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Twin to Twin Transfusion Syndrome

Diagnosis and Treatment of TTTS, Denver

Most families are thrilled when they discover they are expecting a baby, and that joy is often doubled (or tripled!) when a multiple pregnancy is announced. However, multiple pregnancies carry additional risks that singleton pregnancies do not. One such condition is a rare but very serious condition called twin to twin syndrome (TTTS).

About Twin to Twin Transfusion

Twin to twin syndrome is a condition that affects identical twin pregnancies. It is not hereditary or genetic and there is nothing the parents did to cause this condition to develop.

There are several different ways that twins can grow and be carried. One of the more high-risk ways twins can share a womb is by also sharing a placenta (called monochorionic twins). These twins are at risk of developing TTTS. This occurs when the twins are connected through a network of abnormal blood vessels that allow them to share blood unequally.

One twin (the donor) receives less blood volume, which leads to slower growth and little to no urinary output. The lack of urine creates little to no amniotic fluid, which is a condition called oligohydramnios. On ultrasound, the technician may refer to this twin as “stuck” or “saran-wrapped” because the sac so closely surrounds the baby.

The other twin (the recipient) becomes overloaded with blood, putting strain on the fetus’ heart, which can lead to heart failure. This increased volume of blood also increases the production of urine, leading to too much amniotic fluid (called polyhydramnios).

Unfortunately, this condition is very serious. Without treatment, nearly all cases of TTTS result in a loss of the entire pregnancy; and all are at extremely high risk of brain damage. The good news is that there have been many advances in the diagnosis and treatment of this condition, which has given new hope to parents who are facing TTTS.

Twin to Twin Transfusion Syndrome Diagnosis

Twin to twin transfusion syndrome is diagnosed through an ultrasound. Mothers who have a shared or single placenta and same sex twins are monitored closely for this condition as well as other complications. When the medical team has determined that one twin is has excessive amniotic fluid (polyhydramnios) and the other has little to no amniotic fluid (oligohydramnios), TTTS is diagnosed. Many mothers also feel rapid growth in the womb and/or a significant increase in contractions due to the polyhydramnios.

TTTS Stages

TTTS diagnoses are put into stages. Stage I TTTS is the least severe, requiring no intervention. However, the pregnancy will be monitored closely as the condition often changes rapidly. Stage II TTTS is determined when the bladder of the donor twin is no longer visible. Intervention is required. Stage III TTTS is determined when blood flow is severely abnormal. Treatment is necessary at this stage. Stage IV is determined when the recipient twin has developed fetal hydrops (swelling under the skin) and appears to be in heart failure. Stage V TTTS is determined when one or both twins have died. If there is a surviving twin, careful examination will be made to ensure the baby can continue a healthy singleton pregnancy.

Twin to Twin Transfusion Syndrome Treatment

The medical team works closely with the parents to create a plan of treatment that takes into consideration the TTTS stages, progression of condition, the babies’ gestational age and the parents’ wishes. The team explains all possible treatment options and what risks each carries. Support is available at every step of the diagnosis and treatment process. Learn more about the treatment options we offer for TTTS.