New Jersey Twin-to-Twin Transfusion Syndrome (TTTS) Lawyers

The likelihood of having twins is approximately 31.2 per 1,000 births, according to the Centers for Disease Control and Prevention, and that number has risen in the last few years. Twins are commonly known as fraternal or identical. Identical, or monochorionic, twins occur in approximately 70% of twin births. However, three types of twins exist. One type of twins occurs when two placentas and amniotic sacs each house a fetus. Alternatively, twins can share a placenta but have two separate amniotic sacs, or one placenta and an amniotic sac. The second type, one placenta and two amniotic sacs, produces identical twins and a higher risk of twin-to-twin transfusion syndrome. The condition occurs in 5 to 15% of monochorionic twin pregnancies. The condition typically arises in the second trimester, between the 16th and 26th week, and requires appropriate treatment to avoid complications. Like many conditions affecting pregnancies, it worsens if left untreated.

If you suspect that your twins’ injuries or death are the result of medical negligence involving twin-to-twin transfusion syndrome, consult with a knowledgeable and experienced birth injury attorney on our legal team who can further examine the circumstances and ascertain whether you have grounds to file a lawsuit. Our seasoned birth injury lawyers in New Jersey are highly equipped in the skills and resources necessary to conduct investigations of medical negligence, uncover evidence supporting malpractice, and zealously advocate for parents and their children. Call 866-708-8617 for a free review of your case.

The Meaning of Twin-to-Twin Transfusion Syndrome

Twin-to-twin transfusion syndrome (TTTS) begins when blood vessels in the placenta create an imbalance in blood flow, causing one twin to give too much blood to the other. The additional blood flowing from the placenta through the umbilical cord to the receiving twin causes a strain on the bladder when the kidney produces extra urine. The bladder enlarges and can cause polyhydramnios (too much amniotic fluid), heart failure, or swelling. The amniotic fluid must be optimal for proper fetal development, meaning a fetus must receive an adequate amount, but not an overwhelming amount. With TTTS, one fetus receives too little, and one receives too much.

Potential Complications of Twin-to-Twin Transfusion Syndrome

The risks associated with twin-to-twin transfusion syndrome include swollen tissue and heart failure from thickened blood, which may cause the recipient fetus to die. Excessive blood thickens and strains the heart to pump it. The donor fetus has the opposite problem of too little blood, which can cause organ failure. Furthermore, since they share placental blood vessels, the death of one fetus may cause brain damage or death of the other.

No Known Cause, But There are Signs of TTTS

Doctors do not know what causes TTTS, but an ultrasound at 10 to 14 weeks gestation can detect a twin pregnancy and whether the fetuses share a placenta. TTTS occurs only in twins sharing a placenta but not an amniotic sac. An ultrasound will also show a disparity in amniotic fluid between the two. Since the amniotic fluid affects the health and development of a fetus, physicians may also note whether one twin weighs significantly more or is far bigger than the other. They can also measure each fetus’s sac’s appropriate amniotic fluid level. Each sign of the condition has a definite stage from which a physician can ascertain the severity of the conditions using the Quintero staging system.

Stages and Progression of Twin-to-Twin Transfusion Syndrome

The first stage of TTTS manifests as the imbalanced amniotic fluid. The second stage is recognized by a missing bladder in one of the fetuses. Essentially, it does not appear on the ultrasound because it is empty. An ultrasound detects the third stage when irregular blood flow develops in the receiving fetus as circulation problems. Stage four appears as a swollen chest and abdomen, which means the receiving twin’s fluid buildup is causing heart failure. The last stage results in death.

Spectrum of Available Treatments for TTTS

Only specific hospitals offer treatment for TTTS through laser fetoscopy (fetoscopic laser photocoagulation or FLP), which is an option for pregnancies up to 26 weeks. Scoping later in the pregnancy raises the safety risk. During this surgical procedure, a tiny scope with a laser enters the mother’s abdomen through a small incision. The laser burns the blood vessels, causing fluid imbalance. The final part of the short procedure is vacuuming the excess fluid around the recipient fetus. FLP is more successful than other methods but does carry risks, such as fetal loss, premature rupture of the membranes, separation of the fetal and placental membranes (chorioamniotic separation), premature birth, amniotic fluid leaks into the mother’s intestines and liver, infection, bleeding, and injury to nearby tissue or organs.

