Identical twins that share a common placenta (monochorionic twins) usually have blood vessel connections between the two fetuses. In about 15% of these pregnancies, twin-twin transfusion syndrome (TTTS) occurs when these blood vessels produce an imbalance or uneven sharing of the blood. As a result, blood from one twin (the "donor twin") is pumped to the other twin (the "recipient twin"). When this occurs, the heart of the donor twin must do extra work to support the recipient twin. The recipient twin gets too much blood and the donor twin does not get enough.
This unequal sharing of blood causes problems for both babies. The amniotic fluid level can be high for the recipient twin and low for the donor twin. Blood flow is going away from the donor twin who may become anemic (have a low blood count). The recipient twin can develop heart failure from having the burden of pumping extra blood. This may cause increased fluid to build up in the fetus that can lead to fetal death.
If left untreated, one or both twins may die. Because there are blood vessel connections in the placenta between the fetuses, one twin can be affected by death of the other twin. There is an increased risk of neurological complications or death in the remaining twin.
Once the condition has been detected, a targeted ultrasound will be performed to rule out the presence of additional anomalies in the twins. Amniocentesis may be recommended to look for chromosomal abnormalities and a specialized ultrasound of the fetal hearts, called an echocardiogram, may also be performed. TTTS is a progressive disease in which mild cases require only careful monitoring of twin growth and amniotic fluid. Severe cases in which one or both twins appear to be in danger may require fetal intervention.
Not every pregnancy with this condition will require fetal treatment. If it is determined that fetal intervention is the best option for your pregnancy, the team at the Center will develop a comprehensive plan for you and your babies during and after birth. All patients that have been diagnosed with TTTS should learn about potential fetal interventions. There are several treatment options available. Based on the severity of the case, your doctors at the Center will recommend the most appropriate treatment option.
The procedure is typically performed under regional (epidural or spinal) anesthesia. Afterwards, the mother will be admitted to the Women's Center at Children's Memorial Hermann Hospital to closely monitor the pregnancy. Medications and bed rest may be prescribed to minimize the risk of preterm labor. After discharge, mothers will continue to be followed by the Center and your obstetrician for ongoing care.
Type of delivery: The delivery plan will be carefully discussed with you and your obstetrician.
Place of delivery: If all of the prenatal monitoring suggests that your pregnancy is going well, the twins can be delivered at the hospital of your choice. However, the hospital should be prepared to handle any additional needs of your newborns and have a neonatal intensive care unit with the capability to provide specialized care.
Time of delivery:There is no reason to intentionally induce an early delivery. As long as the fetuses and mother are stable, the pregnancy should be allowed to proceed to term. If the twins' condition deteriorates, earlier delivery may be necessary.
Immediately following delivery, doctors will carefully evaluate and begin treatment if necessary. Most infants will be born without any problems. You and your loved ones should be able to immediately hold and bond with your newborns. If needed the babies will be stabilized in an intensive care unit and treated by the neonatologists (specialists in the care of high-risk newborns).
Complicated twin / multifetal pregnancies will be followed for any signs or symptoms of neurologic complications. The multidisciplinary team at the Center will evaluate which treatment option is best for you and your pregnancy. If longterm follow up with a pediatric specialist is required, the clinic coordinators will help each family bridge the gap, connecting families with the specialists.
April 3, 2020
Christine and Blake Dugger learned they were pregnant with twins in December, 2017. “The entire pregnancy was a surprise,” Christine Dugger says. “We have two older daughters, who were six and three at the time, and we were very much not planning on having more children, but whe...
When you contact The Fetal Center, you will be in touch with a dedicated coordinator who will walk you through the process step-by-step and help you to understand every aspect of your care.
The Fetal Center at Children's Memorial Hermann Hospital
UT Professional Building
6410 Fannin, Suite 210
Houston, Texas 77030
Phone: (832) 325-7288
Toll free: (888) 818-4818
Fax: (713) 383-1464
Email: thefetalcenter@memorialhermann.org
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Located within the Texas Medical Center, The Fetal Center is affiliated with McGovern Medical School at UTHealth Houston, UT Physicians and Children’s Memorial Hermann Hospital.