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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2006.02.037 Byline: Yao-Lung Chang (a)(b)(c), Ramen H. Chmait (c), Patricia W. Bornick (c), Mary H. Allen (c), Ruben A. Quintero (c) Abstract: This study was undertaken to gain insight on the cause of absent or reverse end-diastolic velocity (AREDV) in the umbilical artery (UA) of the donor twin by analysis of individual placental mass and vascular anastomoses in patients with twin-twin transfusion syndrome (TTTS) treated with laser. Author Affiliation: (a) Chang Gung Memorial Hospital, Linkou Medical Center (b) Chang Gung Memorial Hospital, Chang Gung University College of Medicine Tao-Yuan Hsien, Taiwan (c) Florida Institute for Fetal Diagnosis and Therapy, St Joseph's Women's Hospital, Tampa, FL Article History: Received 8 September 2005; Revised 19 February 2006; Accepted 26 February 2006 Article Note: (footnote) Reprints not available from the authors.

The cause of absent or reverse end-diastolic velocity (AREDV) in the umbilical artery (UA) of the donor twin are described by analyzing the individual placental mass and vascular anastomoses in patients with twin-twin transfusion syndrome (TTTS) treated with laser. The results suggest that preoperative AREDV might result from a small individual placental territory (IPT), placental vascular anastomoses, or both.

Study is conducted to review the experience in the management of twin reversed arterial perfusion sequence to derive management recommendations. Results reveal that surgical management of twin reversed arterial perfusion sequence is indicated in high-risk patients while the surgical approach and the surgical technique should be tailored to the specific clinical presentation, preferably by performing the surgery within the sac of the twin reversed arterial perfusion sequence fetus and avoiding disruption of the dividing membrane.

Laser photocoagulation may be more effective than amniocentesis in treating twin-twin transfusion syndrome, especially in the third trimester of pregnancy. This was the conclusion of a study of 173 women pregnant with twins whose babies were affected by this condition. Twin-twin transfusion syndrome occurs when a blood vessel malformation allows one twin to receive more blood at the expense of the other twin.

The twin-twin transfusion syndrome is most likely to happen if the placenta contains deep anastomoses rather than superficial anastomoses, according to an examination of 131 placentas. All 85 placentas with deep anastomoses resulted in twin-twin transfusion syndrome compared to only 1 of the 18 placentas with superficial anastomoses. Twin-twin transfusion syndrome occurs when one twin receives most of the nutrients and grows at the expense of the other twin.

Using a laser to destroy blood vessels between twin fetuses can spare the life of one fetus when the other one has intrauterine growth retardation. If the smaller twin dies, it can adversely affect the bigger twin by taking its blood supply.

Doctors describe the prenatal treatment of two fetuses with an obstructed urinary tract. The technique they describe should only be used if conventional surgical techniques fail.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2008.05.026 Byline: Ruben A. Quintero (a), Ramen H. Chmait (d), Jane Carver (b), Patricia W. Bornick (c), Mary H. Allen (c), Eftichia V. Kontopoulos (a) Keywords: fetus; operative fetoscopy; oximetry; oxygen saturation; twin; twin-twin transfusion syndrome Abstract: The purpose of this study was to assess fetal tissue venous oxygenation (StO2%) in utero during laser therapy for twin-twin transfusion syndrome via visible light spectroscopy (VLS). Author Affiliation: (a) Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL (b) Department of Pediatrics, University of South Florida, Tampa, FL (c) Tampa General Hospital, Tampa, FL (d) Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA Article History: Received 26 September 2007; Revised 25 January 2008; Accepted 27 May 2008 Article Note: (footnote) Cite this article as: Quintero RA, Chmait RH, Carver J, et al. In utero fetal oximetry via visible light spectroscopy in twin-twin transfusion syndrome. Am J Obstet Gynecol 2008;199:636.e1-636.e4.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.11.062 Byline: Ramen H. Chmait (1), Lisa M. Korst (1), Patricia W. Bornick (2), Mary H. Allen (2), Ruben A. Quintero (3) Keywords: fetal growth; laser therapy; twin-twin transfusion syndrome; twin weight discordance Abstract: The objective of the study was to compare twin weight discordance and prevalence of intrauterine growth restriction (IUGR) before laser therapy and after birth in pregnancies complicated by twin-twin transfusion syndrome (TTTS). Author Affiliation: (1) Department of Obstetrics and Gynecology, Keck School of Medicine, University Southern California, Los Angeles, CA (2) Department of Obstetrics and Gynecology, Tampa General Hospital, Tampa, FL (3) Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, FL. Article History: Received 1 July 2007; Revised 11 September 2007; Accepted 27 November 2007 Article Note: (footnote) Cite this article as: Chmait RH, Korst LM, Bornick PW, et al. Fetal growth after laser therapy for twin-twin transfusion syndrome. Am J Obstet Gynecol 2008;199:47.e1-47.e6.