They made my husband and me comfortable. Even though there were no guaranteed outcomes, at least my husband and I knew we were making informed decisions. And we couldn’t have done that without Dr. Miller and Dr. Simpson.
After a few months of being married, Celeste Fine was surprised to find out she was carrying identical twins. Just as the joy of having her family double had sunk in, doctors saw signs of a rare condition that required an intervention to save both babies.
“At my 14-week appointment, the doctors explained I was presenting with twin-twin transfusion syndrome (TTTS),” Celeste recalls. “The boys shared a placenta with a membrane separating them. Baby A — Elias — had a lot of fluid around him. And Baby B — Mattin — had less fluid around him.”
Sharing a placenta — an organ in the uterus that provides oxygen and nutrients to the fetus and removes waste products from the baby’s blood — can cause an imbalance in the blood supply between the twins. This condition can cause a host of complications for both babies, as one twin receives too little blood and the other receives too much.
Celeste’s obstetrician recommended she see a doctor in Philadelphia who performed a highly specialized in utero surgery that stops the flow of blood from one twin to the other.
“The doctor in Philadelphia said our case was too far gone, so we weren’t a candidate for the surgery. He recommended we either terminate the entire pregnancy or terminate Baby B in an effort to try to save Baby A,” she says.
The couple decided to seek a second opinion and made an appointment with Dr. Lynn Simpson, FACOG, Maternal-Fetal Medicine division chief at NewYork-Presbyterian/Columbia and Dr. Russell Miller, medical director of the Carmen and John Thain Center for Prenatal Pediatrics at NewYork-Presbyterian Morgan Stanley Children’s Hospital. Dr. Miller and Dr. Simpson also performed the utero surgery.
“Dr. Miller reviewed our records and conducted his own ultrasound assessment. ‘Your babies meet the criteria for twin-twin transfusion syndrome, which means I would recommend surgery,” she remembers. “Dr. Miller must have thought we were crazy because we were so excited to find a doctor who saw a way to give both babies a shot to live.”
The doctors warned the couple due to the advanced stage of the condition and the length of time remaining in the pregnancy, the odds of successful outcomes for both babies was about 30 percent. But the couple was grateful that they didn’t have to make the difficult decision of terminating one baby to try to save the other.
“When we went to other places, they didn’t put effort into helping us make the right decision. We called with questions and never heard back from them,” Celeste says. “But at New York-Presbyterian, they were so respectful about what a big decision this was. Not only were they talented surgeons, they were experienced guides in helping us make the right decision for our family.”
She adds: “They made my husband and me comfortable. Even though there were no guaranteed outcomes, at least my husband and I knew we were making informed decisions. And we couldn’t have done that without Dr. Miller and Dr. Simpson.”
At 18 weeks, Dr. Miller and Dr. Simpson performed fetoscopic laser photocoagulation, a minimally invasive procedure that disconnects the blood vessels that were transporting blood from Mattin to Elias. By the next day, the ultrasound showed both babies were improving.
“Dr. Miller and Dr. Simpson celebrated with us. It was amazing.”
Dr. Miller and Dr. Simpson monitored Celeste and the twins for the remainder of the pregnancy. At 36 weeks the boys were born—Elias weighing 5 pounds, 10 ounces and Mattin weighing 5 pounds, 3 ounces.