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Twin-to-Twin
Transfusion Syndrome

When Two or More Babies
Share a Placenta

By Alexandria Powell

But amnioreduction isn't a cure for TTTS – it only reduces some of the effects. The fluid is likely to build up again, and the procedure will need to be repeated. Each time, the risk of bleeding, infection or ruptured membranes goes up.

Laser coagulation of the communicating placental vessels is a form of fetal surgery. First performed in 1995, laser coagulation actually stops TTTS by using a laser (inserted endoscopically into the uterus) to seal off the blood vessels that are allowing transfusion from one twin to the other. The procedure does have risks to both mother and fetuses, and until recently, there was no proof that laser coagulation was superior to amnioreduction.

However, in 2004, the Eurofoetus study, a randomized, controlled trial overseen by European researchers, showed that laser coagulation did lead to better outcomes than amnioreduction for advanced TTTS.

There are many factors that influence how TTTS will be treated in any given case, Dr. Luks says. First is the severity of the disease at the time of diagnosis. "If it presents in Stage III or Stage IV, at that point it's pretty much a given that the only thing that can help, if anything at all, will be the laser," he says.

But if TTTS is found in a lesser stage, such as Stage I, there is a decent chance that the syndrome will not get worse, but in fact will remain stable or improve, Dr. Luks says. "But there is also a risk that it could worsen," he says. "That's the one thing that we don't have a handle on yet – if you are diagnosed with Stage I, it is impossible to predict, 'Well, you are going to be Stage II or Stage III by next week. Or in two weeks. Or in two days.' That we can't do. We've seen all possible combinations."

Want to see more?

• Vanishing Twin Syndrome: A Mysterious Occurrence in Multiple Pregnancies
• Check out our Article Library.
• Two Babies, One Sac, More Risks: The Triumphs of Monoamniotic Twins
• Double the Stuff? What You Really Need to Prepare for Twins
• Talk about it!