Fetal Laser Surgery Helps Pregnant Families with Twin-to-Twin Transfusion Syndrome

Ready to grow their family, Sarah and Jesus were thrilled to learn that they were expecting twins. Having had previous uncomplicated pregnancies, Sarah’s first and second trimesters were relatively easy with the twins.

But in October 22, 2018, at 23 weeks pregnant, Sarah and Jesus’ excitement turned to shock when a routine echocardiogram showed that one of the twins had heart abnormalities caused by twin-to-twin transfusion syndrome (TTTS), a prenatal condition in which twins share unequal amounts of the placenta's blood supply resulting in different growth rates. In their case, Baby A was experiencing heart abnormalities and had too much fluid in their amniotic sac while Baby B had too little fluid in their amniotic sac.

“We were in shock and in disbelief that this was happening to us and our family,” says Sarah. Without intervention, TTTS can cause extreme prematurity and developmental issues in either twin and in the worst cases can be fatal. The couple immediately started to examine their options.

The next day their doctor put them in touch with case managers and social workers at the Chicago Institute for Fetal Health (CIFH) at Ann & Robert H. Lurie Children’s Hospital of Chicago. As one of only a few comprehensive fetal centers in the country, the Institute cares for families with complex pregnancies and offers pre-birth care and interventional treatment, including treatment for twin-to-twin transfusion syndrome.

Just two days after learning about the complication, the couple left their home in Coal Valley to travel to Chicago to meet with fetal specialists at CIFH. Sarah underwent a full day of comprehensive testing including an echocardiogram and ultrasounds, lab work and more, all of which confirmed that their unborn babies had stage three TTTS. Baby A was experiencing abnormal blood flow through the umbilical cord and into their heart and would need surgery to be repaired.

“Every person we came in contact with was kind and showed compassion to us during our struggles,” Sarah says of the team at CIFH.

Sarah underwent a selective fetoscopic laser photocoagulation (SFLP), a minimally invasive laser surgery, performed by Dr. Aimen Shaaban, Director of the Chicago Institute for Fetal Health and the team of fetal specialists. During this surgery, the mother is lightly sedated and stays awake while fetal surgeons use a small camera to locate the abnormal blood vessel connections in the placenta. They permanently seal the blood vessels which stops the transfer of blood between fetuses and slows or halts the progression of TTTS.  

“This was a very scary time for us,” Sarah recalls of the emotional day. “The team of anesthesiologists reassured me throughout the whole surgery to help me stay calm and to make sure I was comfortable. I will never forget that.”

After spending one night in the hospital recovering, Sarah and Jesus traveled back to their home and stayed in contact with the team at CIFH through the remainder of her pregnancy. The couple continued going back to their local doctor for routine echocardiograms and ultrasounds and did not need any more interventional treatment following their stay in Chicago.

“Despite the serious nature of TTTS, the outcomes after surgery are very good in most cases,” said Dr. Shaaban. “At CIFH, we have refined our approach over hundreds of cases and expect that 95% of the time after the operation at least one twin will survive, and greater than 80% of the time both twins will survive.”

On January 4, 2019, Sarah and Jesus welcomed two beautiful babies, Clara and Nora, to their family. At three years old, both twins are developing typically for their age, hitting all their expected milestones. Sarah says, “We are so grateful for the timely care that we received, and thanks to CIFH, our girls are doing incredible.”

The Chicago Institute for Fetal Health

With more than 40 years’ experience, The Chicago Institute for Fetal Health is a regional leader in the research and care of pregnant women with fetal complications. As one of only a few comprehensive fetal centers in the country, the institute is able to offer pre-birth counseling and care, as well as corrective fetal intervention if needed.

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