Children's Hospital Colorado

TTTS Diagnosis and Decision

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Coming to terms with TTTS

Twin-to-twin transfusion syndrome (TTTS) is a disorder that affects identical twin pregnancies. It can occur when two fetuses share a placenta because there isn’t a barrier separating the two fetuses from each other. At the Colorado Fetal Care Center at Children’s Hospital Colorado, our doctors are experts at identifying and treating twin-to-twin transfusion syndrome.

Our families discuss their TTTS diagnosis

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

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

TTTS resources for families

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

TTTS: the basics

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

At the 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

What is TTTS?

Nicholas Behrendt, MD, maternal fetal medicine specialist, 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

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
  • 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.

UP TO 10 Multidisciplinary experts collaborating on your case
5 Fetal surgeons
88% TTTS survival rate of one or both twins (since 2012)
Jenna Boomer, care coordinator at Children's Colorado.
"Whatever we can do, we're willing to do."
Jenna Boomer, care coordinator

Additional fetal cardiology resources

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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