Twin-to-Twin Transfusion Syndrome: Symptoms, Causes, Treatment

What are the symptoms of twin to twin transfusion syndrome?

Twin-to-twin transfusion syndrome (TTTS) is a condition that affects identical twins who share a placenta. It occurs when there is an imbalance in the blood flow between the twins through the shared placenta. The symptoms of TTTS in the affected twins can include:

• Increased Amniotic Fluid (Polyhydramnios): One twin (the recipient) may have excess amniotic fluid, causing an enlarged uterus and making the mother’s abdomen appear swollen.
• Decreased Amniotic Fluid (Oligohydramnios): The other twin (the donor) may have reduced amniotic fluid, leading to a smaller uterus and a higher risk of umbilical cord compression.
• Growth Discrepancy: The recipient twin may grow larger than the donor twin due to the imbalance in blood flow and nutrients.
• Heart Problems: The recipient twin might experience high blood pressure in the heart due to the increased blood volume.
• Anemia in Donor Twin: The donor twin may suffer from anemia due to the loss of blood to the recipient twin.
• Hydrops Fetalis: Severe cases may result in fluid buildup in the body tissues of one or both twins, leading to severe swelling.
• Heart Failure: Both twins are at risk of heart failure due to the increased strain on their circulatory systems.
• Premature Birth: The condition often leads to preterm labor or premature birth due to the complications of TTTS.

Early diagnosis and management are crucial to improve outcomes for the twins. Regular monitoring through ultrasound and other diagnostic methods helps manage the condition and decide on the appropriate interventions.

What are the causes of twin to twin transfusion syndrome?

Twin-to-twin transfusion syndrome (TTTS) occurs in identical twins who share a single placenta, known as monochorionic twins. The main causes of TTTS involve issues with the blood vessels in the shared placenta:

• Imbalance in Blood Flow: TTTS is primarily caused by an imbalance in the blood flow between the twins through the shared placental blood vessels. This imbalance can occur due to abnormal connections between the arteries and veins in the placenta, which may cause one twin to receive too much blood (recipient twin) while the other receives too little (donor twin).
• Vascular Connections: In monochorionic twins, the placenta contains shared blood vessels that can become abnormal. These abnormal connections can lead to unequal blood distribution between the twins.
• Placental Anomalies: Structural abnormalities in the placenta, such as an uneven distribution of blood vessels or abnormal blood vessel connections, can contribute to the development of TTTS.
• Genetic Factors: While specific genetic causes are not well understood, genetic factors might influence the development of TTTS, especially given its association with identical twins.
• Other Factors: Conditions like a large placenta or an abnormal number of blood vessels in the placenta can also increase the risk of TTTS.

Timely diagnosis and intervention are crucial for managing TTTS and improving outcomes for both twins.

What is the treatment for twin to twin transfusion syndrome?

The treatment for twin-to-twin transfusion syndrome (TTTS) focuses on addressing the imbalance in blood flow between the twins and managing the associated complications. The primary treatment options include:

1. Amnioreduction: This procedure involves removing excess amniotic fluid from the recipient twin’s sac through a catheter inserted into the uterus. It helps to relieve pressure and improve blood flow. This procedure is typically performed if there is a significant fluid imbalance.
2. Laser Therapy: The most effective treatment for TTTS, laser therapy involves using a laser to coagulate (seal off) abnormal blood vessels in the placenta that are causing the blood flow imbalance. This procedure is performed through a fetoscope inserted into the uterus and helps to correct the blood flow between the twins.
3. Selective Reduction: In severe cases where the condition is life-threatening for both twins, selective reduction might be considered. This involves terminating one of the twins to improve the chances of survival for the remaining twin. This is a difficult decision and typically considered only in extreme cases.
4. Medication: Certain medications may be used to manage symptoms or improve outcomes, such as steroids to help mature the twins’ lungs if early delivery is anticipated.
5. Close Monitoring: Regular ultrasounds and fetal monitoring are crucial to track the progress of the condition and the effectiveness of the treatments. This helps in making timely decisions about further interventions or delivery.
6. Early Delivery: If the condition does not improve with other treatments or if the health of the twins deteriorates, early delivery of the twins may be necessary. The timing of delivery depends on the gestational age and the severity of TTTS.

Management of TTTS requires a multidisciplinary approach, including obstetricians, maternal-fetal medicine specialists, and neonatologists, to optimize outcomes for both twins.