Fetal Surgery Saves Twins
On August 13, 2005, Heather and Mike Little of St. Louis, Missouri, learned Heather was pregnant and having twins.
Heather's OB/GYN referred her to specialist E. Mike Vlastos, MD, who confirmed Heather was carrying monochorionic diamniotic twins. Dr. Vlastos followed Heather closely and confirmed the diagnosis of twin-twin transfusion syndrome (TTTS) at 16 weeks.
Dr. Vlastos contacted the Fetal Care Center of Cincinnati, and soon afterwards, Mike and Heather drove from St. Louis to Cincinnati for their appointment at the Fetal Care Center.
Team Meeting and Difficult Decision
Heather underwent 12 hours of testing and met with Timothy Crombleholme, MD, FACS, FAAP, director of the Fetal Care Center, and William Polzin, MD, associate director, as well as with other members of the fetal care team.
The tests and consults ultimately revealed that Heather and Mike would have to make a difficult decision between amnioreduction or laser surgery to coagulate the blood vessel connections between the fetuses. "There were no problems as far as the babies' hearts were concerned," Heather recalled, but there were other problems that would require Heather and Mike to make a tough decision.
The decision was whether to first try amnioreduction—removal of excess amniotic fluid from the recipient twin—or to have laser surgery to coagulate or block the blood vessel connections between the fetuses. Because amnioreduction does not treat the cause of TTTS, but only one of its effects, the fluid is likely to accumulate again, which would require another amnioreduction. Some studies have shown a better outcome with laser surgery, known as selective fetoscopic laser photocoagulation, although it has not been shown conclusively that laser surgery reduces the incidence of neurological and other developmental problems.
Heather and Mike weighed what they had learned about the risks and benefits of both choices and called Dr. Vlastos. "He told me he thought it was pretty serious, and we should do whatever we could," says Heather. "It was a very hard decision, but we decided to go ahead with the surgery."
Fetal Surgery
Heather underwent fetal surgery at the Fetal Care Center at Cincinnati Children's to selectively sever blood vessel connections between the twins. She had an epidural for the procedure, which took about two hours, and Dr. Crombleholme disconnected 11 blood vessels between the twins. "It was a very aggressive form of TTTS, and we made a good decision," Heather says.
After recuperating for a few days Heather and Mike returned home. Heather did not have to return to the Fetal Care Center for the remainder of her pregnancy, but she stayed on modified bed rest until delivery and was followed extremely closely by Dr. Vlastos.
Twins Delivered
Heather delivered her twins by caesarean section on January 27, 2006, at St. Johns Mercy Medical Center in St. Louis. Olivia, who had been the recipient twin in utero, weighed 3 pounds, 15 ounces and was 15½ inches long. Sophia, who had been the donor twin, was 2 pounds, 9 ounces and 13 inches long.
"Dr. Crombleholme told me that making it to 30 weeks of pregnancy would be a victory, and I made it to 31," Heather reports.
Although Heather left the hospital after four days, the girls had to spend almost two months in the hospital's neonatal intensive care unit. By late July 2006, Olivia was 16 pounds (considered normal for a baby that age), and Sophia was 11 pounds, 5 ounces.
The Fetal Care Center of Cincinnati has treated 232 cases of TTTS since 2004 and is a unique collaboration among three leading medical institutions – Cincinnati Children's Hospital Medical Center, Good Samaritan Hospital and The University Hospital.
