Twin-to-twin transfusion disorder (TTTS) is an uncommon pregnancy condition that affects identical twins or other multiple pregnancies. TTTS happens in pregnancies where twins share one placenta (fetal membrane) and blood vessels that supply oxygen and nutrients that are important for growth. These pregnancies are termed as monochorionic.

There are some cases when the blood vessels inside the placenta are not uniformly apportioned and there is an imbalance in the circulation between the twins. One twin, the giver twin, parts gives more blood than it gets consequently and develops malnourishment and organ problems. The beneficiary twin gets an excess of blood and is vulnerable to heart failure and other cardiovascular problems.

TTTS can happen during pregnancy, even when a mother is in the process of giving birth at term. The placental problems cause a transfusion to happen between the twins.


Chronic TTTS  show up during the early months of pregnancy at 12 to 26 weeks’ development. These are more serious because the babies are immature. Moreover, the twins will affected by  TTTS  longer. Without treatment, babies cannot survive or may have birth defects.

Acute TTTS happens suddenly when there is a significant distinction in the blood pressures between the twins. This may happen in labor at term, or during the last trimester of pregnancy when one twin becomes ill or may even die because of the anomalies in their mutual placenta. Acute TTTS twins may have a greater chance for survival dependent on their gestational age, yet may have a possibility of having defects.


The donor twin

The donor twin may have the following:

  • Loss of blood volume  or hypovolemia
  • Decreased urination
  • Low levels of amniotic fluid
  • Cardiovascular dysfunction

The recipient twin

The recipient twin may have the following:

  • Increasing blood volume  or hypervolemia
  • Increased urination
  • Polyhydramnios or an abnormal increase in amniotic fluid.
  • Cardiovascular dysfunction and even heart failure


The physician may speculate twin-to-twin transfusion syndrome based on a prenatal ultrasound. Further testing may be done to quantify amniotic fluid volume, bladder filling and blood circulation in the twins.

Maternal evaluation of the cervical length and uterine activity is basic in all women suspected of having TTTS.

A significant factor in diagnosing TTTS is cardiovascular function of the twins. This is the reason why a finding of TTTS will include a detailed assessment of the fetal heart (fetal echocardiography) in the twins.

Physicians can evaluate the seriousness TTTS with the Quintero staging system. Quintero stages I and II bring about blood volume imbalance, while stages III and IV demonstrate cardiovascular problems. Stage V refers to the demise of one or the two twins.



Treatment for twin-twin transfusion syndrome may include:

  • Close monitoring with regular ultrasound examinations
  • Fetoscopic selective laser ablation
  • Amnioreduction
  • Selective cord occlusion

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