The enclosed articles explain the importance of bed rest and increased protein and calories when a mother is pregnant with multiples. The importance of bed rest and increased protein and calories increases when you are diagnosed with twin to twin transfusion syndrome.

Because of polyhydramnios, the uterus is enlarged beyond what it would be for the current gestational week for multiples. The mother is at increased risk for pre-term labor beyond what a mother with multiples would ordinarily experience. Upright positioning adds pressure on the cervix and should be avoided. Checking the cervix and putting in a cerclage has helped save as much as 25% of TTTS babies because of the weakened cervix. It is crucial for the cervix to be checked every visit by ultrasound. Having the mother lay on her left side, on the couch, in bed, in a recliner, outside on a lawn chair, on the floor with her kids, helps reduce pressure to the cervix and prevent pre-term delivery. We highly recommend parents to also call the National Sidelines Organization and order one of their packets on bed rest. We have enclosed some of their information for you to read at this time.

Dr. Julian De Lia has investigated the nutritional aspects of TTTS. He recommends that his patients drink 3 cans per day of either Boost or Ensure High Protein in addition to their meals. Dr. De Lia explains, "TTTS patients at mid-pregnancy have severe hypoproteinemia and anemia. These maternal metabolic parameters may influence fetal TTTS characteristics and explain maternal sensitivity to intravenous fluid in complicated multiple pregnancies in general. We believe our data are sufficient to support the use of nutritional supplements in the management of early (monochorionic twins with subtle growth and amniotic fluid differences) and severe TTTS regardless of specific invasive therapy used (i.e., fetoscopic placental laser surgery, reduction amniocentesis, septostomy, etc.)

We have seen nutritional therapy and rest help many women. Not only do they begin to feel better, not being malnourished anymore, but in some, the signs of the TTTS go away! Nutritional therapy has helped avoid laser surgery or other treatments. Mothers also feel immediate relief that there is something they can do right away to help their babies.

Based on our contact with thousands of TTTS pregnancies and the research being done by Dr. De Lia and his staff at the International Institute for the Treatment of TTTS, this is extremely important information. REMEMBER: nutritional therapy, bed rest, and weekly cervix checks by ultrasounds and cerclages when necessary.