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What is twin-to-twin transfusion syndrome?

Dr. Jeanne Morrison, PhD
Family Practitioner

Twin to twin transfusion syndrome (TTTS) is an abnormality of the placental vasculature during pregnancy which affects identical twins. Identical twins share a common monochorionic placenta. If the placenta contains abnormal blood vessels the umbilical cord blood flow and the circulations of the fetuses becomes connected. As a result one fetus, known as the donor, receives less blood flow and the nutrients it contains which the other fetus, known as the recipient, receives more blood flow and the nutrients it contains.

At birth, both infants may have problems depending on the severity of the transfusion syndrome. The donor twin may have too little blood and need a blood transfusion, while the recipient twin may have too much blood and may need to have the amount of blood in his or her body reduced. While the infants are identical twins, they may have significantly different birth weight as the donor is frequently small from gestational age due to the lack of nutrients during intrauterine life which the recipient is bigger as a result of the increased volume of blood in the circulatory system.

Twin-to-twin transfusion syndrome (or TTTS) is a condition that arises in 10 percent of monochorionic twin pregnancies (where twins share a single placenta) and occurs when the twins are transfusing their blood from one twin (donor) to the other (recipient). As a result one twin has very little to no fluid around it (oligohydramnios) and the other twin has too much fluid (polyhydramnios).

In some cases, TTTS can be observed with frequent checks. However, when it progresses to more advanced stages and either of the twins is showing signs of heart failure, TTTS can be fatal for both twins in more than 90 percent of cases. There are minimally invasive procedures that can be performed with little risk to the mom and markedly improved survival for the twins.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.