Twin to Twin. Crystal Duffy

      Foreword

      Having more than one baby in a pregnancy has always intrigued pregnant women. Perhaps it is considered a blessing by some to increase a family by two at one time. When I started my residency training in Obstetrics and Gynecology, I remember reading the phrase “the human womb is only designed to carry one fetus at a time with any degree of biological grace.” Indeed, some forty years later, I have come to appreciate the truth in this statement. In those early years of my career, one in eighty pregnant women carried twins. The advent of assisted reproductive technologies (IVF and other methods) and a growing trend to defer motherhood until later in life have increased the incidence of twins to one in thirty pregnancies.

      Once, all twin pregnancies were treated the same. Now, we know that identical or monochorionic (MC) twins can develop severe complications as often as four out of ten cases. This type of twinning is rare—only three out of 1000 pregnancies. It is a chance of nature, although the incidence is reported to be higher in IVF pregnancies. One of the complications of MC twins is severe twin-twin transfusion syndrome (TTTS)—this occurs in only 10 percent of these pregnancies. Shared blood vessels in the single placenta allow for blood movement between the patient‘s unborn babies—one becomes a “donor” and one a “recipient.” Without treatment the loss of both twins occurs in 90 percent of cases. Some thirty years ago, in utero laser therapy was introduced to spot weld these connecting blood vessels using a small telescope (fetoscope) to find them in the womb. Although premature delivery remains an unsolved problem, experienced centers now report the survival of both twins in more than 70 percent of TTTS pregnancies.

      In her book, Crystal tells the story of the highs and lows in her desire to have a successful pregnancy. She shares with the reader the sorrow of pregnancy loss and the elation of discovering that she had spontaneously conceived identical twins. Her joy is short-lived when she is diagnosed with TTTS. The reader is then taken down a journey of treatment, complications and the need for a prolonged stay in the hospital before she delivers her premature twin girls. The author‘s narrative is told in a unique first person perspective that allows the reader to look in on the emotions of separation from Crystal‘s husband and her first born daughter while she is hospitalized before delivery. Unique bonds are developed with the nursing staff, her obstetrician, and her sonographer. Crystal also shares the anxiety of separation from her newborn girls as they mature in the neonatal intensive care unit. The book concludes with a return to elation as the new family of five is finally reunited at home.

      Medicine is a unique profession. A patient like Crystal meets you in the worst of circumstances, yet she is willing to place complete trust in your knowledge and skills to care for her unborn children. There can be no greater privilege than this. Since I learned to perform laser treatment fifteen years ago, I have undertaken over 700 procedures. Each case is unique. There have been many successes such as Crystal‘s pregnancy. And yet, there have been frustrating losses even when the procedure goes well from a technical point of view.

      To be asked to author the introduction to this book is a unique honor. It truly tells the story of a patient‘s trials and tribulations with TTTS. The book is a must read for any patient diagnosed with TTTS. It will provide hope that all is not lost in their pregnancy.

      Kenneth J Moise Jr, MD (a.k.a. Dr. Miller)

      Professor of Obstetrics, Gynecology and Reproductive Medicine

      McGovern School of Medicine – UT Health

      Co-Director, The Fetal Center

      Children’s Memorial Hermann Hospital

      Houston, Texas

      Chapter 1

      The Ultrasound

      Certificates and degrees crowded the wall above a large wooden desk full of patient charts and scattered

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