Twin-to-Twin Transfusion Syndrome

Twin-to-twin transfusion syndrome (TTTS) is a common yet serious concern for identical twin pregnancies as it endangers the well being of both babies. The good news for families facing TTTS is that with early diagnosis and intervention, treatment can successfully reverse the effects of the condition, but parents must know what questions to ask and when to seek tests and treatment.

Who Is at Risk for TTTS?

The reason TTTS develops is unknown, however doctors do know that it is not inherited, genetic, or caused by anything that a mother or father has or has not done. The condition occurs between identical twin fetuses that are monochorionic (MC) - or twins who share a single placenta. Approximately one in 360 pregnancies and two-thirds of all identical twin conceptions will result in MC twins at risk for TTTS. Experts believe that between 1,500 and 2,000 cases of TTTS occur in the U.S. annually, almost equal to the number of sudden infant death syndrome (SIDS) cases.1

What is TTTS?

TTTS is an unbalanced blood flow between MC fetuses. Because MC twins share the same placenta, they also share blood vessels that distribute blood to each baby. For reasons that are unknown, 10% to 15% of MC twin fetuses will develop an uneven flow of blood between the shared blood vessels, resulting in TTTS.

During TTTS, the smaller twin (often called the donor twin) does not receive enough blood while the larger twin (often called the recipient twin) becomes overloaded with too much blood. In an attempt to reduce its blood volume, the recipient twin will increase the amount of urine it produces, resulting in the development of a very large bladder and too much amniotic fluid around the twin, or polyhydraminos. At the same time, the donor twin will produce less than the usual amount of urine and the amniotic fluid around the twin will become very low or absent, or oligohydraminos. Together, these TTTS conditions cause one twin to over develop while the other twin will suffer from under development.

Left untreated, TTTS can result in the loss of one or both twins and present serious developmental issues for surviving babies. 1 According to CDC, 2,250 SID cases occur in the U.S. each year.

How to Fight TTTS

The key question to ask is if the twin fetuses share a single placenta. If they share one placenta, it is important to schedule a TTTS check immediately with a maternal-fetal medicine specialist or expert in TTTS, and follow up with checks every two weeks throughout the pregnancy. Expectant parents should never feel timid about proactively asking their doctors about TTTS and insisting on regular tests, as it is the best way to protect their little ones from the effects of the condition.

Once TTTS has been diagnosed, it is imperative to seek consultation and treatment with a specialist within a few days of the diagnosis. Because fetuses develop rapidly and TTTS has such a dramatic impact on unborn babies, postponing treatment by even a few days can considerably alter the potential for successful intervention.

What to Expect from TTTS Treatment

TTTS is treated with a variety of procedures depending on the stage of the condition. Laser treatment targets the blood vessels shared between the twins and attempts to correct the flow of blood and nutrients so that it is better balanced. TTTS treatments can increase the survival rate of both babies by 60% and one baby by 80%. The earlier treatment is sought in the development of TTTS, the greater the potential for helping each baby.

TTTS is a serious condition, but with early detection and treatment, there is hope. Knowledge is power and for expectant parents of twins, it is important to know the conditions that present risks for TTTS and the confidence to ask for tests and immediate treatment if diagnosed.

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Twin-to-Twin Transfusion Syndrome

Who Is at Risk for TTTS?

What is TTTS?

How to Fight TTTS

What to Expect from TTTS Treatment

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