Twin-to-twin transfusion syndrome
Show Alternative Names
TTTS
Fetal transfusion syndrome
Twin-to-twin transfusion syndrome is a rare condition that occurs only in identical twins while they are in the womb.
Twin-to-twin transfusion syndrome - Animation
Twin to Twin Transfusion Syndrome, or TTTS, is a disease of the placenta. This condition affects twins or other multiples that share a single placenta containing blood vessels going from one baby to the other. Blood from the smaller donor twin is transferred to the larger recipient twin through interconnecting vessels causing an unequal exchange of blood. The recipient twin is at risk for heart failure receiving too much blood from both the placenta and donor twin, forcing its heart to work harder, while the donor twin is at risk for loss of blood. Laser surgery may be performed to correct the problem. A laser is endoscopically inserted into the womb to burn and seal the interconnecting blood vessels, restoring the normal flow of blood. Following treatment, the babies are regularly monitored.
Causes
Twin-to-twin transfusion syndrome (TTTS) occurs when the blood supply of one twin moves to the other through the shared placenta. The twin that loses the blood is called the donor twin. The twin that receives the blood is called the recipient twin.
Both infants may have problems, depending on how much blood is passed from one to the other. The donor twin may have too little blood, and the other may have too much blood.
Symptoms
Most of the time, the donor twin is smaller than the other twin at birth. The infant often has anemia, is dehydrated, and looks pale.
Anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different type...
Read Article Now Book Mark ArticleThe recipient twin is born larger, with redness to the skin, too much blood, and a higher blood pressure. The twin that gets too much blood may develop cardiac failure because of the high blood volume. The infant may also need medicine to strengthen heart function.
Cardiac failure
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...
Read Article Now Book Mark ArticleThe unequal size of identical twins is referred to as discordant twins.
Exams and Tests
This condition is most often diagnosed by ultrasound during pregnancy.
Ultrasound during pregnancy
A pregnancy ultrasound is an imaging test that uses sound waves to create a picture of how a baby is developing in the womb. It is also used to chec...
Read Article Now Book Mark ArticleAfter birth, the infants will receive the following tests:
- Blood clotting studies, including prothrombin time (PT) and partial thromboplastin time (PTT)
- Comprehensive metabolic panel to determine electrolyte balance
- Complete blood count
- Chest x-ray
Treatment
Treatment may require repeated amniocentesis during pregnancy. Fetal laser surgery may be done to stop the flow of blood from one twin to the other during pregnancy.
After birth, treatment depends on the infant's symptoms. The donor twin may need a blood transfusion to treat anemia.
The recipient twin may need to have the volume of body fluid reduced. This may involve an exchange transfusion.
The recipient twin may also need to take medicine to prevent heart failure.
Outlook (Prognosis)
If the twin-to-twin transfusion is mild, both babies often recover fully. Severe cases may result in the death of a twin.
Review Date:
7/12/2023
Reviewed By
John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
References
Malone FD, D'Alton ME. Multiple gestation: clinical characteristics and management. In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 37.
Obican SG, Odibo AO. Invasive fetal therapy. In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 34.
Unal ER, Newman RB. Multiple gestations. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 39.
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