Twin-Twin Transfusion Syndrome in Cases with Suspected Close Proximity of Umbilical Cord Insertions

We encountered 3 cases of twin-twin transfusion syndrome (TTTS), in which preoperative ultrasonography revealed that the cord insertion sites of the twins were close. Two cases were successfully treated with fetoscopic laser photocoagulation (FLP); however, the third case could not be treated surgically because fetoscopy revealed that the cord insertions formed a V-shaped joint above the placenta and that all chorionic vessels of the placental surface were shared by the twins. No residual anastomoses were detected on placental examination in the 2 cases treated with FLP. Our experiences indicate that the feasibility of FLP could be evaluated using fetoscopy, not just ultrasonography, in cases of TTTS accompanied by proximate umbilical cord insertion.