FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 332:224-227 January 26, 1995 Number 4 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background In monozygotic twin pregnancies, there are placental vascular communications between the two fetuses. In 15 percent of such pregnancies there is an imbalance in net blood flow between the twins, resulting in the twin–twin transfusion syndrome. The recipient twin may have severe hydramnios during the second trimester of pregnancy, and there is a high risk of perinatal death and cerebral palsy in survivors. This condition can now be treated by endoscopic coagulation of the vascular anastomoses responsible for fetofetal transfusion with a neodymium:yttrium–aluminum–garnet (Nd:YAG) laser.

Methods We performed intrauterine surgery in 45 pregnant women carrying twins at 15 to 28 weeks of gestation (median, 21); in each case there was severe hydramnios in one fetus due to the twin–twin transfusion syndrome. With the use of local anesthesia and continuous ultrasound visualization, a rigid fetoscope 2 mm in diameter, housed in a 2.7-mm cannula, was introduced transabdominally into the amniotic cavity of the recipient twin. A systematic search was made for all vessels approaching or crossing the membrane between the twins, and these were coagulated with an Nd:YAG laser by means of a fiber in the side arm of the cannula.

Results Coagulation of the communicating vessels was successful in all cases. The total number of fetuses who survived to delivery was 48 (53 percent), and the number of pregnancies with at least 1 survivor was 32 (71 percent). Among the live-born infants, the median gestational age at delivery was 35 weeks (range, 25 to 40), and the median birth weight was 2098 g (range, 550 to 4252). The median interval between the endoscopic laser procedure and delivery was 14 weeks (range, 0 to 21). All the survivors were developing normally at a median age of 12 months (range, 2 to 24).

Conclusions Our preliminary experience suggests that the twin–twin transfusion syndrome can be treated effectively by endoscopic laser coagulation of the communicating placental vessels.

Source Information

From the Harris Birthright Research Centre for Fetal Medicine, King's College School of Medicine, Denmark Hill, London SE5 8RX, United Kingdom, where reprint requests should be addressed to Professor Nicolaides.

Full Text of this Article

Related Letters:

Twin–Twin Transfusion Syndrome
Elliott J. P., Fisk N. M., Bajoria R., Wigglesworth J., Ville Y., Hyett J., Nicolaides K.
Extract | Full Text  
N Engl J Med 1995; 333:387-389, Aug 10, 1995. Correspondence

This article has been cited by other articles:

• Faye-Petersen, O. M., Crombleholme, T. M. (2008). Twin-to-Twin Transfusion Syndrome: Part 2. Infant Anomalies, Clinical Interventions, and Placental Examination. NeoReviews 9: e380-e392 [Abstract] [Full Text]  
• Faye-Petersen, O. M., Crombleholme, T. M. (2008). Twin-to-Twin Transfusion: Part 3. Mortality and Neurodevelopmental Outcomes Following Intervention. NeoReviews 9: e393-e398 [Abstract] [Full Text]  
• Fox, C., Kilby, M. D., Khan, K. S. (2005). Contemporary Treatments for Twin-Twin Transfusion Syndrome. Obstet Gynecol 105: 1469-1477 [Abstract] [Full Text]  
• Gohlke, B. C., Huber, A., Hecher, K., Fimmers, R., Bartmann, P., Roth, C. L. (2005). Fetal Insulin-Like Growth Factor (IGF)-I, IGF-II, and Ghrelin in Association with Birth Weight and Postnatal Growth in Monozygotic Twins with Discordant Growth. J. Clin. Endocrinol. Metab. 90: 2270-2274 [Abstract] [Full Text]  
• Senat, M.-V., Deprest, J., Boulvain, M., Paupe, A., Winer, N., Ville, Y. (2004). Endoscopic Laser Surgery versus Serial Amnioreduction for Severe Twin-to-Twin Transfusion Syndrome. NEJM 351: 136-144 [Abstract] [Full Text]  
• Duncombe, G. J., Dickinson, J. E., Evans, S. F. (2003). Perinatal Characteristics and Outcomes of Pregnancies Complicated by Twin-Twin Transfusion Syndrome. Obstet Gynecol 101: 1190-1196 [Abstract] [Full Text]  
• Gardiner, H. M., Taylor, M. J.O., Karatza, A., Vanderheyden, T., Huber, A., Greenwald, S. E., Fisk, N. M., Hecher, K. (2003). Twin-Twin Transfusion Syndrome: The Influence of Intrauterine Laser Photocoagulation on Arterial Distensibility in Childhood. Circulation 107: 1906-1911 [Abstract] [Full Text]  
• Audibert, F., Boullier, M., Boithias, C., Kerbrat, V., Vial, M., Frydman, R. (2003). Embryo reduction and birth weight discordance in dichorionic twins. Hum Reprod 18: 437-440 [Abstract] [Full Text]  
• Taylor, M. J. O., Govender, L., Jolly, M., Wee, L., Fisk, N. M. (2002). Validation of the Quintero Staging System for Twin-Twin Transfusion Syndrome. Obstet Gynecol 100: 1257-1265 [Abstract] [Full Text]  
• Quintero, R. A., Bornick, P. W., Allen, M. H., Johnson, P. K. (2001). Selective laser photocoagulation of communicating vessels in severe twin-twin transfusion syndrome in women with an anterior placenta. Obstet Gynecol 97: 477-481 [Abstract] [Full Text]  
• Cincotta, R B, Gray, P H, Phythian, G, Rogers, Y M, Chan, F Y (2000). Long term outcome of twin-twin transfusion syndrome. Arch. Dis. Child. Fetal Neonatal Ed. 83: 171F-176 [Abstract] [Full Text]  
• Adzick, N. S., Nance, M. L. (2000). Pediatric Surgery- Second of Two Parts. NEJM 342: 1726-1732 [Full Text]  
• SOUKA, A. P., HEATH, V., FLINT, S., SEVASTOPOULOU, I., NICOLAIDES, K. H. (1999). Cervical Length at 23 Weeks in Twins in Predicting Spontaneous Preterm Delivery. Obstet Gynecol 94: 450-454 [Abstract] [Full Text]  
• Elliott, J. P., Fisk, N. M., Bajoria, R., Wigglesworth, J., Ville, Y., Hyett, J., Nicolaides, K. (1995). Twin-Twin Transfusion Syndrome. NEJM 333: 387-389 [Full Text]