Twin to Twin Transfusion Syndrome (TTTS) is a complication of pregnancy in identical twin fetuses. In TTTS, there is an imbalance of blood flow between fetuses who share one placenta.
TTTS cannot occur in non-identical twin pregnancies, namely twin pregnancies with each fetus having one placenta or placenta. TTTS is a rare pregnancy complication. This pregnancy complication is known to only occur in 15 percent of cases of identical twin pregnancies.
Causes of Twin to Twin Transfusion Syndrome (TTTS)
TTTS occurs due to abnormal blood flow in the placenta or placenta. The placenta is an organ that supplies oxygen and nutrients from pregnant women to the fetus, and removes metabolic waste from the fetal blood.
In a normal identical twin pregnancy, each fetus will share one placenta, with balanced blood circulation to and from each fetus. While in TTTS, one of the fetuses does not get sufficient blood supply (donor fetus). At the same time, the other fetus receives even more blood flow (recipient fetus).
It is not known what causes abnormal blood flow to the placenta, including whether heredity and environmental factors play a role in its occurrence twin-to-twin transfusion syndrome.
Symptoms and DiagnosisTwin to Twin Transfusion Syndrome (TTTS)
TTTS is a pregnancy complication that can develop seriously. Therefore, it is important for pregnant women who are carrying twins to recognize the symptoms and signs, including:
- Pregnant women gain weight quickly.
- The size of the stomach is larger than the usual gestational age.
- Abdominal pain, fullness, and contractions appear.
- Swelling of the legs in early pregnancy.
Obstetricians can determine TTTS through a pregnancy ultrasound examination. Through ultrasound, the doctor will see signs of TTTS in the fetus. Signs of TTTS differ between recipient fetuses and donor fetuses, as described below:
Signs in the recipient fetus
- The size of the fetus is larger than the donor fetus.
- Excessive amount of amniotic fluid.
- Signs of heart failure in the fetus due to excess blood.
Signs in the donor fetus
- The size of the fetus is smaller than the recipient fetus. This condition is also known as IUGR.
- Bladder size that is smaller than normal.
- No or very little urine in the bladder.
- Have little amniotic fluid.
When to go to the doctor
Check with your obstetrician if you are carrying twins and have symptoms of TTTS. Pregnancy check-ups should be carried out regularly once a month in the first and second trimesters, then every one to two weeks in the third trimester.
If pregnant women have been diagnosed with TTTS, prenatal care needs to be done more often. Examinations need to be carried out every week after 16 weeks of pregnancy to monitor the condition of the mother and fetus until delivery.
Handling of Twin to Twin Transfusion Syndrome (TTTS)
Handling TTTS aims to deliver all fetuses in a safe condition. The treatment method depends on the severity of TTTS, including:
- Amniocentesis or removal of amniotic fluid in a fetus with excess amniotic fluid, to maintain blood flow.
- Laser surgery through endoscopy, to repair blood vessels that cause an imbalance in the blood supply to the fetus.
If the patient has undergone the above procedure and the condition of the fetus is considered ready to be born, the doctor will carry out the delivery even though it is still premature. Premature labor can be performed normally using induction drugs or by cesarean section.
ComplicationsTwin to Twin Transfusion Syndrome (TTTS)
In a number of conditions, TTTS can cause the fetus to be born prematurely. Other complications that may occur in the fetus are:
- Fetal death in the womb
- Birth defects in recipient fetus
- Anemia in donor fetus
TTTS that develops more severely can cause hydrops fetalis, both in the recipient fetus and the donor fetus. Hydrops fetalis is a buildup of fluid in a number of fetal organs. Hydrops fetalis in the fetus can cause pregnant women to mirror syndrome, which causes symptoms such as preeclampsia in pregnant women.
Prevention of Twin to Twin Transfusion Syndrome (TTTS)
TTTS is a disease that attacks pregnant women with identical twins without a known cause. Therefore, it is not known how to prevent it. However, for pregnant women who have been diagnosed with TTTS, more routine prenatal check-ups can reduce complications for the fetus and pregnant women.
