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Table 1. Comparison Between Laser Therapy and Amnioreduction.  


Treatment of Twin-Twin Transfusion Syndrome

  • Authors: A. Cristina Rossi, MD
  • CME Released: 10/12/2012
  • Valid for credit through: 10/12/2013
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Target Audience and Goal Statement

This activity is intended for obstetrician gynecologists and other physicians who manage multiple pregnancies.

The goal of this activity is to evaluate interventions for pregnant women with TTTS.

Upon completion of this activity, participants will be able to:

  1. Distinguish ultrasound findings characteristic of TTTS
  2. Evaluate interventions to reduce amniotic volume in cases of TTTS
  3. Assess the efficacy and safety of laser therapy for TTTS
  4. Compare techniques of selective infanticide in cases of TTTS


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  • A. Cristina Rossi, MD

    Department of Obstetrics and Gynecology, University of Bari, Bari, Italy


    Disclosure: A. Cristina Rossi, MD, has disclosed no relevant financial relationships.


  • Elisa Manzotti

    Publisher, Future Science Group, London, United Kingdom


    Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine


    Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

CME Reviewer

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC


    Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

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Treatment of Twin-Twin Transfusion Syndrome: Septostomy



Septostomy is the intentional rupture of the intertwin septum by ultrasound guidance and is aimed at balancing the amniotic fluid pressure in the two sacs leading to a correction of the placental circulation, mainly in the donor twin’s vessels. In addition, filling the amniotic sac of the donor twin decreases cord compression, improves fetal hemodynamics and increases urine production by the donor twin.[10] Similarly, in serial amnioreduction, septostomy has the disadvantage of removing the clinical sign (polyhydramnios) but not the etiology of TTTS (placental anastomoses). Adverse effects of septostomy are similar to those described for serial amnioreduction, such as preterm labor and premature rupture of membranes. An additional risk is represented by the creation of a monoamniotic pregnancy that can be associated with cord entanglement. The incidence of survival rate following septostomy for TTTS varies widely from 36[10] to 83%.[11] A possible explanation might be the differing severity of TTTS at the time of intervention. Although there is a trend toward increasing gestational age at delivery with septostomy compared with amnioreduction,[12] a randomized trial of amnioreduction versus septostomy showed that overall perinatal survival was similar between the two groups, and septostomy offered the advantage of requiring a single procedure.[13]

Because of lower survival rates and higher risk of neonatal morbidity compared with laser therapy, septostomy is not commonly performed as treatment of TTTS.