Amnioreduction. Before laser therapy became trendy for ttts management, serial amnioreductions with or without amnioseptostomy were successfully used to increase perinatal survival in such complicated twin pregnancies. The decrease of amniotic fluid volume in the recipient's sac alleviates the pressure on the placenta and helps prolong the pregnancy while avoiding fetal demise; neurological damage can still occur.
AKA TTTS. Ttts is when twins share abnormal blood vessel connections allowing one baby to "steal" blood from the other. Another name for this syndrome is poly/oli twins because one will have too much amniotic fluid (polyhydramnios) and the other too little fluid (oligohydramnios.) this is a high risk situation that will need to be carefully monitored by serial ultrasound and may require early delivery.
Complications. Ttts is a serious condition that complicate 8-10% of twin pregnancies with monochorionic diamniotic placentation, when one twin has smaller amount of amniotic fluid in one sac (oligohydramnios), and another bigger (polyhydramnios). The reason for that lies in the anomaly placental vessels connection, which leads to a different blood supply of the fetuses: smaller to donor, larger to recipient.
Ultrasound. Determining the type of twins and their condition by prenatal ultrasound is the only way to diagnose ttts.
Clinical label. If a prenatal ultrasound shows one fetus larger than the other, you expect the process to be involved. Once it is detected, they often repeat the study often to see how much it affects the smaller twin. At some point they may decide to deliver early to prevent loss of the smaller baby.
Large uterus. Rapidly enlarging uterus is the hallmark of ttts and results from massive polyhydramnios in the recipient's gestational sac. Prompt expert medical care can help avoid death to both twins.
Laser, amnioreductio. Laser to try to separate the two fused placentas and/or amnioreduction can help manage ttts to a certain extent. Laser is preferred but both methods have pretty high failure an complication rates. Ttts is a bad diagnosis to have..