Coordinated, High-Risk Pregnancy Care for Healthy Twins and Happy Parents
December 15, 2021
Lexi Hinkle’s pregnancy was anything but typical. Early on, Hinkle learned she was expecting identical twins. What’s more, the babies shared a single placenta – a condition called monochorionic twins, which increases the risk of serious medical problems.
For both reasons, Hinkle was followed closely by maternal fetal medicine specialists at University Hospitals MacDonald Women’s Hospital. When at 27 weeks of pregnancy, the twins developed a rare but serious complication called Twin Anemia Polycythemia Sequence (TAPS), thankfully, Hinkle and her babies were already in the best place for care.
“After diagnosis, the first thing I did was research everything I could about TAPS and got involved in the TAPS Support Foundation. This is a fairly new disease and is often misdiagnosed or missed altogether,” Hinkle says. “I was so grateful my doctors identified the problem right away. It was a relief they could care for both me and my babies.”
Comprehensive, High-Risk Pregnancy Care
The UH Center for Maternal and Newborn Care is unique in that it brings together experts from UH MacDonald Women’s Hospital and UH Rainbow Babies & Children’s Hospital under one roof. Specialists work as a team to care for pregnant women and their babies. They include maternal fetal medicine physicians, neonatologists, obstetricians, pediatric specialists including neurologists and cardiologists, genetic counselors and many others.
This comprehensive expertise includes intrauterine fetal care before birth. It also allows for a seamless transition from fetal to neonatal care after delivery in the highest risk pregnancies, including those with TAPS.
TAPS is a slow imbalance in the blood flow between monochorionic babies and can begin at any time during pregnancy. The condition causes one baby to act as a donor, sending too many red blood cells to the recipient twin. As a result, the donor can become anemic and at risk of heart failure. The recipient’s blood becomes too thick, increasing the risk of blood clot and stroke. The condition can be fatal for both babies.
“TAPS is an extremely rare disease. Less than five percent of all births are twins. Only about 30 percent of twins share a placenta. And of those, less than 10 percent go on to develop TAPS,” says David Hackney, MD, chief of Maternal Fetal Medicine at University Hospitals, and one of Lexi’s physicians. “For mothers expecting monochorionic twins, we look for TAPS using very specialized Doppler ultrasound testing in the middle cerebral artery. Not all hospitals perform this critical testing.
Although treatment for TAPS may include intrauterine laser surgery or intrauterine blood transfusion, Hinkle’s doctors chose a wait and watch approach.
“We evaluate and plan treatment based on each unique case. Due to the babies’ severity, risk for fetal surgery and gestational age, the safest approach was for Lexi to carry the twins as long as possible,” says Jane Corteville, MD, director of OB Imaging at University Hospitals and an obstetrician on Hinkle’s care team. “Treatment is typically safer outside the womb.”
Caring for Mom and Baby
For the next seven weeks, Hinkle and her babies were closely monitored by her maternal fetal medicine team. Hinkle underwent ultrasound screenings twice a week and had multiple fetal echocardiograms to examine the babies’ hearts.
Finally, at 34 weeks of pregnancy, Lexi’s doctors determined the twins were strong enough for delivery and Katarina and Josephina were born via C-section, each under 4 pounds. Although TAPS typically resolves after birth, neonatologists were standing by to perform an emergency blood transfusion if necessary. And NICU staff immediately began caring for the preemie twins after Hinkle and her husband had a chance to hold them.
“I was amazed at how closely all our doctors worked together. We were so blessed that the babies didn’t have to be transported to another hospital for care,” says Hinkle, who stayed with the twins in the NICU for 26 days after their birth. “I could visit my babies day or night during my recovery.”
A New Beginning
Today, seven months after the twins’ birth, Katarina and Josephina have no lasting complications from TAPS. They are sitting up, blowing raspberries and giggling. They’re also enjoying being doted on by their 4-year-old sister Isabella.
“Everyone was so reassuring and passionate about what they did,” Hinkle says. “The care I received was exceptional.”