Therapeutic Reduction Amniocentesis: This is the 'most widely
available therapy' and involves draining the excess amniotic
fluid (polyhydramnios) by inserting a needle into the amniotic
sac of the recipient. It relieves the mother's abdominal discomfort,
and prolongs TTTS pregnancies by reducing the risk of spontaneous
rupture of the membranes or premature labor from the enlarged
uterus. In addition, by reducing the pressure inside the womb,
it has been reported to change the nature of the transfusion
in some TTTS cases. Survival rates with amniocenteses approach
80% in some centers, but health status of surviving infants
are not always reported. Recent reports (see section of Medical
Research and Articles) indicate a 60-75% survival rate with
amniocentesis, but 10-30% of the survivors have had neurological
(brain) abnormalities when ultrasounds were performed in the
nursery. Since the babies remain connected, there is the continuing
transfusion process between the twins (both chronic and acute).
This may explain the higher rate of medical problems in the
surviving babies than methods that disconnect the babies.
Amniotic Septostomy: This is the intentional creation of a hole in the membrane septum between the babies' bags of water with a needle during ultrasound scanning. It allows for some of the excess amniotic fluid in the recipient's bag of water to enter the sac of the donor who usually has no to very little amniotic fluid. In one report of 12 TTTS cases, the septostomy to delivery interval was 8.5 weeks and 83% (20/214) of the twins survived. The health of the surviving twins was not given. The babies remain connected with this, and there is now the additional risks associated with twins who sit in the same sac (monoamnionic) such as possible umbilical cord entanglement.
Medication Therapy: Several drugs have been used in TTTS cases for various purposes. These include:
Digoxin Therapy for Fetal Heart Failure: Here doctors give this heart medication as pills to the mother, or inject it directly into the twin that is showing signs of heart failure. Giving this medication may help the heart beat stronger when it is overloaded with blood.
Indomethacin Therapy to Curtail Amniotic Fluid Production: Here doctors also give this mediation to the mother hoping to decrease the urine output in the recipient and lessen the amount of polyhydramious. Indomethacin is an aspirin-like medication (non-steroidal anti-inflammatory drug) with numerous side effects in the baby, one of which is on the kidney where decreased urine production occurs. It is the most powerful drug for treating pre-term labor and is used more often for this purpose in TTTS. When used as a single treatment for TTTS cases, the results have been disappointing.
Tocolytic Medications to Stop Premature Labor: In addition to indomethacin, there are several other drugs that are used in TTTS cases to stop labor.