Delicate surgery saves 2 unborn lives
Mother shares the story of her identical twins and what she learned
It was just about two years ago that Mellissa and Tom Lasslo of Price got the good news: Mellissa was carrying twin girls. "It was a bonus," she smiles as she recalls. "We already had one daughter."
That was February. By springtime, in the 16th week of her pregnancy, there were signs that something was wrong. "I got huge, way ahead of schedule," she says.
An ultrasound scan showed one of the identical twins was twice as big as her sister, about 10 ounces for the bigger one, five ounces for the smaller. The swelling and disparate size of twins were classic symptoms of a fetal developmental condition known as Twin-to-Twin Transfusion Syndrome, or TTTS.
Twins share a placenta
Some background: Identical twins develop from a single fertilized egg. In addition to the similar physical appearances they show in later life, they often share a common placenta in the womb. The placenta is a special structure in many mammals that connects the fetus to the mother's uterus. It is here that the blood vessels of the mother and fetus come in close contact without mixing each other's blood directly. The network allows oxygen and nutrients to transfer from the mother's blood to the baby's blood, and for carbon dioxide to be carried from baby to mother.
That shared, or monochorionic, placenta can cause problems. One of the twins - the recipient - may get the majority of the circulation.The other - the donor - will be left with less. As Mellissa explains, that's bad for both.
The little twin is starved, the bigger one is over-nourished. In the case of her babies, the smaller twin's amniotic sac was almost empty of fluid, giving an appearance she describes as "shrink wrapped." That fetus' bladder was also collapsed. The bigger twin's amniotic sac was bulging, a sign that her little kidneys and heart were overworked.
Mellissa says she referred herself to the University of Utah Medical Center to consult with specialists there. At the U, she underwent a two-hour ultrasound that confirmed the diagnosis of TTTS and also led to another referral.
Choosing an option
"They told me of a surgeon at Hollywood Presbyterian Hospital who could perform an operation in utero," she says. So she traveled to Hollywood and was examined by Dr. Ramen Chmait. "He told me there were four options. One of them was not an option for him. That was letting one baby go so the other could live," she recalls.
Mellissa chose the recommended option, which offered an 85 percent chance that at least one would live, and a 50-50 chance they would both survive.
She underwent surgery on May 8, 2012. The babies were just 19 weeks old.
"I was conscious the whole time. I got to watch what was going on inside on video," she says. The pictures you see in this article are what she saw during the operation.
By gently guiding a thin, flexible laparoscope into the womb, the surgeon was able to navigate around the placenta and use a laser to occlude the shared blood vessels one at a time. "He wanted us to send him the placenta after the babies were born so he could study his work," Mellissa says. "So we did." Also removed at the time of surgery was a half-gallon of fluid from the recipient baby's amniotic sac. "It looked like a pitcher of beer, foam on top," Mellissa quips.
The placenta - commonly called the afterbirth - was shipped to Dr. Chmait just after Chloe and Lola saw the light of day on July 11, 2012, by an emergency c-section. They were alive, but still at risk because they were premature - born at 29 weeks compared to the average 40 - and tiny. Lola weighed in at two pounds, six ounces, and was 14.5 inches long. Chloe, the donor twin, was a mere one pound, 14 ounces, and an inch shorter than her "big" sister. "My husband says Chloe's head was only as big as a hen's egg," Mellissa recounts.
Heart surgery for Lola
Lola, the recipient twin, had to go through heart surgery - critical pulmonary stenosis - when she was just two weeks old. That was performed at Primary Children's Hospital in Salt Lake.
The twins are home now, and have begun walking. They are sharing family life with Tom, Mellissa and their older sister, Sarah.
Christmas is not far away and TTTS Awareness Day was last Saturday, so Mellissa wants to take advantage of both occasions to give thanks and to raise awareness. Â
"I'm not sure how you can thank all of the people that saved your children's lives, but I do know that helping raise awareness is one way I can help and say thank you! Dr. Erin Clark, Dr. Ramen Chmait, University of Utah NICU, Primary Children's NICU, Â Dr. Robert Gray and all of the nurses, cannot be thanked enough. We had prayers from every faith and I truly believe that by God's will, he saved our little miracles and brought a lot of people together. It was definitely a trial for our family, but we are stronger because of it," she states.
There is an international non-profit group, the Twin-to-Twin Transfusion Syndrome Foundation, that works to heighten public awareness, particular among people who are expecting twins or triplets. They are at tttsfoundation.org.
TTTS is not communicable and not hereditary. It is random. "It also can happen fast," Mellissa says. If the fetuses are identical and share one placenta, it is a good idea to have regular examinations right up until birth, she advises.