In Utero Surgery Saves Twins Experiencing Rare Transfusion Syndrome

Natalie Littlejohn was 19 weeks into her pregnancy with twins, and feeling a little concerned.

"In each ultrasound, one baby was always in the same place," she explains in her gentle Southern accent. "The tech said nothing was wrong. But call it mom's intuition…I knew something wasn't right."

Twin-to-Twin Transfusion Syndrome

Further testing picked up signs of Twin-to-Twin Transfusion Syndrome (TTTS), a rare condition that affects identical twins sharing the same placenta.

Blood is distributed in an unbalanced fashion between the babies, so that one gets too much, while the other gets too little.

This results in massive collections of amniotic fluid around the "recipient" baby and very little around the "donor."

If not treated, both babies die in 80 to 100 percent of the cases, and survivors are often permanently damaged.

Though Natalie lives in Shreveport, Louisiana, her doctor referred her to the fetal therapy program at EvergreenHealth – one of only a handful of hospitals in the country offering the treatment she needed.

In Utero Surgery

Three days later, Natalie was at EvergreenHealth Medical Center, where perinatologist Dr. Martin Walker performed a delicate in utero surgical procedure called fetoscopic laser photocoagulation.

"The procedure involves a tiny incision, an endoscope the size of a spaghetti strand, and blood vessels as small as a string of thread," Dr. Walker explains.

"I use a light, camera, and laser in the endoscope to locate and then seal off the blood vessels that are causing the TTTS. Once those connections are coagulated with the laser, their circulations return into balance and amniotic fluid levels for both babies start to return to normal."

Two days after the procedure, Natalie was on her way back to Shreveport, where the remainder of her pregnancy was monitored by her own doctor.

Successful In Saving Babies

Dr. Walker and his partner, Dr. Bettina Paek, have treated more than 550 TTTS cases since the program began in 2003.

"Nine out of 10 TTTS pregnancies now end with at least one surviving baby," he shares, "while both babies survive nearly 75% of the time."

Patients have come to EvergreenHealth from all over the country. The program prides itself on being open to all, regardless of ability to pay.

"I didn't invent the procedure, but I have helped further the techniques and the equipment used, and bring it to a wider community," Dr. Walker adds. "And there are even more advances on the horizon that will allow us to go inside the uterus, surgically correct abnormalities, and allow babies to develop normally."

Wyatt & Walker

The rest of Natalie Littlejohn's pregnancy was problem free.

At 36 weeks, she delivered two healthy boys – Wyatt and Walker – the latter named after the doctor Natalie calls "an angel."

Dr. Walker insists the success of EvergreenHealth's program is due to the collaborative work of many people, all of them dedicated to providing both a great outcome and patient-centered care.

"No matter what you do surgically, no matter how good you are at making a diagnosis," he says, "none of it works if you don't have an outstanding team along side you."

For More Information

Learn more about Twin-to-Twin Transfusion Syndrome treatments at EvergreenHealth

Learn more about care for high-risk pregnancies at EvergreenHealth