Twin to Twin Transfusion Syndrome

Twin to Twin Transfusion Syndrome

Learn about TTTS.

5/9/2008

Jesselle Davis

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Twin to Twin Transfusion Syndrome

April 28, 2008

Jesselle Davis

When most people think of someone being pregnant with twins they think “Oh how cute, what a blessing!” or something among those lines and you have your few that give you this shocking look of pity and think “Oh my God, GOODLUCK!”, but no one has a clue exactly how delicate and stressful carrying identical twin babies can be. When I found out I was pregnant it was a total shock, being that I was on birth control, but when I found out I was carrying twin babies I dropped to the floor. Of course, the shock wore off and the tears of joy started streaming down then the tears of joy became tears of sadness and heartbreaking ones. The doctors told me I had what they claim to be a rare disease that only identical twin babies go through called, Twin to Twin transfusion syndrome.

Twin to Twin transfusion syndrome, otherwise known as TTTS, is a rare disease that happens in identical twin fetuses or the other name for this pregnancy is Monochorionic twins. The reason is because identical twin fetuses share only one placenta unlike fraternal twins which have their own placenta. As we all know, and if you don’t know, now you will, the placenta is where the unborn baby receives all its nutrients, blood, etc from the mother, the amniotic sac is where the baby lives for nine months in the mother’s womb, the amniotic sac is made up of partial water received from the placenta and the babies urine which at this stage does not harm the fetus because it simply consist of all the nutrients received from the mother. Now this is where most people are grossed out because they just learned that the amniotic sac has urine, I know I was, but it’s important to know that this is how the baby survives and grows. A lot of people also don’t know and when they hear this they argue that then the babies are fraternal because most think that when you have identical twins their both in one sac but in reality there are two different types of identical twins, either they share one sac and one placenta or they are in their own individual sacs and share one placenta. Mine were in their own amniotic sac, which is what helped the specialist realize what was happening. Either way, Twin to twin transfusion syndrome only happens in identical twins. This rare disease happens only ten percent of all identical twin pregnancies (fetus.ucsfmedicalcenter.org/twin/learn_more).

This is how Twin to Twin transfusion syndrome works. As we discussed earlier, Monochronic twins share one placenta, within this placenta are blood vessels that both fetuses share equally but in Twin to Twin Transfusion Syndrome there is an unequal sharing of blood. The smaller twin, otherwise known as the donor twin, may not receive as much blood because it in way gives all of its nutrients, blood, and liquid to the larger twin; otherwise known as the recipient twin. The recipient becomes overloaded with too much blood. Now with the identical twins that are in their own sacs run a bigger risk, the recipient twin that receives more liquid in their sac runs the risk of having excess fluid in their sac which is called polyhydramnios which will possibly leak; they will suffer from cardiac failure because of too much blood being received and/or die. While the donor twin might have reduced amniotic fluid, absent urination because their bladder will start to disappear because they are not receiving enough liquid to help them urinate, they will shrink, disappear, however you would put it and eventually die. Although Twin to Twin Transfusion Syndrome does not behave the same way in every patient, some cases are more sever then others. In my case, the smaller twin was already having a shrinking bladder, a lot smaller than the other and had the lining of the amniotic sac close to her body, time was running out.

Mireille Reeff, Philippe Cattin, Gabor SzÐ"©kely

The way Twin to Twin Transfusion Syndrome is diagnosed by an ultrasound specialist. Not every ultra sound technician is specialized or trained to detect this disease, a lot of multiple pregnancies with this rare disease go undetected and unfortunately, the pregnancy terminates with a spontaneous abortion otherwise known as a miscarriage. Maybe when someone is learning how to be an ultrasound specialist they should be better trained to detect Twin to Twin transfusion syndrome. The way its detected is very simple but only the trained eye can see this, remember the identical twins that have two separate sacs are easier to detect, they see less fluid in the donor twin’s amniotic sac by measuring the liquid within it and with the recipient twin, and they detect how much excessive water is in their amniotic fluid.

Once the specialist have detected this they send all of the ultrasound images to another specialist, who happens to be a doctor specialized in this type of rare disease. There are only about a handful of these miracle workers in the world and only three are in the United States. The one who basically bettered the surgery, wrote a book on it and has saved so many little lives is located in Tampa, Fl his name Dr. Ruben Quintero. After, he takes a look at your ultrasounds, he determines whether or not you and your babies are good candidates to come in and be evaluated. I can honestly tell you, all these steps are so nerve wrecking. When you arrive at the hospital they start to run a bunch of test on you and your babies. They first draw blood from you to see your white t cell count make sure there aren’t any infections, they do an extensive ultrasound on the babies and then finally they give you options. The options are hard to hear and there is one very easy choice if the donor twin is strong enough to survive, in other words if it’s not too late for the smaller fetus. You also have to be less than thirty six weeks of pregnancy and over 31 weeks (fetus.ucsfmedicalcenter.org/twin/learn_more). The options are Expectant management which means the parents decide to do nothing, watch the development of the fetuses by having ultrasounds done frequently and only hope both babies survive which there is a ninety five percent rate that