State of The ART Management of Monochorionic-Di-amniotic Twins and Fetal Surgery

Twin-to-twin transfusion syndrome (TTTS) increases perinatal morbidity and mortality for 10 to 15% of monochorionic (MC) gestations. The purpose of this abstract is to provide an update on the evolving treatments in TTTS as it pertains primarily to laser photocoagulation, as well as to provide recently published information on outcomes.MC gestations are at risk due to the angioarchitecture of the shared placenta, with anastomoses of varying type, size, and quantity. The chronic unbalanced distribution of blood volume across placental anastomoses between the donor and recipient fetuses leads to multisystem organ impairment including mala-daptive changes in both fetuses.Fetoscopic laser photocoagulation of placental anastomoses is an effective treatment addressing the underlying pathophysiol-ogy. Further research is needed to improve survival rates, reduce risks of fetoscopy, and gain understanding of the predic-tion, assessment, and optimization of long-term outcomes for TTTS survivors.