What is twin-to-twin transfusion syndrome and how early can you detect it?
Twin-to-twin transfusion syndrome typically develops between weeks 16 and 26 of a woman’s pregnancy. But an ultrasound as early as 10 to 14 weeks can put doctors on alert that there is a twin gestation, and if they are sharing a placenta.
What is twin to twin transfusion syndrome (TTTS)?
Twin to twin transfusion syndrome is also referred to as chronic inter-twin transfusion syndrome. TTTS occurs about 15 % of the time among identical twins. Fraternal twins are not at risk for this syndrome because they do not share a placenta.
How is TTTS diagnosed?
This is why a diagnosis of TTTS will include a detailed examination of the fetal heart (fetal echocardiography) in both the recipient and donor. Doctors can assess the severity of each case of TTTS using the Quintero staging system.
Can TTTS be inherited?
Since TTTS doesn’t have a genetic cause or associated risk factors, the probability of developing TTTS in a future pregnancy is always the same as it was before. Twin-to-twin transfusion syndrome is a very complicated medical condition, and it can be a heartbreaking diagnosis.
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How quickly can TTTS progress?
Results: Among 132 consecutive cases of TTTS, 46 women presented with Stage I disease. In the majority (69.6%), disease remained stable (28.3%) or regressed (41.3%). Of cases that progressed, 79% did so within 2 weeks and 93% progressed to at least Stage III.
How do you know if you have TTTS?
TTTS is diagnosed by ultrasound. The earlier the disease is diagnosed – specifically when the disease is in its early stages – the better the prognosis.
What percentage of twins have TTTS?
Twin-twin transfusion syndrome (also called TTTS or twin to twin transfusion syndrome) is a condition in which the blood flows unequally between twins that share a placenta (monochorionic twins). TTTS occurs in about 10 to 15 percent of monochorionic, diamniotic (two amniotic sacs) twins.
Can TTTS be prevented?
TTTS is caused by abnormal connections between twins that form when the placenta first develops. This is a purely mechanical and random event that can't be avoided. “The mother can do absolutely nothing to prevent it,” says Dr. Norman Davies, maternal fetal medicine consultant at Mayo Clinic.
Can both babies survive TTTS?
In almost 90 percent of those pregnancies, at least one baby will survive and be healthy after leaving the hospital NICU. Having both twins survive advanced TTTS remains a challenge, however. Across all medical centers in the United States, about half of pregnancies treated for TTTS end with two healthy babies.
Can TTTS be mild?
The severity of TTTS can range from mild to severe. Weekly ultrasound measurements of fluid levels, the function of the fetal hearts, and blood flow through the umbilical cords are used to determine how severe the problem is and if treatment is needed.
Can TTTS happen with a fused placenta?
Although extremely rare, vascular anastomoses can occur between placentae in a dichorionic pregnancy and potentially lead to an unexpected TTTS. Clinicians should be alert of this possibility if a discordance on the amount of amniotic fluid is present.
What is a daisy baby?
All babies affected by TTTS, including TAPS, SIUGR and TRAP are called Daisy Babies. We dream of acres of daisies one day to honor and love all of our babies and have a sacred place to go. It is never about the storm. It is about the day after. That is what we are fighting for.
Can both twins survive TTTS?
In most instances, the appropriate, optimal therapy will be fetoscopic laser intervention. Our center was one of the first in the world to perform fetoscopic laser to treat TTTS. Survival rates for at least one twin are greater than 85% and for both twins is approximately 60% at our center.
Can diet help TTTS?
Diet supplementation was associated with lower overall incidence of TTTS (20/52 versus 8/51, P = 0.02) and with lower prevalence of TTTS at delivery (18/52 versus 6/51, P = 0.012) when compared with no supplementation.
How rare is twin transfusion syndrome?
Twin-twin transfusion syndrome affects approximately 5 to 15 percent of identical twin pregnancies, meaning that approximately 6,000 babies may be affected each year.
Can TTTS cause preterm labor?
