Investigating effectiveness of treatments for TTTS
Finding out you are expecting twins can be a joyous and yet frightening prospect, most parents immediately think ‘I have to buy 2 of everything?!’. However, multiple foetuses can cause problems most parents haven’t even considered. One of these is twin-to-twin transfusion syndrome.
Twin to twin transfusion syndrome or TTTS, occurs in monochoriomic monozygotic pregnancies and the syndrome affects 1 in 2000 or approximately 10-15%. TTTS occurs when one foetus (the recipient) becomes significantly larger than the other (donor). This is due to unequal distribution of the placenta shared. TTTS is a largely misunderstood condition and most ...view middle of the document...
Labour can be affected in some of the following ways;
• Premature labour, additional pressure can put strain on the uterus
• Breech/transverse, the extra room can put the foetus in unhelpful positions
• Prolapsed umbilical cord, the cord also have more room to move and can become knotted, round the babies neck, and can fall in the birth canal before the baby
• Increased risk of haemorrhage after delivery
Does polyhydramnios have an impact on maternal impact? Shruti Saralaya et al (2013)
Shruti Saralaya (2013) 'Does polyhydramnios have an impact on the maternal outcome?' International Journal of Pharmaceutical and Biomedical Research 4 (4) page 234-237 [online] available at: http://bit.ly/1mRS9ym
Bar chart comparing cases and controls complication in mother according to Shruti Saralaya et al (2013)
Shruti Saralaya et al (2013) study offers a insight into a generally unknown condition, the study was conducted with 100 participants, including 50 cases and 50 controls for equal representation, the study was based on what earlier scientist thought was a correlation for the condition, for example preterm labour with TTTS is high, but not effect on percentage with pregnancy induced hypertension as well as gestational diabetes. Saralaya didn’t work alone on this and worked with multiple other people on the study, suggesting that the results will be more reliable as there will be less researcher bias which is increased as this was an observational study.
Depending on the severity of TTTS a woman will be diagnosed with each stage from 1 to 5, with one being least severe and 5 the most.
Severe polyhydramnios in recipient and olighydramnios in donor twin, however donor is still able to fill bladder and this is visible on a ultrasound.
Donor is now severely dehydrated and bladder is no longer visible.
Foetal distress is now seen; pulsatile flow is evident on Doppler examination and other signs of cardiovascular stress.
Signs of heart failure in one or both twins including pericardial effusion, pleural effusion and oedema.
Demise of one or both foetuses. If one foetus dies its likely the second will die within days.
Treatment depends on how advanced the syndrome is but there are a number of options, there are many factors which impact on which treatment is decided. Factors include the health of the mother, severity of syndrome, health of babies and many others. There is no one size fits all treatment for TTTS and is decided on a case-by-case basis. One treatment is amnioreduction.
Amnioreduction is a very invasive procedure and is similar to amniocentesis in the way it is performed. First the area of skin being punctured is numbed with a local anaesthetic, then a long thin needle is inserted into the uterus and pierces the amniotic sac of the recipient, then fluid is removed usually by vacuum syringes, when the professional performing the procedure is happy with fluid removed...