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Feto-fetal transfusion syndrome (TTTS):
Indication and performance of laser coagulation

Patient information - What should you know, what should you ask?

What is twin-to-twin transfusion syndrome?

TTTS can occur in approximately 10% of all twin pregnancies in which the two children share one placenta (monochorial twin pregnancy). In this case, there is a hemodynamic imbalance between the two twins. This means that one of the two children receives a significantly larger share of the blood volume than the other child due to the connection of the blood circulations via the placenta. Without treatment, the condition is associated with an increased risk of mortality (approximately 80%) and morbidity.

How is the diagnosis made?

The diagnosis is made by ultrasound. An increased amount of amniotic fluid is found in the recipient (polyhydramnios) and a significantly reduced amount or even no amniotic fluid is found in the donor (oligo- or anhydramnios). Later, there is a change in Doppler values. Often there is a weight discrepancy.

How is TTTS treated?

In cases of marked feto-fetal transfusion syndrome (FFTS), the treatment of choice is fetoscopic laser coagulation of the placental anastomoses.

How is the laser surgery performed?

Laser surgery is usually performed under local anesthesia of the abdominal wall. An ultra-thin optic, only 1 mm in diameter, is used to reduce the risk of rupture of the membranes after the procedure, thus significantly increasing the chances of survival of both children.
The vascular connections between both children (anastomoses) are localized and sclerosed with a Nd:YAG laser.
At the end of the operation, we carefully check whether all anastomoses are closed. Finally, the amniotic fluid is reduced through the abdominal wall. 

What are the complications?

The complication rate is very low with experienced fetal surgeons.
The most common complication is amniotic fluid leakage or leakage (dribbling from the puncture site; approximately 30% up to 32+0 SSW). This can lead to late abortion or premature delivery with a poor prognosis. By reducing the injury to the amniotic membrane by using the ultra-thin 1mm technique, this complication can be reduced to 16%.

Other risks described in the literature include hemorrhage, umbilical cord injury, fetal injury, and infection. These are extremely rare overall.

What are the chances of survival for the children after laser surgery?

One child survives in 97% and two children in 81% when the ultra-thin technique is used.

These figures represent the world's best outcome achieved by us, which sets us apart from other centers as a highly professional center for fetal surgery in the field of laser coagulation of feto-fetal anastomoses.

Feto-fetal transfusion syndrome (TTTS)

Berlin Center for Prenatal Diagnostics and Fetal Surgery
MVZ Evangelisches Waldkrankenhaus

Prof. Dr. med. Michael Tchirikov

Specialist in obstetrics and gynecology
Focus: Special obstetrics and prenatal medicine

Consultation hours

Stadtrandstra├če 555
13589 Berlin

Mondays:8 am to 5 pm
Tuesdays:8 am to 5 pm
Wednesdays:Surgery day in the EWK 8 am to 5 pm
Thursdays:8 am to 5 pm
Fridays:8 am to 12pm
Telephone: +49 (0)30 - 42206830200
* Legally insured and self-payer