What is a potential complication of the donor twin in twin-to-twin transfusion syndrome?

In twin-to-twin transfusion syndrome (TTTS), there is an unequal sharing of blood supply between the two twins—typically, one twin (the donor) loses blood to the other twin (the recipient). The donor twin experiences insufficient blood volume, leading to severe anemia and potential ischemic injury due to a decrease in perfusion and oxygenation. When the donor twin is under perfused, it can develop ischemic injury, contributing to a range of complications.

Ischemic injury in this context refers to the damage that occurs when tissues do not receive enough stable blood flow to meet their metabolic needs, resulting from the hypovolemic state caused by the unequal transfusion. Therefore, hypotension in the donor twin can lead to significant dysfunction of vital organs, exacerbating the risks associated with TTTS.

Hyperinsulinemia, increased amniotic fluid, and polyhydramnios are typically associated with the recipient twin, who is over-perfused and may develop excessive fluid due to elevated cardiac output and increased urine production. These conditions do not directly relate to complications stemming from the donor's compromised status in TTTS.