Identical twins, when sharing a placenta, can cause a serious condition which is called TTTS or twin-twin transfusion syndrome. This is a rare condition but does happen in pregnancies when the mother is carrying identical twins.

In this condition, an abnormal blood vessel connection gets formed in the placenta and this causes the blood to flow unevenly between the babies. The donor twin gets dehydrated and the recipient twin develops a high blood pressure which causes the production of excess urine that fills the amniotic sac.

The disease is not a disease caused by the babies but is a disease of the placenta and this tends to affect both the twins. The donor twin does not produce enough urine and this leads to poor growth. The recipient twin produces excess urine which leads to an excess amniotic fluid which also puts a strain on the heart of the recipient twin leading to a heart failure.

Management of twin to twin tranfusion syndrome(TTTS) needs utmost care and can be done in a twin pregnancy clinic where the doctors are experienced to take care of this disorder.

Diagnosis for TTTS

The condition can end up being fatal for both the twins if not treated immediately. The doctor may advise a fetal surgery to cure the condition and to save one or both the babies. The diagnosis is better if the condition develops 20 weeks after the gestation. This is an emotional decision but should be made immediately to save the babies lives.

The condition will be suspected by the doctor in case any of the flowing conditions is seen during an ultrasound:

  • Difference in the fetus size of the same gender
  • Amniotic sacs of different sizes
  • Single placenta
  • Buildup of fluids on the skin of one of the fetus
  • Congestive heart failure in the recipient twin
  • Excess of amino fluid in the recipient twin
  • Decrease in amniotic fluid in the donor twin

Symptoms of TTTS

The mother of the twins may experience some of these symptoms if she has a TTTS:

  • Feeling of rapid womb growth
  • A large measuring uterus
  • Contractions or abdominal pain
  • A sudden body weight increase
  • Hands and legs swelling in early pregnancy

Treatment options for TTTS

TTTS has claimed both the babies’ lives; however, there have been some new treatments for this condition.

Amniocentesis is used in order to drain off the excess fluid which improves the blood flow in the placenta and this helps to reduce the preterm labour risk. The procedure can save 60% of the babies who are affected by TTTS. The other option is to use a laser surgery which helps to seal off the blood vessels connection and helps to save 60% of the babies.

In case the lungs of the twins have matured then the doctor may advise delivery.

TTTS occurs around 15% of the times; however fraternal twins have no such risk because they grow in different placentas. The condition is random and one cannot prevent the disorder, it is also not hereditary.


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