Researchers to compare prenatal treatments for serious twin complication

Researchers at The Childrens Hospital of Philadelphia are beginning a study to compare two treatments for a serious condition that may occur in pregnant women carrying twins. In twin-twin transfusion syndrome (TTTS), abnormal circulation between the twins and the placenta they share may cause one twin to be much smaller than the other, and surrounded by much less amniotic fluid. The imbalance in circulation may kill one or both fetuses, or damage the health of twins who survive.

Physicians usually diagnose TTTS using prenatal ultrasound, augmented by other tests such as fetal magnetic resonance imaging and amniocentesis. Although TTTS occurs in only 200 to 1800 pregnancies annually in the U.S., the condition has a disproportionately high impact. In approximately 17 percent of cases in which a twin dies before, during or shortly after birth, the cause is TTTS. Estimates of the frequency of TTTS vary widely because of differing criteria for diagnosing the syndrome.

Timothy M. Crombleholme, M.D., a pediatric and fetal surgeon at the Center for Fetal Diagnosis and Treatment at Childrens Hospital, is the principal investigator of the national, multicenter clinical trial, which is comparing two treatments for TTTS. The current standard treatment is amnioreduction, in which excess amniotic fluid surrounding one fetus is drained through a needle inserted into the mothers abdomen. Another treatment, laser photocoagulation, uses heat from a laser, inserted through a flexible tube, or fetoscope, to seal off the blood vessels connecting the two fetuses. The goal of the laser treatment is to separate the communicating circulation between the twins which causes the syndrome.

Without prenatal treatment for TTTS, both twins usually die. Even with treatment, survival of both twins is not guaranteed, and survivors are nearly always born prematurely, sometimes with health complications, including brain injury and heart conditions related to the abnormal pre

Contact: John Ascenzi
Children's Hospital of Philadelphia

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