What are the stages of TTS?

What is Stage 3 twin-to-twin transfusion syndrome?

Stage 3: The imbalance of blood flow starts to affect the heart function in one or both babies. This is seen in abnormal blood flow in the umbilical cords or hearts of the twins.

How quickly does TTTS progress?

Results: Among 132 consecutive cases of TTTS, 46 women presented with Stage I disease. In the majority (69.6%), disease remained stable (28.3%) or regressed (41.3%). Of cases that progressed, 79% did so within 2 weeks and 93% progressed to at least Stage III.

Can twins survive TTTS?

The majority of TTTS twins who have appropriate treatment during pregnancy will survive and the majority of survivors will be normal and healthy. If untreated, the survival rate for TTTS twins is approximately 10 to 15 percent. Once TTTS babies are born, blood supply sharing is no longer a factor.

How is Stage 2 twin to twin transfusion diagnosed?

A twin to twin transfusion syndrome diagnosis is confirmed by ultrasound. The condition becomes evident when the ultrasound images show that one child has extra amniotic fluid and the other child has significantly decreased amounts. Abnormalities in the blood-flow patterns in the umbilical cord may also be found.

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Can TTTS stay at Stage 1?

Among 132 consecutive cases of TTTS, 46 women presented with Stage I disease. In the majority (69.6%), disease remained stable (28.3%) or regressed (41.3%).

What happens if one twin dies from TTTS?

Because of the blood vessels that connect the circulations of the two fetuses across the shared placenta, if one twin dies, the other twin faces significant risk of death or damage to vital organs. If one twin dies, the surviving twin has up to a 40 percent risk of some form of brain injury.

What is a daisy baby?

All babies affected by TTTS, including TAPS, SIUGR and TRAP are called Daisy Babies.

How early can TTTS be treated?

There are a few options to treat TTTS before birth, but only the most severe cases should be treated with fetal intervention. Observation, with or without bed rest. If TTTS occurs in the third trimester, conservative measures and early delivery are usually recommended.

Can TTTS cause cerebral palsy?

Twins with TTTS are often born prematurely after an extremely distressing and highly hazardous fetal period. Follow-up studies report varying rates of cerebral palsy (CP) and long-term neurodevelopmental impairment (NDI).

Is there anything you can do to prevent TTTS?

TTTS is caused by abnormal connections between twins that form when the placenta first develops. This is a purely mechanical and random event that can't be avoided. “The mother can do absolutely nothing to prevent it,” says Dr. Norman Davies, maternal fetal medicine consultant at Mayo Clinic.

How common is twin-to-twin transfusion?

Twin-twin transfusion syndrome affects approximately 5 to 15 percent of identical twin pregnancies, meaning that approximately 6,000 babies may be affected each year.

Can TTTS regress?

Most cases of TTTS present in the early second trimester and are staged according to the system shown in the table (table 1), formerly called the Quintero classification system. The stage may remain stable, regress, or progress over time, and progression can occur rapidly.

What is the difference between TTTS and TAPS?

TTTS and TAPS are both chronic forms of feto-fetal transfusion. TTTS is characterized by the twin oligo-polyhydramnios sequence (TOPS), whereas TAPS is characterized by large inter-twin hemoglobin differences in the absence of amniotic fluid discordances.

What is Quintero stage?

Quintero staging is a system of quantifying the severity of twin-to-twin transfusion seen in monochorionic twin ges- tations through sonographic assessment. In 1999, Ruben A. Quintero and his associates1 proposed a staging sys- tem for monochorionic twins predictive of twin-to-twin transfusion and its prognosis.

What is TAPS in twins?

TAPS is a rare condition that occurs when there are unequal blood counts between the twins in the womb. Unequal blood counts cause the twins to suffer from an imbalance in red blood cells and hemoglobin. This means one twin is not receiving the appropriate amount of oxygen and nutrients it needs to develop properly.

What is the survival rate of identical twins?

The survival of monochorionic twins diagnosed in the first trimester is 89%. Twin-to-twin transfusion syndrome (TTTS) occurs in 9% and is the most important cause of death.

How does TTTS affect the mother?

Left untreated, TTTS will often worsen. The recipient tries to deal with excess fluid by creating more and more amniotic fluid - this will overstretch the uterus. This may cause the mother discomfort and may put pressure on the cervix, the lower part of the uterus.

What is twin syndrome?

Twin-to-twin transfusion syndrome (TTTS) is a rare pregnancy condition affecting identical twins or other multiples. TTTS occurs in pregnancies where twins share one placenta (afterbirth) and a network of blood vessels that supply oxygen and nutrients essential for development in the womb.

How does one twin absorb the other?

Parasitic twins differ from vanishing twins. With vanishing twins, early ultrasound or fetal heartbeat confirms the presence of two fetuses. But in later tests, only one fetus remains. The vanishing twin is absorbed by the remaining twin, the placenta, or the mother's body.

What do you say when one twin dies at birth?

simplest expression of sorrow is best, plus appreciation of the surviving baby as you do not want to detract from that. A donation to a neonatal charity would be appreciated I am sure and a present for the baby. It would be so sad if the joy at his/her birth were always to be overshadowed by the loss of the twin.

How long can a Grade 3 placenta survive?

Grade II: 30-38 weeks gestation. Grade III: 39 weeks until birth.

What sIUGR twins?

Selective intrauterine growth restriction (sIUGR) occurs when there is unequal placental sharing which leads to suboptimal growth of one twin (left). In normally developing monochorionic twins, the twins share the placenta equally, including the shared blood vessels between the twins (vascular communications).

What is a trap pregnancy?

Twin reversed arterial perfusion (TRAP sequence) is a rare condition of monochorionic twin pregnancies. It arises when the cardiac system of one twin does the work of supplying blood for both twins. The twin supplying the blood is known as the "pump twin" and develops normally in the womb.

Can diet help TTTS?

Absolutely. The data from these two studies show one thing – increased protein and attention to maternal nutrition DOES help the mothers and babies.