Severe twin-to-twin transfusion syndrome in a scared uterus successfully treated with serial amnioreduction

Abstract

Background: Twin-to-twin transfusion syndrome (TTTS) is a vascular abnormality unique to monochorionic pregnancies. The associated polyhydramniosportends significant risk to uterine rupture especially in a scared uterus. Serial amnioreduction is an established technique that reduces the risks of severe polyhydramnios thereby preventing overstretching of the uterus and ameliorates maternal symptoms.
Methods: The case records of a patient who has had three previous caesarean sections and presented with respiratory distress following severe polyhydramnious were reviewed.
Result: A total of 7,225mls of amniotic fluid was removed over a 3 month period; and grade II discordant intrauterine growth restriction (IUGR) was confirmed at delivery. 
Conclusion: Serial amnioreduction was successful in relieving maternal symptoms and prevented the risk of uterine rupture in a woman with three previous caesarean section scars.

Keywords: Twin-to-Twin Transfusion Syndrome, Polyhydramnios, Amnioreduction.