Twin-to-Twin Transfusion Syndrome Diagnosis This may lead to preterm labor or preterm rupture of membranes followed by delivery. For this reason, maternal assessment of the cervical length and uterine activity is essential in all women presenting with suspected TTTS.
Is twin-to-twin transfusion syndrome hereditary?
The common placenta may also be shared unequally by the twins. The events in pregnancy that lead to TTTS are all random. TTTS is not hereditary or genetic, nor caused by anything the parents did or did not do.
What is a daisy baby?
All babies affected by TTTS, including TAPS, SIUGR and TRAP are called Daisy Babies. We dream of acres of daisies one day to honor and love all of our babies and have a sacred place to go. It is never about the storm. It is about the day after. That is what we are fighting for.
What can be done about TTTS?
Laser fetal surgery is the only treatment that targets the cause of the TTTS. In this procedure, a laser fiber enclosed in a long, thin telescope is inserted into the uterus to separate the blood vessels on the placenta that run from one twin to the other.
How is twin to twin transfusion treated?
Twin-twin transfusion syndrome can be treated with fetal laser photocoagulation (FLP), which selectively and sequentially ablates connections, depending on the type, to prevent the loss of one or both fetuses.
What is twin-to-twin transfusion syndrome (TTTS)?
TTTS is a syndrome that affects the structure of the placenta. The placenta is an organ that forms during pregnancy, attaching to your uterus and providing blood and nutrients to your baby. In TTTS, there is an intrauterine blood transfusion from one fetus to the other.
How does TTTS affect twins?
This leads to low levels of amniotic fluid. The donor baby also becomes dehydrated and grows more slowly. The donor twin usually has 20 percent less birth weight than the recipient twin. The donor twin’s hemoglobin may be 5 g/dL less than the recipient’s. TTTS can affect both twins negatively.
What is TTTS in a fetus?
In TTTS, there is an intrauterine blood transfusion from one fetus to the other. There are many blood vessels in the placenta. In TTTS, abnormal blood vessels form in the placenta, and blood flows unevenly between the fetuses. TTTS leads to unequal placental sharing, which means that one baby receives more blood than the other.
What happens if a twin gets a hydrops?
The recipient twin, on the other hand, has to deal with an abnormally high blood flow. They grow larger in size and urinate constantly, leading to excessive amniotic fluid. The recipient’s blood becomes abnormally thick, and they can develop heart failure as a result. This can lead to hydrops fetalis, a condition characterized by generalized edema (accumulation of fluid).
What is the survival rate of twin to twin syndrome?
If left untreated, the twin-to-twin syndrome survival rate is very poor — approximately 10–15 percent. Even if both babies are delivered, the mortality rate of severe TTTS is 60–100 percent, and there’s also a very high risk of neurologic injuries.
When can you deliver twins with TTTS?
In severe cases, or if TTTS is diagnosed later in the pregnancy, delivering the twins might be the best option. The best time to deliver babies with TTTS will depend on many individual factors. Your medical team will probably try to deliver the babies as far into the third trimester as possible.
How many stages are there in Quintero?
The five stages of the Quintero TTTS staging system are:
What is TTTS?
Twin to twin transfusion syndrome (TTTS) is a condition that occurs only in monochorionic pregnancies when the blood flow between the babies becomes unbalanced, and one baby donates blood to the other. This causes the donor twin to become dehydrated and stop making urine, which results in a decrease in amniotic fluid. The recipient baby produces higher-than-normal amounts of urine, resulting in excess amniotic fluid. The donor twin experiences slower-than-normal growth, while the recipient twin is at risk of heart failure due to the extra volume of blood. Without intervention, the condition can be fatal for both twins.
How many births are there in a monochorionic diamniotic twin?
Monochorionic diamniotic twins occur at a rate of three to four in 1,000 live births. TTTS develops in about 10 to 15 percent of those pregnancies. The condition does not occur when twins are non-identical (fraternal).
What happens if you have a taps twin?
With TAPS, the donor twin is at risk for anemia and the recipient twin is at risk for polycythemia, both of which can lead to fetal loss. Dr. Saul Snowise, Midwest Fetal Care Center.
