“I see two heartbeats.”  In October of 2009, those were the scariest words I had ever heard.  Had I heard the sonographer correctly?  Were there really two babies?  Yes.  Twins.  Identical twins.  I panicked.  Were we ready for this?

My doctor talked us through the risks associated with having twins, especially identical twins.  Having a high-risk pregnancy wasn’t new to me, as I had been considered high risk with my previous pregnancy due to my age and pregnancy-induced high blood pressure.  My oldest son was born healthy and full term.  But as my doctor continued to outline the risks, including his warning of the possibility of Twin-to-Twin-Transfusion-Syndrome (TTTS), I wasn’t really listening.  I was still processing the fact that I was carrying two babies.

My husband and I were slowly beginning to wrap our heads around the reality of raising twins when, in late December, we had another visit to the high-risk doctors for an ultrasound.  It was just before Christmas, I was 16 weeks along, and my husband and I were excited because we were going to find out the gender of our babies.  During the ultrasound, Baby A was cooperating beautifully and quickly revealed to us that he was a boy.  Baby B was not in a good position to confirm his gender and wouldn’t cooperate by turning to give us a better view.  But considering they were identical, one boy meant two boys!  We were thrilled.  Two more boys to join their big brother Luke.  A few minutes later the doctor came in and we quickly learned the reason why Baby B wasn’t  moving as much to give us the view we wanted.  The amniotic fluid levels on the babies were a little off, with Baby B having less fluid than the doctor wanted to see (and making it more difficult for him to move around), and Baby A having slightly more.  He suggested that we return the next week so they could begin monitoring us for TTTS.

The following week, the fluid levels showed even more of a discrepancy.  My doctor explained that now it wasn’t a question of if I would develop TTTS, but when.  The following Monday, January 4, 2010 found me back in the ultrasound room.  I was 18 weeks along, and by now I had done my research and new what they were looking for on the ultrasound.  If the fluid levels were less than 2 cm in the donor (Baby B) and more than 8 cm in the recipient (Baby A), that would confirm a diagnosis of TTTS.  Baby B was just under 2 cm, and Baby A was slightly over 8 cm.  Combine those findings with a bladder that was difficult to see in Baby B(another sign of TTTS), and the diagnosis was confirmed.  I officially had Twin-to-Twin-Transfusion-Syndrome.

It was suggested that I be referred to the Fetal Therapy Center at the University of Miami for a consultation with Dr. Ruben Quintero.  I appeared to be a good candidate for laser surgery, a treatment with good success rates.  Left untreated, TTTS has an almost 90% mortality rate for the babies.  There was no discussion between my husband and me.  We were going to Miami.  That afternoon I spoke with Dr. Quintero’s office, and after reviewing my file they wanted to see my as quickly as possible since TTTS can progress extremely rapidly.

By Tuesday night we were in Miami.  Wednesday was the most difficult day of my life, waiting for a call to indicate that my insurance company had approved the consultation and surgery.  Finally the call came late Wednesday afternoon, and we were set for our consultation the next morning.  I don’t think I slept much that night.  Knowing how quickly TTTS can progress, I wondered if the babies were even still alive?  I was too early in my pregnancy to feel them move.  The ultrasound the following morning would let us know.

“I see two heartbeats.”  This time, these were the sweetest words I had ever heard, as the sonographer confirmed the next morning that both babies were, indeed, still alive.  The disease had progressed in the few days since we had left Jacksonville, with Baby B’s bladder was no longer visible, and he had very little amniotic fluid.  His amniotic sac was essentially shrink-wrapped around him, making it impossible for him to move.  But, both babies were still alive.  I was scheduled for surgery the next day.

On Friday, as I was being prepped for surgery, I found myself wondering whether they would survive the procedure.  I knew that the survival rates following surgery were positive, but it was still a possibility that at least one wouldn’t make it.  Finally it was time for the surgery.  I was awake for the procedure, and because the surgery was performed via a camera inserted into my belly, I was able to watch the process unfold before my eyes.  I was amazed when toward the end of the surgery I was asked if I wanted to see my babies.  Suddenly there was Baby A’s tiny hand on the screen, followed by his face.  And then…yep, definitely a boy!  Because Baby B had so little fluid and was in an awkward position, it was difficult to see him.  What I did get to see was his tiny chin tucked against his chest, with the smallest whisper of an amniotic sac visible between his chin and chest.  He looked like he was covered in saran-wrap.

I was overwhelmed with relief when Dr. Quintero and Dr. Kontopoulos stated in the OR that they felt it was a success.  However, the first 24 hours following the procedure would be the most risky.  I was exhausted after the surgery, but again found myself unable to sleep.  Would the babies survive the night?

Early Saturday morning the sonographer arrives to do one more ultrasound to view the babies.  I was so nervous, as was she.  She was hoping for a positive result as much as I was, I believe.  She switched on the machine, squirted gel across my belly, and began the ultrasound.  She turned to look at me.  “I see two heartbeats.”

Following this amazing surgery, the babies did amazingly well.  The developed normally, had good weight gains, and normal fluid levels.  Viewing the ultrasounds toward the end of my pregnancy, you never would have known that there had been a life-threatening issue.  I delivered at 37 weeks…not because of any problems with the babies, but because I had developed mild pre-ecclampsia.

On May 15, 2010, we welcomed Jacob Nathaniel (Baby A, the recipient) and Cole Alexander (Baby B, the donor) with Jacob weighing in at 6 lbs 9 oz, and Cole weighing 5 lbs 12 oz.  Very respectable weights for any twins, let alone survivors of TTTS.

We were so incredibly blessed during this pregnancy.  Blessed to have an OB practice who are knowledgeable and aware of TTTS.  Blessed to have an incredible high-risk practice right here in Jacksonville who are very proactive.  I was closely monitored and my TTTS was caught early.  We were blessed to have made it to Miami, and to have had a successful surgery.  Many others are not so lucky.

The Tattersall Family - Peggy and Eric, Luke, Cole and Jake