Twin-to-twin transfusion syndrome

Twin-to-Twin Transfusion Syndrome (TTTS)

image showing twins with TTTS.

Twin-to-Twin Transfusion Syndrome (TTTS), also known as feto-fetal transfusion syndrome (FFTS), twin oligohydramnios-polyhydramnios sequence (TOPS) and stuck twin syndrome, is a serious complication in pregnancies involving monochorionic multiples (twins or more fetuses sharing a single placenta). It is characterized by a disproportionate blood supply between the fetuses, leading to high morbidity and mortality rates.

Causes and Pathophysiology

TTTS occurs in pregnancies where twins share a single placenta (monochorionic pregnancies). Abnormal blood vessel connections in the placenta lead to an imbalanced blood flow between the fetuses, where one twin (the donor) pumps blood to the other twin (the recipient).

Symptoms

Symptoms of TTTS may include:

• Discrepancy in amniotic fluid levels between the sacs (oligohydramnios in the donor twin and polyhydramnios in the recipient twin)
• Rapid growth of the recipient twin
• Growth retardation in the donor twin

Diagnosis

Diagnostic ultrasound for TTTS.

Diagnosis of TTTS is primarily done through ultrasound, where differences in amniotic fluid and fetal size can be observed.

Treatment

Treatment options depend on the severity of TTTS and may include:

• Amnioreduction (removal of excess amniotic fluid)
• Fetoscopic laser photocoagulation (sealing off the abnormal blood vessels)
• Selective reduction in extreme cases

Prognosis

Severe cases of TTTS have a high mortality rate, ranging from 60 to 100 percent if untreated. Early detection and intervention can significantly improve outcomes.

External Links

• Mayo Clinic - Twin-to-Twin Transfusion Syndrome
• National Organization for Rare Disorders - Twin-to-Twin Transfusion Syndrome

Twin-to-twin transfusion syndrome Resources
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