Twin-twin transfusion syndrome (TTTS) is a rare, serious condition that can occur in pregnancies when identical twins share a placenta. Abnormal blood vessel connections form in the placenta that allow blood to flow unevenly between the babies. One twin is called the donor and becomes dehydrated and does not produce as much urine as it should, resulting in a low amount of amniotic fluid and poor fetal growth. The other is called the recipient and develops high blood pressure and produces too much urine and over fills the amniotic sac. The excess fluid can put a strain on the recipient twin’s heart, sometimes leading to heart failure.
- Occurs in 10% to 15% of monochorionic( share the same placenta) twins
-1 to 3 per 10,000 births
-17% of all perinatal mortality in twins
- Mortality of 80%-100% if left untreated
That was what we were up against when we went to see the maternal fetal concerns specialist. I had more ultrasounds performed and a fetal echocardiogram as well to check the blood flow in the hearts of the boys. We were brought into a room to go over all our options.
There were multiple options given but the two that the doctor more so suggested where laser surgery to basically cauterize the vessels in the placenta to try to regain equal blood flow or selective cord occlusion, meaning terminating life of the donor twin. Surgery of course was our choice but at that point I was only 17 weeks and if they were to do a microscopic procedure they could risk rupturing the amniotic sac and losing both babies. The doctor informed us we would be monitored very closely to get me farther along and at a safer spot in the pregnancy to do the surgery.
Now you’re probably wondering what was going on in my head after all this information being thrown at me in basically less than 2 days. I was completely terrified and upset, asking why is this happening to us? I was scared of possibly undergoing surgery and the risks that where associated with it. We had no clue what the outcome was going to be and I hate the unknown. I’m the type of person that needs to know what is going to happen and have a plan to get me through.
TTTS has stages 1-5 to determine the severity of the disease. At our initial appointment with the fetal concerns doctor we were at a stage 3. Here is a brief description of the stages for you.
- Stage 1 is an imbalance in amniotic fluid.
- Stage 2 is the bladder is not visible in the donor twin on ultrasound.
- Stage 3 is an imbalance in the blood flow in the umbilical cord or heart.
- Stage 4 is an imbalance of blood flow causing heart failure.
- Stage 5 is death of either one or both of the babies.
I came in a few days later for another ultrasound to check where things were at, they even had everything set up in case surgery was going to happen. At our recheck things were miraculously better sitting between stage 1-2. Surgery wasn’t needed at this time and they would monitor me with ultrasounds and echocardiograms to make sure things were continuing to stay stable.
We were all thrilled and thought this was where everything was starting to look up and I had hoped that things would continue to get better and I started enjoying and being excited again about the anticipation of having two little boys to complete my family.
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