Twin-to-Twin Transfusion Syndrome is a serious, progressive condition that occurs almost exclusively in identical twins (because they share the same placenta) when they are in the womb.
This story profiled a successful procedure using selective fetoscopic laser photocoagulation for Twin-to-Twin Syndrome which resulted in the birth of two healthy babies. However, this piece tends to downplay the likelihood of an unsuccessful outcome, especially for severe cases. It lacks balance in presenting the risk and benefits of another common treatment option and provided no insights from an independent expert. It should have mentioned that treatment for Twin-to-Twin syndrome is an area of evolving research and there is uncertainty over which cases will benefit and to what degree from available treatment options. Further, while seemingly healthy babies may be born, there is less research about their long-term prognosis and potential for serious developmental and health problems.
Cost of treatment is not mentioned, nor is it mention whether this procedure is covered by health insurance.
To some degree, this story both overstates and understates the benefits of selective fetoscopic laser photocoagulation. Survival rates of one or both twins are generally reported to be 60-80% and vary depending upon the severity of the case. This piece reports the high end of survival rates, 76-80%. (See Harms of Treatment comments.) In addition, this article states that amnioreduction has a high rate of adverse outcomes, leaving the reader with the impression that selective fetoscopic laser photocoagulation is the best option. While the merits of the two techniques are cause for some debate in medicine, some experts believe the two techniques have comparable short-term survival rates and that more study is needed to determine the long-term adverse effects from either procedure.
The potential harms of the treatment are not clearly described from the hospital featured or the literature. Article focuses most on the poor outcomes without treatment. Likewise there is not consistent use of the rates of survival of one (higher numbers) versus both twins (lower numbers) or the differential risk of harm to one twin versus the other.
The story failed to note that there is conflicting medical evidence as to how the outcomes of selective fetoscopic laser photocoagulation compare to other procedures. (See Treatment Options criterion.)
No disease-mongering. If anything, the story didn’t adequately address the seriousness of Twin-to-Twin Syndrome and the real possible for devastating outcomes.
No independent medical experts were interviewed to provide balance. Much of the story was the anecdotal experience of a couple who had recently had a successful delivery of twins with Twin-to-Twin Syndrome. And one of the surgeons who performed the procedure was also interviewed. Since there is some debate about this approach in medicine, there should have been some reflection of that in the story.
Other options including no treatment, amnioreduction, and terminating the pregnancy prior to viability were presented as alternatives to fetoscopic laser photocoagulation. Close inpatient observation with decision to deliver if either twins condition begins to deteriorate is also an option that is not quite the same as "no treatment" or "termination."
Selective fetoscopic laser photocoagulation is new, highly specialized procedure that is not available in every state. As the story states, a woman might need to travel to have the procedure. However, there are dozens of experienced clinics (not just 10) across the country, several of which are conducting research on this procedure sponsored by the National Institute of Children’s Health and Human Development.
This article correctly states that selective fetoscopic laser photocoagulation was adopted to a greater degree in Europe than in the U.S. This procedure has become more widely accepted and offered in the U.S. in recent years, but it is still relatively new and continues to be evaluated. (See Availability of Treatment comments.)