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Warning-sign checks

Twin-to-twin transfusion syndrome: when to get help

Go through these in order and stop at the first one that applies. If you are reading this for someone else, answer for them.

  1. 1

    Is any of this happening now?

    Call 911

    Call emergency services for heavy bleeding, severe breathing difficulty, collapse, a seizure, or pain that is sudden and extreme.

    These symptoms do not always mean TTTS has worsened, but they need timely assessment.

    Other emergency signs, for anyone
    • Someone who is struggling to breathe, gasping, choking, or cannot get words out
    • Someone who has chest pain, tightness or pressure lasting more than a few minutes
    • Someone who has sudden weakness or drooping on one side of the face or body, slurred speech, or sudden confusion
    • Someone who is unconscious, or cannot be woken
    • Someone who is bleeding heavily and it will not stop with firm pressure
    • Someone who has had a seizure that will not stop, or does not wake up afterwards
    • Someone who has lips or skin that look pale, blue, grey or blotchy
    • Someone who you believe has taken an overdose or swallowed something poisonous
  2. 2

    Is any of this happening?

    Be seen today

    Contact your maternity or fetal medicine team promptly if your abdomen suddenly becomes much larger or tighter, or if you develop increasing pressure, cramping, or shortness of breath.

    Seek urgent maternity assessment for:

    • Reduced or changed fetal movement after movements have become established
    • Regular contractions or signs of labor
    • Vaginal bleeding
    • A gush or ongoing trickle of fluid from the vagina
    • Severe or persistent abdominal pain
    • A severe headache, vision changes, or sudden swelling
  3. 3

    Does any of this apply?

    Book an appointment

    Keep every scheduled ultrasound and pregnancy appointment, even if you feel well.

    Routine questions about scan results, future appointments, delivery planning, or emotional support can be discussed during scheduled follow-up.

Every sign above is quoted from the sofidex article on Twin-to-twin transfusion syndrome. If you are not sure, err upward — it is always reasonable to be checked.