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Monochorionic Pregnancies and Twin to Twin Transfusion Syndrome (TTTS)

Below leading TTTS consultant, Dr Ruwan Wimalasundea answers all your frequently asked questions:


TTTS Guide

More than six per cent of mothers who responded to Tamba’s 2008 survey said their babies were affected by Twin to Twin Transfusion Syndrome (TTTS). While the condition is rare, Tamba wants to do more to help families whose twins were affected by it.  

TTTS affects twins who share not only a placenta but also some of the same circulation, resulting in the transfusion of blood from one twin (the donor) to the other (the recipient) in the womb. In most cases the donor twin may become smaller and anaemic due to not having enough blood supply. The recipient twin has a higher blood volume, which can strain the foetus’s heart and lead to heart failure.

The donor twin is also likely to have a decreased urinary output, leading to a lower than normal level of amniotic fluid, whereas the reverse is true for the recipient twin.  The excess fluid in the recipient twin (polyhydramnios) can be quite uncomfortable for the pregnant mother and pressure on the cervix can lead to ruptured membranes and early delivery. 

During your first ultrasound scan, the sonographer will look to see if your twins are monochorionic (one chorionic membrane) and, if so, your pregnancy will be closely monitored for signs of TTTS. Indications of TTTS include differences in the size of the twins’ abdomens, estimated birth weights, amounts of amniotic fluid and bladder volumes. 

If diagnosed, health professionals will continue to monitor your pregnancy carefully with frequent ultrasound examinations. You may be referred to a specialist centre for laser ablation therapy, which separates the blood vessels in the placenta.

In the video below Professor Mark Kilby from Birmingham Women's Hospital talks about what happens when one baby passes away during a monochorionic twin pregnancy and what the risks are for the surviving twin. 

TTTS parent stories guideWhere can I get further information?

Parents who are experiencing Twin to Twin transfusion can register for free to download our Twin to Twin Transfusion guides and our booklet of Twin to Twin Transfusion Syndrome Parents Stories. You can also join Tamba’s Twin to Twin Transfusion Syndrome Facebook support group.

Twinline can also be a great support to parents experiencing a difficult multiples pregnancy. Twinline listeners are not qualified to provide medical advice, but they can provide emotional support and a listening ear. Twinline is open from 10am until 1pm and 7pm and 10pm every day on 0800 138 0509.

TTTS and the future

Tamba will be commissioning further research over the coming years to help improve the care for parents with pregnancy complications, such as MCMA pregnancies and Twin to Twin Transfusion Syndrome. Keep an eye on our website and social media channels for updates.

Below a mother shares her experience of being diagnosed with TTTS:


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