Where is Peter Van Eerden?
Dr. Peter Van Eerden is a maternal fetal medicine (MFM) specialist with expertise in high-risk pregnancies at Sanford Health in Fargo. His team of MFMs and pediatric specialists at Sanford is comprehensive and collaborative, equipped to treat most conditions. For complex situations that require fetoscopic laser surgery or open fetal surgery, Dr. Van Eerden refers patients to the Midwest Fetal Care Center (MWFCC), a collaboration between Children’s Minnesota and Allina Health. “It’s important that we refer patients to a center that is fetal-trained, sees a high volume of complex procedures, and delivers great outcomes for moms and babies,” said Dr. Van Eerden. “MWFCC checks all the boxes. They have the infrastructure to do surgical procedures that effectively treat my patients.”
Can a donor twin have heart failure?
The recipient baby produces higher-than-normal amounts of urine, resulting in excess amniotic fluid. The donor twin experiences slower-than-normal growth, while the recipient twin is at risk of heart failure due to the extra volume of blood. Without intervention, the condition can be fatal for both twins.
How is Twin to Twin Transfusion Syndrome diagnosed?
Your healthcare provider may suspect this disorder if any of the following is seen during an ultrasound:
What is TTTS in medical terms?
Twin to twin transfusion syndrome (TTTS) is a serious disorder that occurs in identical twins and higher-order multiples who share a placenta. This occurs when the blood vessels of the babies’ shared placenta are connected.
What does it feel like to have twins with TTTS?
A mother whose twins have TTTS may experience: A sensation of the rapid growth of the womb. A uterus that measures large for dates. Abdominal pain, tightness, or contractions. A sudden increase in body weight.
How much can amniocentesis save?
Amniocentesis can save approximately 60% of affected babies. Laser surgery can also be used to seal off the connection between the blood vessels and appears to save 60% of affected babies. Delivery is also an option if your healthcare provider determines the twins’ lungs have reached maturity.
Why do twins have respiratory defects?
Respiratory, digestive, heart, or brain defects in the recipient twin because of excess fluids
What is Twin-to-Twin Transfusion Syndrome?
Twin-to-twin transfusion syndrome (TTTS) is a rare pregnancy condition affecting identical twins or other multiples. TTTS occurs in pregnancies where twins share one placenta (afterbirth) and a network of blood vessels that supply oxygen and nutrients essential for development in the womb. These pregnancies are known as monochorionic.
What is the Quintero staging system?
Doctors can assess the severity of each case of TTTS using the Quintero staging system. Quintero stages I and II represent progressive stages of blood volume imbalance, while stages III and IV indicate progressive stages of cardiovascular dysfunction. Stage V refers to the death of one or both twins. Quintero staging is important because it provides a standardized prenatal estimate on disease severity and the likelihood the condition will worsen.
What happens if amniotic fluid ceases to exist?
If amniotic fluid ceases to exist this is known as anhydramnios . If the blood volume in the donor twin’s circulatory system is not effectively reaching the body, cardiovascular dysfunction can occur. This places the donor at risk for death.
What is the role of amniotic fluid in a fetus?
This affects development of the bladder and leads to low levels of amniotic fluid. Amniotic fluid, which consists of fetal urine, provides a cushion in the womb. In addition, as a fetus grows, it swallows this fluid. This aids in the development of its respiratory, urinary and gastrointestinal systems.
How does hypervolemia affect the heart?
A persistent state of hypervolemia ultimately affects the function of the heart muscle in the recipient, which is working hard to pump the increased amount of blood. Hypervolemia can exceed the capacity of the cardiovascular system (the heart and circulatory system of blood vessels) and can then lead to cardiovascular dysfunction and even heart failure and death.
What is the prognosis of TTTS?
An important factor in determining the prognosis of TTTS is the state of cardiovascular dysfunction in the twins. This is why a diagnosis of TTTS will include a detailed examination of the fetal heart (fetal echocardiography) in both the recipient and donor.
