Learn About Twin-To-Twin Transfusion Syndrome
Twin-to-twin transfusion syndrome is a rare condition that occurs only in identical twins while they are in the womb.
TTTS; Fetal transfusion syndrome
Twin-to-twin transfusion syndrome (TTTS) occurs when the blood supply of one twin moves to the other through the shared placenta. The twin that loses the blood is called the donor twin. The twin that receives the blood is called the recipient twin.
Both infants may have problems, depending on how much blood is passed from one to the other. The donor twin may have too little blood, and the other may have too much blood.
Most of the time, the donor twin is smaller than the other twin at birth. The infant often has anemia, is dehydrated, and looks pale.
The recipient twin is born larger, with redness to the skin, too much blood, and a higher blood pressure. The twin that gets too much blood may develop cardiac failure because of the high blood volume. The infant may also need medicine to strengthen heart function.
The unequal size of identical twins is referred to as discordant twins.
Treatment may require repeated amniocentesis during pregnancy. Fetal laser surgery may be done to stop the flow of blood from one twin to the other during pregnancy.
After birth, treatment depends on the infant's symptoms. The donor twin may need a blood transfusion to treat anemia.
The recipient twin may need to have the volume of body fluid reduced. This may involve an exchange transfusion.
The recipient twin may also need to take medicine to prevent heart failure.
Michael Bebbington is a Neonatologist and an Obstetrics and Gynecologist in Austin, Texas. Dr. Bebbington is rated as an Elite provider by MediFind in the treatment of Twin-To-Twin Transfusion Syndrome. His top areas of expertise are Twin-To-Twin Transfusion Syndrome, Myelomeningocele, Anemia, Diaphragmatic Hernia, and Endoscopy. Dr. Bebbington is currently accepting new patients.
The Johns Hopkins Hospital
Dr. Ahmet Baschat is director of the Center for Fetal Therapy and professor in the Johns Hopkins Medicine Department of Gynecology and Obstetrics. His areas of clinical expertise include prenatal diagnosis and therapy of a wide range of fetal conditions including congenital diaphragmatic hernia, intrauterine growth restriction, twin-to-twin transfusion syndrome (TTTS), as well as other complications of monochorionic twin pregnancies. Dr. Baschat received his undergraduate and medical degrees from The Royal College of Surgeons in Ireland. He earned his doctorate in medicine (Dr. Med) from the University of Lübeck, where he also completed a residency in obstetrics and gynecology. Dr. Baschat also completed residencies at Newton-Wellesley Hospital and at University of Maryland Medical Center. He performed a fellowship in maternal-fetal medicine at University of Maryland Medical Center and went on to develop its Center for Advanced Fetal Care. Dr. Baschat joined the Johns Hopkins faculty in 2014. Prior to joining Johns Hopkins, Dr. Baschat was professor and director of Maternal-Fetal Medicine and the Section of Fetal Therapy at the University of Maryland School of Medicine. Dr. Baschat’s research interests include interventions and management techniques for fetal growth restriction and placental insufficiency. He has also done extensive research on the use of high resolution prenatal ultrasound techniques, including Doppler and fetal echocardiography, to predict and detect fetal complications. Dr. Baschat serves on a variety of boards and is a member of the American Congress of Obstetricians and Gynecologists (ACOG), the International Society of Ultrasound in Obstetrics & Gynecology and the International Fetal Medicine and Surgery Society. He has been recognized with several awards and honors, including the 2010 Award for Excellence in Research by the Society for Maternal-Fetal Medicine. Dr. Baschat’s passion for developing an individualized care plan for each of his patients has been the hallmark of his practice. Dr. Baschat is rated as an Elite provider by MediFind in the treatment of Twin-To-Twin Transfusion Syndrome. His top areas of expertise are Twin-To-Twin Transfusion Syndrome, Intrauterine Growth Restriction, Bilateral Renal Agenesis Dominant Type, Diaphragmatic Hernia, and Endoscopy.
The Johns Hopkins Hospital
Dr. Jena Miller is an assistant professor in the Department of Gynecology and Obstetrics and the Department of Surgery at Johns Hopkins. She is also a member of the Johns Hopkins Center for Fetal Therapy. She has a wide range of training in fetal medicine and fetal therapy. Her expertise includes operative fetoscopy, management of complicated monochorionic twins, high-risk pregnancies, multiple gestations, prenatal diagnosis and treatment. Dr. Miller completed her undergraduate training at the University of North Florida, followed by medical school and residency at the University of Miami Miller School of Medicine. She completed a maternal-fetal medicine fellowship at the University of Maryland and pursued additional opportunities in fetal medicine in Europe. Prior to joining Johns Hopkins, Dr. Miller was an Assistant Professor in Maternal-Fetal Medicine at Eastern Virginia Medical School and served as the director for the Sentara EVMS Fetal Care Center. Dr. Miller’s research interests include risk assessment and management of complicated monochorionic pregnancies as well as use of simulation and modeling for improving fetal intervention techniques. She has received grant support from the Fetal Health Foundation for use of 3D printing of fetal spina bifida from ultrasound imaging. Dr. Miller is a fellow of the American Congress of Obstetricians and Gynecologists. She is dedicated to teaching and was awarded the APGO Excellence in Teaching Award in 2014. She is absolutely dedicated to finding the optimal management plan specifically for each family. Dr. Miller is rated as an Elite provider by MediFind in the treatment of Twin-To-Twin Transfusion Syndrome. Her top areas of expertise are Twin-To-Twin Transfusion Syndrome, Myelomeningocele, Bilateral Renal Agenesis Dominant Type, Lung Agenesis, and Endoscopy.
If the twin-to-twin transfusion is mild, both babies often recover fully. Severe cases may result in the death of a twin.
Summary: The purpose of this study is to prospectively evaluate the efficacy of KARL STORZ curved fetoscope (11508AAK) and its straight version (11506AAK) for in-utero surgery
Summary: An extension of the CORDMILK trial, the CORDMILK follow-up trial will evaluate the neurodevelopmental outcomes at 22-26 months age of term/late preterm infants who were non-vigorous at birth and received umbilical cord milking (UCM) or early cord clamping (ECC).
Published Date: July 12, 2023
Published By: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Obican SG, Odibo AO. Invasive fetal therapy. In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 34.
Unal ER, Newman RB. Multiple gestations. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 39.