TTTS: Twin-to-Twin Transfusion Syndrome

10 March 2022

Serious injury partner Andrea Rusbridge raises awareness of TTTS and comments:

“These claims are complicated and difficult because there are risks inherent with any treatment and especially so with high-risk pregnancy. 

Although these cases are rare, it can be shown that with the right treatment and continuous monitoring, TTTS can be resolved whilst being conscious of the inherent risks of high-risk pregnancies.” 

What is Twin to Twin transfusion? 

Twin to Twin Transfusion Syndrome (TTTS) is a rare condition where one twin receives too much blood and the other too little through a shared placenta. It is caused by abnormal connecting blood vessels in the twins' placenta (Antenatal care with twins - NHS (

TTTS affects around 10-15% of identical twins that share the same blood supply through the placenta. Also known as Monochorionic diamniotic twins, MCDA occurs in about 1 in 300 pregnancies. TTS is usually diagnosed between 18 – 20 weeks gestation. 

This condition can be life threatening to one or both twins if they are not regularly monitored through ultrasound scans. If TTTS is left untreated, there is a risk of death for one or both twins due to lack of blood and oxygen reaching vital organs. 

Treatment available

One form of treatment for this condition is laser therapy, which can split the placenta to resolve TTTS.  However deep vessels within the placenta are not visible to doctors when performing this treatment and therefore it is possible for TTTS to return.

In the event there is a possibility of premature labour, steroid injections can be administered to assist babies with the development of their lungs to help them breathe. (

This was the case for a mother in Northampton. She was informed there were concerns of early labour and therefore steroid injections were administered before 28 weeks, to help with lung development in her twins.  A decision was made to undergo an emergency caesarean section and happily her twins were born healthy at 32 weeks.

Our client

Such early interventions are essential in these cases. Andrea Rusbridge, clinical negligence specialist, is acting for a client who was pregnant with MCDA identical twins with TTTS. We are exploring a claim for one of the twins, who suffered from a brain injury and has been diagnosed with cerebral palsy due to the delay of steroid injection treatment.



This information is for educational purposes only and does not constitute legal advice. It is recommended that specific professional advice is sought before acting on any of the information given. © Shoosmiths LLP 2024

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