Laser surgery saves twins

When 3-month-old Zoe and Violet Hannings are awake, they don't stop. But there was a moment early in jen hannings' pregnancy when her world stood still. During a routine ultrasound at 20 weeks, doctors determined the babies had a dangerous condition. Zoe and violet shared a single placenta -- and blood vessels connected the two. Instead of blood flowing equally, violet was receiving too much blood from zoe. It's called Twin-to-Twin Transfusion Syndrome -- or T-T-T-S.

The fetal heart muscles start to thicken, and valves begin to leak.
 

"They actually can go into heart failure and die," says Dr. Michael Bebbington, a Maternal Fetal Medicine Specialist Children’s Hospital of Philadelphia.

During fetal surgery, doctors insert a laser through the mother's abdomen to seal off the twin's shared blood vessels.
 

"What the surgery does is break the connections between the two fuses, and so, the transfusion stops," says Dr. Bebbington.
 

In at least 90 percent of the surgeries, doctors successfully save one of the babies. 74 percent of the time, both survive.

Doctors say the Hannings twins are now healthy and should continue to develop normally.
 

"I think we'll just explain what miracles they are when they get to the point where they can understand that."
 

The condition develops in about 15-percent of monochorionic twins -- babies who share the same placenta.

TOPIC: LASER SURGERY SAVES TWINS
REPORT: MB #3184

BACKGROUND: According to the American Pregnancy Association, twin to twin transfusion syndrome (TTTS) is a very serious disorder that occurs in identical twins. TTTS happens when the twin babies share blood vessels. As a result, one baby receives more blood flow while the other baby is deprived of blood flow. TTTS occurs about 15 percent of the time; however, fraternal twins do not face this risk due to the simple fact that they do not share a placenta. It is important to understand TTTS cannot be prevented. Some symptoms of TTTS are difference in umbilical cord sizes, difference in size between the two amniotic sacs, and evidence of fluid build-up. Additionally, if one baby is bigger than the other in the womb, this is also a warning sign. The pregnant mother should watch for noticeable signs in rapid growth of womb, abdominal pain, early and premature contractions, and early pregnancy swelling in hands and legs.

EARLY TREATMENT: Before technological advances and medical breakthroughs, the most common form of TTTS treatment was amniocentesis. With amniocentesis, excess fluid is drained, and the blood typically begins to flow normally again. Even then, this process is usually only 60 percent effective when it comes to saving the babies’ lives. Septostomy is often performed if the amniotic fluid is drained. With septostomy, a small hole is made in the amniotic membranes. This procedure allows the amniotic fluids to even out in and rebalance for each baby. Unfortunately, many babies also lost their lives early on while still in the womb when amniocentesis was not used.

IMPROVED TREATMENT: Another treatment used for TTTS is laser surgery. With laser surgery, the blood vessels are sealed so that the blood cannot continue to pass through from baby to baby. With laser surgery, a scope is inserted through the mother's abdomen and into the twin's sac who is receiving more blood flow. Often, laser surgery completely restores blood flow, and both babies survive, in turn, eliminating TTTS. An advantage of laser surgery compared to amniocentesis is that amniocentesis may need to be performed multiple times throughout pregnancy, whereas laser surgery is typically a one-time event.

FOR MORE INFORMATION, PLEASE CONTACT:
The Children’s Hospital of Philadelphia
Philadelphia, PA
(800) 468-8376
http://www.fetalsurgery.chop.edu
 

(Information provided by Ivanhoe)