Twin To Twin Transfusion Syndrome

Understanding what twin to twin transfusion syndrome is all about is the first step in ensuring a healthy pregnancy for your identical twins.

Twin-to-twin transfusion syndrome (TTTS) is a potentially life-threating medical condition which occurs during a pregnancy with identical twins. Few people know for certain if their twins are identical though, so precautions are usually followed to ensure TTTS is detected if it occurs.

Once a pregnancy with twins is diagnosed, the health care provider will want to do further ultrasounds to detect the growth of the babies. When the growth of one baby starts to outpace the other, often TTTS is suspected. Depending on when the ultrasound is done it may or may not make a difference in the outcome. And, keep in mind there can still be babies with TTTS who are not detected with ultrasound if TTTS is late in developing.

The majority of identical twins with TTTS are diagnosed prior to 28 weeks gestation. One twin becomes apparently undernourished, as observed by estimated size and weight, and the other twin is significantly larger.



The cause of TTTS is a placenta which does not function correctly. The result is one baby who receives more blood and more nourishment at the cost of the other. The one on the giving end is the donor twin and the other the recipient. The donor twin will also have less amniotic fluid which is called oligohydramnios. This often results in what is referred to as "stuck-twin" syndrome." The baby with less fluid ends up being compressed within the uterus while the recipient twin continues to grow with excess fluid known as polyhydramnios.

Often times, TTTS will be detected around 28 weeks when the condition is most precarious. When twins die due to TTTS, this is the time during gestation it will often occur. Some twins will also be delivered at this time in an attempt to save their lives.

Not only the donor twin is at risk of death either, from being deprived of nutrients. The recipient twin is also at risk, mostly from an overload of blood and nutrients which puts a strain on the heart. So both twins are at risk and the pregnancy needs to be monitored closely.

Once twins with TTTS are delivered, their complexion varies in color. The donor twin is most likely to be more pale and anemic looking as a result of receiving less blood during pregnancy. The recipient twin will look more red as a result of having more blood supplied during pregnancy. The differences in color will fade with time, but they may cause parents to be concerned that their twins are not really identical since they may not look much alike.

The care of babies with TTTS will involve a stay in the neonatal intensive care unit. The donor twin may even need a blood transfusion from being deprived while in utero. These babies need to be monitored closely in the first few weeks after birth to ensure their healthy survival.

If your care provider tells you that your babies might have TTTS, don't panic, but be aware of what might lie ahead. Follow your provider's advise in doing what is best for the healthiest outcome of your identical twins.

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