What happens to a donor twin?
The donor twin. The donor twin experiences progressive loss of blood volume ( hypovolemia ). Therefore, its kidneys don’t have to filter as much fluid from the blood, and as a result, urination decreases. This affects development of the bladder and leads to low levels of amniotic fluid. Amniotic fluid, which consists of fetal urine, ...
What is Twin to Twin Transfusion Syndrome?
Simply put, Twin to Twin Transfusion Syndrome is a disease of the placenta. When identical twins share one placenta (monochorionic twins), it is sometimes possible for abnormal blood vessels to connect the umbilical cords and circulatory systems of the twins. Due to these abnormal connections, blood isn’t always distributed evenly between the two babies—meaning one baby may receive too much blood flow, whereas the other will not get enough. Although the twin receiving less blood (the donor) is at risk for anemia, dehydration, and developmental delays, the twin getting more blood (the recipient) is also at risk for problems such as high blood pressure, heart failure, respiratory and digestive issues, brain defects, and he may overflow the amniotic sac with urine. TTTS can be fatal to either or both twins.
When can TTTS be detected?
It is possible for this condition to arise at any point during pregnancy, as early as 12 weeks or as late as scheduled labor.
Is there any treatment for TTTS?
Early detection is key. Once diagnosed, all cases will be continually monitored throughout the remainder of the pregnancy. Doctors may suggest draining excess fluid from the recipient-twin’s amniotic sac in order to help even out the blood flow (amnioreduction). For more severe cases, doctors may recommend early delivery or laser treatment, called fetoscopic laser photocoagulation. During the surgery, a small incision is made so that a tiny telescope can be inserted into the uterus to see all the blood vessel connections, at which point the surgeon will seal shut the abnormal connections in order to disconnect the babies blood flow from one another.
How is twin to twin transfusion syndrome (TTTS) managed before birth?
Our prenatal management of babies with TTTS centers on monitoring the babies frequently with high-resolution fetal ultrasonography and fetal echocardiography. This testing allows us to measure the amount of amniotic fluid around your babies. It also allows us to assess how well blood is flowing within your babies’ umbilical cords, as well as within other blood vessels.
Who will be on my care team?
That way, you are assured of getting the best possible information by some of the most experienced physicians in the country. For TTTS, your care team will include a maternal-fetal specialist, a fetal interventionist, a pediatric cardiologist, a neonatologist, a nurse specialist care coordinator, a perinatal social worker and several other technical specialists. This entire team will follow you and your babies closely through the evaluation process, and the team will be responsible for designing and carrying out your complete care plan.
What is the long-term prognosis for my babies?
The long-term prognosis for babies with TTTS depends on how soon the condition is treated after it has developed, as well as the age of the babies at delivery. The earlier the babies receive treatment and the longer they stay in the womb before birth, the less likely they will experience complications.
Will my baby require long-term follow-up?
Because of all the potential health issues associated with TTTS, your babies will require long-term follow-up care. At Children’s Minnesota, we have developed a detailed care plan for babies who experienced TTTS during gestation. Your babies’ plan will be implemented by a comprehensive team of specialists, including a pediatrician (who will coordinate your babies’ overall care), a pediatric cardiologist, a developmental specialist, and any other caregiver your baby may require to manage any twin to twin transfusion syndrome long term effects.
How many babies survive fetoscopic photocoagulation?
That percentage is dramatically improved for babies who undergo fetoscopic laser photocoagulation. In almost 90 percent of those pregnancies, at least one baby will survive and be healthy after leaving the hospital NICU. Having both twins survive advanced TTTS remains a challenge, however.
How is twin to twin transfusion syndrome diagnosed?
How is twin to twin transfusion syndrome (TTTS) diagnosed? A twin to twin transfusion syndrome diagnosis is confirmed by ultrasound. The condition becomes evident when the ultrasound images show that one child has extra amniotic fluid and the other child has significantly decreased amounts.
What is a twin to twin transfusion?
