Which Therapy is Right for Me?
Choosing the management option most appropriate for you is a challenging task. As parents your choice is very individual and there is no "right" or "wrong" decision. It is important to consider all your options before you make a management decision. For example, an initial amnioreduction removes the necessary amniotic fluid pocket for successful Laser therapy and and may therefore limit or delay the possibility for definitive treatment. The following table gives you an overview of the typical procedure related risks and outcomes.
It is important to emphasize many factors may mean these group statistics are not directly applicable to your specific, very individual case. Placental location, degree of IUGR of the donor, cervical length, prior procedures, all have important individual influence.
Pregnancy termination may be the best choice for families that are unwilling to accept any of the risks associated with any therapeutic approach.This choice recognizes that recurrent TTTS is extremely rare - most likely any future pregnancy will be normal.
Umbilical cord occlusion is often the first choice in patients where one fetus (usually the smaller donor twin) has serious sonographically detectable problems. These mean that the baby has suffered irreparable damage from TTTS or has severe growth restriction and is likely to die following a laser procedure because the placental portion of that fetus is too small. Fetal congenital abnormalities (birth defects) are more common and may influence your decision. This procedure gives a very good chance of the single survivor being healthy and delivering near term.
Laser coagulation of placental anastomoses gives the best chance to for of both babies to survive and deliver near term. Some factors which we will help you evaluate, may make this procedure less successful.. Fetal status, especially of the donor, may influence your decision, but it is impossible to be certain that the placenta will be enough to sustain the smaller fetus after the laser procedure. This procedure is the clear choice when preserving both babies is the goal.
Beyond 26 weeks gestation, it may not be safe to perform the laser procedure. In very selective instances between 26 and 28 weeks, amniodrainage, one or two procedures only, may be appropriate to gain one or two weeks of further intrauterine time for maturation. For us, this is the least desirable situation and is the most dangerous procedure - we never offer this as first line treatment for TTTS.
Do I have TTTS? Do I need treatment? Which treatment is the right one? Treatment choices are not easy - you cannot decide this alone. Although the family's wishes and choices are the most important, it is our team's responsibility to provide the highest level of understanding possible, to make that choice the best one for each family, in the family's own terms.
For a detailed assessment, call us. The Center for Advanced Fetal Care 410 328 3865.