A life-saving procedure, even before birth

Christina and Jim were surprised to learn that they were expecting identical twin girls at one of their scheduled ultrasounds. These young parents of Sofia, 4, and Bryce, 2, were already accustomed to the regular checkups and ultrasounds that accompany pregnancy, but when Christina went in for her 20-week check-up at Advocate Christ Medical Center, nothing was routine about the appointment.

Christina’s twins were diagnosed with Stage 4 Twin-to-Twin Transfusion Syndrome (TTTS), a condition that occurs when there is an imbalance of blood flow between the twins in the womb. This syndrome occurs when twins share a placenta (called a “monochorionic pregnancy”) and one twin receives too much blood and the other too little. Christina was immediately sent to Dr. Karishma Rai, a maternal fetal medicine specialist at Advocate Christ who informed her that one of her twins was in severe heart failure. Dr. Rai referred Christina to Dr. Suwan Mehra, a fetal surgeon and co-medical director of the Center for Fetal Care at Advocate Children’s Hospital in Park Ridge, Illinois. Christina raced to the Park Ridge campus where Dr. Mehra performed a second ultrasound that confirmed the diagnosis.

“When TTTS occurs, it happens very quickly,” says Dr. Mehra, “There are five stages of the syndrome. Stage 4 is very serious, and the babies are often near death at this point.”

Due to the severity of Christina’s case, Dr. Mehra called his team in to perform fetoscopic laser ablation therapy, or a fetoscopy, late that night. During the procedure, Dr. Mehra used an ultrasound to guide him as he inserted a small scope through Christina’s abdomen and into her uterus. Then, using a laser that is fed through the scope, he selectively coagulated blood vessels on the shared placenta. This ensured that each twin had her own unique blood supply, which allowed for normal development. Christina was extremely nervous about the procedure, but Dr. Mehra explained that doing nothing was not an option.

“Performing a fetoscopy not only improves the chances of survival for the babies, but also lessens the risk of neurological injury after birth from 25% to 8%,” Dr. Mehra explained.

Christina says that during her first ultrasound after the fetal surgery she was frightened she would be told that one of the girls hadn’t survived. To her great relief, Dr. Mehra told her that he still heard two heartbeats. The laser ablation had been successful.

Dr. Mehra monitored Christina and the twins for several weeks before she returned to her primary obstetrical provider and was delivered via cesarean section at nearly 35 weeks at Advocate Christ Medical Center by Dr. Sam Flosi.

“It’s a big achievement to have someone with such an advanced stage of TTTS make it to almost 35 weeks,” says Dr. Mehra. “Christina did great. She was cared for by our entire team. We all helped her get through.”

Today, Sadie and Mira, named after Dr. Mehra, are doing great. The twins spent 17 days in the NICU before heading home. While in the NICU, Mira underwent a successful surgery to fix pulmonary stenosis, a condition in which the pulmonary valve doesn’t open as it should. Mira now gets her heart checked every six months and is otherwise doing well. Sadie and Mira will turn one-year-old on October 26 and Christina says they’ve been enjoying this summer as a family.

“To see the whole family together and all the kids playing together, it’s surreal,” says Christina.