Navigation Links
Timeliness, a Critical Factor in Treating TTTS

It's one of the biggest controversies in fetal surgery and the cause of heated debate among surgeons and maternal-fetal medicine physicians// around the world: What's the best way to treat twin-twin transfusion syndrome (TTTS), one of the most common conditions requiring fetal surgery and the leading cause of mortality in twins?

The benchmark, NIH-funded study on TTTS, conducted at 17 centers in the United States, will be presented February 9 at the annual meeting of the Society for Maternal-Fetal Medicine in San Francisco, and it won't likely resolve the question of which is the best procedure.

The study, led by Timothy Crombleholme, M.D., director of the Fetal Care Center of Cincinnati, shows that the question isn't which surgical procedure is better, it's when the procedure is done.

Dr. Crombleholme issued a clarion call to fetal care specialists around the world. "The earlier in gestation TTTS is diagnosed, the more severe the syndrome tends to be," says Dr. Crombleholme, who is also a pediatric surgeon at Cincinnati Children's Hospital Medical Center.

"We have to shift attention to diagnosing this earlier in the progression of the syndrome and being more aggressive about intervention. We can't conclude that one therapy is better than another, but it's apparent that we're going to compromise survival if treatment isn't initiated before it gets to be severe."

In TTTS, the way in which blood flows through the connecting blood vessels on a shared placenta is unequal. As a result, the donor twin has slowed growth and decreased amniotic fluid, while the recipient has too much amniotic fluid and develops a form of heart failure. Without treatment, TTTS is fatal for at least 90 percent of twins, and both twins are at risk for severe complications.

There are two main treatment modalities: amnioreduction, in which excess amniotic fluid is removed from the recipient twin, or a fetoscopic laser proce dure to treat the anatomic basis for the syndrome. Until now, the only major study comparing these two treatments for TTTS was the Eurofetus trial, which compared laser and amnioreduction as primary therapies. That study, published in The New England Journal of Medicine in 2004, found that, at six months, there was better survival among twins using laser vs. amnioreduction.

The NIH-funded study, which began in 2002, required participants to have more severe disease and to have already failed an initial amnioreduction. But when the Eurofetus results were published, everyone thought that laser was superior and stopped referring patients. The American investigators asked that the trial be stopped. Unbeknownst to investigators at that time, the trial oversight committee found significant differences between the two treatment modalities and recommended that the trial be stopped, which it was in May of 2005.

The trial had uncovered higher mortality among recipient twins who received laser treatment. But overall, survival of one or both twins of the same pregnancy was no different between the two treatments. In addition, there was no difference between survival rates of donor twins and recipient twins. How is this possible?

"It turns out that in amnioreduction, there were significant numbers of treatment failures, so patients were dropping out in the amnioreduction arm because they were failing therapy, whereas they were dying in the laser therapy," says Dr. Crombleholme. Statistically, these patients are considered to have had the same outcome: a treatment failure. So, ultimately, there was no significant difference in survival of one or both twins between the two treatments."

What Dr. Crombleholme and his colleagues did find were two predictors of success. One was the stage of severity of TTTS. The other was the echocardiographic finding of heart failure. Fetal echocardiography, which is not done routinely in TTTS in most c enters, should be done whenever a patient is diagnosed, according to Dr. Crombleholme.

"While one cannot conclude from this study that one therapy is better than the other, neither can one conclude that they're equivalent, because it included patients who failed an initial amnioreduction and then went on to get laser," says Dr. Crombleholme.

Source-Eurekalert
SRI
'"/>




Related medicine news :

1. Ultrasound Screening Could Improve The Outcome Of Critically ill Patients
2. Sleep Not Critical For Early Brain Development Of Baby Dolphins
3. Critically Ill Patients More At Risk Of Infection If Glucose Is Present In Their Lung Secretions
4. Dietary supplementation of Folic Acid Requires Critical Evaluation
5. Past President Narayanans Condition Still Critical
6. Critical Decisions Have To Be Taken By Mothers Of Premature Babies
7. Heart Transplant Twin Recovering, But Brother Critical
8. Australia In Search Of A Better Way to Handle Critically Ill Patients and Balance Elective Surgery
9. Yeast Genome Unravels Genes Critical For Maintaining DNA Integrity
10. Drug Trial Goes Foul, Six Volunteers Critically Ill
11. Sensory Input Necessary During "Critical Periods" Of Brain Development
Post Your Comments:
*Name:
*Comment:
*Email:


(Date:1/19/2017)... ... January 19, 2017 , ... LabRoots ... scientists from around the world, announces the launch of its newly redesigned website. ... portal to research breakthroughs and trending news, vital information on upcoming virtual events ...
(Date:1/19/2017)... ... , ... Cosmetic Town, an online plastic surgery community, begins 2017 with an ... for their readers to get the information they desire. The procedures are now listed ... used on those particular areas. , “We are excited to streamline our listings in ...
(Date:1/19/2017)... NJ (PRWEB) , ... January 19, 2017 , ... ... certified dermatologist by the American Board of Dermatology and fellowship trained Mohs and ... the National Institutes of Health, Dr. Li completed his internship in internal medicine ...
(Date:1/19/2017)... ... January 19, 2017 , ... ... doctor who administered fillers that resulted in severe facial disfiguration. After four frightening ... on by doctors at UCLA Medical Center, who removed the substances in a ...
(Date:1/19/2017)... , ... January 19, 2017 , ... ... and privacy panel system. , The Tranquility privacy panel system was designed ... office environment. Tranquility panels help reduce noise and provide the visual privacy required ...
Breaking Medicine News(10 mins):
(Date:1/19/2017)... Incretin Mimetics/GLP-1 Agonists, SNDRIs, Lipase Inhibitors, Serotonin Receptor Agonists, Sympathomimetic-GABA Receptor ... market is expected to grow at a CAGR of 27.1% ... 38.7% in the second half of the forecast period. The market ... to 2027. The market is estimated at $1,058 million in 2016, ... ...
(Date:1/19/2017)... RATON, Fla. , Jan. 19, 2017 /PRNewswire/ ... a medical device company specializing in the treatment ... such as keloids, with superficial radiation therapy, today ... and full year 2016 financial results on Thursday, February ... The Company will hold a conference call with ...
(Date:1/19/2017)... January 19, 2017 New ... to Address Motor Symptoms and Motor Complications in ... ...      (Logo: http://photos.prnewswire.com/prnh/20151014/276718LOGO) C ... European Neurological Review,2016;11(Suppl. 2): 2-15, http://www.touchneurology.com/articles/safinamide-new-therapeutic-option-address-motor-symptoms-and-motor-complications-mid-late ...
Breaking Medicine Technology: