Twin-To-Twin Transfusion SyndromeSymptoms, Doctors, Treatments, Advances & More
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, the 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.
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. He is also highly rated in 13 other conditions, according to our data. His clinical expertise encompasses Twin-To-Twin Transfusion Syndrome, Intrauterine Growth Restriction, Bilateral Renal Agenesis Dominant Type, Diaphragmatic Hernia, and Endoscopy. Dr. Baschat is board certified in American Board Of Obstetrics And Gynecology.
TriHealth Tri-State Maternal-Fetal Medicine Associates - Good Samaritan Campus
Mounira Habli is a Neonatologist practicing medicine in Cincinnati, Ohio. She has been practicing medicine for over 28 years. Dr. Habli is rated as an Elite provider by MediFind in the treatment of Twin-To-Twin Transfusion Syndrome. She is also highly rated in 9 other conditions, according to our data. Her clinical expertise encompasses Twin-To-Twin Transfusion Syndrome, Placental Insufficiency, Myelomeningocele, Intrauterine Growth Restriction, and Endoscopy. Dr. Habli is board certified in American Board Of Obstetrics And Gynecology - 2008 and American Board Of Obstetrics And Gynecology - 2012. Dr. Habli is currently accepting new patients.
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. She is also highly rated in 11 other conditions, according to our data. Her clinical expertise encompasses Twin-To-Twin Transfusion Syndrome, Myelomeningocele, Lung Agenesis, Bilateral Renal Agenesis Dominant Type, and Endoscopy. Dr. Miller is board certified in American Board Of Obstetrics And Gynecology.
If the twin-to-twin transfusion is mild, both babies often recover fully. Severe cases may result in the death of a twin.
Summary: Each year world-wide, 2.5 million fetuses die unexpectedly in the last half of pregnancy, 25,000 in the United States, making fetal demise ten-times more common than Sudden Infant Death Syndrome. This study will apply a novel type of non-invasive monitoring, called fetal magnetocardiography (fMCG) used thus far to successfully evaluate fetal arrhythmias, in order to discover potential hidden elect...
Summary: The purpose of this study is to evaluate whether the entry technique surgeons use to get inside the uterus to perform fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome has an effect on the rates of chorioamniotic membrane separation.
Published Date: August 18, 2025
Published By: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Khalil A, Mustafa HJ. Multiple gestations. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 9th ed. Philadelphia, PA: Elsevier; 2025:chap 39.
Malone FD, D'Alton ME. Multiple gestation: clinical characteristics and management. 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 37.
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.