040214 - Urban Living
April 24, 2014

Volume 36 | Number 6

Laser Procedure Saves Lives of Couple’s Unborn Twins


MHUnbornTwins_WEB.jpg
ADDING TO THE ROSTER—Minnesota Twins baseball pitcher
Nick Blackburn and wife Alicia pose with daughter Payton, 2,
and son Easton, 1. The family of four will soon become six
when Alicia gives birth to twin boys later this month.

 

By Kathryn Klein  |  Memorial Hermann

Hallmark cards, heart-shaped balloons, flowers, chocolates, and breakfasts in bed are nice, but one Oklahoma mom is expecting an extra-special Mother’s Day delivery this year that just might top them all.

A few days after Mother’s Day, Alicia Blackburn is scheduled to give birth to healthy twin boys – an event that, up until a few months ago, she and her husband Nick Blackburn – a Major League Baseball pitcher for the Minnesota Twins – weren’t sure would ever come to pass.

“There were times I was pretty concerned about the chances of both boys surviving,” said Nick. “In situations like this, it’s hard not to think about the bad side of things.”

On the baseball front, Nick has had a difficult few months. He has yet to play in a game this season as he continues to undergo rehab for two recent surgeries – one last October to remove a bone chip from his throwing elbow and one in January on his right wrist. But despite his personal injuries, the only condition Nick has been worried about lately is that of his wife, who was diagnosed with a potentially fatal fetal disorder several weeks into her current pregnancy.

“The struggles on the baseball field are nothing compared to family struggles,” said Nick. “In the end, baseball is just a game. It will continue on much longer than I will. But my family means everything to me.”

Late last year, the Blackburns received the difficult news that their twins were diagnosed with twin-to-twin transfusion syndrome, a rare condition that occurs when identical twins who share a common placenta share blood unevenly between their blood vessel connections. One twin, the recipient, gets too much blood and the other, the donor, gets too little. If left untreated, one or both twins could die.

“When I first got the news, I think I was in denial,” said Alicia. “I asked my doctor if he was worried and when he said yes, that’s when I realized the seriousness of the situation.”

MHUnbornTwins_crosssection_WEB.jpg

Twin-to-twin transfusion results in an unequal
sharing of blood in the womb between identical
twins. The recipient twin, right, is usually born
larger, with too much blood and increased blood
pressure. The donor twin, left, is born smaller
with paleness, anemia and dehydration.

One out of every 30 pregnancies result in twin births, according to the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. The majority of identical twins share a common placenta which provides oxygen and nutrients to the babies. Among placenta-sharing twins, about 15 percent go on to develop twin-to-twin transfusion syndrome. According to the Twin-to-Twin Transfusion Syndrome Foundation, at least 4,500 cases occur in the United States each year. Severe twin-to-twin transfusion syndrome has a 60 to 100 percent mortality rate.

“Upon my diagnosis, I immediately joined a twin-to-twin transfusion syndrome support group online,” said Alicia. “I asked family and friends for their prayers. We also prayed about it ourselves. We knew God was in control and all we could do was try to make the best decisions with the information made available to us.”

The Blackburns also knew they had to act fast to save the lives of their unborn babies. Seeking out the best specialists in the country, they were referred to the Texas Fetal Center at Children’s Memorial Hermann Hospital in Houston, where a team of maternal-fetal experts counseled the couple on the details of their situation and their treatment options.

“When Alicia first came to us, she was scared,” said Karen Moise, lead clinical nurse coordinator at the Texas Fetal Center. “We tried to ease her fears by answering her questions and reassuring her we could handle this. We see 400 of these cases a year; this is what we do. Then, we did an ultrasound to assess the severity of her twin-to-twin transfusion syndrome.”

Several treatment options are available depending on the severity of the case. One option is a serial amnio-reduction, which involves removing excess amniotic fluid from the amniotic sac surrounding the twin who’s received excess blood. The twin getting too much blood is larger than the twin getting too little and therefore has more amniotic fluid. The serial amnio-reduction may temporarily restore the balance in the volumes of amniotic fluid of both twins, and is typically repeated multiple times over the course of the pregnancy as the fluid tends to re-accumulate. The procedure reduces the risk of membrane rupture, reduces maternal discomfort, and may prolong the pregnancy.

