Twin-to-Twin Transfusion Syndrome Treatment & Management

Updated: Aug 03, 2018
  • Author: Terence Zach, MD; Chief Editor: Ronald M Ramus, MD  more...
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Approach Considerations

The most common procedure to treat TTTS is reduction amniocentesis. This procedure involves draining the amniotic fluid from around the recipient twin. This procedure may improve circulation in the donor twin especially if the anastomosis are superficial in the placenta and the TTTS is a lower stage. This procedure may need to be performed multiple times during the pregnancy.

Fetoscopic laser photocoagulation of chorionic plate vessels is a highly specialized procedure performed in a few centers around the world. This is mostly reserved for more severe cases, especially those that do not respond to amnioreduction. In pregnancies treated with fetoscopic procedures, the overall survival is 75% with 85% having at least 1 fetus survive. [8]  The fetal death rate for the donor is higher that the recipient following this procedure. [9]  A study by Slaghekke et al that included 274 women with TTTS reported that laser coagulation of the entire vascular equator (Solomon technique) was associated with a reduction in twin anaemia polycythaemia sequence (3% vs 16% for the standard treatment) and recurrence of twin-to-twin transfusion syndrome (1% vs 7%). [10]  Another study by Van Klink et al found no difference in the long-term neurodevelopmental outcome in surviving patients with TTTS treated by the Solomon technique compared to the standard laser technique. [11]


Timing of delivery depends on multiple factors. The ideal would be for delivery at term; however, evidence of lack of fetal growth or nonreassuring antepartum testing or preterm labor may result in a premature delivery.

Medical care of twins after birth is directed toward problems related to prematurity, anemia, polycythemia, and hydrops fetalis.

  • Severely anemic donor twins may require packed RBC transfusions or partial exchange transfusions.

  • Polycythemic recipient twins may require partial exchange transfusion to lower serum hematocrit levels.

  • Newborns with hydrops fetalis may require mechanical ventilation, thoracocentesis, pericardiocentesis, and paracentesis.


Nutritional supplementation with commercially available dietary supplements during pregnancies has been reported to reduce the severity and incidence of TTTS. In addition, patients who took dietary supplements required fewer invasive procedures. [12]