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Twin Twin Transfusion Syndrome Archive Questions

Below are Dr. Baschat’s answers to Twin Twin Transfusion Syndrome questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



Now displaying records 1 to 15 of 18.

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Q : 1

06/07/2013
I am 18 weeks pregnant with twin boys. Earlier this week I was diagnosed with TTTS. Today I had an MRI, a fetal echocardiogram, and another ultrasound. I am told that I am stage one and the heart and brain function of both babies is normal at this point. I was looking for your advice on when you normally perform laser surgery for this condition. Is there a stage that you look for? Also, do you have any statistics surrounding your success rate from performing this procedure? Thank you in advance for any input you may have.

We offer laser for all stages of TTTS. Our latest results were just published in the American Journal of Obstetrics & Gynecology. Using our laser technique 70% of patients have two surviving normal children. If you are interested in scheduling a consultation please feel free to call 410 328 3865. We would not repeat MRI etc, but just perform an ultrasound and counsel based on our findings at that time. Best regards Ahmet Baschat, MD


Q : 2

11/25/2012
Is your service familiar with the management of maternal-fetal Rh incompatibility and in utero blood transfusion?

Our team is a regional and national referral center for Rhg disease. Dr Harman is one of the founders of in utero treatment of Rh -disease. Sincerely Ahmet Baschat, MD


Q : 3

07/15/2011
My daughter is 17 weeks pregnant with identical twins and was diagnosed with the early stages of TTTS at 16 weeks. She will be monitored weekly with ultrasounds. Is there anything else that we can do at this point or do we just have to wait to see if things stabilize or progress before any intervention can take place?

Dr. De Lia advocates high protein drinks to aid stabilization of the condition. I have not seen any studies that show that this conclusively works, but there is certainly no downside. Early referral to a laser center such as the University of Maryland is the best option at the early stages of TTTS when the outcomes are typically better.


Q : 4

06/30/2011
I am 29 weeks pregnant with identical twin girls and their weight is very different. The big one is 1.106 grams and the little one is 646 grams. What kind of complications will the smaller baby have if she is born at this gestational age? Apparently she is almost seven weeks behind her sister.

The complications with discordant twins depends on the type of placental circulation. In order to give you a better prediction, a detailed ultrasound examination of the fetal circulations will be necessary. Regular monitoring will be essential to detect early fetal deterioration.


Q : 5

05/13/2011
I had an uterine ablation 6 years ago. I am currently 8 weeks pregnant and according to the ultrasound everything looks normal. What are the risks for this pregnancy? Have you ever seen someone successfully carry a baby after ablation?

I am not sure if you are referring to endometrial ablation, uterine embolization or uterine resection. In any case, if things are looking normal at this point that is reassuring. A sonogram at 11-14 weeks gestation with first trimester biochemistry and uterine artery Doppler studies will be helpful in documenting normal placental development. Normal pregnancy outcome is definitely possible.


Q : 6

04/13/2011
Do you perform abdominal cerclage?

Unfortunately, abdominal cerclage is not a procedure I perform.


Q : 7

03/31/2011
What kind of laser do you use to perform ablation of placentas? How much does the procedure cost?

At UMMC, we use the KTP laser. The costs are normally covered by your health insurance, but you should call your provider to verify that information.


Q : 8

01/05/2011
I'm 16 weeks pregnant with twins and I'm 22 years old. I was never told they were identical and now my doctor thinks I have TTTS so he's sending me to have more testing done. Can anyone with TTTS get the fetoscopic laser surgery?

You are correct, anyone with TTTS can have laser surgery if they meet the severity criteria, At the University of Maryland we have performed laser surgery as early as 14 weeks and as late as 26 weeks. To find out more information feel free to visit our Web site (www.umm.edu/fetal_therapy/index.htm) or call for an appointment at 410 328 3865. If you are calling for an appointment ask to speak to Nicole or Debbie who schedule most of our fetal therapy referrals. Best regards Ahmet Baschat, MD


Q : 9

10/15/2010
I'm 16 weeks pregnant with identical twin boys who have been diagnosed with TTTS, stage 2. Do you perform laser ablation at this stage of pregnancy? What is the success rate?

