Northridge Drama : Rare Procedure Gives Unborn Twin a Chance

Soon after a Valencia woman checked into Northridge Hospital Medical Center suffering labor pains and contractions in the sixth month of her pregnancy, she and her husband were faced with a difficult decision.

Doctors said the twins she was carrying were dying because their blood vessels had mingled. One fetus was dangerously swollen and the other withering.

The couple, Patricia and Randy Moller, were told that they could wait until one fetus died, then the second could be delivered. Or they could try an experimental medical procedure that might save both twins--or kill them: deliver one twin prematurely and leave the other in the womb.

“When it was first presented. . . . I rejected it,” Randy Moller said of the last option. “It was just an additional risk” to his wife, he said.

Chance for Both

But Patricia Moller said she and her husband finally agreed to the unusual operation, wanting to do anything for the twins that “could give them both a chance.”

On Tuesday, the Mollers both said they had no regrets about their decision, even though one of the twins died after the procedure, which was performed Friday.

“There are many unknowns with this type of surgery, and the unknowns are proving themselves out,” Patricia said from her hospital bed.

But her Northridge doctor also had some good news for her Tuesday, as he gave the first detailed report on the outcome of the procedure. The fetus in the womb appears to be improving, said Dr. Khalil Tabsh, director of high-risk obstetrics at Northridge Hospital Medical Center.

Tabsh also reported that the baby that died Sunday morning had problems that would have proved fatal no matter what course of action was taken.

The decision to deliver one twin and leave the other in the womb was made because the blood supplies of the two fetuses were linked in a rare, often-deadly condition called twin-to-twin transfusion, Tabsh said. In such cases, one of the twins pumps much of its blood into the other, weakening itself and dangerously overloading the heart and tissues of its sibling.

Similar to Caesarean

The procedure used Friday, called a hysterotomy, is similar to delivery by Caesarean section and has been been used to take a single fetus from the womb, treat a medical problem, and return the fetus intact to grow to full term, medical experts said. But Tabsh and obstetricians at several research hospitals said it apparently had not been tried to save imperiled twins.

Patricia Moller, 30, had been hospitalized since July 3, when she started experiencing contractions in the 24th week of her pregnancy. Tabsh said the contractions were caused by extreme swelling of one of the twins and its amniotic sac, the fluid-filled membrane that protects the developing fetus.

Normally, two arteries and a vein run through the umbilical cord of each developing twin to the placenta, a large ball of intertwined blood vessels in which nutrients and waste pass back and forth between each fetus’s blood and that of the mother.

A twin-to-twin transfusion occurs when vessels from the two fetuses become joined within the placenta, Tabsh said, allowing blood to flow directly from one to the other.

The condition develops in about 20% of identical twins, but only becomes a life-threatening problem, as in the case of the Moller twins, in the rare occasions when an artery from one fetus joins a vein from the other, the physicians said.

Higher blood pressure in arteries causes the blood to flow into the other fetus’s vein.

Weight Less Than Half of Normal

In the case of the Moller twins, the “donor” fetus, named Daniel by the couple, weighed less than half the normal two pounds expected in a twin at 27 weeks, Tabsh said.

In a grainy, black-and-white ultrasound image of the womb obtained before the surgery and displayed on a television set at the hospital, Daniel looked tiny next to his twin.

The fetus receiving the extra blood flow, the one left in the womb, had swollen to twice the normal weight. Ultrasound images of the surviving fetus, taken Tuesday, showed that the swelling had started to go down, Tabsh said.

The image of the surviving fetus, named David by the Mollers, floated in slow motion on the television screen--its beating heart, eyes, nose and mouth all clearly defined--as his father calmly described to reporters the decision to go with the hysterotomy.

“As the condition continued to worsen, it became apparent that it seemed like the right thing to do,” he said.

Tabsh called doing an untried operation “nerve-racking.”

“You’re doing the first case, and you don’t know what the hell you’re going to be facing,” he said. He said he consulted doctors at University of California, San Francisco Medical Center who have specialized in other uses of hysterotomy.

Tabsh said the smaller twin died 38 hours after the operation from failure of lungs and other organs.

Daniel’s amniotic sac contained no fluid, Tabsh said, a condition that had prevented his lungs from developing. If he had been left in the womb, he would have died later, the physician said, and the continued pumping of blood into David would have killed that twin as well.

Looking fatigued and relieved, the twins’ mother, who was listed in good condition, said, “Once we got them to an age where we felt that the one could survive being born, we thought this was the best option, because we could give them both a chance.”