Elective laparoscopic fetal laser photocoagulation in twin-twin transfusion syndrome: a case report.

Twin-twin transfusion syndrome (TTTS) is a complication of multiple gestation in which arteriovenous vascular communications occur in a shared placenta. Due to these communications, there is an imbalance of blood flow between the developing fetuses. This results in 1 twin becoming the donor and the other becoming the recipient. In severe cases, the recipient may experience polycythemia, polyhydramnios, and hydrops fetalis, while in the donor oligohydramnios and severe anemia may develop. It has been reported that fetal mortality can reach as high as 60% to 80% if TTTS develops before 26 weeks' gestation and goes untreated. Therapeutic options available include decompression amniocentesis, amniotic septostomy, interruption of the placental vessel communications, and selective fetal reduction. Selective fetoscopic laser photocoagulation of abnormal vascular communications has shown to result in increasing survival rates and has become a definitive treatment option for severe TTTS. The case report presented involves a 32-year-old, gravida 5, para 2 patient at 19 weeks' estimated gestational age with a monochorionic diamniotic twin gestation with TTS diagnosed using ultrasonography presenting for an elective laparoscopic fetal laser photocoagulation.