Meanwhile, the recipient twin is overloaded with blood and volume, and is urinating excessively as a result. Thus, the ‘donor’ twin will make a lot less - and sometimes no - urine. This is accomplished by emphasizing the blood flow to the most important organs (the brain and the heart) and shutting down less vital organs, such as the kidneys. When a fetus is anemic, or doesn’t have enough blood and oxygen, it tries to use what it has most efficiently. How Does This Blood Imbalance Affect the Fetus? As a result, if there are no connections flowing in the opposite direction, one twin receives too much blood and the other too little. Unfortunately, the corresponding vein that would normally bring the now nutrient-rich blood back to that same fetus instead is directed toward the other twin via this abnormal “arterio-venous” connection. More specifically, an artery branches off from the donor twin’s umbilical cord, entering the placenta in order to obtain oxygen and nutrients for the blood from the mother’s circulation. The twins do not have malformations, but one transfuses the other through abnormal or imbalanced blood vessel connections in the shared placenta. Twin-to-Twin Transfusion Syndrome (TTTS) is a serious, progressive disorder. In these instances, there may be significant transfer of blood from one twin (the so-called “donor”) to the other twin (the so-called “recipient”), resulting in twin-to-twin transfusion syndrome (TTTS). As a result of these connections, in about 10-15% of monochorionic twins (sharing one placenta) an imbalance in the circulations of the fetuses can develop. ![]() Because there is no barrier separating the two fetuses from each other, there are almost always blood vessel connections in the placenta shared by two fetuses in monochorionic twin (MC) pregnancies.
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