What is the recommended intervention for patients in Quintero stage II of twin-twin transfusion syndrome?

In cases of twin-twin transfusion syndrome (TTTS), particularly in Quintero stage II, fetoscopic laser ablation of placental anastomoses is considered the recommended intervention. At this stage, there is evidence of moderate oligohydramnios in the donor twin and polyhydramnios in the recipient twin, indicating a significant and potentially harmful imbalance in the blood supply between the twins due to shared placental blood vessels.

Fetoscopic laser ablation involves the minimally invasive procedure where laser technology is used to coagulate the abnormal blood vessels on the placenta that are causing the transfusion imbalance. This intervention can effectively correct the hemodynamic differences between the twins, improve outcomes, and significantly reduce the risk of complications associated with TTTS. The benefits include improved survival rates for both twins and a reduction in the risk of severe morbidity.

While expectant management with Doppler studies may be appropriate for early stages of TTTS or in cases where there are no significant clinical signs, stage II indicates a more serious condition that typically requires intervention. Cervical cerclage is unrelated to TTTS management as it is meant to prevent preterm labor due to cervical insufficiency. Intravenous estrogen therapy does not have a role in managing this