04-jan-2024
Twin to Twin Transfusion Syndrome (TTTS) is a condition that affects identical twins who share a placenta. It occurs when one twin, the donor twin, provides too much blood to the other, the recipient twin. This leads to an imbalance in the amount of blood circulating between them and can cause serious health problems for both twins. TTTS is caused by unequal blood flow through connecting vessels in the placenta, leading to one twin having too much blood and the other having too little. This can lead to fetal anemia in the recipient twin and hydrops fetalis, or fluid buildup in various organs of both twins. If left untreated, TTTS can be fatal for both twins.
Twin-to-twin transfusion syndrome (TTTS) is a rare condition that affects monochorionic twins, or those who share the same placenta. It occurs when the blood vessels connecting the two fetuses are not properly formed and one fetus can receive more nutrients than the other. This can lead to complications such as premature birth and low birth weight, as well as long-term health issues for both babies. Risk factors for developing TTTS include gestational age, size of the fetuses, and vanishing twin syndrome (VTS). Gestational age is important because TTTS is more likely to occur in pregnancies that are between 16 and 24 weeks gestation. Fetus size also plays a role because smaller fetuses tend to be at higher risk for TTTS than larger ones. Lastly, VTS increases the risk of TTTS because it means that one of the twins has already died in utero and therefore there is an imbalance in blood flow between them. The second most common cause of TTTS is placenta previa. This condition occurs when a placenta blocks the outlet of the uterus during pregnancy. Additionally, some cases of polyhydramnios may also present with TTTS.
Common signs and symptoms of TTTS include oligohydramnios polyhydramnios sequence (OPs), abnormal fetal movements, growth discrepancies between the twins, and an increase in amniotic fluid around one baby while the other has too little. It is important for expecting parents to be aware of these signs and symptoms so they can seek medical help as soon as possible if they suspect TTTS. Early diagnosis and treatment are essential for reducing the risk of complications from this condition.
● Maternal symptoms include a risk of shoulder dystocia (difficulty birthing the baby), preeclampsia (high blood pressure during pregnancy) and gestational diabetes. While these complications are more likely to be seen in mothers who experience gestational diabetes, they may also be seen in mothers who have had preeclampsia before.
● Fetal/neonatal complications of TTTS include oligohydramnios polyhydramnios sequence, intrauterine growth restriction and apnea. While this condition usually does not affect the infant's chances for survival, it can cause the infant to have low blood sugar, respiratory distress syndrome and possibly even death.
Treatment options for TTTS include laser ablation surgery or selective fetoscopic laser coagulation (SFLC). Surgery- to remove the dead or dying tissue, and selective laser coagulation (using a laser to destroy the blood supply) to destroy the blood vessels and prevent hemorrhage.
The treatment plan is determined by which baby is on top, which uterus will be removed, what stage of TTTS each baby has, and any complications that have happened during delivery.
TTTS is the result of a shared placenta, which means that twins share a placenta and a blood supply. This pregnancy complication can occur in monochorionic twins, which are two fetuses with one placenta each. The twin receiving more nutrients than his or her sibling will take in too much blood from the shared placenta and has excessively high oxygen levels. This causes the other twin to be deprived of oxygen, leading to fetal distress and non-reassuring fetal heart rate patterns. There are several complications that can occur due to TTTS such as cerebral palsy , hydrocephalus, and neurodevelopmental delay disorders. Neurodevelopmental delay disorders are a group of conditions that include abnormalities in brain development. The most common condition is cerebral palsy, which can be classified as either spastic or athetoid.
● Spastic cerebral palsy is characterized by involuntary contractions of the muscles of the body so that they shake and jerk with little control over the muscle movements.
Athetoid cerebral palsy is characterized by difficulties with voluntary motor skills such as walking, talking, or coordination
Other neurodevelopmental delay disorders include autistic -spectrum disorders, developmental delay with or without intellectual disability, organic mental illness, and psychomotor delay with or without intellectual disability.
Nimai Institute of Medical Sciences Private Limited (NIMS) was founded by its founder chairman Dr Santosh N. Madrewar, a renowned Pediatrician, who has designed an unique Mother and Child Health Concept, integrating modern medical management with Ayurvedic treatments and traditional Indian ethos making Pregnancy and Birthing a Joyous Celebrations and Child development focused on Physical, Mental, Social and Spiritual Well-being.
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