World TTTS (Twin to Twin Transfusion Syndrome) Awareness Day December 7 is
World TTTS Awareness Day. As a
pediatrician, member of the TTTS Foundation's Medical Advisory Board, and mother of monochorionic twins (twins with a single placenta), I
share the TTTS Foundation's passion for combating TTTS through public awareness.
Whether you are pregnant with twins or know someone pregnant with twins, please
read this article for important information about TTTS.
What is Twin to Twin Transfusion Syndrome (TTTS)?
TTTS occurs in roughly 15% of twins who share a placenta (called
monochorionic twins). It's important for every family pregnant with twins to
find out early in their pregnancy if their babies share a placenta. If your
twins do not share a placenta, they are not at risk of TTTS.
In twins who share a placenta, it is not unusual for there to be blood vessel
connections between them. Normally, these connections retain a reasonable
balance of blood flow to and from each baby. However, in TTTS, the blood flow
between the twins becomes unbalanced. The placenta sends too much blood to one
baby and too little to the other. One twin becomes overloaded with blood while
the other becomes anemic. Left undetected and untreated, TTTS can be
life-threatening for one or both twins.
Why is TTTS awareness is so important?
TTTS is a life-threatening condition, but it does not have to be life-taking.
Medical advancements have resulted in excellent outcomes for twins who are
diagnosed and treated early. The earlier TTTS is detected, the better the
outcome-- hence why awareness of TTTS is so vital.
The most important thing parents can do is educate themselves on the signs
and symptoms of TTTS. Research has shown excellent outcomes for twins with TTTS
when parents and doctors are educated about TTTS and are actively monitoring for
signs of TTTS.
What are the physical signs of TTTS?
•Sudden increase in weight gain.
•Sudden sensation of the abdomen being tight or uncomfortably stretched.
•Decreased movement of one or both babies.
•Hand or feet swelling early in pregnancy.
•Contractions before your due date.
Though the signs above may be associated with other conditions, it's
important that pregnant mothers with these symptoms seek medical attention to rule out
TTTS.
How is TTTS diagnosed?
If your twins share a placenta, it is vital from the beginning that a
doctor who has expertise in managing twins with TTTS is involved in your care.
Even though your twins may never develop the condition, it's important to have a
doctor involved who knows how to detect and treat TTTS should your twins develop
it. Typically, perinatologists (OB/Gyns who specialize in high-risk pregnancies)
are well-trained in the management of TTTS. If your doctor is not a
perinatologist, you can continue to see your doctor while also seeing a
perinatologist for consultation.
TTTS is diagnosed by ultrasound. Twins who share a placenta require frequent
ultrasounds to monitor for TTTS. Ultrasound findings that may suggest TTTS in
twins who share a placenta include:
•Amniotic fluid measurement is less than 3 or greater than 8 centimeters.
•Weight difference of more than 20-25% between the babies or slowed
growth in one or both babies.
•Marked difference in bladder size or the inability to see the bladder of
one baby.
•Signs of body swelling or heart thickening in a baby.
More information on TTTS
Every parent with twins who share a placenta (whether or not they have been
diagnosed with TTTS), should contact the
Twin to Twin Transfusion Syndrome
Foundation right away. The TTTS Foundation has great information on their
website. In addition, they will send written information about TTTS to families
and their doctors. Because early detection is important in the treatment of
TTTS, families should contact the TTTS Foundation as soon as they discover their
twins share a placenta. Though the majority of twins will never face TTTS,
knowing about TTTS will allow parents to actively monitor and detect it early
should it occur.
Fortunately, advances in medical technology have resulted in increasingly
better outcomes for babies affected by TTTS. Treatments for TTTS include
amnioreduction and selective laser photocoagulation. You can find out more about
each of these and other treatments at the
TTTS Foundation website. If your
twins are diagnosed with TTTS, it's important to discuss each treatment option
with your doctor. The TTTS Foundation can help facilitate discussion with your
doctor by providing you with some important talking points. In addition, if your
doctor is not an expert in managing TTTS, the TTTS Foundation can help you and
your doctor find a TTTS expert who can provide consultation to you and your
doctor.
About the TTTS Foundation
The TTTS Foundation was founded by Mary Slaman-Forsythe in 1989 with the
mission to combat TTTS through early detection and treatment. Mary and her
foundation have helped countless families affected by TTTS. December is TTTS
Awareness Month, the same month Mary's twins, Matthew and Stephen were born. I
had the good fortune of connecting with Mary during my pregnancy and through the
writing of
Twins 101. Mary is an energetic, knowledgeable, and
compassionate mother who is an international expert in TTTS. She is a wealth of
information and gives great pep talks too. Please don't hesitate to contact her
should you have any questions about TTTS.
