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Laser fixes serious curveball for twins

Kim Kyle Morga, Houston Chronicle
Published 12:18 pm, Friday, June 21, 2013

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  • Alicia Blackburn, poses with husband Nick Blackburn, daughter Payton and son Easton. She came to the Texas Fetal Center at Children's Memorial when her twins Braxton and Austin (pictured at right) required surgery for twin-to-twin transfusion syndrome. Photo: Courtesy Photo
    Alicia Blackburn, poses with husband Nick Blackburn, daughter Payton and son Easton. She came to the Texas Fetal Center at Children's Memorial when her twins Braxton and Austin (pictured at right) required surgery for twin-to-twin transfusion syndrome. Photo: Courtesy Photo

 

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Pregnant with twins?

A Find out what type of twins you're having as early as 12-13 weeks' gestation.

A If you're having identical twins, see your doctor every two weeks starting at 16 weeks' gestation.

A If there's any discrepancy in fluid levels, request a referral to a specialist.

Source: Dr. Kenneth Moise at the Texas Fetal Center at Children's Memorial Hermann Hospital

Twin-to-Twin Transfusion Syndrome by the numbers:

A 10 percent to 15 percent of identical twins develop twin-to-twin transfusion syndrome.

A There are 4,500 cases per year of the syndrome in the U.S.

A Severe cases have a 60 percent to 100 percent mortality rate.

A Laser ablation boosts the survival rate to 60 percent to 85 percent.

Source: USA National Center for Health Statistics

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Already the parents of 3-year-old Payton and 17-month-old Easton, Alicia and Nick Blackburn were surprised to be expecting again, never mind twins. Then more news came out of left field when the couple learned the babies had a potentially fatal complication.

"It was at the 16-week ultrasound, when we were excited to find out the gender of the babies, that the doctor noticed a fluid discordance," Alicia said. "I asked the doctor if he was worried about it, and he said he was."

Alicia had twin-to-twin transfusion syndrome, a condition that occurs when twins who share a common placenta produce an uneven sharing of blood between their blood-vessel connections. Identical twins have a 10 percent chance of developing this syndrome, and it's typically diagnosed at 20 to 22 weeks' gestation. Without treatment, there's a 90 percent chance of losing both babies.

"It was hard not to focus on what could happen," said Nick, a pitcher for the Minnesota Twins. "The bad stuff is always in the back of your mind. At times, it was hard for me not to expect the worst."

The couple lives in Oklahoma, but Alicia was referred to the Texas Fetal Center at Children's Memorial Hermann Hospital in Houston for further monitoring.

Co-director Dr. Kenneth Moise said the problem is that one baby ends up being the donor and the other the recipient.

"The donor gets into trouble because he or she kind of goes into hibernation mode," Moise said. "The recipient can go into heart failure from having too much blood sent its way."

But an in-utero procedure involving laser ablation can change the outcome.

Through an incision smaller than the circumference of a drinking straw, a scope is inserted in the mother's abdomen to locate the extraneous vessels. Moise said laser light is sent through a tiny rod placed at the border of the connecting vessels, stopping the blood flow.

"In essence, we create two placentas, and (blood) circulation is now separate," Moise said.

Moise said the procedure was first reported by European physicians in 1990, but American doctors were doubtful until 2004, when studies showed that the fetuses of women undergoing laser ablation had far better outcomes.

Since then, Moise and his colleagues have performed the procedure more than 400 times, but what's unique about the fetal center at Memorial Hermann is they always have two surgeons in the operating room at once.

"Two babies in the womb, two sets of eyes, can be quite helpful," Moise said.

There are about 17 laser centers across the country performing the procedure, Moise said, but only a handful have experienced the volume done at the Texas Fetal Center.

"The unfortunate part about TTTS is you can never predict when symptoms will show up," Moise said. "Some patients come in acutely ill, and in a day or two have to go in for surgery."

TTTS can happen with triplets, although it's rare.

"We have devastating stories of patients who come to us too late," Moise said. "We have to get to patients early because they'll do better. Within about two weeks post-op, the babies are doing fine. But we always say true success is two beautiful babies in the nursery."

On Feb. 14, Alicia, 24 weeks pregnant, underwent laser ablation at the Texas Fetal Center. Without complications, she went on to deliver two healthy baby boys on May 14. Austin, the "donor" baby, weighed in at 5 pounds 13 ounces. Braxton, the "recipient" baby, weighed in at 6 pounds, 8 ounces.

"They're good-looking guys," Nick said. "But I may be biased."

Nick himself is recovering from two surgeries of his own: one to remove a bone chip from his throwing elbow and another to correct an injury in his right wrist. He hoped to be back on the mound this month.

Alicia is thankful for everything. Not only is her husband back pitching with the Twins, surgery saved their twins.

"They're not supposed to be here, and they're here," Alicia said. "I think that will show in their personalities as they grow up. They're tough boys."