Twin to Twin TransfusionSyndrome (TTTS)

Maintain a diet a balanced diet during pregnancy.Twin to twin transfusion syndrome(TTTS) is a serious disorder that occurs in identical twins and higherorder multiples who share a placenta. This occurs when there is a connectionin the two babies’ blood vessels of their shared placenta. Thisresults in one baby (this twin is referred to as the recipient) receivingmore blood flow, while the other baby (this twin is referred to as thedonor) receives too little. Twin to twin transfusion syndrome is alsoreferred 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 donot share a placenta.

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

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

How is Twin to Twin Transfusion Syndrome diagnosed?

Your healthcare provider may suspect this disorder if any of thefollowing 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 thedonor 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 TransfusionSyndrome?

Up until recently twin to twin transfusion syndrome has claimedthe life of both babies, but technology has brought about two newtreatment options for this condition. The use of amniocentesis todrain off excess fluid appears to improve the blood flow in the placentaand reduce the risk of preterm labor. Amniocentesis can save approximately60% of affected babies. Laser surgery can also be used to seal offthe connection between the blood vessels and appears to save 60% ofaffected babies. Delivery is also an option if your healthcare providerdetermines 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 pregnancyto maintain proper blood flow in the placenta, while laser surgeryusually only requires one treatment.

What are the potential complications of Twin to Twin TransfusionSyndrome?

    • 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 developing anemia
  • Fetal demise/death

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

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

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

Last Updated: 04/2004