What is the best treatment option for managing Twin-Twin Transfusion Syndrome (TTTS)?

In the context of Twin-Twin Transfusion Syndrome (TTTS), the most effective treatment is the coagulation of placental anastomoses. TTTS occurs in monozygotic twins who share a placenta and are connected by placental blood vessels. This condition leads to an imbalance in blood flow between the twins, often resulting in one twin receiving excessive blood flow (the "recipient") while the other does not get enough (the "donor").

Coagulation of the placental anastomoses involves using a laser to sever the abnormal blood vessels that connect the twins' circulations. This procedure is performed through a fetoscopic approach and directly addresses the underlying pathology of TTTS by interrupting the blood flow that is causing the imbalance. It has been shown to improve outcomes for both twins, reducing the risk of complications like heart failure in the recipient twin and growth restrictions in the donor twin.

While other options like amniotic septostomy and serial amnioreduction may provide some benefit in managing complications associated with TTTS, they do not specifically target the pathological anastomoses that cause the syndrome. Fetal reduction is typically considered in cases where the number of fetuses is the primary concern and not specifically aimed at