Rare Fetus Condition Forces Twins’ Parents to Make Tough Choice

Soon after a Valencia woman checked into a hospital suffering labor pains and contractions in the sixth month of her pregnancy, she and her husband faced a difficult decision.

Doctors at Northridge Hospital Medical Center said the twins she was carrying were dying because their blood vessels had commingled. One fetus was dangerously swollen, the other withering.

The couple, Patricia and Randy Moller, were told that they could wait until one fetus died, then deliver the second. Or they might try an experimental medical procedure which might save both twins--or kill them.

“When it was first presented. . . I rejected it,” Randy Moller said of the second option, which involved delivering one twin prematurely and leaving the other in the womb. “It was just an additional risk” to his wife, he said.

But Patricia Moller, 30, 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 the twin delivered Friday died Sunday.

Some Signs of Improvement

Dr. Khalil Tabsh, director of high-risk obstetrics, had some good news for her Tuesday: the fetus in the womb appears to be improving.

Tabsh also said it was subsequently learned that the fetus delivered Friday had serious problems that would have proved fatal even if no procedures had been tried.

Previously, the procedure, which is called a hysterotomy and is similar to delivery by Caesarean section, had been used to take a single fetus from the womb, treat a medical problem, and return the fetus intact, doctors said. But Tabsh and obstetricians at several research hospitals said it had apparently not been tried as a way to save imperiled twins.

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. In such cases, Tabsh said, one of the twins pumps much of its blood into the other, weakening itself and dangerously overloading the heart and tissues of its sibling.

In the case of the Moller twins, the growth of the “donor” fetus, who was given the name Daniel by his parents, was so stunted that he was less than half the normal two-pound weight expected for a twin in its 27th week, Tabsh said. The surviving baby is called David.

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

Tabsh called the operation “nerve-wracking.” He said that even though the smaller twin ultimately died, the decision to remove him proved to be right. 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 to develop, he would have died later. And in the process, the continued pumping of blood into David would have killed that twin as well, he 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,” Patricia Moller said.