Twin-twin transfusion syndrome (TTTS) is discussed in more detail elsewhere. It affects 15% of monochorionic pregnancies and historically has perinatal mortalities of up to 80% if untreated. Recent advances in management such as amnioreduction, septostomy, laser ablation of placental vessels or selective reduction using bipolar cord occlusion has significantly improved perinatal survival such that between 60 and 79% of affected pregnancies have at least one fetus surviving with the various techniques. However, a recent randomized control trial of placental laser ablation versus amnioreduction/septostomy demonstrated that as compared with the amnioreduction group, the laser group had a higher likelihood of survival of at least one twin to 28 days of age (76 versus 56%; relative risk of the death of both fetuses, 0.63; 95% confidence interval, 0.25-0.93; p = 0.009) and 6 months of age (p = 0.002). Infants in the laser group also had a lower incidence of cystic periventricu-lar leukomalacia (6 versus 14%, p = 0.02) and were more likely to be free of neurologic complications at 6 months of age (52 versus 31%, p = 0.003) . The authors suggested that endoscopic laser coagulation of anastomoses is a more effective first-line treatment than serial amnioreduction for severe twin-to-twin transfusion syndrome diagnosed before 26 weeks of gestation. However, it remains unclear what the most appropriate management for early stage disease should be and randomized trial in this group is awaited.
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Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.