Severe Brain Damage from Twin-Twin Transfusion Syndrome Treated with Serial Amnioreductions after 26 Weeks: A Case to Reconsider the Gestational Age Limits of Laser Therapy

We report a case of monochorionic twin pregnancy complicated by twin-twin transfusion syndrome (TTTS) diagnosed in the late second trimester and treated with two amnioreductions. Three days after the first amniodrainage, the recipient twin developed intracranial ventriculomegaly and, similarly, after a few days, the donor showed signs of brain damage at MRI. We discuss the possible mechanism of brain damage of amnioreductions performed after 26 weeks of gestation in a monochorionic pregnancy with TTTS as a result of a placental 'steal' phenomenon. Copyright (C) 2009 S. Karger AG, Basel