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TTTS: How our identical twin girls miraculously beat the odds

When Cayla Dougherty and her husband, DJ, learned they were expecting not one, but two identical twin girls, they were surprised and overjoyed. Like new parents-to-be, they couldn’t wait until their twin girls arrived – but until that day came – the couple enjoyed going to their weekly ultrasound appointments to see their babies grow and develop, and watch their little hearts beat together on the large monitor.

Just like any other routine appointment, Cayla was scheduled for the twins’ 20-week anatomy scan followed by a celebratory baby shower two weeks later with her closest family and friends. But, the couple’s excitement quickly gave way to worry. During the ultrasound, their perinatologist could not find a tiny heart vessel on the scan. So, Cayla was referred to a pediatric cardiologist for an echocardiogram 10 days later, which revealed a life-threatening diagnosis that would change the course of her pregnancy.

Cayla’s cardiologist found the heart vessel in question but noticed something new – her babies were showing signs of Twin-Twin Transfusion Syndrome (TTTS). The couple’s twin girls – Grace and Caroline – shared a womb and a placenta, but they had grown even closer in the 10 days since their last scan. Their blood supplies, once separate, had grown together. Because Caroline was donating blood to her sister, Grace had too much blood flooding her little heart and an oversupply of amniotic fluid. Caroline had very little amniotic fluid and almost no visible bladder. Several hours later, Cayla’s perinatologist confirmed TTTS and immediately contacted Texas Children’s Fetal Center®. Filled with fear and hope, the couple boarded a flight to Houston that afternoon. As soon as they arrived at Texas Children’s that evening, Cayla was checked in and monitored closely. She had more scans, including an echocardiogram on her twins’ hearts, and anxiously watched and listened as doctors listed the multitude of things going wrong.

“I remember being so exhausted, my eyes were starting to close as the doctors continued reading the dopplers and discussing which stage of TTTS we fit into,” Cayla said. “Dr. Magdalena Sanz Cortes, our maternal fetal medicine physician, reviewed our options, and in doing so, was very compassionate and forthright with us. She explained the list of possible risks with placental surgery on 22-week old unborn babies. We listened to survival rates for one versus two babies. Our heads were swimming. We decided to proceed with the surgery and we prayed, and told God we surrendered to His plan for our little girls.”

On that very same evening just shy of midnight, Dr. Sanz Cortes performed selective fetoscopic laser photocoagulation surgery, the standard of care for severe TTTS. It is a minimally invasive surgical procedure that uses a small camera to find abnormal blood vessel connections in the placenta and disconnects them using a laser. The procedure prevents the exchange of blood between fetuses, often halting the progression of TTTS and normalizing the blood flow. For the Doughertys, the surgery proved to be a life saver for their girls.

“The doctors told us we had 48 hours to see if the girls would tolerate the separation of blood supply,” Cayla said. “They took me for my first follow-up scan just before the 24-hour mark. Caroline already had one to two more centimeters of fluid. It was working! Then, we waited for another 24 hours, hoping and praying that my body would not go into labor from the operation. One echocardiogram and two more scans later, we had collected a wall full of photos showing positive responses to the laser surgery.”

After fetal surgery, Cayla recuperated in the hospital for a few days. Since premature labor is a potential concern for patients following TTTS-related laser surgery, Dr. Sanz Cortes advised Cayla to limit her physical activity and get plenty of rest for the remainder of her pregnancy. Following her discharge, Cayla received follow-up care closer to home and continued to keep in touch with her fetal team. At 36 weeks, Cayla and DJ welcomed their beautiful twin miracles on Nov, 6, 2017, each weighing just over five pounds.

“Not a day – sometimes even an hour – goes by that I don’t think about our incredible journey and realize how fortunate we are to have both our baby girls,” Cayla said. “We are infinitely grateful to our cardiologist in Atlanta for identifying the problem and our perinatologist who referred us to Texas Children’s Hospital.

We are thankful to our angel, Dr. Sanz Cortes, and the fetal team at Texas Children’s for achieving the unimaginable. With time, I realize I don’t need to put our fight with TTTS behind us. Instead, I embrace it because our journey will always be part of us and our little family.”

Today, 3-year-olds Caroline and Grace are doing amazingly. They love to dance, talk, play dress up and they recently started pre-school this year. The girls are inseparable and are each other’s best friends. When the Doughertys see their daughters now, they are reminded of their TTTS journey and are grateful to our Fetal Center and the life-changing intervention that made it possible for their girls to be here today.

Click here to learn more about Twin-Twin Transfusion Syndrome and the innovations our Texas Children’s Fetal Center team uses to treat this condition and improve long-term patient outcomes.

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Cayla Dougherty