Surviving Twin in Rare Surgery Is Born Early

An infant boy, whose twin brother died last month after he was removed from their mother’s womb, has been born prematurely but “has a very good chance of surviving,” doctors at Northridge Hospital Medical Center said Monday.

The other twin was removed from the womb in a rare operation July 25 when both fetuses were endangered because their circulatory systems had become linked.

The apparent success of the operation in saving at least one of the twins offers hope that it may be used to rescue other unborn twins afflicted with the same condition, said the physician who performed the surgery, Dr. Khalil Tabsh, the hospital’s director of high-risk obstetrics.

Valencia Family

The surviving boy was born Wednesday, almost three months prematurely, to Patricia Moller of Valencia, but the birth was not revealed until she met with reporters Monday as she prepared to leave the hospital with her husband, Randolph.

The mother said that she had hoped both boys would survive but “I’m just happy I have a son who is alive and going to make it.”

The boy, named David, was in serious but stable condition. He will probably be allowed to go home in “about two and a half to three months, if there are no other complications,” said Dr. Theodore Glatz, the neonatologist in charge of his care.

“From what we see now, he has an excellent chance of being completely normal,” Glatz said.

The boys developed a condition called twin-to-twin transfusion, which occasionally afflicts identical twins. David’s umbilical vein became connected to an umbilical artery of Daniel, as the parents named the other twin.

Because blood pressure in the artery was higher than the pressure in the vein, Daniel’s heart pumped his blood into David. Daniel’s development was stunted by the transfusions, and the excess fluid was injuring David.

Medical Threats

By their 27th week of gestation, Daniel weighed 1 pound, 1 ounce, only half the expected normal weight at that point, and his urinary system and lungs were not developing properly. David, by contrast, had swollen to twice the normal weight, which was threatening him with heart failure.

Left alone, the babies “had virtually no chance of survival,” Glatz said.

In virtually all such cases, Tabsh said, the mother goes into labor prematurely and both babies die. All eight of the previous cases he had treated ended with the death of both infants, he said, estimating that both Moller twins were within “a few days, maybe a week at most” of death when he operated July 25.

Daniel, who was being compressed by his swelling twin, stood a better chance of survival outside the womb and David’s chances were improved by being alone in the womb, doctors concluded. They proposed removing Daniel by Caesarean section.

Patricia Moller, 30, said she and her husband struggled over the decision of whether to agree to early delivery of the first boy.

Father’s Decision

“I was delighted that there was an inkling of hope that both babies could live. I was trying not to listen to the possibility that both could die,” she said. “It was a scary decision because I’d have to have two Caesareans in a short time. Finally, I just left to my husband. . . . “

“It was hard at first, but the the options became clearer as I considered my wife’s condition and David was getting worse with the swelling,” Moller said.

Tabsh performed a hysterotomy, opening the womb in the manner of a Caesarean delivery, and removed Daniel, who died two days later.

While hysterotomies have been performed with single babies who have been removed from the womb for treatment of prenatal conditions and returned, this was the first instance he knows of in which the hysterotomy was performed specifically in an attempt to save twins, Tabsh said.

Continued Development

The primary medical significance is that David continued to develop in the womb and his swollen condition began to disappear, the physician said.

Although this period lasted only two weeks, until the mother underwent a second Caesarean for the delivery, Tabsh said, he believes that in other cases the fetus could be carried much longer. David had to be delivered early because the mother’s amniotic sac ruptured, which would not necessarily occur in other cases, he said.

David was born weighing 4 pounds, 3 ounces. Four ounces of fluid were drained from his abdomen and the rest was allowed to dissipate normally, reducing him to 2 pounds, 3 ounces, the hospital said. A ventilator to assist his breathing was removed Sunday.