Twin to Twin Transfusion Syndrome

Twin to twin transfusion syndrome (TTTS) is a serious disorder that occurs in identical twins and higher order multiples who share a placenta. This occurs when there is a connection in the two babies' blood vessels of their shared placenta. This results in one baby (this twin is referred to as the recipient) receiving more blood flow, while the other baby (this twin is referred to as the donor) receives too little. Twin to twin transfusion syndrome is also referred to as chronic intertwin transfusion syndrome.

How often does Twin to Twin Transfusion Syndrome occur?

TTTS occurs about 15 percent of the time among identical twins. Fraternal twins are not at risk for this syndrome because they do not share a placenta.

What can I do to make sure my twins do not develop Twin to Twin Transfusion Syndrome?

TTTS is a random event that cannot be prevented by doing or not doing any specific thing. It is not a genetic disorder nor is it a hereditary condition.

How is Twin to Twin Transfusion Syndrome diagnosed?

Your healthcare provider may suspect this disorder if any of the following is seen during an ultrasound:

• Marked difference in the size of fetuses of the same gender
• Difference in size between the two amniotic sacs
• Difference in size of the umbilical cords
• A single placenta
• Evidence of fluid build up in the skin of either fetus
• Findings of congestive heart failure in the recipient twin
• Polyhydraminos (excess amniotic fluid) in the recipient twin
• Oligohydraminos (decreased or too little amniotic fluid) in the donor twin

Does the mother have any signs of Twin to Twin Transfusion Syndrome?

A mother whose twins have TTTS may experience:

• Sensation of rapid growth of the womb
• A uterus that measures large for dates
• Abdominal pain, tightness, or contractions
• Sudden increase in body weight
• Swelling in the hands and legs in early pregnancy

What treatment options are available for Twin to Twin Transfusion Syndrome?

Up until recently twin to twin transfusion syndrome has claimed the life of both babies, but technology has brought about two new treatment options for this condition. The use of amniocentesis to drain off excess fluid appears to improve the blood flow in the placenta and reduce the risk of preterm labor. Amniocentesis can save approximately 60% of affected babies. Laser surgery can also be used to seal off the connection between the blood vessels and appears to save 60% of affected babies. Delivery is also an option if your healthcare provider determines the twins' lungs have reached maturity.

What are the advantages of having laser surgery instead of an amniocentesis?

Amniocentesis may need to be done repeatedly throughout the pregnancy to maintain proper blood flow in the placenta, while laser surgery usually only requires one treatment.

What are the potential complications of Twin to Twin Transfusion Syndrome?

Complications can include:

• Premature labor either due to ruptured membranes or induction
• Respiratory, digestive, heart, or brain defects in the recipient twin because of excess fluids
• Donor twin developes anemia
• Fetal demise/death

Is there anything else that I need to be aware of if I have been diagnosed with Twin to Twin Transfusion Syndrome?

The Twin to Twin Transfusion Syndrome Foundation recommends that weekly ultrasounds be performed after 16 weeks through the end of the pregnancy to monitor TTTS. They recommend that this be done even if the warning signs of TTTS have decreased.

The TTTS Foundation can be contacted at http://www.tttsfoundation.org/ or at 1-800-815-9211.

Reprinted with permission from American Pregnancy Association