Of all the questions that concern TTTS couples, this seems to be the most important so the answer will be the most comprehensive. The treatments for TTTS pregnancies depend, in part, on when in pregnancy the twins become affected. If the twins are mature enough to survive outside the womb (beyond 25 weeks), immediate delivery is an option for TTTS babies. However, the doctors must weigh the health effects of the prematurity on the twins versus the continued effects of the TTTS abnormalities as they try to prevent any handicaps in the survivors.
The Foundation continuously reviews the latest medical scientific reports (see section on Medical Research and Articles) to determine for TTTS couples which treatments appear to lead to the highest survival rates for the babies, the highest number of healthy survivors, and the lowest rates of prematurity for the twins. The Foundation also recognizes that it is impossible to save all TTTS twins and completely eliminate the risk of handicap in survivors regardless of treatment because of the nature of the placental abnormalities in TTTS.
The different treatments for TTTS can be classified into those that address the connecting blood vessels in the monochorionic (shared) placenta, those that treat the symptoms, and, sadly, those that reflect a sense of hopelessness on the part of the doctors. We know that none of the treatments have been evaluated in what doctors call 'randomized studies' or 'comparative trials.' A randomized trial means taking a group of TTTS cases and only treating half, then comparing the outcomes in the treated patients to the untreated patients. Such studies may be reasonable in other diseases, but the well documented, historic TTTS death and morbidity (damage) rates calls into question the ethics of such studies. The Foundation does not support this type of experiment for TTTS parents. A comparative trial takes TTTS cases and treats them with one of two or more available therapies to see which has the best outcomes.