Children's Hospital Colorado
Nicole, treated for TTTS at Children's Colorado, sits with her school-age twin girls.

TTTS Diagnosis and Decision

Coming to terms with TTTS

When their pregnancies became high risk, Nicole and Alyssa came to the Colorado Fetal Care Center. While their stories are unique, their journeys are the same.

See what it was like for these families to receive a twin-to-twin syndrome (TTTS) diagnosis and to say "yes" to fetal surgery.


A graphic illustration of twin-to-twin transfusion syndrome.

TTTS: the basics

Twin-to-twin transfusion syndrome (TTTS) is a serious, rare fetal condition that can develop in utero when identical twins share a placenta.

Get an in-depth overview of this disease, along with twin-to-twin syndrome symptoms, what the babies experience, how it's diagnosed and treatment options.

Learn more about TTTS

Facing a TTTS diagnosis

We think carrying twins is work enough, which is why we're here to handle the rest.

At our Colorado Fetal Care Center, we offer the most comprehensive, state-of-the-art testing, counseling and treatment for TTTS available. And thanks to our care coordinators, all of your appointments will take place in one day, in one location.

Learn more about your visit to our fetal care center

Up to 10 Multidisciplinary experts collaborating on your case
5 Fetal surgeons

What is TTTS?

Nicholas Behrendt, MD, maternal fetal medicine specialist at our Colorado Fetal Care Center, explains twin-to-twin transfusion syndrome, how it develops, the stages of TTTS and why the disease is dangerous to developing twins.



Your guide to the TTTS stages

The stages of TTTS represent the severity of the fetuses' condition and the complications each baby may experience.

The stage of your babies' TTTS helps your care team to design the optimal treatment plan and to determine whether fetal intervention is necessary.

See what both fetuses experience and which treatments are possible at each TTTS stage.

Signs and symptoms

Difference in amniotic fluid levels: one twin has too much fluid and the other has too little

Potential intervention

  • Monitor closely via frequent ultrasounds
  • Amnioreduction (drainage of amniotic fluid)

Signs and symptoms

Donor twin's bladder isn't visible

Potential intervention

  • Monitor closely via frequent ultrasounds
  • Amnioreduction
  • Laser procedure

Signs and symptoms

Abnormal blood flow in the umbilical cords and/or abnormalities in fetal heart function

Potential intervention

Laser procedure followed by amnioreduction

Signs and symptoms

Fetal hydrops: abnormal fluid accumulation for either fetus in the skin, heart, lungs or abdomen

Potential intervention

Laser procedure followed by amnioreduction

Signs and symptoms

Loss of one or both fetuses

Potential intervention

Possible evaluation of surviving fetus and further planning

Note: Potential fetal intervention relies on many factors during evaluation and therefore may vary. Ask your doctor to learn more about the Cincinnati Modification of Quintero Staging System that we use at Children's Colorado. This helps determine what fetal interventions could be possible according to your unique case of TTTS.

Choosing a fetal care center

All fetal care centers aren't alike. Some may only do evaluations or diagnostics, while others may not have a depth of experience treating your babies' fetal condition, meaning you may need to travel elsewhere for treatment.

Before you entrust a fetal care center with your babies' future, make sure they have the capabilities, technologies and expertise to care for you and your babies throughout – and even after – your pregnancy.

Watch to learn what questions you should ask before choosing a fetal care center.


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Browse and connect with world-class maternal and fetal medicine specialists at Children's Hospital Colorado.

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Meet more patients

Your journey is unique, but you're not alone. Moms across the country come to us for the diagnosis and treatment of their babies' TTTS.

Read their success stories
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Advanced fetal treatment resources

Our Colorado Fetal Care Center cares for moms and babies with the most complex fetal conditions.

See what we offer
Jenna Boomer, care coordinator at Children's Colorado.

"Whatever we can do, we're willing to do."

Jenna Boomer, care coordinator

Partnership with the University of Colorado School of Medicine

Children's Hospital Colorado partners with the University of Colorado School of Medicine, where many of our physicians and care providers serve as faculty.


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