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Written by The Twin Source


Sometimes during pregnancy, complications arise without warning. Other times, your body will provide clues that you should call the doctor. Both scenarios could happen with twin to twin transfusion syndrome (TTTS): Your doctor might pre-emptively prepare you for this possible diagnosis, or you yourself might sense that something is not "right."

There is great hope for babies diagnosed with TTTS, according to The Twin to Twin Transfusion Syndrome Foundation, but you must be a strong advocate for your medical care.

In order to do this, you must know the facts about TTTS. This article focuses on the facts, and provides links to resources and expert opinions. If you have questions or concerns, always consult your doctor. If you are dissatisfied with the answers you receive, always get a second opinion from a high-risk pregnancy doctor such as a maternal-fetal medicine (MFM) specialist or perinatologist. In fact, when you are pregnant with multiples, you should always have regularly scheduled appointments with your high-risk pregnancy doctor, who should work in partnership with your OB/GYN.

The Facts About TTTS

  • TTTS affects identical twins while they are in the womb sharing one placenta. It has been reported to occur with fused placentas, but this is extremely rare.
  • TTTS occurs when one twin, the recipient, begins to receive more than normal amounts of blood flow from the placenta and the other twin, the donor, begins receiving too little. As a result, the recipient will create excessive amniotic fluid and the donor will have little to none. This is the first sign of TTTS seen on ultrasound.
  • TTTS affects up to 20% of identical twin pregnancies, but the percentage is believed to be higher as it is not tracked well and numbers do not include losses prior to 20 weeks.
  • TTTS cannot be prevented, is completely random, and has not been found to be genetic or hereditary.
  • TTTS is very serious and can threaten the lives of both twins.
  • There are two main treatment options available. The first is amnioreduction, which can be used to help drain excess fluid from the recipient twin. The second is intra-uterine laser surgery, which is used to cauterize the shared blood vessels between the babies and stop the imbalance of blood flow. Early delivery should also be considered, as placentas can fail toward the end of pregnancy and some babies have less than half the placenta nourishing them.
  • In addition to the treatments above, it's important to pay attention to the health of the mother-to-be. Treating maternal malnutrition is crucial, and bed rest is common. A mother-to-be can start both of these treatments immediately.


Things to Consider

  • When you find out you are pregnant with twins, ask immediately if there is one placenta or two. If there is one, you are at risk for TTTS until the second cord of the second baby is clamped at birth. If you have two fused placentas, you still need to watch for symptoms of TTTS, but the odds of getting TTTS are extremely unlikely. You should know if you have one placenta or two by 8 weeks into your pregnancy, but definitely by 12 weeks.
  • Your doctor should always answer your questions clearly and appropriately. The Twin to Twin Syndrome Foundation suggests 15 questions you should ask your doctor if you are having twins or triplets.
  • Make sure you and your babies are monitored very closely. Regular weekly appointments and sonograms should be occurring with any and every twin pregnancy. It is crucial, as with all twin pregnancies, to be in the care of a high-risk pregnancy doctor, who should work in partnership with your OB/GYN, and to get weekly ultrasounds starting by 16 weeks through delivery even if you have no signs of TTTS.


Resources and Support

The Twin to Twin Transfusion Syndrome Foundation:

From the National Institutes of Health (NIH):

From the American Pregnancy Association:

From The Fetal Treatment Center:

Raising TTTS Awareness:


NOTE: The information contained on The Twin Source is not intended for medical diagnosis. Any medical information found on this site should be discussed with your health care professional. Always consult your doctor for any medical advice.

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