Twin to twin transfusion syndrome (TTTS) is a condition that occurs only in monochorionic pregnancies — ones in which two or more genetically identical babies (usually twins) share the same placenta. Although all identical twins share a placenta, TTTS develops in about 10 to 15 percent of those pregnancies. The condition does not occur ...
What do you see on an ultrasound at 16 weeks?
Because there are no physical signs of TAPS in the mother, she MUST have MCA (or middle cerebral artery) Dopplers at every ultrasound starting at 16 weeks through delivery of the babies. Other signs to look for on ultrasound would be a thicker and darker side of the placenta compared to a paler thinner side. There can also be what is called ‘starry liver’ or white spots on the liver of one baby.
How big are the blood vessels in the placenta?
The blood vessels that are shared with TAPS between the babies in the placenta are very small (less than 1cm in size) where the blood vessels that are shared between the babies in the placenta with TTTS are larger. We compare them visually like dental floss to yarn.
What is a tap?
TAPS, or twin anemia polycythemia sequence, is a form of TTTS but is different in that TTTS involves an unequal sharing of blood volume (creating a amniotic fluid difference) and TAPS creates an unequal sharing of red blood cells only (no amniotic fluid difference).
What is TTTS in pregnancy?
TTTS, or twin to twin transfusion syndrome, is a disease of the placenta (or afterbirth) that affects identical twin pregnancies. TTTS affects identical twins (or higher multiple gestations), who share a common monochorionic placenta. The shared placenta contains abnormal blood vessels, which connect the umbilical cords and circulations of the twins.
What is the TTTS Foundation?
The TTTS Foundation helps families every day with TAPS. TAPS is a silent killer and we are passionate about empowering parents and are dedicated to continuing to increase awareness to save lives before it is too late.
Why is it important to have the placenta analyzed and injected with dye?
It is also crucial to have the placenta analyzed and injected with dye to identify the smaller vessels that are responsible for TAPS and the larger vessels to create TTTS.
How high can you get a TTTS?
Yes , when you have TTTS the amniotic fluid increases in the sacs of the recipient baby who receives more than normal amounts of blood. The measurement is called the Maximum Vertical Pocket or MVP which normally is between 2-8cm. When the pocket goes over 8cm you will start to feel larger. We have helped mothers as high as 22cm which is dangerously high. If you have not been pregnant before, even 8.1cm may cause discomfort. If you have had a baby before, you may be able to handle a 10 or 11cm pocket because your uterus has already stretched before.
What is the best treatment for TTTS?
“For severe cases of TTTS, the best treatment we have right now is laser ablation,” explains Dr. Larry Rand, director of the Fetal Treatment Center at UCSF. Lasers pinpoint the blood vessel connections between the babies and physically cut them and seal them. You are basically separating the babies’ blood flows from each other.
How many babies can you have with laser ablation?
According to Rand, with early detection and the laser ablation, there is a 65 percent chance of having two surviving babies and an 85 percent chance that one of the twins survives.
What does it mean when your belly is growing?
The increase in belly size often goes hand in hand with rapid increases in body weight. In addition, other symptoms can include pain, tightness, or early contractions, meaning your body starts getting ready for birth too early in your pregnancy.
How many babies die from TTTS?
If left untreated, 80 percent to 90 percent of twins with TTTS will die. Therefore, early screenings in mothers with twins are crucial.
What causes TTTS?
TTTS is caused by abnormal connections between twins that form when the placenta first develops . This is a purely mechanical and random event that can’t be avoided. “The mother can do absolutely nothing to prevent it,” says Dr. Norman Davies, maternal fetal medicine consultant at Mayo Clinic.
How rare is TTTS?
TTTS is rare. Twenty-five percent of twins share a common placenta, and approximately 10 percent of those twins develop TTTS. TTTS is rare, but since two little lives are at stake, maternal-fetal experts want all mothers of twins to be aware of this syndrome.
What is TTTS in a baby?
TTTS is a disease of the mother’s placenta and only occurs when you have twins sharing the same placenta. When that happens, the key problem is abnormal blood vessels within the placenta.
