Treatment:

DESCRIPTION:

Feto-Fetal Transfusion Syndrome (FFTS) or Twin-to-Twin  Transfusion Syndrome (TTTS)

This syndrome is characterized by an imbalance of blood flow and net loss of blood from one fetus to the other, caused by connected blood vessels in the shared placenta. Interfetal transfusion is a common phenomenon in monochorionic multiple pregnancies, and usually balanced. However, in the case of a chronic imbalance of flow between the twins, TTTS develops. Arterio venous anastomoses are responsible for the imbalance of blood flow. The syndrome occurs exclusively in monochorionic, diamniotic twin pregnancies.

TTTS is a disease of the placenta and the babies are usually normal if treated in an early clinical stage.

SYMPTOMS:

Imbalance of blood flow causes different symptoms in the donor and the recipient fetus.

Donor Fetus

• hypovolemia
• hypotension
• severe anemia
• drop of urine production
• oligohydramnios
• slow gro wth

Recipient Fetus

• hypervolemia
• hypertension
• myocardial hypertrophy
• cardial insufficiency
• increased urine production
• polyhydramnios
• fast growth

INCIDENCE AND CAUSES:

Twin-to-Twin Transfusion Syndrome (TTTS) occurs in 10-15 % of monochorionic diamniotic twin pregnancies. To date, the causes of TTTS are not known. This syndrome is not hereditary or genetic nor is it caused by the environment or by any action of the pregnant mother.

PROCEDURE:

TTTS occurs usually between the 15th and 26th week of gestation. The laser photocoagulation of communicating vessels is done as soon as TTTS is recognized. No emergency surgery is necessary, but the procedure needs to be done as soon as possible.

The procedure is conducted under local anesthesia and color doppler sonography. A trocar is first inserted in the abdominal wall and the amniotic sac of the recipient twin and then replaced by a fetoscope. When the site of placental anastomoses is determined, vessels are coagulated in non-contact mode with a high-power diode laser. As a result, each twin maintains a separate portion of the placenta, and the twins are now completely separated.

Placental anastomoses before laser coagulation

Placenta after laser coagulation of vascular anastomoses

ALTERNATIVE TREATMENT OPTIONS:

Serial amniodrainage helps to alleviate the symptoms. Reduced pressure in the womb after amniodrainage may improve blood supply towards the fetuses. However, the symptoms of TTTS may recur and demand more intervention. To cure the source of the syndrome, laser coagulation of vascular anastomoses is the only treatment option.