(Health Korea News / Hae-ri Lim) #A, in her 30s, who became pregnant naturally with identical twins, felt great discomfort in the 15th week of pregnancy as her stomach suddenly became distended due to increased amniotic fluid. Ms. A, who visited the hospital, was diagnosed with twin transfusion syndrome and underwent fetal endoscopic surgery and was able to give birth to a healthy child later.
Twin-to-Twin Transfusion Syndrome (TTTS) is a serious complication that can occur during pregnancy with identical twins. It refers to a pathological condition that occurs when a fetus shares blood vessels with the placenta within the uterus. It is known to occur in 9-15% of identical twin pregnancies.
Twin transfusion syndrome, which occurs when twins share the same placenta, is caused by problems in the vascular connection between the twins. It is characterized by unbalanced blood flow between the two fetuses, that is, circulatory disorders, where one fetus receives excessive blood from the other and is overloaded, while the other fetus receives insufficient blood, worsening the physical condition of both fetuses. If this imbalance persists, each fetus may experience problems such as heart strain, kidney dysfunction, and growth failure. In severe cases, the risk of stillbirth increases. If detected and treated early, the fetal survival rate is greatly improved, but if not treated, the prognosis is very poor, with 73 to 100% of both fetuses dying.
One fetus suffered from polyhydramnios and the other suffered from oligohydramnios.
The main symptom is abdominal distension due to polyhydramnios. Due to the difference in the amount of amniotic fluid between the two fetuses, polyhydramnios occurs in one fetus and oligohydramnios occurs in the other fetus. The diagnosis is confirmed through a comprehensive evaluation including imbalance in amniotic fluid volume, growth differences between fetuses, and abnormalities in fetal heart function through ultrasound examination.
The stage of twin transfusion syndrome is divided into five stages depending on the severity. In stage 1, the amount of amniotic fluid between the two fetuses is different, but Doppler ultrasound, which shows the flow of blood in the blood vessels, is normal. Afterwards, it progresses to stage 2, where the donor fetus’s bladder is not visible on ultrasound, stage 3, when amniotic fluid volume differences and abnormal blood flow patterns appear, stage 4, when hydrops in the fetus is discovered, and stage 5, when one fetus is stillborn.
Treatment methods require various approaches depending on the degree of progression. In the first stage, the fetal condition is monitored through intensive observation to see if it improves naturally. However, in cases of stage 2 or higher severity, active treatment methods such as intrauterine fetal endoscopic laser treatment or early childbirth are necessary. Fetal endoscopic laser treatment is recommended between 16 and 26 weeks of pregnancy as a method to relieve blood flow imbalance by blocking the blood vessels of the two fetuses connected in the placenta. The average birth period after treatment is between 32 and 34 weeks of pregnancy, with most births occurring prematurely.
Kim Ho-yeon (obstetrics and gynecology professor), director of the Center for Integrated Treatment of High-Risk Mothers and Newborns at Korea University Ansan Hospital, said, “First of all, it is very important to accurately determine whether identical twins are identical in the early stages of pregnancy,” and added, “We can reduce the risk of twin transfusion syndrome that occurs in identical twins through early detection.” “It can be lowered and regular prenatal check-ups and ultrasound examinations are important,” he explained.
Professor Song Gwan-heup of the Department of Obstetrics and Gynecology said, “Fetal endoscopic laser treatment has recently shown a high success rate in the medical field, giving us the opportunity to have healthier children.” He added, “The Korea University Ansan Hospital Integrated Treatment Center for High-Risk Mothers and Newborns also offers fetal endoscopic surgery for twin transfusion syndrome.” “It is being carried out successfully,” he said.
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