Referral Guidelines for Stage 1 Twin-Twin Transfusion Syndrome Trial

The Center for Fetal Diagnosis and Treatment (CFDT) at Children’s Hospital of Philadelphia is participating in a randomized controlled trial comparing conservative management and selective laser photocoagulation (SLPC) surgery in stage 1 twin-twin transfusion syndrome (TTTS). SLPC will be offered within 72 hours if a patient is randomized into the laser group.

Referral guidelines for physicians

The following circumstances have to be met to be eligible for the study:

  • TTTS Stage 1 as per Eurofetus criteria
  • Gestational age 16+0 < 26+0 (depending upon placental location)
  • Age > 18 years

A patient is not eligible for the study if she meets any of the following exclusion criteria:

  • Therapeutic amniocentesis/amnioreduction prior to referral
  • Short cervix < 15 mm on transvaginal ultrasound
  • Severe maternal discomfort
  • Preterm premature rupture of the membranes (PPROM)
  • Fetal malformation unrelated to TTTS
  • Follow-up is impossible
  • Triplets or other higher order multiple pregnancy

Comprehensive evaluation of each pregnancy is essential to determine if a patient qualifies for this clinical trial. To refer a patient or discuss a case, call us at 1-800-IN UTERO (468-8376) and ask to speak with a CFDT patient coordinator.

selective laser photocoagulation therapy illustration Selective laser photocoagulation is performed fetoscopically, under conscious sedation, to target and interrupt placental vascular communications between fetuses.

IRB #13-010724

Additional study details and criteria can be found on

Next Steps
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Know what questions to ask when considering fetal surgery so you can make an informed decision that is right for you and your baby.

Pregnant Mom and Child

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From the moment of referral through delivery and postnatal care, your family can expect a supportive experience when you come to us with a diagnosis of a birth defect.