December is International TTTS awareness month, a global initiative to increase public awareness about the risks of being pregnant with monochorionic twins and guiding parents to the right medical advice and treatment. “There is an urgent need to drive awareness and knowledge about TTTS. The more people who are aware, the more lives can be saved,’’ says Dr. Lou Pistorius, Maternal Fetal Medicine Specialist at Panorama Perinatology.
Pregnancy and childbirth is often referred to as the “most natural thing in the world.” Thankfully, many pregnancies progress without serious complications. However, some women experience difficulties that can involve their health, their baby’s health, or both. Diseases or conditions the mother had before she became pregnant can lead to complications, while others occur during the pregnancy or during labor and delivery.
Twin-to-twin transfusion syndrome (TTTS) is a condition occurring where identical twins share a single placenta, called monochorionic twins. One in every five sets of twins share a single placenta. TTTS develops in one in every ten sets of twins with a single placenta, when blood vessels from one twin’s portion of the placenta “short-circuits” to the other twin’s portion. One twin (the “donor”) then little by little pumps some of its blood through the placenta to the other twin (the “recipient”).
If this carries on long enough, the donor twin ends up with less and less blood in its circulation, causing the production of less amniotic fluid. Eventually, the donor becomes stuck to the side of the uterus because there is almost no amniotic fluid in its sac. In the most serious cases, the donor may not survive because of insufficient nutrients and/or oxygen. The recipient, on the other hand, produces an excess of amniotic fluid. There may be so much amniotic fluid that the mother would notice a sudden increase in the size of the uterus, and experience discomfort or pain in the abdomen. The amount of amniotic fluid might be so much that it could cause a miscarriage or result in preterm labor. The overload of blood in the recipient twin’s circulation can also cause heart failure and death of this twin.
Despite the seriousness of the TTS diagnosis, early detection and prenatal care can reduce the potentially negative consequences.
Luckily, this was the case with Anja and Friedrich Sonnendecker.
As Friedrich Sonnendecker described it, “Something went wrong. Anja’s tummy doubled in size in just three days. We were scared, devastated. There were many times when we just wanted to give up and could not see very far ahead.”
After seeking consultation from different doctors, they contacted Dr. Pistorius, Maternal Fetal Medicine Specialist at Panorama Perinatology. Using the latest GE Healthcare’s ultrasound technology, TTTS was diagnosed. He developed a treatment plan that included a complex laser surgery, that he hoped would be able to save the twins.
Dr. Pistorius said, “After seeing Anja’s case we admitted her to the hospital for laser surgery the same night. A thin instrument called a fetoscope was inserted under ultrasound guidance, through the abdominal wall into the cavity of the uterus to view the blood vessels in the placenta. With a laser fiber, all vessels connecting the two twins were obliterated. In this way, the joint placenta was artificially divided in two, and we drained the excess amniotic fluid.” The team gave the anxious parents a 33% chance of success.
The operation was thankfully a success. The twin girls are now five years old and in good health, enjoying every moment of their young lives.
“Holding on to our 33% chance of hope resulted in 100% perfect little human beings, and we could not be more grateful! Looking back at our journey and at these two miracles that stand in front of us, we know that every struggle and every tear was worth it,” said Anja.
“Any woman who is pregnant with twins and is experiencing any symptoms of TTTS is asked to reach out to their doctors early on to give the best chance for reducing the risks that might occur,” says Dr. Pistorius. “While we celebrate the success stories, at the same time our hearts are with the parents who have experienced the devastation of losing one or both twins because of TTTS.”
