Delayed Diagnosis of Twin-Twin Transfusion Syndrome in Humanitarian, Resource-Limited Settings: A Case Report

¹Faculty of Medicine, Gulu University, Gulu, Uganda

²Faculty of Epidemiology and Population Health, London School Hygiene and Tropical Medicine, London, United Kingdom

³Department of Medical Microbiology, Faculty of Medicine, Gulu University, Uganda

⁴Department of Public Health, Gulu University, Uganda

⁵The AIDS Organization, Kampala, Uganda

⁶Department of Sexual and Reproductive Health, Gulu University, Uganda

*Corresponding author: Jerom Okot, Faculty of Medicine, Gulu University, Gulu, Uganda, Tel: +256769641285, E-mail: [email protected]

Citation: Okot J, et al. (2026). Delayed Diagnosis of Twin-Twin Transfusion Syndrome in Humanitarian, Resource-Limited Settings: A Case Report. Cases. 5(1):27.

Copyright: Okot J, et al. © (2026).

ABSTRACT

Background: Twin-to-twin transfusion syndrome, though rare, poses risks for fetal demise if undetected. This late-diagnosed Twin-Twin Transfusion Syndrome case from South Sudan demonstrates persistent challenges in identifying high-risk pregnancies in humanitarian settings. Case presentation: A 38-year-old multigravida at unknown weeks’ gestation presented with fever, labour pains, drainage of liquor, and fetal hand prolapse. Her antenatal care only reported non-specific symptoms without most diagnostics. Evaluation revealed malaria, suspected twin pregnancy, and malpresentation. Undiagnosed Twin-Twin Transfusion Syndrome became apparent only during emergent cesarean delivery, finding a demised anomalous donor twin. The acute intrapartum decompensation pointed to stage V Twin-Twin Transfusion Syndrome. Conclusion: This case reinforces literature on missed screening opportunities to recognize Twin-Twin Transfusion Syndrome before Quintero staging with poorer prognoses. Subtle signs like sudden abdominal enlargement during third trimester were likely overlooked due to limited access to comprehensive ultrasound and Doppler surveillance. Strengthening displacement-sensitive antenatal protocols, building frontline imaging capacity, improving provider awareness, and prompt referrals could help mitigate Twin-Twin Transfusion Syndrome -related morbidity and mortality in marginalized populations. Global health efforts must address these persisting care gaps in pregnancy surveillance and access to specialty care, especially in humanitarian settings.

Received Date: November 14, 2025
Publication Date: March 30, 2026

Keywords: Twin-Twin Transfusion Syndrome, Monochorionic Twins, Humanitarian Settings, Low-Resource Obstetrics, Prenatal Diagnosis, Northern Uganda