As the name suggests, twin to twin transfusion syndrome (TTTS) occurs in pregnancies involving twins or multiple children. Rather than each child having their own placenta, they share a single placenta, often resulting in an imbalance of blood and nutrients passed between them. This can cause a number of health problems for both twins, and the condition carries serious consequences if not diagnosed early enough.
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Pregnancies in which multiple fetuses share one placenta are called monochorionic. The Journal of Clinical Medicine reported in 2019 that monochorionic pregnancies occur in only 0.4% of the population. However, when they do occur, complications like TTTS are common.
A 2018 report shared by the National Center for Biotechnology Information (NCBI) estimated that TTTS can occur in 10 to 15% of monochorionic pregnancies. While it is a potential complication in any pregnancy involving multiple children, this condition can occur without any other risk factors.
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How TTTS Affects Each Child
Twin to twin transfusion syndrome affects each child differently, as the transfusion is typically unequal. The donor twin gives more blood to the other twin than it receives, while the recipient twin suffers problems due to receiving more blood than its system can handle.
By donating more blood than it receives, the donor twin can suffer a multitude of complications, such as the following:
- Reduction or loss in amniotic fluid
- Underdeveloped organ systems
- Cardiovascular dysfunction
Loss of blood affects the heart and kidneys. Problems with the kidneys affect the bladder, which affects the level of amniotic fluid in the womb. Loss of amniotic fluid then affects other body systems. This chain of cause and effect can have disastrous consequences for the donor fetus.
The twin on the receiving end of TTTS faces the opposite problem of the donor twin. Problems can include:
- An overworked cardiac system.
- Excess blood volume.
- Excess amniotic fluid.
While the donor twin suffers from scarcity, the recipient twin suffers from excess. Too much blood puts pressure on the heart and circulatory system while also producing more urine, and therefore more amniotic fluid. Heart failure and other cardiac problems are associated with the recipient twin, as its system simply cannot handle what it is receiving.
Potential Consequences of TTTS
Johns Hopkins Medicine highlights several possible consequences for twin to twin transfusion syndrome. For the twins, the most common cause of death is cardiac failure. Excess amniotic fluid also puts the mother at risk for preterm labor. Additional complications may arise after birth for the children, with cardiac and neurological issues among the most common.
TTTS Diagnosis and Treatments
Lack of diagnosis and intervention when it comes to TTTS can result in infant fatalities. Early detection is therefore crucial to ensure the safety of the mother and the children.
Failure to diagnose and treat this syndrome can constitute medical malpractice in some cases. If you faced this scenario, a birth injury lawyer can evaluate whether you can hold a doctor responsible for failing to detect the syndrome in time.
Quintero Staging System
The earliest method of detection is an ultrasound, followed by tests to measure amniotic fluid level and blood flow. A fetal echocardiogram for each twin can also detect cardiac problems that may signal the presence of twin to twin transfusion syndrome.
Once they have diagnosed TTTS, doctors can test the level of the condition through the Quintero staging system, which measures the severity of cardiovascular problems experienced by the twins.
In Utero Laser Surgery
The most common and effective treatment for twin to twin transfusion syndrome is laser surgery, called fetoscopic laser coagulation. This procedure cuts off the blood flow between the twins, reducing some of the problems caused by the transfusion.
Laser surgery does not completely eliminate all the risks and complications associated with TTTS. Moreover, if a doctor does not diagnose and intervene early enough, those risks could still present problems for the pregnancy and the children’s development after birth.
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The Birth Injury Lawyers Group Can Answer Your Questions
While rare, understanding what twin to twin transfusion syndrome is can help mothers carrying multiple children be aware of the risk, leading to earlier diagnosis and intervention. That early intervention is key to successful treatment. If you believe your doctor failed in their duty to perform the necessary tests to find TTTS in your pregnancy, you may have grounds for a medical malpractice claim, entitling you to compensation.
Infant mortality is a tragic consequence of undiagnosed TTTS cases, and even children who survive can suffer long-term cardiac and neurological problems from the condition. These scenarios could leave families facing high medical bills, continued treatment for affected children, and emotional trauma.
The Birth Injury Lawyers Group serves families who have suffered from doctors’ failure to diagnose and treat birth defects. If you have any questions about twin to twin transfusion syndrome or suspect your risks could have been mitigated with proper intervention, we can help. Call for a free consultation today: (800) 222-9529.