In a twin-to-twin transfusion syndrome (TTTS) at 20 weeks (Stage II on Quintero staging), the most effective treatment to improve dual survival is:

• A Serial amnioreduction of polyhydramnios in the recipient twin's sac
• B Selective fetal reduction of the donor twin
• C Fetoscopic laser photocoagulation of placental vascular anastomoses ✓
• D Expectant management until Stage III disease

Explanation

Fetoscopic laser photocoagulation of placental anastomoses (FLP) is the treatment of choice for TTTS Stage II–IV before 26 weeks gestation. The Eurofoetus trial (NEJM 2004) demonstrated superior neurological outcome and dual fetal survival with laser over serial amnioreduction. Laser photocoagulation targets communicating vessels between the twins, addressing the underlying haemodynamic imbalance. Serial amnioreduction is palliative and associated with higher neurological morbidity in survivors compared to laser.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.