[Show abstract][Hide abstract] ABSTRACT: Limited evidence suggests the best way to improve survival without neurological impairment in children with twin-to-twin transfusion syndrome is to perform laser treatment to the placenta. Identical twins occur in about one in 320 pregnancies. Sometimes identical twins share the same placenta and blood flow, and the proportion of blood shared between the twins is usually equal. Twin-to-twin transfusion syndrome happens when the blood flow is uneven and passes from one twin (the donor) to the other (the recipient). This can happen when the placenta has deep artery-to-vein connections. The donor twin usually has very little amniotic fluid, and frequently does not grow well and is very small. The recipient twin has excessive amniotic fluid, and often has a distended bladder and other medical problems. The risk of death for both twins is high, around 80% if there is no treatment. There is also risk of physical or neurological damage to both twins if they survive. Various options for treatment exist. These include (1) the repeated removal of excessive amniotic fluid (amnioreduction); (2) laser treatment of the abnormal vessels in the placenta (endoscopic laser surgery); (3) puncture of the membrane between the twins (septostomy); and (4) the selective ending of one twin's life (selective feticide). The review found three trials, involving 253 women and 506 babies. There were no studies on laser treatment versus puncturing the membrane, nor on selective feticide. The evidence showed that laser treatment was associated with more babies being alive without a neurological abnormality when compared to removing the excess amniotic fluid. However, where there is insufficient expertise to perform laser surgery or when the pregnancy is beyond 26 weeks, amnioreduction remains the treatment of choice. Further research is needed on the best treatment for mild and very severe forms of the problem.
[Show abstract][Hide abstract] ABSTRACT: Corticosteroids given to women in early labour help the babies' lungs to mature and so reduce the number of babies who die or suffer breathing problems at birth. Babies born very early are at risk of breathing difficulties (respiratory distress syndrome) and other complications at birth. Some babies have developmental delay and some do not survive the initial complications. In animal studies, corticosteroids are shown to help the lungs to mature and so it was suggested these drugs may help babies in preterm labour too. This review of 21 trials shows that a single course of corticosteroid, given to the mother in preterm labour and before the baby is born, helps to develop the baby's lungs and reduces complications like respiratory distress syndrome. Furthermore, this treatment results in fewer babies dying and fewer common serious neurological and abdominal problems, e.g. cerebroventricular haemorrhage and necrotising enterocolitis, that affect babies born very early. There does not appear to be any negative effects of the corticosteroid on the mother. Long-term outcomes on both baby and mother are also good.