For more advanced stages of twin-to-twin transfusion syndrome, a selective laser ablation procedure may be necessary. Laser ablation involves identifying the vessels that connect the two fetuses, and using a laser to interrupt the blood flow in these vessels. Survival with this procedure has been reported to be as high as 85 percent for one twin and 60 percent for both.

“Alicia only had stage 1 twin-to-twin transfusion syndrome, the less severe form, but twin-to-twin transfusion syndrome can advance without warning and progress to stage 5 – which is death of one or both babies – in a matter of days,” said Moise. “And, in Alicia’s case, the abundance of amniotic fluid was placing her at risk for premature labor, delivery and loss. It was clear to us that it was time to intervene.”

After much prayer and serious consideration, Alicia, together with her husband, opted for the in-utero laser ablation. The procedure took place on Valentine’s Day this year.

“In this procedure, we used a drinking straw-sized catheter to go in and locate the connecting vessels between the babies,” said Kenneth Moise, M.D., Alicia’s surgeon, co-director of the Texas Fetal Center at Children’s Memorial Hermann Hospital, and coincidentally, husband of Karen Moise who first welcomed the Blackburns to the center.

“We then used laser light to spot-weld the vessels so that the circulation of each baby was now separated. On the way out, we also removed excess amniotic fluid that had accumulated in the larger twin’s sac,” the doctor explained.

“The procedure took about an hour and was fairly straightforward,” he said.  “All went exactly as it should have.”

“When Dr. Moise came out and
told me everything had gone well,
it was such a huge relief. It literally
gave me goose bumps.”

              - Nick Blackburn, father

“When Dr. Moise came out and told me everything had gone well, it was such a huge relief. It literally gave me goose bumps,” said Nick. “I knew there were still major steps ahead before we could call it a complete success, but he was very confident with the immediate results of the surgery.”

Problems after surgery, if they arise, usually occur the first week after the procedure. After two weeks passed and the doctors saw that the fluid in both twins’ sacs had returned to normal, indicating the disease process had abated, Dr. Moise once again delivered the happy news.

“We couldn’t feel more blessed,” said Alicia. “I see so many other women who develop twin-to-twin transfusion syndrome and hope to make it to 26 weeks. I’m just so grateful for my whole medical team – my doctor in Oklahoma and the Moises and their staff in Houston – for all being so proactive in my case. They are the reason I’m looking to deliver two healthy boys at 36 weeks.”

“Thousands of women are diagnosed with this unfortunate fetal syndrome but don’t realize treatment is available that could save their babies’ lives,” said Dr. Moise. “The survival rate is high and only getting better. No more multiples need die unnecessarily. That’s why we’re here.”

It’s been three short months since Alicia’s successful surgery, and while she continues to be closely monitored and get regular ultrasounds, she’s already counting down the days until she delivers the twins, bringing the running total for team Blackburn to six. The Blackburns have two other children – daughter Payton, 2, and son Easton, 1.

“The twins are set to arrive two days after Mother’s Day,” Alicia said. “I’m just praying for two healthy boys. Having all my kids healthy will be the best Mother’s Day ever.”

Nick says he’s thrilled to have a healthy, growing family. Fatherhood, he said, has changed his whole outlook on life.

“My wife and kids are motivation for me to prolong my career,” he said. “It’s tough now being away so much, but the more I can accomplish, the more I’ll be able to provide for them. It’s a great feeling to come home to your family after any kind of a day at the stadium. Good or bad there is always support from them.” Does he see baseball in the twins’ futures?

“My wife is also athletic and competitive so it’s in their genes,” he said. “The way things are going, we pretty much have a basketball team. If they all decided to play sports, I would be pretty excited. If not, I think I’ll keep them anyway.”

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