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Objective: To study perinatal outcomes of pregnancies complicated by twin-twin transfusion syndrome (TTTS), which were treated with the authors' intervention modalities. Maternal outcomes of these populations were also explored., Material and Method: All pregnancies diagnosed TTTS that delivered in King Chulalongkorn Memorial Hospital between January 2000 and November 2009 were enrolled in this descriptive study Patients' data before August 2008 were retrospectively assessed. Perinatal survival, neonatal morbidities, and maternal outcomes were recorded and analyzed. Antenatal ultrasonographic findings were also analyzed to determine prognostic factors on perinatal outcomes., Results: Twenty-five cases of TTTS were recruited in the present study. Overall perinatal survival was 58% (29/50) with no significant difference in perinatal in among various stages of disease (p = 0.19). Survival in stage I-II, stage III, and stage IV were 64.3%, 45.8%, and 75%, respectively. There was no maternal mortality in the present study The most common maternal morbidity was preeclampsia (6/25; 24%). Progression of disease was the only significant prognostic fact or for perinatal mortality (p < 0.001)., Conclusion: Overall perinatal mortality rate of TTTS in the presented populations was still high (42%). Progression of disease was the only significant prognostic factor for poor perinatal outcome in the preset study Since the case number of the present study was too small, the conclusion that the prognosis of the conservatively treated TTTS was unrelated to the staging cannot be drawn.

Objective: The present study was undertaken to determine perinatal and maternal outcomes in severe preeclamptic women between 24-33-week gestation and compare the outcomes between expectant and aggressive management., Material and Method: A retrospective descriptive study of 99 women with severe preeclampsia between 24-33(+6)-week gestation who delivered at the King Chulalongkorn Memorial Hospital from January 2002 to December 2005 was included. The outcomes were analyzed according to the gestational age at the time of admission (< 28 weeks' and > or = 28 weeks' gestation) according to expectant compared with aggressive management. Statistical analysis was performed by student t-test and chi2-test., Results: The perinatal morbidity and mortality were significantly high in the gestational age < 28 weeks group. There were 11 perinatal deaths, 8 in those managed at < 28 weeks and 3 in those managed at 28-29 weeks' gestation (p < 0.05). Maternal morbidities were similar among both groups. There was no maternal death., Conclusion: Delivery at remote from term, especially < 2-week gestation, increases neonatal morbidity and mortality in severe preeclamptic women. Expectant management should be done in the tertiary care center with close maternal and fetal monitering.

Acardiac twin is a rare event with high perinatal mortality rate and the management strategies remain controversial. The authors report 4 cases of twin pregnancies associated with one acardiac twin diagnosed at King Chulalongkorn Memorial Hospital during the period 1993 to 2002. Two cases were expectantly managed and intrauterine interventions were performed in order to occlude umbilical artery of the acardiac twin in 2 cases, by using Guglielmi detachable coil (GDC) embolization and absolute alcohol injection. Overall, the perinatal mortality rate for the pump twin was 50% and the survival rate of expectant management in the present series was 100%. GDC embolization was judged to be technically successful since it completely occluded the circulation to the acardiac twin. However, the pump twin was dead which might have resulted from the compromised state due to cardiac failure. At present, it seems that conservative management with close antenatal surveillance is the treatment of choice when the twin-weight ratios are substantially less than 70%. Invasive techniques should be considered when there is ultrasound evidence of hydramnios or congestive heart failure of the pump twin at a previable gestational age.