'Game changing for pregnancies.' First laser surgery on twins in the womb at Dell Children's
CEDAR PARK, Texas (KXAN) — Jeanette Becerra can't wait to meet her identical twin boys.
It runs in the family.
"Dad's side, they have identical twins," Becerra said. "When I did my first ultrasound, they found two hearts. I was like, 'Wow!' Like, I was so surprised!"
Becerra, 26, and her boyfriend were preparing for the babies when she got an unexpected diagnosis after seeing several specialists last fall.
"I did panic a little bit — got really upset because the second specialist told me that I could lose one baby," Becerra explained. "And, so that got me really sad."
It was at that point that she was referred to specialists at the new Comprehensive Fetal Care Center at Dell Children's Medical Center in Austin.
"I was feeling my stomach really bloated. My stomach was getting so big. And, I was having so much pain on my ribs, because that's where the baby was at," she said.
Jeanette was 22 weeks along in her pregnancy and said she was told one of her twins was not receiving enough blood.
The rare disorder is known as twin-to-twin transfusion syndrome.
"On the surface of the placenta, there are blood vessels that connect the blood supply of the two babies. And so there's blood that is flowing back and forth between the two babies. As long as that process is balanced, in that there's equal amounts of blood flowing in both directions, then everything's great. But if that exchange of blood becomes unbalanced, so that one twin is giving more blood to the co-twin than it's getting back, then we end up with what's called twin-to-twin transfusion syndrome," explained Dr. Michael Bebbington, co-director of the center and Professor of Department of Women's Health at UT Austin Dell Medical School.
Dr. Bebbington said it's a condition that, if left untreated, could result in about an 85% to 90% chance of mortality, with loss of the pregnancy. He explained that it affects 15% of identical twins worldwide.
"I was sad and, really, it just got me to crying day and night, but my family just was praying for me. Churches were praying for me. Friends were praying for me. So, they just got me into a peace," Becerra said.
A historic surgery
In December, the babies underwent laser surgery in utero at the center, with Dr. Bebbington leading the team.
Becerra was under conscious sedation, which means she was sedated but not asleep and she could still breathe for herself and speak.
"We use a scope that goes into the sac of the twin that has extra fluid," Dr. Bebbington explained. "Map the placenta to identify where the connecting blood vessels are, and then use a laser fiber that drops down through the scope and use the laser energy, basically, to clot the blood in the where the connections are. So, essentially taking that placenta where there's blood flowing in both directions and stopping the blood flow between the twins."
It was a first for his team.
He said before this, moms would have to make trips to Dallas, Houston or even out of state to get treatment.
"It's a huge advantage now for people who live in Austin and in Central Texas, so that we can provide these types of very innovative and cutting-edge therapies without families having to travel," Dr. Bebbington explained. "There really are very few centers in the United States that can offer this type of surgery."
He's already working with a patient from Oklahoma and expects other families from nearby states to travel to Dell Children's for the specialized care.
Care for moms and babies
The fetal center opened in May and applies cutting edge diagnostic tools to pregnancies where the baby has complications.
Besides the twin-to-twin transfusion syndrome, doctors will also be able to perform open fetal surgery for spina bifida repair.
"A lot of what we can do can be game changing for pregnancies," Dr. Bebbington said. "When we look at doing things like our open fetal surgeries for spinal bifida, by doing a surgery earlier in the pregnancy, we can significantly alter the life course of that child to minimize the amount of disability that it would have."
Dr. Kenneth Moise is also a co-director of the center along with Dr. Bebbington, and they're both leading a growing team.
Dell Children's just announced the opening of a new Maternal Care Center. Mothers diagnosed with complex and rare fetal conditions who are patients of the fetal center will now be able receive their obstetrical care all in one place.
They'll also be able to deliver their babies there instead of going to another hospital.
"In days gone by, mom would deliver at one hospital, babies would be transported to the children's hospital," Dr. Bebbington said. "And that's not a good situation for what's, you know, a very stressful time for families. So, what the comprehensive care center, the maternal care center and a special delivery unit, basically take all of those facets of care and bring them into one place so that we can keep families together."
Ready to meet the twins
Becerra, who is on bed rest, said Dr. Bebbington will be delivering her babies.
"I feel better. I don't have that pain anymore on my ribs. I don't feel bloated. I just feel good," she said.
He's monitoring her and the twins closely every week. She's due in April, but the babies will be delivered earlier to minimize any complications.
Dr. Bebbington said there is no way to predict which identical twin pregnancies will be affected by the syndrome.
"The recommendation is that they all receive close surveillance with ultrasound every 2 weeks from 16 weeks' gestation to try and detect the process in its earliest stages. Recognition/detection is the key to having a successful outcome," Dr. Bebbington said.
Becerra has already picked out names for the twins and is working on the nursery.
"The babies — I just want them with me already because they're my first babies," Becerra said. "I'm really excited for my twins."