What is fetofetal transfusion syndrome (TTTS) ?
Twin to twin transfusion syndrome (TTTS) is a prenatal condition in which twins share unequal amounts of blood supply of the resulting placenta in both fetuses growing at a rate different. TTTS is not related to anything the mother did or did not do during pregnancy.
Identical twins share a single placenta. Usually they are in different bags, sacks amniotic fluid. This type of pregnancy is called monochorionic twins (one placenta) and di-amniotic (two sacks). In the twins, monochronionic-di amniotic (mo-di twins), blood vessels, which run from one twin to the other on the surface of the placenta are shared. Very often the net flow of blood between the twins is fairly uniform, but when there is an imbalance of blood flow through these blood vessels, such that one of the twins is increasing the blood supply to the other, TTTS can happen then. The fetus with increased blood flow is called the recipient twin, and the fetus less is called the donor twin.
Because the donor twin has less blood flow, the baby grows slower and lower. Therefore, the bladder is small or invisible and amniotic fluid begins to decline. The recipient twin, however, has too much blood flow. It grows faster and is bigger than the other twin. The recipient baby tries to urinate excess fluid to have more blood, so having an increased bladder and excess amniotic fluid
There are five stages of TTTS :.
Step 1: There is an imbalance of amniotic fluid with a small amount (<2cm) around the donor twin and a large amount around the recipient twin (> 8 cm). Twins are often more than 20% difference in size
Step 2: .. The bladder of the donor twin is not visible or is not filled with urine during an examination of ultrasound
Stage 3: the imbalance of blood flow begins to affect heart function in one or both babies. This is seen in abnormal blood flow in the umbilical cords or twin hearts of
Step 4: .. The imbalance of blood flow causes signs of heart failure in one of the twins
Step 5 :. One or both of the twins has passed away from severe TTTS
for Phase 1 of the cases, observation may be all that is necessary, but for stage 2 or higher cases , fetal surgery may be the best option.
How TTTS diagnosed?
A routine prenatal ultrasound will show if there are twins in pregnancy, and we can see if the twins are identical and share a placenta. This is a fundamental determination, because if so, their babies are at risk of developing TTTS (risk 15-20%).
The Institute of Attention SSM St. Louis fetal health, it is recommended that screening ultrasounds be performed every two weeks between 16 and 24 weeks of pregnancy. If signs of TTTS develop, such as different levels of amniotic fluid or growth differences, then ultrasound can be performed more frequently to determine if the TTTS is really progressing. We will determine at what stage of TTTS is present. A fetal echocardiogram (echo) gives us much more information about heart function and anatomy. Treatment options depend on the stage of the TFF, ranging from observation to laser surgery placenta.
How TTTS administered during pregnancy?
A highly specialized specialist in maternal-fetal medicine should control TTTS and determine if the stage is progressing. The progression can occur very quickly, within a few days. We examine each case closely, and our team of doctors and nurses explain the treatment options for your specific case. Options include:
Observation through frequent ultrasounds:
Stage 1 cases may not require intervention, but it is important to track twins progress frequently and closely, to rule out progression to phase 2 or beyond. In Fetal Care Institute, which often perform ultrasounds every week
fetoscopic laser photocoagulation :.
In cases of TTTS Stage 2 or higher, at approximately 16 to 26 weeks gestation, surgeons use a laser to block blood vessels that communicate between the two fetuses. The surgeon inserts a fiber optic endoscope tip pen size in the womb of the mother and examines the entire placenta to find blood vessels crossing.
Once all these are mapped, a small laser fiber is inserted and the laser energy is used to stop blood flow between the twins. Twin separation blood flow is as functionally separate the placenta, allowing each twin to independently develop
This procedure removes excess fluid around the larger twin, reducing the amniotic pressure and reduce the risk of preterm delivery. This is usually done with laser photocoagulation fetoscopic.
The staff at the Institute for Fetal Care is here to support you, arming yourself with knowledge about all of your options, and help with your decision what is right for you and his family. Although untreated cases of TTTS can become serious, threatening the lives of the twins, fetoscopic laser photocoagulation can completely cure TTTS.
How does TTTS my baby after delivery?
twins with untreated TTTS during pregnancy usually advanced stages do not do well after delivery-there is a risk of 90% of doom and, for those who survive a 15-50% risk of neurological disability.
good news, however, is that there are many treatment options during pregnancy that can significantly improve survival and reduce the risk of neurological disabilities. If TTTS of her twins has been managed and treated successfully during pregnancy, there are many more likely to be healthy babies
Credits .: cardinalglennon