Cincinnati Children's Fetal Care Center

Patient Stories | Cravens triplets and TTTS

Triple the Fun, Not Triple the Trouble: Illinois Family Receives Expert Care at Cincinnati Children’s Fetal Care Center

For expecting parents, finding out about a new baby is an exciting moment. When Kiah Cravens and her husband, Rich, found out she was pregnant with triplets, excitement was just one of many emotions they felt.

“I was shocked, I panicked, I laughed and I cried,” Kiah said. “I can’t even describe how we were feeling.”

It was Kiah’s second pregnancy. The first time around, it had taken nearly three years before she was able to get pregnant with their daughter, Rayna, who is now a healthy 3-year-old. The next time, things didn’t take that long.

“We were surprised when we found out we were pregnant again right away, and even more so when we went in for my 12-week checkup. At first, the ultrasound technician congratulated us on twins—then she saw the third baby.”

An Unexpected Diagnosis: Twin-Twin Transfusion Syndrome (TTTS)

Kiah and Rich, who live in southern Illinois, were referred to a specialist nearly two hours away in Evansville, Indiana, for prenatal care for their triplets. Then, at 16 weeks, they learned that being pregnant with multiples wasn’t the only curveball of this new pregnancy.

The triplets were diagnosed with twin-twin transfusion syndrome (TTTS), a rare condition where abnormal vessels form in the shared placenta (monochorionic) of twins or other multiples, leading to uneven blood flow between the fetuses. Often, one of the fetuses acts as a “donor” that becomes dehydrated, and another fetus, the “recipient,” gains too much fluid and develops high blood pressure. Left untreated, TTTS can be fatal. 

“We don’t know why TTTS only happens in about 15% of monochorionic twin pregnancies, but it can develop at any time during the pregnancy,” said Foong-Yen Lim, MD, surgical director of the Fetal Care Center at Cincinnati Children's. “It can also progress rapidly, which makes early diagnosis and monitoring extremely important.”

During an ultrasound, Kiah’s physician in Evansville saw that one of her triplets—baby B—had too much fluid while the others—baby A and baby C—had very little. Her doctor also couldn’t see baby C’s bladder on ultrasound. That’s when he referred Kiah to the Fetal Care Center at Cincinnati Children’s.

“We have a very good team that works together to care for patients alongside referring physicians,” Dr. Lim said. “It is a collaborative effort with with maternal-fetal medicine specialists, radiologists, fetal cardiology teams, surgical teams and others to closely monitor moms and babies. We also worked closely with Kiah’s local physicians on her monitoring to make sure she received the best possible outcome.”

Rapid Care for a Rapidly Evolving Situation

Kiah met with her care team in Cincinnati when she was 16 weeks pregnant. At this time, Dr. Lim found that baby B was showing signs of heart problems, and baby C had growth restrictions. Dr. Lim was concerned that symptoms would get worse, quickly.

“We worry about doing surgery too early since it can lead to early delivery, and these triplets were too young to survive outside of the womb,” Dr. Lim said. “We wanted to balance the risk of surgery with the benefits it could provide for them.”

The team, including Dr. Lim, David McKinney, MD, and Morgan Laumann, RN, continued to monitor Kiah and her triplets closely. At 17 weeks and 1 day, Baby C’s fluid dropped so low that they could not wait any longer. Kiah went into surgery that night.

“The team cared about us, sat with us and talked with us,” Kiah said. “They got on our level and didn’t use big terms so we could understand what was going on. It was a scary time, but they helped ease our minds tremendously. I’m forever grateful to them.”

Dr. McKinney and Dr. Lim used laser surgery to treat the triplets’ connecting blood vessels and drain Baby B’s excess amniotic fluid. The results were nearly immediate.

“On our next ultrasound, we saw that baby C had developed a bladder overnight and things were looking really good,” Kiah said.

Kiah and Rich returned to Illinois a week later, and Kiah was put on modified bedrest to stave off labor for as long as possible. However, at 29 weeks and 5 days, the babies were ready to arrive and, via C-section, Kiah delivered three small but healthy boys: Walker (baby A), Gentry (baby B) and Creed (baby C).

Living—and Thriving—with Triplets

Walker, Gentry and Creed celebrated their first birthday in August and are thriving, particularly for three babies who spent months in the Newborn Intensive Care Unit (NICU).

“They did so well, and we were extremely fortunate to not have too many scares in the NICU after they were born,” Kiah said. “Now, two of them are trying to walk and the third isn’t far behind. They’re extremely busy and into everything, everywhere. They are the happiest babies.”

Kiah and Rich look forward to seeing their four children grow up together.

“I’m excited for them to be able to go outside with their sister and enjoy all the fun things they can do together,” Kiah said. “I think she’ll have fun with them when they can run around with her.”

Earlier this year, Kiah, Rich and their children had a chance to return to Cincinnati Children’s to introduce their triplets to the team that saved their lives.

“We got to go back and let Dr. McKinney, Dr. Lim and everyone else hold the babies,” Kiah said. “We wanted to show them what they had done for us.”

(Published December 2023)