A fetal surgery can strengthen the blood bond between twins, and save their lives.
Heather Hanson’s second pregnancy was going well – including the welcome surprise that she was carrying twins – when her 18-week ultrasound revealed one baby was significantly smaller than the other. At that point, ounces matter, and when the larger fetus measured at 12 ounces versus the smaller one’s 9 ounces, something was clearly amiss.
The diagnosis: a disorder called twin-to-twin transfusion syndrome (TTTS), which occurs when there’s an imbalance of blood flow between identical twins who share the same placenta. It occurs in some 15 percent of such pregnancies, resulting in one baby receiving adequate blood flow while the other doesn’t get enough.
“We went from happy to confused and scared,” says Hanson, an elementary school teacher who lives in Appleton with her husband, Adam. “It’s a scary time when you are facing such a serious and difficult syndrome.”
The Hansons were referred to the Fetal Concerns Center of Wisconsin, which has a long track record of pioneering care for problematic pregnancies involving birth defects or medical conditions. It’s a joint venture combining the resources of Children’s Hospital with Froedtert & The Medical College of Wisconsin, and one of some two dozen such centers in the United States. It’s also the only program in Wisconsin that performs in utero interventions for a wide range of conditions, including open fetal surgery for spina bifida, cardiac interventions and fetal transfusions.
The FCCW is co-directed by Dr. Amy Wagner, a pediatric surgeon, and Dr. Erika Peterson, a maternal fetal medicine specialist. Both are also assistant professors at the Medical College, and they know just how deeply their work impacts expectant parents and their children. “I enjoy the bond we form with families,” Wagner says.
To enhance that bond, Wagner works to see things through her patients’ eyes. “I have two little girls, so I try to empathize with what my patients are going through, not only in the language I use but by showing kindness and compassion.”
Among the life-saving procedures offered through FCCW is surgery to treat TTTS. It involves a laser ablation of the shared vessels in the placenta that nourish the fetuses. It’s usually conducted between 16 to 26 weeks of pregnancy. “Without treatment,” Peterson says, “some babies have almost no chance of survival.”
It was an easy decision for the Hansons. “We knew immediately that the TTTS surgery was the right choice,” Heather says. “We never wanted to regret that we didn’t do everything in our power to help our sons.”
To help patients like the Hansons, the FCCW assembles a comprehensive team of medical professionals – it can include specialists such as the mother’s OB-GYN, neonatologist, nurse care coordinator and genetic counselor – to complement the roles Wagner and Peterson play. “It’s a highly collaborative process that involves coordinating different services,” says Peterson. “It’s actually easier once we get in the operating room.”
Heather’s surgery was done in 2012 when the twins, Evan and Owen, were at 21 weeks of gestation. Heather went into labor at 29 1/2 weeks, and after she was hospitalized with a week of bed rest, the twins were finally born. Owen weighed 3 pounds, 8 ounces, and Evan was 2 pounds, 3 ounces. After 9 1/2 weeks in neonatal intensive care, the boys came home, two more testaments of a onetime groundbreaking procedure that is now becoming routine.
“Some of these procedures didn’t exist even 10 years ago,” Peterson says. “It’s exciting to be at the forefront of challenging and refining them.”
Today, the Hanson twins are developing typically for their age. “I sometimes look back at the footprints in their baby books that are shorter than my little finger,” Heather says, “and then I look at the two rambunctious little boys running around my house. I’m grateful every single day for the doctors who made this miracle possible.”