“My twins were killing each other in my stomach” the story of a mother suffering from transfusion-transfused syndrome

“My twins were killing each other in my stomach, they were saved by a miracle”

Aged 29, Laura Watson describes the diagnosis she received regarding her pregnancy. The story told by the Mirror is astonishing and moving. Doctors diagnosed her with transfusion-transfused syndrome, one of the most serious complications of certain twin pregnancies. This condition is characterized by abnormal blood flow between the two babies when there is only one placenta, leading to uneven development and risks to both babies and mother.

The young mother was flown from Northern Ireland to St George’s Hospital in London for a specialist procedure designed to help evenly distribute blood flow between the two babies. But 5 weeks later, a scan showed that one of the little twins had become dangerously anemic due to reduced blood flow. Surgeons performed an emergency caesarean section at 23 weeks gestation and delivered the baby, Meabh Weir who weighed just 500g and her sister Clodagh Weir who weighed 1.3kg on October 3, 2022.

Laura and her husband James were only able to catch a glimpse of the children before they were taken to a neonatal intensive care unit. The mother then received three liters of blood transfusion before finally being allowed to hold her newborn three days later.

Now 9 months old, the twins are doing well after spending months in hospital, although Clodagh developed a congenital heart defect for which she will need lifelong screening. On December 24, 2022, the two girls had the chance to meet their older brother and spend their first Christmas as a family.

Transfusion-transfused syndrome: what are we talking about?

If 80% of twin pregnancies are bichorionic, 20% are monochorionic (only 1 placenta for both fetuses). The latter represent pregnancies at very high risk of fetal complications. One of the most serious complications is the transfusion-transfused syndrome in monochorionic bi-amniotic pregnancies (2 amniotic bags).

This syndrome results from an imbalance in blood flow between the twins’ circulations. Thus, blood exchanges are more favorable to one to the detriment of the other. There is a transfusion baby (who gives more than he receives) and a transfused baby (who receives more than he gives back).

• For the baby with a transfusion, who has a reduction in blood pressure, this will lead to a reduction in diuresis with the appearance of oligohydramnios (insufficient quantity of amniotic fluid).
• For the transfused baby, who has an increase in blood volume, this will lead to polyhydramnios (excess volume of amniotic fluid).

In the event of ultrasound alert signals, the mother will be referred to one of the 12 centers in France capable of treating TTTS. The management of the transfusion-transfused syndrome is based on intrauterine placental surgery treatment carried out endoscopically.

Very high precision surgery that remains high risk

This procedure consists of introducing an endoscope into the amniotic cavity of the transfused fetus then identifying and coagulating the abnormal vessels (placental anastomoses) using a laser fiber passed through the operating channel of the endoscope.

The procedure is carried out under local or epidural anesthesia for the pregnant woman.

This treatment allows 8 times out of 10 to have at least one baby alive and without after-effects and in 35 to 50% of cases, there are 2 surviving babies. But unfortunately, we still deplore 20% of deaths of two twins (half of which are due to premature birth after the surgical procedure due to simple mechanical effects).

Beyond 30 weeks of amenorrhea the laser intervention becomes delicate, it can be performed: