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Twin-to-Twin Transfusion Syndrome

Twin-to-twin transfusion syndrome (TTTS) occurs when identical twins who share a placenta and blood vessels have unequal blood flow. As a result, one unborn baby (the donor) does not get enough blood while the other unborn baby (the recipient) gets too much blood.

Twin-to-Twin Transfusion Syndrome Treatment: Why Choose Us?

High-risk pregnancy doctors at the Fetal Care Center are among a select few in the country with the expertise to perform fetal laser surgery to treat TTTS. This surgery takes place while your unborn babies are still in the womb.

Twins, Caden and Cooper
Twins, Caden and Cooper, underwent in utero laser surgery to treat twin-to-twin transfusion syndrome

About Twin-to-Twin Transfusion Syndrome

TTTS is a rare condition, affecting approximately 1 out of every 1,000 pregnancies. TTTS can cause significant health problems for the twins during pregnancy and after childbirth. Severe cases may result in the loss of one or both babies.

Potential problems include:

  • The donor twin, who loses blood, may be small, anemic and dehydrated. This baby may need a blood transfusion after birth.
  • The recipient twin, who gets too much blood, may be large and have high blood pressure. This twin may also develop heart failure.

Causes of Twin-to-Twin Transfusion Syndrome

Problems with the placenta cause TTTS. It is not a disorder or defect found within the babies. The syndrome occurs randomly.

Diagnosing Twin-to-Twin Transfusion Syndrome

Our maternal-fetal medicine specialists and ultrasound experts use the latest ultrasound technology to detect twin-to-twin transfusion syndrome. We specialize in obstetrical and gynecological ultrasounds, performing more than 5,000 tests every year.

Learn more about high-risk pregnancy tests.

Treating Twin-to-Twin Transfusion Syndrome

Throughout pregnancy, you undergo regular ultrasounds with a maternal-fetal medicine specialist to check the development of your unborn babies.

The Fetal Care Center is among a select few centers nationwide with the expertise to perform a fetal surgery known as selective fetoscopic laser photocoagulation. This procedure treats TTTS while the unborn babies remain in the womb. The number and type of connecting blood vessels, as well as how the unborn babies share the placenta, greatly affect this surgery’s success.

During fetoscopic laser photocoagulation your doctor:

  1. Gives you an intravenous (IV) sedative, local anesthetic and possibly an epidural
  2. Inserts a small metal tube, called a trocar, through a small incision in your abdomen
  3. Inserts a camera-like device called a fetoscope into the tube to see the shared blood vessel connections on the placenta
  4. Uses a laser to close off and disconnect problem blood vessel connections
  5. Drains excess amniotic fluid through the trocar

Fetal surgery increases the risk of pregnancy complications, including preterm labor and delivery. After the procedure, you stay at the Women & Infants Center for monitoring until your doctor clears you to go home. Your doctor monitors your unborn babies’ progress through regular ultrasounds.

Babies who are born early may need to receive advanced medical care in a newborn intensive care unit (NICU). Our Level IV NICU is connected to labor and delivery. Learn more about our NICU.

Contact Us

To make an appointment with a Washington University fetal care specialist at the Women & Infants Center, call 855-925-0631.