Prenatal surgery for twin-to-twin transfusion syndrome is saving lives

December is Twin-to-Twin Transfusion Syndrome Awareness Month, and the parents of twins like Keeley and Kambry Ewoldt are working to educate people on the condition. TTTS is a rare but serious disease of the placenta, and it affects identical twins (or higher multiple gestations) in the womb who share a placenta. If the placenta is shared unequally, one twin may not receive proper nutrients to grow or survive, according to the Twin to Twin Transfusion Syndrome Foundation.

“That leads the smaller (donor) twin to pump blood to the other, larger (recipient) twin,” wrote Drs. Tara Sander Lee and Kathryn Nix for the Daily Signal. “If left untreated, advanced forms of the disease are fatal between 80% and 100% of the time.” Though doctors are often quick to offer abortion in cases of TTTS, there is another option. Laser surgery performed on the placenta while the babies are still in the womb can correct the problem and significantly increase the odds that one or both of the babies will survive.

Intentionally killing one or both of the babies shouldn’t even be a discussion. Doctors can try to save them both.

Keeley and Kambry

At 16 weeks, Keeley and Kambry’s parents learned that the girls had TTTS and set up a plan to travel to undergo the surgery. One of the risks of the surgery is preterm labor, which occurred for these girls who were born at just 22 weeks and one day. Kambry, the donor twin, was born weighing about 13.4 ounces, while Keeley, the recipient twin, weighed one pound. The girls recently celebrated their second birthday and weigh 18.9 pounds each. Both are finally off of oxygen, and while they face other health challenges, they are doing well.

Vince and Pauly

Twins Vince and Pauly Salmonese were diagnosed with TTTS and underwent the surgery when they were just 18 weeks old in the womb in March in New York during the start of the COVID-19 pandemic. Without the surgery they only had a 10% chance of surviving. “I knew I had to do it,” their mother Dana said. “It’s risky to go into the womb with 18-week-old babies, but it would be even more risky not to.”

The surgery was a success, but then Dana’s water broke at just 20 weeks. Contractions didn’t start, however, and since the maternity ward was being turned into a COVID-19 treatment area at the hospital, Dana and her husband Joe were sent home. Dana was put on bed rest and was constantly checking her temperature to make sure she didn’t have an infection. Miraculously, she made it to 31 weeks when doctors decided to deliver the babies. After some time in the neonatal intensive care unit, both boys were reunited at home in September 2020.

“They had a 10 percent chance to live and they did it,” said Dana. “They fought through it … our miracle baby fighters.”

Anna and Ella

Twin sisters Anna and Ella were diagnosed with TTTS in 2014 and their mother Crystal was immediately sent to see a doctor who said she should have the surgery right away in order to give the girls the best chance of survival. The surgery was successful and a few weeks later, the girls were born healthy. Anna weighed five pounds, seven ounces while Ella weighed four pounds and seven ounces. They spent six weeks in the hospital before being able to go home.

Byron and Lincoln

Twins Byron and Lincoln Ryman were diagnosed with TTTS with Byron receiving most of the nutrition and growing to be three times the size of his brother. Doctors offered two options: abort Lincoln in hopes of saving Byron, or undergo the surgery.

“We were actually given the option to terminate Lincoln in the beginning, but thank God we didn’t,” said the boys’ mother. “I wanted two babies, not one.”

Doctors say the couples made the right decision. The surgery was a success, though the boys were born at very different sizes. Byron was born weighing three pounds, six ounces while Lincoln weighed a mere one pound, three ounces. Lincoln spent five months in the hospital and spent two years being fed through a feeding tube, but now their mother says “they are actually two fairly normal boys” of whom she is “really proud.”

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