Fetal Surgery

January 2005

Fetal Surgery




Mike and Pisa Taulau come into the world with their first surgery behind them.

Oceanside residents Millie Taulau and her husband, Tino, were devastated when their unborn twin boys were diagnosed with an often-fatal condition called Twin-to-Twin Transfusion Syndrome (TTTS).

TTTS occurs in 10 to15 percent of twin fetuses that share the same placenta (identical twins) and, if left untreated, has a 

fatality rate of about 80 percent for one or both of the babies. It is normal for identical twins to share blood but problems arise when that sharing is unequal. “In TTTS, abnormal connection of blood vessels in the shared placenta results in an imbalanced flow of blood from one twin to another, affecting circulation,” says David Schrimmer, M.D., director of the UCSD Fetal Surgery Program. “Typically one of the fetuses becomes swollen with too much blood and the other becomes small and underfed because of not receiving enough blood. They often don’t survive.”

The one hope for the Taulau twins was that Schrimmer and his team had just announced a new in-utero surgery at UCSD Medical Center. “We were a little nervous,” saysTino. “But we wanted to do anything we could to help our kids.”

The surgery was performed by Schrimmer and his team in the 20th week of Taulau’s pregnancy. Schrimmer inserted a very thin telescope, called a fetoscope, into the uterus to view the connected blood vessels that were causing the unequal distribution of blood. Using a laser light guided by ultrasound, he severed the connection between the twins so that they would no longer share blood. This resulted in the restoration of normal circulation. The surgery was deemed a success when the babies, Mike and Apisaloma (Pisa), were delivered by cesarean section on September 12, 2005, at 29 weeks gestation.

The procedure was the first successful fetal surgery in a Southern California hospital. Only six other medical institutions in the United States perform fetal surgery for TTTS, the closest being UCSF. Results are encouraging: In 70 percent of the cases both twins survive; in an additional 10 percent of cases, one twin survives. There is a 5 percent risk of brain damage in babies successfully treated with surgery, which is lower than the rate associated with other (non-surgical) TTTS treatments.ding_pt.gif

— Jeffree Itrich