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Twin to Twin Transfusion Syndrome

TTS is a condition affecting approximately 15% of identical twins that are sharing one placenta. It occurs when there are abnormal blood vessels in the placenta connecting one baby to the other. Normally, babies who share a placenta have vessels in which blood flows evenly from one baby to the other. In TTTS, the blood flows unevenly from one baby to the other due to the abnormality in the placenta. This results in one baby, the “donor”, transfusing blood to the “recipient” via the placenta.

The recipient twin is usually the larger baby due to the extra blood flow making them work harder. This can then cause heart failure due to the extra work they need to do. This extra work results in them urinating more, causing an abnormally large amount of amniotic fluid around them.

The donor twin is smaller than the recipient and in severe cases can die from anaemia due to the lack of nutrients. As the baby doesn’t have enough blood, it doesn’t work very hard, which results in the amniotic fluid around it drying up. This causes them to appear “stuck”. When TTTS twins are born, the donor twin usually recovers quicker than the recipient does due to the fact that it isn’t tired from pumping extra blood.

TTTS is a very serious problem that can be either chronic or acute. Chronic TTTS can present itself in the early months meaning that the babies are too immature to be delivered when it is first detected. Acute TTTS can occur at any stage in the pregnancy, even during delivery causing death or disability.

TTTS is a very cruel condition. The babies are normally perfect; the problem is with the placenta.

The Australian TTTS Support Group is an Australian group of parents who have experienced a pregnancy affected by TTTS and whose aim is to provide assistance to those who need it. Their website can be found at

The primary aim of PIPA is to provide practical and emotional support to the parents and families of premature infants. However we do not offer professional advice. We are parents of preterm baby’s and not medical staff. We do offer understanding, support, encouragement and friendship.

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