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Twin-to-twin transfusion syndrome (TTTS) is a rare but life-threatening complication that can affect pregnancies with identical twins sharing a placenta. In a deeply personal episode of the Healthful Woman podcast, Rachel shares the profound challenges, heartbreak, and resilience she experienced during her battle with TTTS.​

The Beginning: Hope, Family, and Cautious Optimism

Rachel’s early experience with pregnancy was shaped by a large, close-knit family, many with their own pregnancy struggles. Despite the awareness, she maintained a positive outlook, recalling, “I don’t usually expect the worst to happen to me. I generally look at things in a way of like the best is going to happen. So, going into pregnancy, even though I definitely was more aware than most people of what could go wrong …I was more excited than nervous.” Her first two pregnancies ended in early miscarriages, but she found hope in being able to conceive, recognizing the silent burdens others, including her close friends and family, face with infertility.

The Diagnosis: An Unexpected Setback

Rachel’s joy of being pregnant brought a mix of anxiety and fear after the discovery that she was pregnant with monochorionic twins, meaning one placenta. Around 19 weeks, concerning signs like contractions and differences in amniotic fluid levels between her twins led to a diagnosis of a short cervix and twin-to-twin transfusion syndrome (TTTS). TTTS results from an imbalance of blood flow across the placenta, where the blood of one twin (the donor) is transferred through the placenta to the other (the recipient), causing risks for both. Without intervention, the condition is often fatal for one or both babies, which required Rachel and her care team to make an urgent treatment decision.

Treatment Options and Heartbreaking Choices

After her TTTS diagnosis and learning about her short cervix, Rachel faced three options: do nothing (almost certainly losing both twins), undergo a laser procedure at a specialized treatment center to try to separate the placenta into two, or have a radiofrequency ablation (RFA) to stop one of the twins’ blood supply, which meant sacrificing one of the twins. Rachel admits that she could not be part of the decision to choose one twin over the other.​ When time and circumstances ultimately removed the option of laser intervention, her doctor proceeded with RFA in hopes of saving the stronger twin. Rachel candidly describes the emotional blur, stating, “Even though I knew that I was doing this to save one baby, it felt like the worst thing was happening…I felt so horrible. I felt like I was ending my baby’s life, and it was so sad.

Finding Strength in Grief

Unfortunately, Rachel continued to suffer complications in the weeks following her RFA procedure. Her fluid levels continued to stay high, despite several treatments to remove the excess fluid, and she continued having contractions. At 23 weeks, she went into preterm labor and had to be rushed to the nearest hospital. Her baby then had to be transferred to another hospital with a higher-level NICU. Rachel describes the painful experience of first seeing her baby girl: “She was in pain. I remember she had red marks on her arms and her feet. And…[the nurse] said that the light from the monitor to monitor the baby’s heart rate or whatever it was, the baby’s skin is so sensitive that it was burning the baby’s skin.” Shortly after, within a few days of being born, the baby passed away. Despite her unimaginable heartbreak, Rachel remembers telling her doctor, “This was God’s plan. This is what was meant to be. And nothing could have changed.”

Listen to the Healthful Woman Podcast

Rachel’s story is a testament to strength amid unimaginable circumstances, and we hope her experience can bring understanding and hope to others navigating the same path. To listen to the full story, and its happy ending in Part 2, check out the Healthful Woman podcast.

For those seeking advanced pregnancy care, we also encourage you to schedule an appointment with our team of maternal-fetal medicine specialists.

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!