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Lives in the Balance: Understanding Twin-Twin Transfusion Syndrome
Twin-Twin Transfusion Syndrome has challenged clinicians, researchers and parents since its identification several decades ago. In this newly-updated video, the staff of The Center for Fetal Diagnosis and Treatment presents a complete overview of the disorder and how advanced prenatal care provides the best hope for positive outcomes.
Transcript: What is Twin-twin Transfusion Syndrome?
Dennis Hasson, Father: That day in the ultrasound room when that technician looked at us like, "You two know you're having twins."
Marie Hasson, Mother: On the ultrasound you could see, you know, a lot of detail because it was a level two ultrasound.
Mark P. Johnson, MD: It's very uncommon. Only 10, 15% of monochorionic twins develop this type of a syndrome.
Marie Hasson, Mother: You could tell they were both girls.
Dennis Hasson, Father: And for one moment it was exciting.
Michael Bebbington, MD: We don't know exactly what it is that causes twin-to-twin transfusion syndrome.
Marie Hasson, Mother: I could see the screen that something was wrong. There wasn't any fluid in the one sac at all.
Michael Bebbington, MD: But we know that it has something to do with the very unique nature of the way the blood vessels connect in the placenta.
Mark P. Johnson, MD: They don't share the placenta equally.
Dennis Hasson, Father: That doctor came in, took a look at these ultrasounds.
Marie Hasson, Mother: And he didn't say a word. He just was looking and kind of taking notes and then he brought us into his office and shut the door and he said, "You know, this is going to--this is going to be a very difficult pregnancy."
Mark P. Johnson, MD: Twin-twin transfusion syndrome is a complicated disorder.
Joy N. Macdonald, RN: A serious complication of monochorionic or identical twin pregnancies.
Mark P. Johnson, MD: Monochorionic meaning that they share a placenta.
Susan R. Miesnik, MSN: In a monochorionic diamniotic pregnancy there is one chorion which is the outer sac and each twin is in its own amnion. So that it's like a single balloon with two filled balloons inside it.
N. Scott Adzick, MD: One twin, the recipient twin, gets too much blood and the other twin, the donor twin, doesn't get enough blood.
Mark P. Johnson, MD: Because the amount of oxygen and nutrition going to the donor baby is less than to the recipient baby, they grow at different rates.
Susan R. Miesnik, MSN: One twin will end up being very large, having excessive amniotic fluid around it or polyhydramnios.
Mark P. Johnson, MD: The opposite kind of occurs in the smaller baby or the donor baby.
Susan R. Miesnik, MSN: The other twin on ultrasound will show itself as being very small for gestational age. It will have decreased amniotic fluid or actually no fluid.
Mark P. Johnson, MD: Over time the amniotic fluid around the donor baby shrinks away until literally the baby becomes shrink-wrapped alongside of the uterine wall or placenta.
Susan R. Miesnik, MSN: As this disease progresses you end up seeing cardiac changes in both of the babies.
Jack Rychik, MD: When we begin to see cardiac changes, one can have significant complications as a consequence which can lead to either residual issues that these fetuses face or even death in either the recipient or the donor.
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