Ella and Caelie's Story
First-time mother Talitha McGuinness was ecstatic when a routine eight-week ultrasound showed she was carrying identical twin girls, only to be devastated six weeks later at her next ultrasound. The doctor who reviewed the later scans discovered a terrible problem. "He told me that both my babies would die if I let nature take its course," remembers the 30-year-old graphic designer from Kannapolis, North Carolina. "I was in shock."
The doctor had noticed that the babies were dangerously different in size. In addition, the smaller one had so little fluid in her amniotic sac that she looked as though she'd been shrink-wrapped to the uterine wall. He explained to Talitha that twin-to-twin transfusion syndrome (TTTS) can cause these abnormalities. The disorder, which affects a tiny percentage of identical twins, occurs when faulty blood vessels in the placenta allow one twin to siphon off blood from the other, sparking life-threatening complications. For the twin referred to as the "recipient," the increased blood supply eventually sends the heart and kidneys into overdrive and leads to congestive heart failure. The "donor" twin, on the other hand, can lose so much blood that heart failure becomes a possibility. The disorder also causes the twins to have uneven amounts of amniotic fluid. As a result, the donor twin risks orthopedic deformities.
Talitha says she had three options: She could abort both babies and try to become pregnant again. She could sacrifice the smaller twin in hopes of saving the larger one. Or she could try laser surgery to close off the faulty blood vessels and let the blood redistribute evenly, a procedure that could result in miscarriage and the deaths of both babies.
"I had to make a life-or-death decision," says Talitha. She left the medical office and called her husband, Lee, 33, in tears.
Talitha's despair grew when she went online that night to learn more about the disorder and the laser surgery that might fix it. Reading stories of families who had lost babies to TTTS was so upsetting that Lee had to take over the research. Within a week, the couple had decided to gamble on the surgery, developed and performed by a Florida physician, Ruben Quintero, MD, director of maternal fetal medicine at the University of South Florida, in Tampa. Dr. Quintero agreed to see the McGuinnesses a few weeks later.
During the 10-hour drive to Tampa for the procedure, Talitha's confidence alternately surged and plunged. "I was excited that Dr. Quintero had agreed to help me, but in my heart I didn't believe we'd end up with two surviving babies," she says. "I'd feel hope bubble up, then I'd think about the risks and brace myself for disappointment."
Talitha felt sick to her stomach with fear, but a presurgical ultrasound the next morning revealed the actual source of her nausea. At 19 weeks, her contractions had started, far too soon for the twins to survive. Dr. Quintero stopped the contractions with medication immediately and, the following day, proceeded with the surgery. After giving Talitha a local numbing agent, he determined which blood vessels in the placenta were faulty. He then slipped a laser fiber through 1/4-inch incisions in her abdomen and uterine wall and sealed off the vessels causing the abnormal blood flow. The babies' fate would be clear in just 24 hours.
The following day Talitha lay on an examining table as a technician maneuvered an ultrasound wand over her belly. "I was so nervous I was holding my breath," she says. "Finally the technician said, 'Baby A seems fine.' Another eternity went by before she said, 'Baby B is okay, too.' That was the smaller twin. I wept when I saw the image on the screen. She had so much fluid in her amniotic sac that she could swim around like a little fish."
There's a slightly higher chance of premature birth following prenatal laser surgery, so after her return home Talitha consulted a high-risk-pregnancy specialist, who put her on bed rest. She astonished everyone by making it to 36 weeks (within the normal range for a pregnancy with twins) and gave birth vaginally to Caelie, who weighed in at 4 pounds, 4 ounces, and Ella, 4 pounds, 10 ounces. "I feel so blessed," says Talitha, who now volunteers at the Fetal Hope Foundation, which provides support to families affected by TTTS and other fetal issues.
Today, her daughters are lively 3-year-olds who love to be the centers of attention, whether they're belting out a favorite song or telling princess stories. In quieter moments, they finger-paint or scribble in coloring books. But their favorite sport hasn't changed. During lessons at the YMCA, both kids plunge into the pool and swim side-by-side -- like little fish.
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