A randomized trial of amnioreduction versus septostomynext term in the treatment of twin-twin transfusion syndrome

Moise, Kenneth J., Dorman, Karen, Lamvu, Georgine, Saade, George R., Fisk, Nicholas M., Dickinson, Jan E., Wilson, R. D., Gagnon, Alain, Belfort, Michael A., O'Shaughnessy, Richard O., Chitkara, Usha, Hassan, Sonia S., Johnson, Anthony, Sciscione, Anthony and Skupski, Daniel (2005) A randomized trial of amnioreduction versus septostomynext term in the treatment of twin-twin transfusion syndrome. American Journal of Obstetrics and Gynecology, 193 3: 701-707. doi:10.1016/j.ajog.2005.01.067


Author Moise, Kenneth J.
Dorman, Karen
Lamvu, Georgine
Saade, George R.
Fisk, Nicholas M.
Dickinson, Jan E.
Wilson, R. D.
Gagnon, Alain
Belfort, Michael A.
O'Shaughnessy, Richard O.
Chitkara, Usha
Hassan, Sonia S.
Johnson, Anthony
Sciscione, Anthony
Skupski, Daniel
Title A randomized trial of amnioreduction versus septostomynext term in the treatment of twin-twin transfusion syndrome
Journal name American Journal of Obstetrics and Gynecology   Check publisher's open access policy
ISSN 0002-9378
1097-6868
Publication date 2005-09
Sub-type Article (original research)
DOI 10.1016/j.ajog.2005.01.067
Volume 193
Issue 3
Start page 701
End page 707
Total pages 7
Place of publication St Louis, MO, U.S.A.
Publisher Mosby
Language eng
Subject 111402 Obstetrics and Gynaecology
1114 Paediatrics and Reproductive Medicine
Formatted abstract
Objective: Left untreated, severe twin-to-twin transfusion syndrome (TTTS) presenting in the early second trimester of pregnancy is often associated with significant maternal morbidity and almost universal perinatal loss. Removal of excessive amounts of amniotic fluid through serial amniocenteses (amnioreduction) has been the mainstay of therapy. We sought to compare amnioreduction to intentional perforation of the intervening twin membrane (previous termseptostomy)next term.
Study design: Pregnant women with TTTS before 24 weeks' gestation were randomly assigned to serial amnioreduction or previous termseptostomy.next term A single puncture technique under ultrasound guidance was used for the previous termseptostomy.next term The primary outcome measure was survival to neonatal discharge, and was assessed based on the number of pregnancies or the number of fetuses as appropriate.
Results: The study was terminated at the planned interim analysis stage after 73 women were enrolled. This was because the rate of survival of at least 1 infant was similar in the amnioreduction group compared to the previous termseptostomynext term group (78% vs 80% of pregnancies, respectively; RR = 0.94, 95%CI 0.55–1.61; P = .82). Patient undergoing previous termseptostomynext term were more likely to require a single procedure for treatment (64% vs 46%; P = .04).
Conclusion: Although overall perinatal survival is not enhanced, previous termseptostomynext term offers the advantage of often requiring a single procedure compared to serial amnioreduction in the treatment of severe twin-to-twin transfusion syndrome.
Copyright © 2005 Elsevier Inc. All rights reserved.

Keyword Twin-to-twin transfusion syndrome
TTTS
Amnioreduction
Septostomy
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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