December is Twin-Twin Transfusion Syndrome (TTTS) Awareness Month — an opportunity to focus attention on TTTS, a rare but life-threatening prenatal condition in which blood flows unequally between identical twins sharing a placenta.
The unequal blood flow results in one twin receiving too much blood and the other receiving too little. The imbalance jeopardizes both twins when left untreated. Management may include closely monitoring ultrasound examinations to check for signs of progression, removing excess amniotic fluid from the larger twin, or in some cases performing minimally invasive surgery.
Since 1995, the Center for Fetal Diagnosis & Treatment (CFDT) at Children’s Hospital of Philadelphia (CHOP) has cared for more than 3,000 complicated multiple gestation pregnancies and performed over 500 fetoscopic procedures to treat TTTS. The center team offers several treatment options, all performed before birth with the goal of intervening before TTTS advances too far.
One treatment option is fetoscopic selective laser ablation, in which fetal surgeons disconnect communicating blood vessels to stop the flow of blood between the twins. The CHOP team also has extensive experience in selective cord occlusion, a surgery that stops the blood flow to one twin in order to maximize the outcome for the other twin.
“In many cases, effective surgical interventions to treat TTTS have been instrumental in halting the disease before it advances too far,” says Mark Johnson, MD, Director of Obstetrical Services at the Center for Fetal Diagnosis & Treatment at CHOP. “While we still do not completely understand the exact complex mechanisms and how they work together to lead to TTTS, we do know that no two placentas are the same, and it’s extremely important to follow these cases closely and be prepared for every possible outcome. Our team will continue to pursue research to create new solutions for these babies.”