Alternatives to Laser Photocoagulation Treatment
The following treatments may be appropriate if a pregnancy is not a candidate for laser photocoagulation treatment:
Serial amniocentesis is the removal of the excessive fluid from around the recipient twin using a needle. This procedure may temporarily restore the balance in the amniotic fluid volumes of both twins. This technique may be useful for milder cases of TTTS, and historically, has often been recommended in these cases. It is generally not effective for severe cases. Generally, serial amniocentesis has been shown to result in a 40 percent to 80 percent survival rate of at least one of the twins, with a approximately 25 percent of the survivors experiencing mental disabilities. With the improvements in photocoagulation treatment, serial amniocentesis is being done less and less.
Septostomy is the creation of a hole in the membrane between the babies using a needle. This causes fluid to move towards the donor’s side and balance the fluid levels. Septostomy has not been shown to be a successful therapy, especially in Stage II to Stage V cases and may create complications such as amniotic bands and cord entanglement. For these reasons, it is rarely done.
Umbilical Cord Ligation
Umbilical cord ligation is a technique that involves tying a knot around the cord of one of the twins to stop its heart from beating, stopping the communication between the fetuses. This is done using similar instruments to the fetoscope. This procedure is used when one of the twins is so close to death that laser ablation (photocoagulation) is not possible, and is done to protect the other twin from the consequences of that death. The communication between the fetuses is definitively ended; however, this eliminates the chance of survival for one twin.
If the prognosis for both twins is very poor, given the risks and potential complications involved, some families decide to not continue the pregnancy.