Syndrome with artery-vein anastomoses - donor twin perfuses the recipient twin

Aetiology

• Twin to twin transfusion syndrome is caused by anastomoses of umbilical vessels between the two foetuses in the placenta of monochorionic twins

Pathophysiology

• Both foetuses are at risk of developing heart failure and hydrops
• The donor suffers high output cardiac failure as a consequence of severe anaemia and the recipient suffers fluid overload

Investigations

• Ultrasound: oligohydramnios polyhydramnios

Management

• Untreated, TTTS has a high mortality rate for both twins, with the donor more likely to survive
• Treatment is now available at specialist centres:
  • Before 26/40 - fetoscopic laser ablation

  • 26/40 - amnioreduction/septostomy

  • Deliver 34-36/40