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Universitätsklinikum Hamburg-Eppendorf (UKE)
University Medical Centre, Hamburg, Germany
Obstetrics and Prenatal Medicine
Twin to Twin transfusion syndrome (TTTS) is a disease of the placenta. It can develop in identical twins during pregnancy because of the presence of connecting blood vessels between the two umbilical cords.
Laser therapy for TTTS
The receiving foetus (the recipient) has too much blood volume, which can result in heart failure and death in the womb. The transfusing twin (the donor) has too little blood volume and may die due to malnutrition.
What is Twin to Twin Transfusion Syndrome?
The recipient produces excessive amounts of urine which leads to an increase in amniotic fluid volume. This may cause discomfort to the mother and result in pressure on the cervix, the lower part of the womb.
With continuing pressure the cervix may open resulting in miscarriage or preterm delivery. The donor twin hardly produces any urine and therefore has almost no amniotic fluid in his sac.
The twins themselves are completely normal in most of the cases. The problem lies in the placenta which then results in disturbed development in the twins.
For further details visit the Obstetrics page.
UKE is one of only a few centres in Europe to offer laser therapy to treat the cause of TTTS before amnioreduction is performed. This results in a significantly higher chance of subsequent normal development for the twins.
With an anterior placenta (on the near wall) of the uterus or following amnioreduction the procedure may be technically more difficult and UKE uses a special form of fetoscope which was specifically designed for this purpose.
The chance for survival of both twins is 70% and that for survival of at least one twin about 90%.
The UKE Obstetrics team
Prof Kurt Hecher
Prof Bernd Hüneke
Prof Thierry Somville
Mr Werner Diehl
Mr Peter Glosemeyer
Dr Manuela Lotz
Mr Gerd Ortmeyer
Dr Bettina Hollwitz
Head of Midwifery
The centre offers a full range of fetal diagnostic and therapeutic services including:
Prof. Kurt Hecher, Chairman of the Department, is one of the pioneers of fetoscopic ablation of vascular anastomoses in twin to twin transfusion syndrome.
Prof Kurt Hecher
Intrauterine surgical procedures such as cord coagulation and other techniques
Comprehensive non-invasive and invasive evaluation of pregnancies at risk for fetal anaemia and an active transfusion programme.
Evaluation and management strategies for placental dysfunction. The team has extensive experience with the management of fetal growth-restrictive disorders.
Prenatal counselling and first trimester diagnosis in affiliation with the Department of Human Genetics.
The unit is certified through the Fetal Medicine Foundation in the application of first trimester nuchal translucency scanning and risk analysis
It is estimated that 15% of identical twin pregnancies with a single placenta, or one in 2700 pregnancies develop twin to twin transfusion syndrome.
However, the true incidence may be higher since many patients with TTTS who have spontaneous miscarriage may not be reported.
How common is TTTS?
The most severe forms of the syndrome develop
in the middle of pregnancy, between 16-26
weeks of gestation.
PPM Consult Ltd. promotes selected clinics and certain specialities within individual hospitals where we believe the standards of care or medical equipment to be exceptional. We provide you with general information but we cannot advise or enter into correspondence about individual cases and we do not arrange or facilitate treatments. We shall not be responsible for the outcome of any treatment or failure to diagnose or treat and we recommend that all patients obtain professional medical advice on their proposed treatments.
Important note to all patients
There is repeated transfusion of small amounts of blood between the two twins through these connections.
The team has extensive experience with the counselling, pre-procedure assessment and management of complicated monochorionic gestations
The increased risk for significant neurological damage in surviving babies remains, but appears to be lower than the risk following serial amnioreduction (6% for severe and 7% for mild neurologic abnormalities).
Patients and families are supported with translation service, airport shuttle, driver service and many other services provided by the International Office of the UKE.
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