Treatment Overview
Twin-to-Twin Transfusion Syndrome Fetal Intervention Service in Korea) is a serious complication unique to identical (monochorionic) twin pregnancies, where both fetuses share a single placenta with interconnected blood vessels. This condition causes uneven blood flow between the twins — one (the donor twin) becomes undernourished with decreased amniotic fluid, while the other (the recipient twin) receives excessive blood, leading to over-circulation and potential heart failure.
In Korea, advanced Fetal Intervention Services for TTTS provide state-of-the-art diagnosis and laser surgical treatment aimed at restoring balanced blood flow and improving survival rates for both twins. These services are led by specialized maternal-fetal medicine teams equipped with advanced imaging, fetoscopic laser surgery systems, and neonatal intensive care facilities.
With Korea’s integration of technology, surgical precision, and comprehensive perinatal support, TTTS management outcomes are among the best in Asia, ensuring safety and stability for both mother and babies.
Purpose & Benefits
Purpose:
- To diagnose TTTS early and accurately in monochorionic twin pregnancies.
- To treat vascular imbalance in the placenta through minimally invasive laser surgery.
- To prevent severe complications such as preterm birth, fetal demise, or neurological injury.
- To monitor fetal health continuously throughout the pregnancy and postpartum period.
Benefits:
- High survival rates for one or both twins through timely intervention.
- Reduced risk of heart failure and brain injury in the recipient twin.
- Lower incidence of preterm birth compared to untreated cases.
- Access to world-class fetoscopic surgery and fetal monitoring technologies.
- Comprehensive maternal support from diagnosis through delivery and recovery.
Ideal Candidates
- Women carrying monochorionic diamniotic twin pregnancies diagnosed with unequal amniotic fluid levels or growth discordance.
- Mothers whose prenatal ultrasound shows polyhydramnios in one twin and oligohydramnios in the other.
- Pregnancies between 16 and 26 weeks gestation, where surgical intervention offers the highest benefit.
- Cases confirmed through Doppler ultrasound showing abnormal umbilical cord blood flow between the twins.
- Women referred for high-risk pregnancy management due to fetal cardiac complications or growth restriction in one twin.
Possible Risks & Complications
Even with expert care, TTTS remains a complex condition with potential complications:
- Preterm labour following fetoscopic intervention.
- Preterm premature rupture of membranes (PPROM) after laser surgery.
- Loss of one or both fetuses if the disease is advanced or progresses rapidly.
- Residual vascular connections, causing recurrence or twin anemia-polycythemia sequence (TAPS).
- Neurological complications such as brain injury if fetal circulation imbalance persists.
- Maternal risks such as infection, bleeding, or fluid imbalance post-surgery.
Korean hospitals minimize these risks through precise surgical planning, sterile fetoscopy techniques, and continuous follow-up care.
Medical & Surgical Techniques Used
Korea’s TTTS fetal intervention programs combine advanced diagnostic imaging and minimally invasive surgical expertise:
- Detailed Ultrasound and Doppler Assessment: Determines the stage of TTTS based on the Quintero classification system and evaluates fetal heart, bladder, and amniotic fluid.
- Fetoscopic Laser Photocoagulation: The gold-standard treatment where abnormal vascular connections on the shared placenta are sealed using laser energy to stop unbalanced blood flow.
- Amnioreduction: In cases of mild TTTS or where laser surgery is not immediately possible, excess amniotic fluid is drained to relieve pressure.
- Fetal Echocardiography: Evaluates cardiac function in both twins to detect signs of strain or heart failure.
- Intrauterine Transfusion (if needed): Restores balanced red blood cell volume when severe anemia occurs in one twin.
- Continuous Maternal and Fetal Monitoring: Real-time ultrasound imaging before, during, and after the procedure to assess twin response and maternal safety.
- NICU Readiness: Immediate neonatal support for premature or compromised twins at delivery.
Korean hospitals perform fetoscopic laser ablation procedures using high-definition imaging and fiber-optic systems that allow precise visualization of placental vessels, enhancing safety and success rates.
Recovery & Aftercare
- Hospital Observation: Mothers remain under hospital supervision for several days post-procedure to monitor uterine contractions and membrane integrity.
