TTTS

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TTTS
Twin To Twin Transfusion Syndrome
What is TTS?
By Aimee Mathers
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• A Brief Outline
• Facts about twins
• What is TTTS?
• What causes TTTS?
• How does TTTS occur? And how often?
• Symptoms
• The Recipient Twin
• The Donor Twin
• How is TTTS detected?
• Treatments

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What to know about twins...

• There are two main categories of twins. Fraternal
  and Identical.
• What are Fraternal twins? Fraternal twins occur
  when the mother releases 2 eggs during one
  ovulation cycle and these are then fertilised.
• the result of separate eggs becoming fertilized
  resulting in two completely different fetuses in
  the womb at the same time. They are known as
  non-identical or dizygotic twins.
• What are Identical twins? Identical twins occurs
  when a single conception splits into two around
  the same time the fertilized egg is becoming
  implanted in the womb ( Usually between the
  fourth and the twelfth day of conception).

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Continued...

• Twins that get to 37 weeks in the womb are
  considered full term, however the average weight
  at term for twins is slightly lower than the
  normal weight of a single baby.
• Twins are usually both delivered by a C-Section,
  although in some instances if the first baby to
  be delivered is not in a breech position the
  first baby may be delivered vaginally, and the
  second baby delivered by a C-Section.

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Some Interesting facts...

• Genetic factors do not appear to have much
  affect upon the incidence of identical twins.
• Identical twins exhibit almost identical brain
  wave patterns.
• The term twins was derived from the ancient
  German word twin or twine meaning two together.
• If the mother herself is a fraternal twin, the
  chances of having twins increases about
  five-fold.
• Twins have been known to develop their own
  language that only they can understand. This
  process is known as Cryptophasia.

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What is TTTS?
TTTS stands for Twin To Twin Transfusion
syndrome. It is a condition that may occur in
identical twins or higher multiple pregnancies.
The disease results when blood passes
disproportionately between one baby and another
through connecting blood vessels in their shared
placenta. The babies are normal. The
abnormalities are in the placenta.
Right Classic "stuck twin" with oligohydramnios
in the donor twin sac and polyhydramnios in the
recipient twin sac
Left TTTS with diamniotic/monochorionic twins
which are discordant for size but have preserved
amniotic fluid.
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Infants With TTTS
This is Alex. This picture was taken at 17 weeks.
He was swallowing. He looks like a normal fetus
at 17 weeks along.
This is Brennan. This picture was taken at 18
weeks. At this point Brennan was very small and
was measuring in about 2 weeks behind Alex in
development. You can see how thin his chest and
abdomen are because he was not being nourished as
well as his brother. That is one of the signs of
Twin-to-Twin Transfusion Syndrome. The dark area
around him is his amniotic fluid. As you can see
here, he didn't have much, even though we had
undergone two amino reduction treatments by this
point.
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What Causes TTTS?
No one really knows why embryos split into
identical twins or why TTTS occurs. However, we
do know that if the embryo splits after four days
a particular type of identical twin pregnancy
occurs known as monochorionic. Most TTTS
pregnancies are monochorionic diamnionic which
means that the two fetuses share a placenta and
individual amniotic sacs.
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How Often does TTTS Occur?
TTTS strikes about 10 of all identical twin
pregnancies. In the U.S. alone, it affects over
7,500 babies, or 3,500 pregnancies each year. The
Death rate for twins who develop TTTS
at mid-pregnancy may be as high as 80-
100 .
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Symptoms

• Identical twins or higher multiple pregnancy
  including a set of identicals
• Excessive amount of amniotic fluid
• Sudden and excessive weight gain in mother
• Swelling of mothers body
• Premature contractions
• Bleeding

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The Recepient Twin
The recipient Twin is receiving too much blood
because some of the blood vessels of the other
baby in the placenta split. These vessels cross
their shared placenta over to the recipient twin.
Because the recipient twin is getting their own
blood plus the extra blood, they become larger in
size. This is one of the first signs of TTTS.
This blood is very thick like syrup and because
it is much thicker than normal blood the heart
has to work extra hard to pump the blood along.
Because of the extra blood, the baby is urinating
a lot. Amniotic fluid is generated by the baby
urinating. This causes the recipient twin to have
too much amniotic fluid and will need to have
some removed as often as needed.
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The Donor Twin
The Donor twin is much smaller in size and is
often called the stuck twin. This baby is
getting too little blood because half of the
blood that it is suppose to be getting is going
to the other twin. This baby isnt getting very
much blood, and is therefore not urinating much.
Because of this, there is very little fluid in
their amniotic sac. When born, it is often the
donor twin who does better, because their hearts
are not as tired. Their heart had it easy. Their
heart hadnt been over exerting itself to pump
any extra blood. It didnt have to pump much
blood at all.
A Donor twin born prematurely.
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How is TTTS detected?
TTTS is detected through an ultrasound
(sonogram). It is critical to have routine
ultrasounds during your pregnancy with multiples.
It is also essential to look for differences in
weights of the babies and to watch closely to
make sure there are no drastic changes in the
weights of the babies.
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Treatments
There is a new laser technology surgery that
dramatically alters the odds for babies with
TTTS. This is performed by inserting a fetoscope
and laser fiber (about half the size of a yellow
pencil), into the mothers womb identifiying the
offending connections and shooting them with the
laser to destroy them.In 90 of the cases where
the operation is performed, at least one twin
survives and in 68 both twins live. Less than 2
of the babies who survive have any disabilities
or birth defects, compared to up to 30 with
other less affective treatments. This is one of
few treatments out there right now for TTTS. It
is a very successful treatment.
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Summary
In my Presentation Of TTTS (Twin to Twin
Transfusion Syndrome) I have explained a little
about the kinds of twins you can have in a
pregnancy, and how TTTS only occurs in Identical
twins. I explained what TTTS was, and how it
occurs. I also explained what happens, in detail,
to each twin during pregnancy. I explained
briefly about how it is detected and the newest
treatment that has come out recently for Twin to
Twin Transfusion Syndrome. I feel very confident
with my work in this presentation and I have
learned a lot about Twin to Twin Transfusion
Syndrome and twins in general.
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Bibliography

• The Twin to Twin Transfusion Syndrome
  Foundation Last Update September 25, 2002
  lthttp//www.tttsfoundation.org/gt (Accessed
  January 2 2003)
• Facts about TTTS lthttp//www.twinhope.com/facts.
  htmlgt (Accessed January 4 2003)
• Twin to Twin Transfusion Syndrome
  lthttp//ttts.8k.com/what.htmgt (Accessed January 7
  2003)
• Twin to Twin Transfusion Syndrome
  lthttp//www.fetalmd.com/ttts.htmgt (Accessed
  January 4 2003)
• An examination of TTTS lthttp//www.bellaonline.c
  om/articles/art2997.abducted scapular planegt
  (Accessed January 13 2003)
• Twin Transfusion Syndrome lthttp//www.stjh.net/c
  auses.aspgt (Accessed December 20 2003)