The woman underwent expensive in-vitro fertilization to become pregnant, only to be told she should terminate the pregnancy. She was carrying identical twins with shared abnormal blood vessels in the placenta who were unlikely to survive. One was in severe heart failure. If they did survive, severe disability was likely.
Her research led her to Dr. Julian De Lia, who pioneered laser surgery to sever the shared blood vessels early enough in the pregnancy to save both babies.
Tuesday morning, De Lia, medical director of the International Institute for the Treatment of Twin-to-Twin Transfusion Syndrome at St. Joseph Regional Medical Center in Milwaukee, explained the procedure during a "grand rounds" at University Hospital.
It was a journey home of sorts for the surgeon, who pioneered the laser surgery in 1988 at University Hospital. He left in 1991 to be closer to the "center of the country," since his patients came from all over the United States and Canada.
Until 1995, he was the only surgeon doing the procedure. Now 20 centers, including a handful in the United States, routinely save the lives of infants with the syndrome.
One-third of all twins are identical and of those, as many as 20 percent — up to 3,500 pregnancies in the U.S. each year — can have the condition, referred to as TTTS. It's usually found during a routine ultrasound, because one twin has an abnormally full amniotic sac and the other is almost dry. The sac can rupture and kill the baby. The baby who gets too much blood can also die of heart failure, while the other can die from lack of blood.
More than 60 percent of the patients De Lia sees, he said, have been counseled to end the pregnancy.
"It's a challenging problem in modern obstetrics. But they decided to fight for their babies. Well over 80 percent of the time, we can change the course of events."
The laser surgery is done between 21 and 25 weeks when the diagnosis is certain, the outcome bleak without it. A surgeon makes an incision and inserts a scope to look for the abnormal connecting vessels, which are shot with a laser. They can't be sutured because the incision would be too large not to harm the baby. And using electrical cauterization doesn't work because the baby is in a bag of fluid. Laser energy is produced in a machine the size of a dishwasher and delivered through a small, fiber-optic cable.
Disconnecting the shared blood vessels in the placenta allows the babies to be carried to a "much more reasonable age, usually about 33 weeks. It's a chance for 12 weeks in Mom in a more normal milieu, where they are able to grow and thrive," De Lia said.
The surgery, now popular in Europe, got its start in 1983 at the U. with early experimentation on sheep and monkeys, including a stint by De Lia at the California Primate Research Center. The first couple to benefit were from Great Falls, Mont., the surgery performed at the U. There are teenagers in the Salt Lake Valley who were among the first patients.
It's a simple concept, but a challenging technique, De Lia said. It's also increasingly important because for unknown reasons, the rate of multiple-babies pregnancies is "through the roof," double or triple what it was 20 years ago.
E-MAIL: lois@desnews.com