“When my husband and I went in for our first ultrasound, we saw twins,” said Kathy. “I started laughing. My husband, John, sat there in shock.”
Kathy, a nurse herself, was over 40 and because she was carrying two babies, was sent to a maternal fetal medicine specialist with expertise in high-risk pregnancies, Dr. Peter Van Eerden at Sanford Health in Fargo.
Dr. Van Eerden monitored Kathy closely with an appointment every week. Because the babies shared one placenta, but had two amniotic sacs, it was possible they would develop twin to twin transfusion syndrome (TTTS) — a condition when the blood flow between the babies becomes unbalanced, and one baby donates blood to the other. This causes the donor twin to become dehydrated and experience slow growth, while the recipient baby risks heart failure due to the extra volume of blood.
Dr. Van Eerden tracked the babies’ growth, fluid and blood flow, and diagnosed TTTS as well as Twin Anemia Polycythemia Sequence (TAPS), a rare form of TTTS that occurs when there is an imbalance in red blood cells and hemoglobin between the twins in the womb, causing the donor baby to become anemic and both babies to become very sick.
A trusted partnership
Throughout Kathy’s care, Dr. Van Eerden consulted with Dr. Saul Snowise, a fetal surgeon and maternal fetal medicine specialist at the Midwest Fetal Care Center — a collaboration between Children’s Minnesota and Allina Health, and one of the few advanced fetal care centers in the Upper Midwest. The two physicians regularly partner together on high-risk pregnancies.
At 22 weeks, Kathy and John followed the advice of the doctors and drove from Fargo to Minneapolis for in utero laser surgery at the Midwest Fetal Care Center. “As a nurse, I was so impressed by the interdisciplinary approach. I felt so well taken care of,” said Kathy. “Our care coordinator walked us through everything, and Dr. Snowise and a pediatric cardiologist answered all of our questions. As Dr. Snowise discussed the procedure with us, he could see we were nervous. I remember him looking us in the eyes and saying, ‘I got this.’”
Kathy was taken to the operating theater and put under mild sedation. Dr. Snowise performed the laser surgery, sealing the blood vessels that were contributing to the abnormal flow of blood between the babies. She and John knew the first 24 hours after surgery presented the highest risk for the babies, so when she didn’t feel one of the twins move all night, she worried. But early the next morning, Dr. Snowise returned with the ultrasound machine, confirming two heartbeats. They were all ecstatic.
“Shortly afterward I walked outside to get the car,” said John, “Dr. Snowise drove past, giving me an enthusiastic thumbs up. I knew our boys were going to be okay.”
A very special delivery
Back in Fargo, Kathy’s water broke at 29 weeks. She was admitted to Sanford Medical Center where she spent two weeks on bedrest under the care of Dr. Van Eerden. At 31 weeks, Kathy went into labor, delivering babies Cian and Rory via c-section. “We knew they would intubate Cian because of his heart,” said Kathy. “They ended up intubating Rory, too.”
Kathy and John shared their fears over Cian’s chance for survival. “We didn’t know what would happen to his heart when he was no longer connected to me,” Kathy said. “But he’s a fighter! He was on an IV heart medication for less than a week. His heart kept getting stronger.”
Six weeks after birth, the brothers were discharged from the NICU on the same day joining their sister, Zoe, at home. Today they are strong, happy boys, meeting their developmental milestones.
Reflecting on the past two years, Kathy says she’s grateful for the partnership between Dr. Van Eerden and the MWFCC. Their teamwork allowed her to receive fetal specialty care close to home in Fargo for the majority of her pregnancy, and fetal surgical care in the Twin Cities when it became necessary. “From diagnosis through delivery and beyond, Dr. Van Eerden and Dr. Snowise are why I have two healthy boys today.”