Twin to Twin Transfusion Syndrome (commonly referred to as “TTTS”) is a condition which can occur in an identical twin pregnancy that is monochorionic/diamniotic. In almost all of these pregnancies, the single placenta contains blood vessel connections between the twins. In approximately 20% of monochorionic/diamniotic twins, the blood flow through these blood vessel connections becomes unbalanced.
In TTTS, the smaller twin (often called the donor twin) does not get 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 urine it makes. This will eventually result in the twin having a very large bladder, as well as too much amniotic fluid. This is known as polyhydramnios.
At the same time, the donor twin will produce less than the usual amount of urine. The amniotic fluid around the donor twin will become very low or absent. This is known as oligohydramnios. As the disease progresses, the donor will produce so little urine that its bladder may not be seen on ultrasound. The twin will become wrapped by its amniotic membrane (known as a “stuck” twin).
Amniotic fluid volume is measured with ultrasound by determining the deepest pocket measurement from the patient’s skin to her back. This measurement is known as the maximum vertical pocket (MVP). TTTS is found to be present when the MVP for the recipient twin is greater than 8 while the MVP for the donor twin is less than 2.
What are the Complications of Twin to Twin Transfusion Syndrome?
The mother may experience premature labor due to rupture of membranes. Brain defects, respiratory problems, and heart complications are all potential complications of this condition. The donor twin may also develop anemia. Some cases result in fetal demise. For this reason, the health care professional should closely monitor the mother’s condition, and any ultrasounds performed in order to provide appropriate care for the developing fetuses.
Are there any Signs of Twin to Twin Transfusion Syndrome?
The mother may experience abdominal pain or contractions. She may also notice a sudden increase in body weight. Sometimes the mother will have swelling in the legs and hands in the beginning of her pregnancy. The uterus may measure larger than usual for the corresponding date.
How is Twin to Twin Transfusion Syndrome Diagnosed?
In addition to an ultrasound revealing amniotic fluid levels, a difference in the size of the umbilical cords may be found. The ultrasound will also show any significant difference in the size of the fetuses of same gender twins. The presence of a single placenta, or evidence of fluid accumulation in the fetuses’ skin are also shown on the ultrasound. The healthcare professional may suspect TTTS if any of these conditions appear. Upon confirmation of this condition, weekly ultrasounds may be recommended throughout the remainder of the pregnancy.
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