Twin to Twin Transfusion Syndrome: An Investigation into Nursing Care Concerns Surrounding Prevention of Complications, Prenatal Viability, Postnatal Care and Bereavement

Twin to Twin Transfusion Syndrome (TTTS) complicates multiple gestation pregnancies as a result of arteriovenous vascular connections within a monochorionic placenta. Untreated, TTTS carries an 80-90% prenatal mortality rate and the majority of survivors will have significant neurological dysfunction (Ward, M.A., 2013). Survival rates and neurologic outcomes improve significantly when treated prior to advanced stage disease, but only one-third of referrals for suspected TTTS are initiated prior to the development of advanced stage disease (Gandhi et al., 2012) and many cases worldwide progress untreated (Akkermans et al., 2014). Prompt detection, by initiating screening sonograms early in pregnancies, is required to increase survival rates. Referral for treatment must also be done urgently to an experienced facility. With current treatment, approximately 15.5% of neonates will have heart disease (Basaranagiu et al., 2014) and all survivors of advanced stage disease will require NICU admission (Pruetz et al., 2011) for medical issues related to prematurity, respiratory distress, hemodynamic imbalances, heart disease, neurological problems and hyperbilirubinemia (Squires, L.S., 2013). Awareness and education of nursing care concerns for TTTS must be increased, including prevention measures for complications, prenatal viability interventions, postnatal care and bereavement. The purpose of this paper is to investigate best practices in the care and education of families experiencing TTTS