The Stuck Twin Phenomenon: Experience with Serial Therapeutic Amniocentesis

Abstract

Expectant management of the “stuck” twin phenomenon is usually associated with a dismal prognosis for both fetuses. Improved outcomes have been reported following serial amniocentesis of the sac of the co-twin. We therefore reviewed our experience with this therapy. Six consecutive sets of affected twins were managed over a 3-year period. Six of 12 (50%) fetuses survived the neonatal period, five of whom (42%) exhibited no long-term sequelae. Hydrops resolved completely in one and partially in two of the six co-twins. All co-twins and two of six “stuck” twins had karyotypes performed which were all normal. Other diagnostic evaluations ruled out fetal infection, fetomaternal hemorrhage, and blood group incompatibility. Autopsies were performed in all cases of stillbirth and neonatal death, revealing no anomalies. This suggested an extreme form of twin-twin transfusion as the etiology of the phenomenon in these cases. Our observations agree with those of others in supporting serial amniocentesis in the management of the “stuck” twin phenomenon.

Key Words:

• Nonimmune hydrops fetalis
• Polyhydramnios
• Twin transfusion syndrome