ABSTRACT
Therapies have been developed that target (1) the polyhydramnios that is known to lead to preterm labor, and (2) the vascular connections within the placenta. These therapies are, respectively, amniotic fluid volume reduction or amniodrainage, and laser ablation. All therapies that are currently known or thought to be effective are invasive and lead to some risk, including pregnancy loss if performed before viability, preterm birth if performed at or shortly after viability, difficulty in monitoring the disease due to amnion-chorion separation, the production of a pseudomonoamniotic gestation with possible cord entanglement and fetal demise, production of a donor fetal ‘sling’ or ‘cocoon,’ and maternal morbidity.8-11 In addition, two other options for therapy need to be considered: termination of pregnancy and selective termination (by laser or cord occlusion).12-17 Many patients may choose to end a previable pregnancy when faced with the prospect of 25-50% mortality for their fetuses and treatments that are intensive and fraught with some risk to maternal health. This decision should be respected. The option of selective termination before viability is unique in the setting of TTTS, is based on the identification of severe disease or a moribund state in one of the fetuses,
and has its own unique ethical issues that also need to be addressed.
