When TAPS occurs, the recipient twin is at risk for successively increasing blood count, called polycythemia , and the donor twin for progressive blood loss, or anemia. Signs and symptoms related to TAPS include thicker than normal blood in the recipient twin and anemia in the donor twin. If suffering from polycythemia, the recipient twin may have a sluggish blood flow in small vessels and may even suffer a spontaneous blockage of blood flow thrombosis.
At 26 weeks, the Center for Fetal Therapy team discovered that their patient's identical triplets had twin anemia polycythemia sequence TAPS. The team quickly set about to perform fetal laser surgery to correct the unbalanced blood flow between the fetuses. These events are detected most reliably by Doppler — a type of ultrasound that examines blood circulation.
This paper is excellent if you want to go in-depth into the differences in blood counts. First of all, not always. Ask that the hemoglobin and reticulocytes be checked and counted for both babies, and your placenta is tested for small connections less than 1 millimeter thick.
Acute peripartum TTTS happens just before or during birth. TAPS is a long, slow transfer of blood from one baby to the othe r.
Only milliliters of blood moves from the donor to the recipient daily, and the most reliable way to detect it is via MCA dopplers.
It happens slowly over a long period of time. However, the reticulocyte counts in acute TTTS twins are very similar between donor and recipient. Acute anemia happens with rapid blood loss, and chronic anemia happens with slow blood loss. Placental color dye injection is also an important diagnostic tool to distinguish between the two conditions. In TAPS, there are only tiny connections. We do know that it is rare, but that it still can happen. However, the long-term effects of spontaneous TAPS are serious.
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. 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. Being told that you are carrying twins or triplets is truly an exciting and blessed moment.
Even with this diagnosis, there is considerable hope for your babies. We will help you. You are not alone. The type of placenta nurturing identical twins plays a significant role in the development of complications in multiple gestation. Identical twins may either have their own separate placentas or they may share a common placenta. The impetus for and the timing of the embryo to split into identical twins is unknown, but the later this occurs the more complications are seen.
Based on , similar to , USA National Center for Health Statistics 4,, total births , the rate of multiple births per year is now 3. Since spontaneous pregnancy loss spontaneous abortion and pregnancy terminations elective abortions that occur prior to 20 weeks go uncounted by the C. Although infertility treatments have increased the rate of multiple birth, they have not diluted the expected incidence of identical twins even though multiple embryos are often produced and implanted.
Studies show a higher rate of identical twins up to 20 times with IVF in women having these treatments than occur naturally. The tragedy of TTTS is that there are two babies at least who begin the pregnancy healthy, without genetic defects, who suffer consequences related to their placenta type. With the introduction of ultrasound in , the survival odds greatly improved because treatment of the TTTS was now made possible while the mother was still pregnant see Warning Signs for the babies below.
In some circumstances the recipient twin my pass away from heart failure due to the excess blood , or in other cases the donor from the loss of blood or having a placental share too small to receive the necessary nutrients.
This sometimes made the situation better for the other twin, but in half of the cases the other twin also passed away or survived with severe birth defects. It is crucial for parents with a multiple gestation to determine their placental type early.
With monochorionic twins, you should watch carefully for the warning signs listed above. Since TTTS is a high-risk problem that can happen quickly and at any time in pregnancy, frequent examinations and ultrasound scans are necessary to catch the problem early. There were 51 cases that were classified into four variants of acute TTTS. Four cases were difficult to classify, with hemoglobin levels that were high normal and low normal, high normal and anemic, or low normal and polycythemic.
Three publications defined the incidence for acute perinatal TTTS of 1.
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