Another option to treat TTTS is amnioreduction or amniocentesis. In this procedure, a doctor inserts a long, thin needle into the amniotic sac and withdraws large volumes of fluid in hopes of diminishing the effects of the syndrome. Risks of this treatment method range from miscarriage, to infection, leaking fluid, passing an infection on to the fetus, and Rh problems when incompatible blood from the mother and fetus intermix.

Diagnostic and Treatment Errors with Twin-to-Twin Transfusion Syndrome

Delayed diagnosis and treatment of TTTS can lead to fetal death. One reason for diagnosis delay is the confusion of the syndrome with other growth and development disorders associated with identical twins in utero. Intrauterine growth restriction and twin anemia polycythemia sequence are two such conditions. The former results in an unequal division of nutritional resources from the placenta that creates a size differential in the fetuses but no difference in amniotic fluid apportionment, and the latter results from tiny vascular connections, while TTTS results from too large connections.

A knowledgeable obstetrician should be able to tell the difference between the various conditions and take detailed tests to diagnose the correct syndrome so they can treat the condition properly. Each condition has distinct treatments. Stage one requires monitoring to see if the condition goes away or requires additional medical intervention. After stage two, a doctor should discuss the recommended treatment approach with the patient.

Confusing TTTS with another twin-related condition or delaying routine ultrasounds throughout the pregnancy may cause birth injuries or death to one or both fetuses. Any time during the pregnancy, a physician who fails to diagnose TTTS by ordering ultrasounds, blood tests, metabolic panels, chest x-rays, and blood tests to find signs of disease may be deemed negligent. In many cases, failure to identify signs, conduct appropriate testing, or sufficiently treat TTTS is considered medical malpractice supporting a legal claim against those responsible.

Failing to treat TTTS is a common issue in malpractice claims involving twin-to-twin transfusion syndrome. When FLP or amnioreduction could have saved one or both fetuses, a treating physician or hospital may be held responsible for not ensuring the appropriate treatment to improve survival rates for both babies. Hospitals employ healthcare professionals who are responsible for conducting laboratory tests, reading results, relaying information to treating doctors, obtaining treatment consent, administering medications, and administering other care and information. When a hospital’s employees make mistakes that lead to birth injuries, they, too, can be held liable to compensate those who are injured.

TTTS Malpractice Attorneys Fighting for Compensation for Injured Victims and their Families in NJ

A medical malpractice claim involving TTTS is medically and legally technical and complex, requiring a well-versed team of lawyers and medical experts who regularly deal with the terminology, practices, network of medical facilities and practitioners, and legal challenges that occur during negotiations and litigation for these claims. Fortunately, you have come to the right place if you have questions and concerns surrounding a possible claim for TTTS-induced injuries. Contact us today at 866-708-8617 or online for a free consultation and further exploration of your legal options regarding injuries or death due to twin-to-twin transfusion syndrome malpractice. We serve injured birth injury victims and their loved ones throughout New Jersey and consult on these cases across the United States.

Get specialized advice about your situation

  • Free Case Evaluation

Get your specific questions answered by completing our contact form

  • How do I know if my child has a pediatric malpractice case?

    If your child suffered an injury, complications, or a medical condition resulting from medical negligence, you may have grounds for a pediatric malpractice or birth injury lawsuit. Learn more.

  • How can I get help to pay for my child's medical bills?

    If a doctor, nurse, hospital, or other healthcare provider failed to provide adequate care for your child and they suffered harm, you can pursue compensation for medical expenses, pain and suffering, and more. Find out about damages.

  • How long do I have to file a pediatric malpractice claim?

    The statute of limitations to file a medical malpractice lawsuit varies from state to state. The time limits may begin when your child's condition is identified, not necessarily when it occurred. Contact us for information that applies to your child's specific case.

  • Get in touch.

Site By