Twin-to-twin transfusion syndrome (TTTS) is a rare, serious condition that can occur while pregnant mothers are pregnant with twins of the same placenta.
It occurs because abnormal blood vessel connections form in the placenta and allow blood to flow unevenly between the fetus. In this article, aFamilyToday Health invites you to learn about this syndrome most thoroughly.
Twins' Transfusion Syndrome (TTTS) is a rare pregnancy condition that affects twins sharing the same egg, sharing the same network of blood vessels but abnormal connections leading to blood condition. Uneven distribution among fetuses. This results in a fetus - known as a donor - giving away more blood than the baby receives and risking malnutrition and organ failure. Meanwhile, the fetus receives too much blood, causing the baby's heart to work too hard, so it is easy to encounter complications such as cardiovascular dysfunction, even heart failure and death.
The twin blood transfusion syndrome leads to a hemodynamic imbalance between the donor and the receiving fetus, causing a volume difference between the amniotic fluid chamber, poly amniotic fluid and amniotic fluid, which is a very dangerous condition for both fetuses .
In the absence of treatment, obstetricians estimate that about 80-100% of the fetus dies before 26 weeks. If 1 in 2 fetuses dies, the other will suffer from severe neurological sequelae. According to the Central Obstetrics and Gynecology Hospital, the rate of twins blood transfusion syndrome is 0.1 - 1.9 / 1,000 born babies.
The cause of twin transfusion syndrome (TTTS) is often the result of abnormalities that occur in the blood vessels at the placenta, when a fetus's blood supply is transferred to the other. pregnancy. This develops during the second trimester of pregnancy, causing the pair of babies to experience serious health problems.
According to health experts, in addition to the above cause, there are some unknown causes that may be related to the mother elected to have this syndrome.
In many cases of pregnancy with twin blood transfusion syndrome, pregnant mothers do not have any symptoms. However, some pregnant women may feel some signs such as:
Abdominal pregnancy abnormally large for gestational age
Feeling increased pressure in the abdomen
Weight increased rapidly
Stomachache
Shortness of breath
Hypertension
Cramps and spasms of the uterus
In the early stages of pregnancy there is swelling of the limbs.
Therefore, during pregnancy, if pregnant women encounter any of the above problems or experience unusual signs, they should go to the hospital to be examined and diagnosed.
The doctor can see that the twins are having problems with TTTS through ultrasound imaging: one fetus is significantly smaller than the other, his amniotic chamber is also smaller and the bladder is usually empty.
Your doctor may suspect your pregnancy is having problems with this transfusion syndrome based on the results of routine pregnancy ultrasound . In that case, the doctor may appoint the pregnant mother to perform more detailed tests such as measuring the amount of amniotic fluid, the blood flow of the donor and the receiving fetus ...
Increasing the volume of amniotic fluid also makes the uterus of the pregnant mother increase in size at a rapid rate. This increases the risk of cervical shortening leading to premature labor or premature rupture of membranes. Therefore, it is necessary to evaluate cervical length and uterine activity for pregnant mothers with suspected TTTS.
An important factor in determining the prognosis of this syndrome is the cardiovascular dysfunction in twins. This is why the twin blood transfusion diagnosis will include a detailed cardiac examination (fetal echocardiography) in both the receiving fetus and the donor fetus.
Diagnosis of TTTS when having the following features: single twin twins, minimal amniotic fluid in the donor fetus and poly amniotic fluid in receiving fetus.
The Quintero fractionation system is used to staging twins transfusion syndrome. This syndrome is divided into 5 stages and stage V is the most severe stage.
Stage 1: There is a significant difference in the amount of amniotic fluid in the twins, the fetus gives very little amniotic fluid and the fetus receives a lot of amniotic fluid. Also observed for pregnant bladder.
Stage 2: The state of amniotic fluid as above. The donor's bladder is smaller in size than the receiving fetus, so it cannot be seen through ultrasound.
Stage 3: Stage 1 or 2, accompanied by abnormal blood flow through the umbilical cord and the vessels around the heart of the fetus.
Stage 4: Edema (fluid buildup) develops in multiple body cavities. This can happen in one or both fetuses.
Stage 5: One or even both fetuses die.
Early diagnosis and intervention are key to treating this syndrome. Depending on the stage of the syndrome and the gestational age of the fetus, doctors will recommend the right treatment. Here are some of the treatments that pregnant mothers can consider:
Follow-up treatment: If detecting twins blood transfusion syndrome occurring in phase 1, pregnant mothers will be assigned an ultrasound, echocardiogram during pregnancy to monitor the fetus. In less serious cases, pregnant mothers do not need other treatment measures.
Amniocentesis: The excess amniotic fluid in the amniotic sac of the receiving fetus is drawn out. Your doctor will use an ultrasound image to insert a long, thin needle into the uterus to absorb less amniotic fluid. This procedure is similar to amniocentesis. This is recommended for the first stage of twins transfusion syndrome and when the syndrome is diagnosed late in pregnancy.
Endoscopic laser laser coagulation: This is a minimally invasive form of surgery in which lasers are used to dilate blood vessels that contribute to abnormal blood flow to the baby. According to some studies, this is the most effective therapy for twins with advanced TTTS.
Birth: If the syndrome is detected late in pregnancy, doctors will prioritize monitoring and waiting for the mother to give birth.
The optimal time of treatment is before 26 weeks. Terminate pregnancy at 34 - 36 weeks, or earlier depending on evolution.
The encounter with the fetus, pregnant women and the fetus may have to face complications such as:
Preterm birth
Amniocentesis
Fetal heart failure in the receiving fetus leads to stillbirth
Anemia, lack of oxygen in the fetus leads to death due to placenta failure or chronic anemia, the remaining fetus faces a risk of damage to the nervous system up to about 25%.
If pregnant with the same egg, pregnant mothers need to go ultrasound with a week rate of 2 weeks / 1 time from 16-24 weeks of pregnancy to be able to detect early signs of TTST syndrome. If you notice early signs of this syndrome, your doctor may order you to have an ultrasound scan every week.
In case your baby is having a problem with twin transfusion syndrome, your doctor can recommend a course of treatment to help the two babies grow together.
According to obstetricians, even without this syndrome, about 10% of twins with the same egg often do not develop evenly, meaning that one fetus will develop more slowly than the other. Pregnant mothers will usually be advised to deliver early if the doctors notice that the smaller fetus stops growing.
Most pregnancies with eggs are born early, before 37 weeks of pregnancy. TTTS syndrome can happen at any time, so pregnant mothers need to have periodic antenatal check-ups at reputable obstetrics and gynecology hospitals to receive the best care.
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