Brief On Twin to Twin Transfusion (TTTS)


This is a rare but serious medical condition that happens in identical twins or higher order multiple pregnancies, where the twins share a common placenta. In this condition, the blood vessels within the shared placentas in the twins are connected.

When this happens, one of the twins called “the recipient” will receive more blood compared to the other twin called “the donor twin”. Twin to twin transfusion phenomenon is also referred to as chronic inter-twin transfusion syndrome.

This condition is very rare, it occurs about 15 % of the time among identical twins only. Non- identical twins (Fraternal twins) are not at risk for this condition because they do not share a placenta. This condition is not hereditary, but a random event that cannot be prevented by doing or not doing anything specific.

How can this condition be diagnosed by the healthcare provider?

The following might indicate a likelihood of Twin to Twin transfusion on an ultrasound:

  1. Noticeable difference in the size of twin fetuses of the same gender.
  2. Difference in size between the two amniotic sacs
  3. Difference in size of the umbilical cords
  4. A single placenta
  5. Evidence of fluid buildup in the skin of either fetus
  6. Findings of congestive heart failure in the recipient twin
  7. Polyhydraminos (excess amniotic fluid) in the recipient twin
  8. Oligohydraminos (decreased or too little amniotic fluid) in the donor twin

Can a Pregnant woman have any signs of Twin to Twin Transfusion Syndrome?

Yes, there are some signs, these include:

  1. Sensation of rapid growth of the womb
  2. A womb that measures large for dates compared to the expected measurement.
  3. Abdominal pain, tightness, or contractions
  4. Sudden increase in body weight
  5. Swelling in the hands and legs in early pregnancy

Treatment and Management options for Twin to Twin Transfusion Syndrome?

Previously, most cases of twin to twin transfusion syndrome have very poor outcome, the lives of both babies are claimed, however with newer technology, there are two new treatment options for this condition.

  1. The use of amniocentesis

This is a method of draining off excess fluid from the womb, and this appears to improve the blood flow in the placenta and reduce the risk of preterm labor. Normally, this method can save approximately 60% of affected babies.

  1. Laser surgery

This is another method of treatment, and can be used to seal off the connection between the blood vessels. This also appears to save 60% of affected babies.

  1. Delivery

Delivery is also an option if your doctor determines the twins’ lungs have reached maturity from 34 weeks of gestation.

What are the Complications Of Twin To Twin Transfusion Syndrome?

These include

  • Premature labor either due to ruptured membranes or induction.
  • Respiratory, digestive, heart, or brain defects/damage in the recipient twin because of excess fluids
  • Donor twin developing anemia
  • Fetal demise/death

Dr. Chudi Godsons

Reference & Photo Credit

American Pregnancy Association