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The mortality rate is more than 70%! Video and text explain the twin transfusion syndrome that makes obstetricians chills

Video explains the twin transfusion syndrome that makes obstetricians chills

Twin Transfusion Syndrome (TTTs) is a serious complication in twin pregnancy The perinatal mortality rate is extremely high. The untreated mortality rate is 70% to 100% It can be said to be an obstetrician’s nightmare What is the mechanism of TTTs. How to diagnose as soon as possible.

About Twin Transfusion Syndrome (TTTs)

Refers to the blood infusion between two fetuses through placental vascular anastomosis, which causes a series of pathophysiological changes and clinical symptoms.
●It is a serious complication in twin pregnancy.
●It is in monochorionic sac twin pregnancies, the incidence of which accounts for 4-35% of monochorionic sac twin pregnancies. The incidence in all twin pregnancies is approximately 1.6%.
● Most fetuses are born prematurely, with a poor prognosis, and the perinatal mortality rate reaches 60%-100%.
Mechanism of TTTs
Because the two fetuses share the same placenta in monochorionic sac twins, the branches of the umbilical vessels are more likely to form an anastomosis in the placenta. The anastomosis forms include arterial-arterial anastomosis, arterial-venous anastomosis and vein-venous anastomosis.

There are obvious communicating branches of blood vessels in the middle of the placenta: The incidence of placental vascular anastomosis in monochorionic twin pregnancy is as high as 85%-100%, but not all placental vascular anastomoses have TTTS. In most cases, arterial-arterial and venous-venous anastomosis is rarely shunted, but if it is an arterial-venous anastomosis, it may just cause high-pressure arterial blood to flow to low-pressure veins, resulting in twin blood transfusion.

 Normal umbilical artery branch 

The umbilical artery (blue) and the umbilical vein (red) on the surface of the normal fetus placenta accompany each other. The blood flow passes through the umbilical artery, flows from the umbilical artery to the placenta, and returns through the accompanying umbilical vein.

TTTS unidirectional umbilical arteriovenous shunt
The umbilical vessel on the surface of the placenta is a single blood vessel, and the umbilical arteries and veins do not accompany each other. The donor umbilical artery (blue) and the recipient umbilical vein (red) enter and exit the same small hole on the surface of the placenta, and there is arteriovenous communication in the deep part of the placenta.

TTTs showed obvious unbalanced growth between twins. Behaves as:

One child has too much amniotic fluid, the fetus is larger, and the other child has severely oligohydramnios or no amniotic fluid and “sticks” to the uterine wall (fixed fetus). This kind of fetal growth is retarded, and the weight difference between the two babies is more than 20%. This condition is called one-pregnancy oligohydramnios/one-pregnancy polyhydramnios sequence sign (TOPS).

Due to twin transfusion syndrome, the blood flow of the two fetuses changes greatly. The blood volume of the recipient increased sharply, hemoglobin increased, blood pressure increased, myocardial hypertrophy, heart enlargement, liver and kidney enlargement, rapid weight gain, thickening of the smooth muscle of the arterial wall, and excessive amniotic fluid.

The blood from the donor is hypoxic (hypoxic blood is contained in the umbilical artery), so the partial pressure of oxygen in the recipient is reduced, and a series of hypoxemia changes, such as fetal edema and hemodynamics Changes coupled with a large increase in blood volume can eventually lead to congestive heart failure.

Causes of death of TTTs

In severe twin transfusion syndrome, both fetuses may die in utero.


●Blood donors: Generally, the blood donors die due to severe blood loss and hypotension.


●Blood recipients: Most of the blood recipients have cardiovascular damage, which is also the main cause of death. It is also possible that the umbilical artery pressure suddenly drops to an extremely low value after the death of the blood donor, which is lower than the venous pressure of the blood recipient, resulting in arteriovenous reflux. The recipient who has been in high blood volume for a long time suddenly loses a lot of blood, causing an extreme hemodynamic disturbance, and the heart is overwhelmed and causes death.

After birth, it showed signs of hyperemia, excessive blood, increased blood viscosity, high blood pressure, cardiac hypertrophy, skin and subcutaneous tissue edema, relatively heavyweight (more than 20% heavier than the blood supply), red skin, red blood cell, hemoglobin ratio The capacity is high.

Treatment of TTTs

● Continuous reduction of amniotic fluid

● Micro diaphragm stoma between twins

● Selective or non-selective fetal mirror laser photocoagulation

In the past few decades in the United States, continuous reduction of amniotic fluid was the most widely accepted method for the treatment of TTTs.