Twin-to-twin transfusion syndrome, causes unbalanced fetal development

The development of several fetuses in the womb can become unbalanced due to the twin-to-twin transfusion syndrome (TTTS). TTTS is a disorder in which the baby gives blood to its twin sister in the womb. This disorder can occur only in twin monozygotic (identical twin) pregnancies with the placenta (monochorionic).

Identical twin pregnancies occur in 3 to 5 pregnancies out of 1,000. In this pregnancy, the amount of the placenta can only be one or two. TTTS can only occur in identical twin pregnancies with one placenta, which represents 75% of identical twin pregnancies. TTTS is a rare condition, only 5 to 38% of twin pregnancies are identical to the placenta.

Of course TTTS disease
In identical twins with TTTS, there is a direct relationship between the blood flow of the donor and the recipient baby through the placental blood vessels. Baby's blood circulation is the cause of the imbalance of blood flow from the mother to the two babies. A baby continues to give blood to his twin brother (blood transfusion). Blood flow in the donor baby's blood decreases, while the blood flow to the recipient's blood flow becomes excessive.

In TTTS pregnancy, the donor baby giving blood to her twin sister becomes smaller than the recipient baby who receives blood, so the development of the two is not balanced. At birth, donor babies usually have a lower weight, pale appearance and anemia (lack of blood). Even though the recipient baby looks bigger than his age, the body appears reddish and jaundice (jaundice) can occur.

Impact of TTTS on infants

Due to lack of blood volume, the donor baby's kidney filters only a little blood and finally a little urine, if any. This is seen in small amounts of amniotic fluid in the donor pregnancy pouch. Due to lack of blood volume, newborns receive little oxygen and nutrients, which interfere with growth. Heart function can also be affected by this disease, which can increase the risk of donor infant mortality.

While in the recipient baby, due to excessive blood volume due to twin transfusions, more urine will be removed and large volumes of amniotic fluid can be found in the gestational sac of the recipient baby. The work of the recipient's heart becomes heavier, which can lead to heart failure and the possibility of death.

TTTS detection

TTTS can usually be detected during ultrasound between 16 and 21 weeks. If there is no treatment, the baby's chances of survival will decrease due to other complications, such as heart failure. If the birth is successful, the birth is usually premature and the baby is at risk of complications due to TTTS and preterm.

Severe TTTS can cause infant death in 60 to 100% of cases, while cases that are not too severe can cause prematurity. This risk depends on the gestational age at the birth of the baby. The younger the gestational age at birth, the greater the impact.

Unstable blood flow during the uterus will interfere with brain development in donor and recipient babies. If the donor baby eventually dies in the womb, blood flow to the recipient baby becomes unbalanced. This can cause death or brain damage to the recipient baby.

For pregnant women with twins, it is important to know the types of twin pregnancies, if they are identical (monozygous) and the extent to which the placenta bleeds in infants. Symptoms of TSE that may be felt by the mother are rapid enlargement of the stomach, uterine size larger than gestational age, abdominal pain, swelling of the hands and feet during young pregnancy. . Pregnant women with TTTS risk must be carefully evaluated by a doctor, so that immediate action can be taken if necessary.

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