Twin-twin transfusion syndrome in a dichorionic-diamniotic gestation with post-laser amniotic band sequence: A case report

Twin-twin transfusion syndrome most commonly develops in monochorionic-diamniotic twin pregnancies but rarely has been documented in dichorionic pregnancies. Twin-twin transfusion syndrome can often be successfully treated with fetoscopic laser surgery; sequelae are infrequent but can include chorion-amnion membrane separation, preterm rupture of membranes, preterm delivery, neurodevelopmental delay, and, rarely, amniotic band syndrome. This report concerns the case of a 30-year-old nulligravid woman who presented for routine anatomy evaluation in the setting of a dichorionic-diamniotic monozygotic twin pregnancy. On initial evaluation, selective growth restriction with discordant amniotic fluid was noted, concerning for the development of twin-twin transfusion syndrome. On subsequent evaluation, she was diagnosed with stage 2 twin-twin transfusion syndrome and underwent successful fetoscopic laser ablation at 20 weeks of gestation. Ultimately, the patient underwent cesarean section at 29 weeks for labor after rupture of membranes. The postnatal course was complicated by amniotic band syndrome in one of the neonates. This case highlights twin-twin transfusion syndrome diagnosed in the rare setting of a dichorionic-diamniotic monozygotic twin pregnancy and a rare postoperative complication of amniotic band syndrome after fetoscopic laser surgery.