Twin to Twin Transfusion
You
just found out you are having twins and are overwhelmed with all the
questions, thoughts and fears that are running through your head.
Should I buy one crib? When will I ever sleep? Can I really
do this? Then, a routine ultrasound brings your world crashing in
around you. The doctors tell you that your twins have a condition
known as “Twin to Twin Transfusion” or TTTS for short.
TTTS
was discovered in 1875 by a German obstetrician, Freidrich
Schatz. In pregnancies, the fetus receives all of its nutrients
from the placenta through the umbilical cord. In the case of
twins, there are two main types of twin placentas that exist.
Dichorionic twins have separate placentas. There is no blood
shared between the two fetuses. In monochorionic twins, the
fetuses share the same placenta. A thin membrane separates the
babies within the placenta. These twins are always
identical. In uncomplicated twin mono pregnancies, they share the
passage of blood back and forth without any issues. In TTTS, this
sharing of blood and nutrients becomes a complication.
When your babies are labeled having Twin to Twin Transfusion, there is
an unequal exchange of blood, placental sharing of nutrients, fluid,
and oxygen between the twins. One twin becomes known as the
“donor” twin and the other is referred to as the “recipient”
twin. The donor twin sends blood and fluids to the placenta, but
doesn’t receive an adequate amount back. The recipient twin also
sends blood and fluids, but receives in return an excess amount of
blood and fluid back. This occurs because an artery of one twin
can connect to a corresponding artery of his/her twin or a vein can
connect from one twin to another. Blood normally flows in a
two-way direction, whereas in TTTS, it is a one-way street.
Twins with this condition try to adapt on their own within the
mother. The donor twin tries to save water and energy.
Since they are working to do so, they often have low urine output which
causes low amniotic fluid volume and poor fetal nutrition. This
can then lead to intrauterine growth restriction (IUGR). The
recipient on the other hand, tries to get rid of the extra fluid by
frequent urination which leads to excess amniotic fluid. They
also have to deal with excess blood cells and this can cause severe
stress on their heart and can increase their blood volume.
The risks to each twin are severe. The donor is at risk for
abnormalities from being compressed, failing placental function (brain
damage, circulatory collapse among several other risks), and
malnutrition long term effects. The donor is known as the
“fragile twin” and cannot cope with the added stress of a premature
birth. The recipient twin has risks mainly due to overload.
Their heart muscle may thicken which can cause heart failure and this
affects all of the baby’s systems. This can last into their
newborn life and be increased if there is a premature birth as well.
Many cases of TTTS are found at ultrasound screenings. However,
if left untreated, there is a high chance that neither twin will
survive. The recipient tries to deal with the extra fluid by
creating more and more fluid which stretches the uterus. This can
cause the cervix to rupture and miscarriage or premature labor can
occur. Many times this happens at an early stage in the
pregnancy, that the chances of the babies’ survival are slim. If you
lose your babies to this condition, there are many websites where
loving, caring communities can help you through this painful
time. One such website is: http://www.b2g2.com/boards/board.cgi?user=ttts8k and another is: http://health.groups.yahoo.com/group/precious_ttts_angels/.
These sites, along with counseling and love and support of family and
friends can help you along with the hardship of losing one or both of
your babies to TTTS.
However, there are many options for those
pregnancies that choose to treat the condition to increase the chance
of their twins’ survival rate. One option is to reduce the fluid
in the placenta. This can be done by an amniodrainage. A
needle is inserted into the recipient’s sac and 2-3 liters of fluid are
removed. This may need to be repeated several times since the fluid
does build up again. The condition is not “fixed”, but rather
causes the babies some extra room and time so a premature birth can
hopefully be avoided. Another option is laser ablation. A
tiny camera is inserted into the uterus. Connecting arteries or
veins are found, and sealed shut. This causes the connection of
blood flow to reduce between the two babies. This only has to be
done once. Dr. De Lia pioneered this surgery over 20 years
ago. He also recommends the mother intakes protein shakes to help
make your bloodwork go back to normal.
The condition of TTTS can worsen at anytime. There is a constant
need to be observed more closely by a specialist. Some mothers
are put on house or hospital bedrest. Depending on your doctors,
you might have to receive steroid injections. These shots help
increase your babies’ lungs to fight the stress of being born
premature. Increased sonograms and Doppler (heart rate, blood
flow) readings will be ordered to follow the twins’ progress and decide
when the babies are better off inside the mother, or on the outside,
with help of a highly qualified medical staff.
Overall, a twin pregnancy that has now been labeled as having Twin to
Twin Transfusion will be a stressful and heartbreaking journey.
But, with the help of doctors that are educated in this field and the
parent’s knowledge on the matter through reading and learning more on
this condition, hopefully this journey ends with two loving, caring
babies by your side. -YoMomma |
