluid from around the recipient twin using a needle. This procedure may temporarily restore the balance in the amniotic fluid volumes of both. This technique may be useful for milder cases of TTTS, and is often recommended in these cases, but is generally not effective for severe cases. Generally, the need for many amniocentesis procedures has been shown to result in a 40-60% survival rate of one of at least the twins, with approximately 25% of the survivors mentally handicapped.
 
Septostomy  
Septostomy is the creation of a hole in the membrane between the babies using a needle.  This causes fluid to move towards the donor’s side and balance the fluid levels.  Septostomy has not been shown to be a successful therapy, especially in stage 2-5 cases and may create complications such as amniotic bands and cord entanglement.
 
Cord Coagulation
Cord coagulation is a technique that involves sealing thecord of one of the twins to stop its heart from beating, stopping the communication between the fetuses.  This is done using similar instruments to the fetoscope. This procedure is used when one of the twins is so close to death that laser ablation is not possible, and is done to protect the other twin from the consequences of that death. The communication between the fetuses is definitively ended, however, this eliminates the chance of survival for one of the twins.
 
Pregnancy termination 
Given the poor prognosis of this condition, when severe, and the need for complicated treatment plans, before 24 weeks, TTTS may be treated with pregnancy termination, generally by labor induction.
Laser Photocoagulation | Alternative Treatments for TTTS | RadioFrequency Ablation (RFA) | Cord Coagulation/Transection
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