Optimizing Fetal Outcomes in Twin-Twin-Transfusion Syndrome using Serial Amnioreduction in Resource-Constrained Unit: A Case Report

Abstract

Background: Twin-twin transfusion syndrome is an important complication of monochorionic placentation in twin pregnancy. The management of this condition in Nigeria and many other developing countries has always been “watchful expectancy” with attendant high perinatal morbidity and mortality. Amnioreduction is a less demanding treatment option compared with fetoscopic laser coagulation management option in terms of cost and expertise, but has not been reported from any unit in Nigeria. Case Presentation: A 28-year-old gravid 2 para 1+0, 1 alive, carrying twin pregnancy was referred at 22 weeks gestation with complaint of mild discomfort due to sudden rapid enlargement of the abdomen. Physical examination and ultrasound scan assessment confirm Quintero stage II Twin-twin transfusion syndrome and she underwent serial amnioreduction at 24, 28 and 31 weeks of gestation with satisfactory outcomes. She had caesarean section at 33 weeks due to an acute episode of severe maternal discomfort and was delivered of 2 live female babies. There were no adverse perinatal events. Conclusion: This case presented demonstrates the role of amnioreduction in the management of carefully selected cases of twin-twin transfusion syndrome and further encouraged its utilization. in resource-constrained units instead of ‘watchful expectancy’ and in the absence of fetoscopic laser photocoagulation