Twin-to-twin transfusion syndrome surgery at Dell Children's saves babies before birth

Jeanette Becerra, 22, was pregnant when she learned that her identical twins were in crisis. The twins shared one placenta while having separate inner layers, which put the two fetuses at risk for twin-to-twin transfusion syndrome. This condition will cause one fetus to become the donor baby with low amniotic fluid, less blood volume and a smaller bladder. At the same time, the other fetus has too much amniotic fluid, an enlarged bladder and produces too much urine. Looking for answers, Jeanette went from one doctor to another. Each told her one or both fetuses were at risk of dying. 

She arrived at the Comprehensive Fetal Care Center at Dell Children's Medical Center, part of Ascension Seton, when she was 18 weeks pregnant. "I knew I was in the right hands," Jeanette said.

The Comprehensive Fetal Care Center is transforming the lives of mothers whose babies have complex prenatal conditions. It saves lives of babies requiring highly specialized and innovative care for successful delivery and healthy infancy. The center is a collaboration between Dell Children’s and UT Health Austin, the clinical practice of Dell Medical School at The University of Texas at Austin.

Leading the Comprehensive Fetal Care Center are co-directors Kenneth Moise, Jr., MD, and Michael Bebbington, MD, MHSc, who have four decades of experience caring for complex in-utero complications.

The center’s fetal surgery team walked Jeanette through every step of the procedure, and Dr. Bebbington tracked Jeanette’s progress carefully until he saw that the situation had become critical. Jeanette's babies had 17 shared blood vessels that needed to be cauterized. 

To do this, Jeanette would undergo a twin-to-twin transfusion syndrome laser surgery. This would be the first surgery of its kind to be performed in Central Texas.

The hour-long procedure is performed in-utero. Using a tiny laser, Dr. Bebbington and the team cauterized the connected blood vessels. 

"No two placentas are the same," Dr. Moise said. Then they did the "Solomon technique," which uses the laser to draw a line on the placenta between the two babies to seal off any tiny, connected blood vessels the team could not see.

After the surgery, the fetal functioning began normalizing, with the recipient fetus beginning to pump its own blood. 

“I operated on babies before they were born,” Dr. Moise said. “Thirty years ago, I never thought that would be a reality. But we are truly changing the geography of healthcare.”

After her recovery, Jeanette was put on bed rest to ensure she didn’t go into labor. She also visited the center weekly for an ultrasound scan of the fetuses until the babies were born.

The babies were born on March 12 and were delivered by C-section around 33 weeks to minimize late-term pregnancy complications.

 As the fetal surgery capabilities of the team at Dell Children’s expand, more mothers-to-be from Texas and around the country will benefit from their expertise. In-utero surgery for spina bifida is also now available. It can allow a baby ultimately to walk rather than use a wheelchair. This complex procedure requires the collaboration of a large group of people in the operating room. "This is a whole other level of intensity," Dr. Bebbington said. "It's a game-changing surgery for the baby and the family."  

Mothers and babies cared for at the Comprehensive Fetal Care Center can receive obstetrical care at the Maternal Care Center, a high-risk obstetrics clinic located in the same suite as the center and deliver the baby at Dell Children’s Specialized Delivery Unit. In addition, Dell Children’s offers the highest level Neonatal Intensive Care Unit so that mom is close to the baby during her recovery. This integration of maternal and fetal care all in one place enhances the overall experience for patients and their families — keeping moms and babies together — and allows for close collaboration between fetal medicine specialists and obstetricians. 

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Connect your patient with leading fetal care physicians

At the Comprehensive Fetal Care Center, our patients benefit from the expertise of specialists across a variety of disciplines. A fetal nurse navigator will guide families from initial contact, preparing for the first visit, coordinating a multidisciplinary team of experts and ensuring the patient’s needs are being met at each point. In addition to our board-certified maternal-fetal medicine specialists, the care team includes genetic counselors, obstetricians, ultrasonographers, psychosocial support team, neonatologists and a wide array of other pediatric specialists who collaborate to provide unparalleled care for patients and families throughout the continuum of care. For questions or referrals to the Comprehensive Fetal Care Center, please call 512-324-0040.