I do perform laser surgery at this gestational age. Our success rate is 96 percent with at least one survivor and 82 percent with two survivors in stage 2 TTTS.


Q : 10

09/23/2010
I was diagnosed with TTTS at 17 weeks, Twin B had less than 2cm fluid, and Twin A had 7 cm. I was not a candidate for surgery. Now I am 20 weeks and Twin B's fluid is 4 cm and Twin A's is still 7cm. Can things get better with no treatment? I thought they could only get worse. All I did was add Ensure twice a day and lots of rest. I'm afraid things can turn around very fast. I'm also afraid that after 24 weeks they wont do surgery if things get bad. What is the chance that things will get better and stay like that?

Things can absolutely get better and stay stable. The key is to continue regular close surveillance to detect deterioration that necessitates intervention.


Q : 11

08/03/2010
Can both twins survive this twin to twin transfusion syndrome with corrective surgery?

Absolutely. This is the goal of fetoscopic laser therapy. In our current experience of over 100 procedures 70% of patients have had double survivors. There are some factors that affect the outcome, but that requires personalized consultation and can not be addressed in a general way. Please do not hesitate to contact me, or the Center for Advancd Fetal Care at 410 328 3865 if you have any further questions. Sincerely Ahmet A. Baschat, MD Professor, Head Section of Fetal Therapy Dept. of Obstetrics, Gynecology & Reproductive Sciences University of Maryland School of Medicine


Q : 12

06/11/2010
I am currently 12 weeks with monochorionic twins. Is there anything I can do to reduce my risk of TTTS?

There is no treatment that has been proven effective in actually preventing TTTS. The only treatment that has the potential in curing it when it develops is fetoscopic laser ablation which I offer at the University of Maryland Medical Center. At your stage the most important thing is to monitor your pregnancy regularly with ultrasound to detect TTTS or selective IUGR as early as possible. This entails a detailled first trimester scan according to the guidelines of the Fetal Medicine Foundation that looks at the babies and the blood flows. If both babies look equal that is great and indicates that the risk for TTTS is very low. A follow-up scan should be performed at 16 weeks to look at a series of ultrasound parameters that can predict TTTS quite accurately. If this second scan is also normal then you will not get acute early onset TTTS (which is the most severe form). Ongoing monitoring should be tailored to the ultrasound findings. If you need some more information do not hesitate to contact me via the web. Ahmet A. Baschat, MD


Q : 13

05/18/2010
Several years ago, I had a spinal fusion to treat scoliosis. I have been told that if I want to have a child, I will need to have a C-section and I will need to have general anesthesia, rather than an epidural. I'm having trouble finding information on my specific situation and the risks to me and to the baby. I would like to work with a physician who has dealt with this scenario before.

Prior spinal fusion does not necessarily require a cesarean delivery. I recommend that you discuss with your obstetrician to make an appointment with a Maternal-Fetal Medicine Specialist at least for a consultation. There are several providers at the University of Maryland that have experience with delivering women with spinal fusion vaginally. The number of the private office to make an appointment is 410 328 6640.


Q : 14

01/28/2010
I am 11 weeks pregnant and from a recent sonogram, I just found that my baby has a thickened nuchal about 7.4mm. Do you recommend treatment for this?

An increased nuchal thickness has many potential causes, and there is no specific treatment for the condition. It will be important for your physicians to determince why your baby has an increased nuchal translucency.


Q : 15

10/10/2009
I am 15 weeks pregnant with mo/di twins and am wondering how often you recommend ultrasounds.

This early in pregnancy, I recommend every other week provided that the examination looks at growth discordance, bladder filling, umbilical and ductus venosus Doppler paramaters and the maximum vertical amniotic pocket volumes. Such comprehensive assessment is necessary to give the most accurate reassurance.


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