Third‑trimester ultrasound diagnosis of twin‑to‑twin transfusion syndrome (TTTS) – A review of two cases

Abstract

Twin‑to‑twin transfusion syndrome (TTTS) is an unbalanced net transfusion of blood between twin fetuses through placental anastomoses. It is a complication of monochorionic diamniotic (MCDA) twin gestation in which one of the twins is the donor while the other twin acts as the recipient. TTTS without treatment is a major cause of increased morbidity and mortality among MCDA twin pregnancies. Ultrasound diagnosis and staging of TTTS are based on Quintero staging which influences the choice of management. We present two cases of ultrasound diagnosed TTTS. A 27‑year‑old G2P1+0 with twin gestation who had an ultrasound scan at 34 weeks gestation, and a diagnosis of Quintero stage 1 TTTS was made. She had an emergency caesarian operation and was delivered of two live babies. A 24‑year‑old G1P0+0 with twin gestation who had an ultrasound scan at 35 weeks gestation, with a diagnosis of Quintero stage 5TTTS. The donor twin was alive while the recipient twin had hydrops fetalis with no cardiac activity. An emergency caesarian section was done and the donor twin survived. TTTS is a common complication among MCDA twins and it is a cause of increased morbidity and mortality among them. Early diagnosis through ultrasonography and prompt management will help reduce the morbidity and mortality associated with the syndrome.

Keywords: Third trimester; twin‑to‑twin transfusion syndrome; ultrasound