American Journal of Obstetrics & Gynecology
Volume 203, Issue 1 , Pages 3-16, July 2010

Twin-twin transfusion syndrome: an ethics-based and evidence-based argument for clinical research

  • David M. Stamilio, MD, MSCE

      Affiliations

    • Department of Obstetrics & Gynecology, Maternal Fetal Medicine Division, Washington University School of Medicine, St. Louis, MO
    • ,
  • William D. Fraser, MD, MSc

      Affiliations

    • Department of Obstetrics & Gynecology, University of Montreal, Montreal, Quebec, Canada
    • ,
  • Thomas R. Moore, MD

      Affiliations

    • Department of Reproductive Medicine, University of California San Diego, San Diego, CA

Received 28 August 2009; received in revised form 29 November 2009; accepted 7 December 2009. published online 22 February 2010.

Aspects of twin-twin transfusion syndrome (TTTS) diagnosis, treatment alternatives, and research opportunities were considered during a consensus conference that was held by the North American Fetal Therapy Network in 2009. A 3-member scientific consensus panel gathered data from expert conference presentations, postconference communications, and comprehensive scientific literature database searches to develop recommendations for TTTS diagnosis, therapy, and research. The panel recommends retaining the Quintero staging system until a superior system has been validated appropriately. It concludes that there is normative equipoise to justify the performance of randomized clinical trials to identify the optimal treatment strategy for mild TTTS. Recommendations for the design and conduct of clinical trials and observational studies are also provided.

Key words: ethics, treatment, twin-twin transfusion syndrome

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 Reprints not available from the authors.

 Authorship and contribution to the article is limited to the 3 authors indicated. There was no outside funding or technical assistance with the production of this article.

PII: S0002-9378(09)02249-2

doi:10.1016/j.ajog.2009.12.006

American Journal of Obstetrics & Gynecology
Volume 203, Issue 1 , Pages 3-16, July 2010

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