question regarding TTTS

Hi all...I am pretty new to this forum, so I figured I would introduce myself and ask a question as well. We are expecting mono/di girls. My due date is August 2nd. These princesses will be joining their two older sisters Rose is 8 and Ruth is 5. We are all really excited. It has been a really new learning experience for me, as there are no twins on my side or my husbands side of the family. This forum has really helped me and showed me I am not alone.

I was wondering is there a date/week that there is no concenrn for TTTS or is it a concern until the babies are delivered?

Thank you.

 

First of all Hi and Welcome!! Congrats on your twin girls! You've done great to get to 25 weeks with no problems (I'm assuming you haven't had any)! TTTS can actually occur any time up to and including delivery, but the chances really go down after 24 weeks or so. The good thing is that if it happens after that, chances are much better for the babies if they have to come early. It's still a good idea to continue good monitoring (ultrasound at least every two weeks). It sounds like you're doing great!

 

TTTS remains a concern until the babies are actually delivered as it can even happen during birth. I would really encourage you to go to the TTTS Foundation and request a copy of their book. It is highly recommended that all monochorionic pregnancies be monitored AT LEAST WEEKLY from week 16 until delivery -- 2 weeks is too long in between ultrasounds as things can change quickly. Acute TTTS (occurring at or after 26 weeks) is as dangerous as chronic TTTS (occuring before 26 weeks) unless it is caught quickly.

 

It can happen at anytime but like Melissa said it is not as big of a concern after 24 weeks. You are doing great, it sounds like you haven't had any problems so far which is excellent. My boys are also mono/di and they are monitored very closely. I have always had u/s every 2-3 weeks I would also ask your doctor to explain to you what some of the warning signs are just so that you are aware. Congrats on the twins and welcome.

 

I really hate to dispute you, but it is NOT less of a concern after 24 weeks. It is different, but it is just as bad. Whoever is telling you this is sorely mistaken. The mortality rate (rate of death) is higher for chronic TTTS due to prematurity but the morbidity rate (life-long handicaps) is significant for acute cases. And there are plenty of babies that are lost to TTTS in the 3rd trimester. With proper monitoring, your likelihood of delivering healthy babies improves. This is directly from the TTTS Foundation website:

" TTTS can occur at any time during pregnancy, even while a mother is in labor at term. The placental abnormalities determine when and to what degree a transfusion occurs between the twins.
Chronic TTTS describes those cases that appear early in pregnancy (12-26 weeks’ gestation). These cases are the most serious because the babies are immature and cannot be delivered. In addition, the twins will have a longer time during their development in the womb to be affected by the TTTS abnormalities. Without treatment, most of these babies would not survive and of the survivors, most would have handicaps or birth defects.
Acute TTTS describes those cases that occur suddenly, whenever there is a major difference in the blood pressures between the twins. This may occur in labor at term, or during the last third of pregnancy whenever one twin becomes gravely ill or even passes away as a result of the abnormalities in their shared placenta. Acute TTTS twins may have a better chance to survive based on their gestational age, but may have a greater chance of surviving with handicaps."

The great news is that only 10-15% of monochorionic pregnancies will develop TTTS. If it is caught early, it can be treated effectively in many cases and your babies will have a great chance. Babies born after 28 weeks have an excellent chance of living a typical life. It is imperative that you be monitored appropriately for TTTS so that you can be treated effectively. Ultrasounds are quick, non-invasive and painless. Why wouldn't you want to monitor weekly to make sure your babies are safe? TTTS can act VERY FAST -- 2 weeks is at least TWO TIMES TOO LONG. Please don't wait -- your babies lives could depend on it.

Brook
Mother of TTTS survivors Lucas and Matthew born at 29 weeks, diagnosed with TTTS stage 2 at 19 weeks 3 days, PPROM after decompressive amniocentesis due to PTL r/t TTTS at 20 weeks 5 days. Recipient born with thick cardiac walls, renal failure and severe respiratory distress. Donor born with severe prolonged renal failure, severe respiratory distress. 66/71 days in the NICU. Today are healthy 28 month old boys who would be dead had I not had proper monitoring.



QUOTE(Ericka B @ Apr 26 2007, 08:33 AM) [snapback]234409[/snapback]
It can happen at anytime but like Melissa said it is not as big of a concern after 24 weeks. You are doing great, it sounds like you haven't had any problems so far which is excellent. My boys are also mono/di and they are monitored very closely. I have always had u/s every 2-3 weeks I would also ask your doctor to explain to you what some of the warning signs are just so that you are aware. Congrats on the twins and welcome.