The natural history of severe TTTS is well established with mortality approaching 100% if left untreated, especially when it presents at less than 20 weeks' gestation (1-3). As a result, numerous treatments have been proposed including selective fetocide, cord coagulation, sectio parva, placental blood letting, maternal digitalis, indocin, serial amnioreduction, microseptostomy of the intertwin membrane, and nonselective or selective fetoscopic laser photo coagulation. However, in the United States serial amnioreduction has been the standard therapy of TTTS.
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