- Medication Support: Tocolytics and antibiotics may be administered to prevent preterm labour and infection.
- Follow-Up Ultrasounds: Frequent imaging checks ensure no recurrence of TTTS and monitor twin growth and amniotic fluid balance.
- Emotional and Psychological Support: Counseling is provided for parents coping with the stress of a high-risk twin pregnancy.
- Delivery Planning: Timing and mode of delivery are determined by fetal growth, stability, and gestational age, with NICU support readily available.
- Postpartum and Neonatal Care: Newborns are closely monitored for breathing difficulties, anemia, or heart function irregularities.
Results & Longevity
Korean TTTS programs deliver some of the highest success rates globally for twin survival and neurological outcomes:
- Survival of at least one twin exceeds 90%, and dual survival rates reach 70–80% in many cases.
- Reduced risk of preterm delivery through early detection and controlled intervention.
- Improved neurological outcomes with lower rates of developmental complications in surviving infants.
- Maternal recovery is rapid, thanks to minimally invasive fetoscopic techniques and expert aftercare.
Long-term follow-up studies show that twins treated in Korea’s TTTS programs typically exhibit normal growth and neurodevelopment, supported by advanced pediatric follow-up systems.
Treatment Process in Korea
1. Early Diagnosis and Staging
Specialized ultrasound and Doppler studies are conducted to assess fluid levels, blood flow, and placental structure. The Quintero staging system (Stage I–V) determines the severity and guides treatment planning.
2. Preoperative Counseling and Planning
The maternal-fetal medicine team provides detailed counseling on treatment options, expected outcomes, and potential risks. Hospital admission and procedure scheduling follow immediately for advanced stages.
3. Fetoscopic Laser Surgery
A small fetoscope is inserted into the amniotic cavity under local or regional anesthesia. The surgeon visualizes the placental vessels and seals abnormal connections with laser energy, restoring independent circulation for each twin.
4. Postoperative Monitoring
Mothers remain under observation for uterine contractions and amniotic fluid levels. Ultrasound scans confirm fetal well-being and detect any early complications.
5. Delivery and Neonatal Support
Delivery is planned in a tertiary care hospital equipped with NICUs to manage potential preterm or low-birth-weight infants.
Why Korea Is a Top Destination
- Globally recognized expertise in fetal laser surgery for TTTS.
- State-of-the-art fetoscopy equipment and advanced perinatal imaging technologies.
- Experienced multidisciplinary teams combining obstetrics, fetal surgery, and neonatology.
- High survival and low complication rates in international comparative studies.
- Comprehensive care for international patients, from diagnosis to postnatal recovery.
Unique Korean Methods & Technology
- Use of AI-assisted vascular mapping systems for precise identification of placental blood flow.
- High-definition fetoscopic visualization ensuring complete vessel ablation.
- Advanced perinatal simulation systems for real-time surgical training and safety.
- Integrated mother–baby monitoring networks connecting prenatal and neonatal units for seamless care.
Cost Range
The cost of TTTS intervention in Korea varies by hospital and gestational stage, but approximate ranges include:
- Diagnostic imaging and staging assessment: USD 800 – 1,500
- Fetoscopic laser photocoagulation surgery: USD 10,000 – 18,000
- Amnioreduction procedure: USD 2,000 – 4,000
- Hospitalization and postoperative monitoring: USD 3,000 – 6,000
- Delivery with NICU support (if preterm): USD 8,000 – 15,000
- Postnatal follow-up and rehabilitation programs: USD 1,500 – 3,000
International patients are often provided with complete treatment packages including interpretation, accommodation, and coordinated care from diagnosis to discharge.
Popular Hospitals and Centers in Korea
- Asan Medical Center (Seoul): Renowned for fetal laser ablation and complex twin management programs.
- Samsung Medical Center (Seoul): Advanced imaging and high-risk pregnancy care integration with world-class NICU facilities.
- Severance Hospital (Yonsei University Health System): Pioneering fetal surgery team offering specialized TTTS care.
- CHA Bundang Women’s Hospital: Expert in fetoscopic surgery and twin pregnancy monitoring.
- MizMedi Women’s Hospital: Provides personalized TTTS screening, intervention, and postpartum recovery support.
