Research Project Hopes to Improve Outcomes for Unborn Twins Sharing the Same Placenta

A unique two-year research project to better identify the cardiac function of monochorionic twins with twin-to-twin transfusion syndrome (TTTS) has been unveiled by St Michael’s Hospital and Bristol's Clinical Research and Imaging Centre (CRICBristol) today [Thursday 17 November].

Monochorionic twins
Sleeping newborn identical boy twins.

Funded by The Capella Foundation, a charity that helps increase awareness of medical complications during pregnancy, the project will seek to find out how the syndrome develops and identify ways to improve survival outcomes.

The research team will investigate novel techniques, using the latest ultrasound imaging equipment from Toshiba Medical. New techniques for functional cardiac assessment will be developed in order to better diagnose and identify treatment that will help reduce the risks associated with the condition.

Monochorionic twins are twins that have a shared placenta. This is currently a much higher risk group of twins than those with separate placentas.

Data released by the Office of National Statistics (ONS), a government agency, has indicated that multiple birth rates are rising, with 10,989 multiple births in 2014 compared to 10,783 in 2013. According to 2015 NHS statistics, Monochorionic, diamniotic twin pregnancies make up approximately 30 per cent of all twin pregnancies and approximately 15 per cent of these are complicated by twin-to-twin transfusion syndrome (TTTS). This is a morbid condition that if untreated leads to the fetal demise in 90 per cent of cases, which is caused by the presence of unidirectional, intertwin, vascular anastomoses on the placenta causing a haemodynamic imbalance between the twins.

The research team led by Dr Sarah Newell at St Michael’s Hospital, part of University Hospitals Bristol NHS Foundation Trust, and the School of Clinical Sciences at the University of Bristol, will work with a team of seven including; two fetal medicine consultants, two neonatal consultants, and general obstetrician, a radiologist, a radiographer and a cardiac sonographer.

The team will investigate new techniques to investigate heart function for unborn monochorionic twins, using the latest ultrasound imaging equipment to scan the hearts of unborn twins, whilst they are in the uterus. The programme is currently scanning all twins with this condition across Bristol, Bath and the South West of England. Currently, St Michael’s is one of five national centres of excellence for the treatment of unborn monochorionic twins.

Dr Newell commented: “We believe we need to change the way we monitor unborn monochorionic twins in order to improve the outcomes of these pregnancies. Twin-to-twin transfusion syndrome is a serious condition that requires surgery, whilst the unborn twins are still in uterus. It carries with it a high risk than one or both twins might not survive. The current way we monitor and predict outcomes doesn’t sit with how the disease progresses, so we need to find a new way.

“Women pregnant with multiples are often alarmed to find themselves automatically placed in a ‘high-risk’ category. In fact, most women carrying twins, triplets or more will go on to have uneventful pregnancies and healthy babies. There are also some complications that arise only in a multiple pregnancy. Each of these is rare, but when they happen they do need medical attention and monitoring. Through this research we will establish improved scanning protocols and applications, leading to better, more precise treatment for these twins.”

The research will be undertaken using Toshiba’s Aplio 500 high-end ultrasound scanner. Its revolutionary High Density Architecture provides the researchers with clinical images of exceptional resolution and detail. Additionally, the system is equipped with a wide range of powerful clinical tools for advanced visualization, quantification and intervention for daily routines during this clinical research project.

Mark Hitchman, Managing Director, Toshiba Medical Systems, said; “Toshiba‘s heritage in applied research and development means that we have developed the technical capabilities to be an important partner in research of this kind.”