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Treatment Options For Twin-To-Twin Syndrome

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TTTS Video

This short video depicts Twin to Twin Transfusion Syndrome (TTTS) and the use of laser surgery to correct the condition.

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Every year in the United States, 3,500 pregnancies are affected by twin-to-twin transfusion syndrome (TTTS). It's a complication that occurs in 10 to 15 percent of identical twins.

Although the disorder can pose serious risks to both babies, specialists at the University of Maryland Center for Advanced Fetal Care offer several treatment options.

This condition only affects identical twins who share one placenta, meaning non-identical (also called fraternal) twins and single babies are not affected by TTTS. In all identical twins who share one placenta, blood goes back and forth between the babies through many placental blood vessels.

In most cases, this exchange is equal. In TTTS, an imbalance exists.

In TTTS, one twin (called the donor) pumps more blood to the other (called the recipient). The donor becomes smaller, anemic and dehydrated, while the recipient becomes larger and must adapt to excessive blood volumes, which causes changes in heart and kidney function.

While the babies start out completely normal, over time, because of the TTTS, they face serious dangers.

If left untreated, TTTS is often fatal to one or both babies, either in utero or immediately after delivery.

Of the babies who do survive, as many as a third have a permanent brain injury or other side effects. The donor twin faces complications due to low blood flow, shortage of oxygen, and small size, while the recipient may have heart failure and heart muscle changes due to the high volume of blood. Both face dangers due to prematurity, often as a result of excessive production of amniotic fluid.

At the Center for Advanced Fetal Care at the University of Maryland Medical Center, Drs. Chris Harman and Ahmet Baschat and their team offer several treatment options to correct TTTS, adjusted individually to the severity of the case.

Powerful medication (that crosses the placenta after the mother takes it) can be used to modify the babies' circulation, the mother's amniotic fluid production, and pre-term labor.

Temporary relief can be obtained by amniocentesis, the draining of fluid with a needle guided by ultrasound into the amniotic cavity. This process, amnioreduction, is sometimes a cure, but often needs to be repeated under very close and careful monitoring.

Earlier, more severe TTTS may require an even more invasive treatment, called selective laser ablation of placental vessels. While using ultrasound, a tiny camera is inserted through a fetoscope (a thin, flexible instrument) into the uterus.

The abnormal vessels can then be identified, and closed off with short bursts of a laser beam. This procedure permanently interrupts the connections between the twins, stopping the TTTS process.

The University of Maryland is among a small group of fetal medicine centers to use fetoscope and selective laser ablation to treat TTTS.

This page was last updated on: May 22, 2007.

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