The blood volume of the recipient twin is increased, which can strain the fetuss heart and eventually lead to heart failure, and also higher than normal urinary output, which can lead to excess amniotic fluid (becoming polyhydramnios). The demise of the fetus is typically a result of ischemia related to the lack of blood flow. The lack of blood flow causes bowel atresia, brain damage, and kidney failure.TTTS usually develops during the period of peak placental growth, starting in week 16 and proceeding through week 25; after this point, the placentas growth decelerates, essentially stopping just after week 30. While TTTS has occasionally been detected beyond this timepoint, it is thought that its occurrence beyond week 30 may be due to a placental embolism that upsets the flow balance of the shared connections between the babies. TTTS is potentially lethal to either or both twins, no matter when it is detected. However, when detected past week 25, emergency delivery may be considered to rescue the babies if the TTTS is severe.Other than requiring a monochorionic twin (or higher multiple) pregnancy, the underlying causes of TTTS are not known. It is not known to be hereditary or genetic. Effects to the surviving fetus
The fetal demise of one of the twins during the second trimester of a monochorionic pregnancy can result in serious complications to the surviving fetus.
In Philippa Gregorys novel Wideacre (1987), the main character Beatrice Lacey nearly becomes addicted to laudanum when her eventual husband Dr. John MacAndrew prescribes it to her after her mothers death. In the adaptation Interview with the Vampire (1994), which was based on the 1976 novel with the same name, Claudia uses laudanum to try and dispose of Lestat: Under the pretext of making peace, she offers him some drunk noble-blood twins to feed on, when she actually had them overdosed with the said drug. In the film Tombstone (1993), Mattie Earp (Dana Wheeler-Nicholson), Wyatt Earps wife is addicted to laudanum. At the beginning of the film at the train station after her husband introduces her to his brothers and sisters-in-law she states, "Well, Wyatt, I couldnt find a single store that had laudanum anywhere." Her sister-in-law Louisa Earp (Lisa Collins) later said " Matter, Honey? Did you say you needed some laudanum? [...] I have some right here," hands Mattie a bottle and says, "Just be careful, now. Its full of hop," to which Mattie replies, "Oh, dont worry. I just get headaches sometimes." Later in the bedroom she and Wyatt shares, Mattie drinking out of a bottle, shows the effects of laudanum, hiding the bottle as Wyatt enters the bedroom asking, "Is that the opium Lou gave you? Its a new bottle, isnt it?