At their 20-week ultrasound, Melissa and Trae Rickford of Lawrence, Kansas, learned that they were having identical twin girls. The news didn't come as a complete surprise – Melissa had grown larger and more quickly than her first pregnancy, and she has a family history of twins. But the ultrasound did show something unexpected: one of the babies was much bigger than the other and had substantially more amniotic fluid.
Melissa and Trae were immediately referred to a perinatal specialist in Kansas City. Melissa received a follow-up ultrasound 2 days later and learned there were complications, but the details about what was wrong were fuzzy.
"Nobody would really tell us what was happening," Melissa says.
Melissa and Trae were referred to Carl Weiner, MD, maternal fetal-medicine specialist at The University of Kansas Health System in Kansas City. There, they received a heart-breaking prenatal diagnosis of twin-to-twin transfusion syndrome, or TTTS.
TTTS is a serious disorder that occurs in about 10-15% of monochorionic, identical twin pregnancies. Monochorionic twins share the same placenta, which connects the babies' blood supply through shared blood vessels. If the blood flow becomes unequal, one twin receives the majority of nutrients and grows more rapidly than the other. This can result in a number of complications and often leads to the loss of one or both babies.
"One of the greatest challenges we face happens to be monochorionic twins," Dr. Weiner says. "It’s a serious disorder and it poses significant risk. The progression of complications can happen very rapidly."