Twin to twin transfusion (TTTS)
TTTS is a condition that can be seen in the minority of identical
twins. When twins share a placenta (known as monochorionic), it is
possible that this sharing could be unequal and the result is a
disproportionate amount of blood flow to favor one baby. TTTS usually
presents in the mid-second trimester of pregnancy, although it may
sometimes present sooner and can cause extremely devastating
complications. One baby tends to be larger and has to pump the extra
blood therefore putting strain on the heart and excess urine production
causing excess amniotic fluid. The other baby is smaller, produces less
urine and therefore has too little amniotic fluid. Unfortunately,
without treatment the majority of babies with TTTS will not survive the
pregnancy. In many situations, treatment is available and careful
monitoring of the babies’ development will be important.
Placenta previa is a condition that occurs when the placenta grows in
the lowest part of the uterus and covers all or part of the opening to
the cervix. This becomes problematic because of a risk for bleeding
particularly when a woman goes into labor. These risks can be
significant and typically a cesarean section is performed to prevent
complications. If too much bleeding occurs a blood transfusion may be
necessary. Careful monitoring will be necessary throughout pregnancy. In
many cases the placenta starts low in the uterus and graduate moves out
of the way of the cervix as the uterus and placenta grow.
Premature rupture of membranes
Premature rupture of membranes (PROM) is when the amniotic sac
(membrane surrounding the baby) ruptures prior to 37 weeks gestation.
Depending on the gestational age and whether labor begins shortly
thereafter, PROM may or may not be a significant complication. If it
occurs near term, there may be no complications, but prolonged rupture
or rupturing significantly earlier than term can increase risk for
infection, induction of labor, and/or poor prognosis for the baby.
Preterm labor is when labor begins prior to 37 weeks. In some cases
interventions can be considered to stop the labor and allow the
pregnancy to continue closer to term and in other situations this may
not be possible. Depending on how far along the pregnancy is, this can
be a very serious complication that could result in significant
complications for the baby.