Results
The 11 patients recruited for this study underwent 18 controlled AR procedures due to severe TTTS. The choice of AR treatment instead of FLA was done by the mother. There were no cases of maternal infection or complications as well as premature delivery in the upcoming 48 hours passed the procedure. Clinical and perinatal outcome characteristics of the study population are presented in Table 1.
Ten of 11 TTTS cases were categorized as Quintero stage III (91%). The gestational age at the first AR treatment ranged from 17 to 32 weeks, with a mean age of 26.8 weeks. The amniotic fluid volume removed during a single session varied between 700-4500 ml. The time required to perform the procedure ranged from 20 minutes to more than two hours, in accordance with the drained volume. Five patients (45.5%) were treated with the serial controlled AR. Thus, the number of amniocenteses ranges from one to four per pregnancy (mean 1.6), in a median interval of 14.5 days. In all cases births were premature with delivery at 28 to 35 gestational weeks. The mean donor weight was 1185±470g and the mean recipient weight was 1566±547g. Nine out of 11 twin pairs were born alive. The outcomes in the other 2 pregnancies were as follows: a spontaneous delivery at week 35 with one surviving twin and the other macerated stillbirth, and a late abortion in week 22 with intrauterine death of one fetus and the co-twin died soon after birth. Therefore, the total survival rate was 19 out of 22 twins (86.4%).