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Endoscopic Laser Surgery for Twin-to-Twin Transfusion Syndrome

Twin-to-twin transfusion syndrome (TTTS) occurs during gestation and affects identical twins who share a single placenta. UCSF Medical Center estimates that the fatality rate of twins with untreated TTTS is approximately 70 to 80 percent.

  1. Placenta

    • The placenta is an organ that attaches to the wall of the uterus and to the fetus via the umbilical cord during pregnancy. It allows for the exchange of blood, nutrients and waste products between mother and fetus. The placenta is expelled along with the fetal membranes after birth.

    Twins and Placentas

    • UCSF reports that 70 percent of identical twins share a placenta, each attached by separate umbilical cords. Ideally, the nutrients and blood flowing from the mother to the twins divide equally.

    TTTS

    • Approximately 10 to 15 percent of twins sharing a placenta develop TTTS when an artery from one fetus attaches to the placenta and mistakenly sends its oxygen and nutrients back to the other "wrong" twin.

    Significance

    • The twin losing nutrients and blood lacks fuel for appropriate growth. Organ systems begin to shut down or fail to develop. The twin receiving the extra nutrients and blood can develop heart failure, soft tissue swelling (hydrops) and other issues that lead to death

    Endoscopic Laser Surgery

    • With this treatment, physicians try to stop the abnormal transfusion. The target is the twin receiving too much blood. The surgeon uses a small fiberoptic scope/camera inserted through the mother's abdominal wall and uterus to search for the transfusion site. Once identified, he severs the connecting vessel with a laser attached to the scope.

    Other Considerations

    • According to Children's Hospital of Boston, early detection via ultrasound is vital in discerning the best treatment option for TTTS.

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