Twin-twin transfusion syndrome

From WikiMD's Wellness Encyclopedia

Twin-twin transfusion syndrome (TTTS) is a rare, serious condition that can occur in pregnancies where identical twins share a single placenta. This condition is also known as Fetofetal Transfusion Syndrome.

Pathophysiology[edit | edit source]

TTTS occurs when there is an imbalance in the blood flow between the twins through the shared placenta. This imbalance is due to abnormal blood vessel connections within the placenta, leading to one twin (the "donor") transferring blood to the other twin (the "recipient"). The donor twin may suffer from reduced blood volume, leading to anemia, growth restriction, and decreased amniotic fluid (oligohydramnios). Conversely, the recipient twin may experience increased blood volume, which can cause polycythemia, excessive amniotic fluid (polyhydramnios), and potential heart failure.

Diagnosis[edit | edit source]

TTTS is typically diagnosed through routine ultrasound examinations. Key indicators include significant differences in amniotic fluid levels between the twins, discrepancies in size, and abnormal Doppler studies of the blood flow in the umbilical cords.

Staging[edit | edit source]

The severity of TTTS is often classified using the Quintero staging system:

  • Stage I: Mild, with a visible bladder in the donor twin and normal Doppler studies.
  • Stage II: The bladder of the donor twin is not visible.
  • Stage III: Abnormal Doppler studies.
  • Stage IV: Hydrops (fluid accumulation) in one or both twins.
  • Stage V: Fetal demise of one or both twins.

Treatment[edit | edit source]

Treatment options for TTTS depend on the severity and gestational age. They may include:

  • Amnioreduction: Removing excess amniotic fluid from the recipient twin's sac.
  • Laser photocoagulation: Sealing off the abnormal blood vessel connections in the placenta using a laser.
  • Selective reduction: In severe cases, reducing the number of fetuses to improve the survival chances of the remaining twin(s).
  • Early delivery: If the pregnancy is far enough along, early delivery may be considered to prevent further complications.

Prognosis[edit | edit source]

The prognosis for TTTS varies widely depending on the stage at diagnosis and the effectiveness of treatment. Early detection and intervention can significantly improve outcomes. However, TTTS remains a high-risk condition with potential complications for both twins, including preterm birth, neurological damage, and in severe cases, fetal demise.

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Contributors: Prab R. Tumpati, MD