Treating Twin to Twin Transfusion Syndrome
There are two common treatments for Twin to Twin Transfusion Syndrome.
Amnioreduction is a procedure where the doctor places a needle into the amniotic sac (bag of water) of the larger, recipient twin. This allows the doctor to remove excess fluid from the bag of water. The doctor uses ultrasound to guide the placement of the needle.
Removing extra fluid can help decrease pressure, improve the blood flow between the twins, and sometimes slow the progression of the TTTS. However, nine out of 10 times, the fluid will return. This is why it is important to continue with ultrasound evaluations to watch the fluid levels for both twins.
Laser treatment is often the best option for severe TTTS because it treats the problem rather than just addressing the symptoms. This surgery, known as Selective Fetoscopic Laser Photocoagulation (SFLP), uses a small laser device to close off all the shared blood vessels between the twins, so that they each have an independent connection to the placenta. This procedure is usually done between 16 and 26 weeks gestation.
During the SFLP procedure, your doctor will use ultrasound guidance to place an endoscope (small camera instrument) in the bag of water of the larger, recipient twin. This allows the doctor to map all the blood vessel connections on the placenta that are shared between the twins. Using the map of the shared blood vessels, your doctor uses a laser fiber to burn (photocoagulate) all the shared connections, sealing them off.
Once all these shared blood vessels are sealed, the doctor makes a thin line of laser burn, connecting all the places where the blood vessels were sealed. This stops the blood flow of any very tiny blood vessels that may be too small to see.
At the end of this procedure, your doctor will do an amnioreduction to bring the amniotic fluid to a normal level. Most moms are able to go home the next day, though this varies.