Adriana Romero Villarreal underwent fetal laser surgery to treat twin-to-twin transfusion syndrome when she was 22 weeks pregnant with sons Felix and Isaac, pictured here with their surgeons, Raphael Sun, MD, and Andrew Chon, MD, and their father, Isaac Bagnall. (OHSU/Christine Torres Hicks)
When Adriana Romero Villarreal found out she was having twins, she was shocked: Twins didn’t run into her family or her partner’s family, so they were excited to welcome the first set.
At her prenatal check-up, Romero Villarreal learned that her pregnancy was considered high-risk. She was referred to Oregon Health & Science University for an ultrasound at 22 weeks, where her care team discovered that the twins had a potentially life-threatening condition called twin-to-twin transfusion syndrome, or TTTS.
“When we first found out the diagnosis, it was really hard for us,” said Romero Villarreal. “You never think it’ll happen to you.”
But with OHSU Doernbecher Children Hospital’s two specialized fetal surgeons, she and her partner, Isaac, had advanced treatment options with a high probability of success.
OHSU has long offered the most complex fetal care in the state, and with the recent addition of surgeons Andrew Chon, MD, and Raphael Sun, M.D, the program can now provide in-utero — or inside the uterus — treatments for nearly a dozen complex conditions that occur during pregnancy, including TTTS. OHSU’s program is one of only five programs nationally to provide medical and surgical interventions for high-risk pregnancies and newborns all under one roof.
On National Doctors’ Day, March 30, this patient family and countless others celebrate the compassionate and accomplished doctors and health care teams, researchers and educators at OHSU working together to provide innovative, world-class care.
Romero Villarreal, who lives in Salem, feels a sense of hope with his team at OHSU.
“They were there for me throughout my whole pregnancy and were always checking in,” she said. “They would act immediately if they noticed something might be wrong.”
Twin-to-twin transfusion syndrome
TTTS occurs in about 15% of pregnancies with identical twins who are monochorionic diamniotic, meaning they share a placenta and have two gestational sacs.
While in the uterus, twins like Romero Villarreal’s have two umbilical cords that share blood vessels on top of the placenta. With TTTS, the blood flows unequally between the twins, resulting in differences in amniotic fluids and could lead to other problems. If left untreated, 90% of pregnancies with TTTS twins are lost.
Her care team, which included specialized fetal surgeons Sun and Chon, presented Romero Villarreal and her partner with several options: selective reduction, which means reducing the number of fetuses in the uterus; a procedure called amnioreduction, which temporarily resolves but doesn’t correct the underlying problem; and an in-utero, or in the uterus, procedure called fetoscopic laser surgery. In the latter procedure, the vascular connections between the twins on the surface of the placenta are lasered and disrupted to help correct the imbalance in blood flow.
Pregnancies with TTTS treated with laser surgery have a 90% chance of resulting in one surviving twin, and a 60% to 70% chance of resulting in two surviving twins.
“The laser surgery seemed like the best option for us,” said Romero Villarreal. “We wanted to make sure we did everything we could to keep both twins.”
The next day, Sun and Chon successfully performed the surgery. It was the second time the procedure had ever been done at OHSU since expanding the fetal care program.
“Families used to have to travel really long distances to get this level of care, so I’m really proud that we are able to offer it here at OHSU,” Sun said. “Many of them came to us because they had the hope that they would be able to take home two survivors.”
Isaac and Felix
Romero Villarreal went home the day after her surgery and returned to OHSU for bi-weekly ultrasounds to ensure that her twins were developing and healthy.
Later on, one twin developed selective fetal growth restriction, which meant the twins weren’t growing at the same rate. Romero Villarreal needed steroid shots and eventually a decision was made to deliver the twins early. She delivered babies Isaac and Felix via cesarean section in early October, at almost 32 weeks gestation. Both babies needed to stay in Doernbecher’s Neonatal Intensive Care Unit, or NICU, for monitoring. Their parents took Isaac home right before Thanksgiving. Felix, who was smaller than his brother, needed some extra help with feeding, as well as treatment for pneumonia. He was able to go home just before the family celebrated Christmas.
“It was such a relief to have both of our twins home and safe,” Romero Villarreal said. “I just love all of us being together.”
That sense of relief and appreciation is why OHSU’s fetal surgery team members do what they do.
“We understand the high risks that come with fetal surgery,” Sun said. “The losses hurt, but the wins are so joyful and that gives us a lot of hope.”