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Twin to Twin Transfusion Syndrome (TTTS)

The Twin to Twin Transfusion Syndrome (TTTS) affects monochorionic (originating from a single fertilized egg) twin pregnancies. In this case the identical twins share one placenta through with nutrients pass from the maternal to the two, typically fully separated fetal circulation systems supplying the twin fetuses.  In rare cases the circulation systems of the twins intersect on the placental surface such that the blood circulations of both twins are connected. We call these interconnections of the twins’ circulatory systems ananstomosis.  This may be problematic if the blood flow is directed from one twin to the other. The blood giving twin is called “donor” and the one who gets too much blood the “acceptor”. The donor is continuously loosing blood while the acceptor´s blood circulation is decompensating under the strain of too much blood. The permanent anaemia of the donor and the decompensating blood circulation of the acceptor lead to discordant growth and unequal liquor of the twins. The amniotic sac of the donor contains too little liquor called Oligohydramnios, while the opposite is true for the acceptor where too much liquor in the amniotic sac results in a Polyhydramnios.

 

How is the TTTS diagnosed?

 

Clinically TTTS leads to a faster increase of the abdominal circumference of the mother. The ultrasound examination reveals a discordant amount of liquor between the twins. Other signs are the discordant filling of the fetal bladder and the signs of the decompensation of the blood circulation of the acceptor (Hydrops fetalis).

All these symptoms will become evident during routine ultrasound scanning. Although they may have different reasons than a TTTS.

 

How does the TTTS progress?

 

The development of a TTTS is dependant on the amount of blood, which is exchanged. Early stages can regress spontaneously. Higher stages of TTTS can end untreated in 90% in fetal demise in utero or during birth. Surviving children may, in part, suffer from neurological damage due to prematurity or as consequence of the demise of the twin during pregnancy. 

 

How can the TTTS be treated?

 

Historically there were different methods like Amniodrainage, Amnioreduction or Septostomy. The only treatment that can mitigate the reasons for TTTS is the fetoscopic laserablation of the anastomoses. This is a minimal invasive method using a fetoscope to enter the amniotic sac through the maternal skin. This fetoscope contains an optic and a fibre optic cable connected to a laser. Through the optic the surgeon can locate the anastomosis on the placental surface and ablate them with the laser. Following the treatment the blood circulations of the twins will be fully separated. Since the advantage of the laser ablation was demonstrated compared to older methods it became the standard therapy for TTTS.

 

How are the success rates of the laser ablation?

 

The results of the surgery strongly depend on the expertise of the surgeon and the equipment used. Surgery in our clinic has a proven record of both twins surviving in 83% and one twin in nearly all of the cases. These results make us one of the internationally leading centres in this field.  With the success of a laser ablation therapy best in clinics with the necessary expertise, we offer excellent medical conditions for the diagnosis and a successful therapy of TTTS.

 

Which complications can occur?

 

All methods mentioned above require the piercing of the amniotic membrane, which are very fragile. Thus, every damage to the amniotic membranes can end in preterm premature rupture of membranes and may induce very premature birth. The risk decreases with the restriction of puncture of the amniotic membrane and the diameter of the instrument used. For this reason Prof.  Dr. Tchirikov developed a new ultrathin fetoscope with a 1mm optic the use of which reduces the damage to the membranes to a minimum. 

Other complications are possible damage to the child during surgery or the incomplete closure of the anastomoses. The latter can lead to the redevelopment of a TTTS. Here the high experience of our surgeons is a crucial factor to reduce the risks of these complications making our clinic a prime address for undergoing such a treatment 

Contact us

Director:                                                                                                                 Prof.Dr.med.habil. Michael Tchirikov

Adress:
Universitätsklinikum Halle (Saale)
Universitätsklinik und Poliklinik für Geburtshilfe
Ernst-Grube-Straße 40
06120 Halle (Saale)

Central Secretariat:
Claudia Heinrich
Telefon: (0345) 557-3250
Telefax: (0345) 557-2448

Delivery Ward:
Telefon: (0345) 557-2454 
Telefax: (0345) 557-2450

Clinical office
Vera Preuß
Telefon: (0345) 557-2324
Telefax: (0345) 557-2448

Outpatient Clinic
Telefon: (0345) 557-2126

Maternity ward (antepartum care) 
Telefon: (0345) 557-2519
             (0345) 557-2521

Maternity ward (postpartum care)
Telefon: (0345) 557-2512
             (0345) 557-2515  

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