Hyannis, MA - August 26, 2000

Twin miracles

By CYNTHIA MCCORMICK

PROVIDENCE, R.I. - First there was good news - Marjorie and Glenn Campbell of Mashpee were expecting twins.

Then an ultrasound at South Shore Hospital in South Weymouth at 19 weeks' gestation confirmed some bad news: The twins were suffering from a potentially fatal syndrome known as twin-to-twin transfusion. Blood vessels in the placenta that are supposed to supply one twin got hooked up to the other fetus.

"One twin becomes a chronic blood donor to the other twin," said Dr. Stephen Carr of Women & Infants Hospital in Providence.

One twin wasn't getting enough sustenance and had stopped growing and moving. The other showed signs of heart strain from handling an overflow of blood to his tiny body.

"We saw one twin was much smaller than the other and had almost no amniotic fluid," Carr said. He said if Mrs. Campbell had done nothing she probably would have lost both fetuses.

What Mrs. Campbell chose to do made Rhode Island medical history. She became the second woman to have fetal surgery in that state, and the first woman to have both babies survive.

With Carr using the ultrasound equipment at Hasbro Children's Hospital in Providence and Dr. Francois Luks guiding the telescopic equipment, Dr. Thomas Tracy used a laser to seal off eight blood vessels, each with a diameter no bigger than the tip of a ball-point pen.

The endoscope that sheathed the laser had to curve inside Mrs. Campbell's belly to get the anterior placentas. There was a risk of damage to fetal blood vessels, and a risk of damage to Mrs. Campbell's uterus.

Mrs. Campbell said she was nervous going into the procedure - she wanted to stay healthy for her three other children, Victoria, 7, Nicholas, 5 and Nathaniel, 13 months. The twins were a surprise she had embraced, and she feared losing them.

She'd been on the Internet with twin-to-twin support groups, gathering information and advice. She'd met with doctors at New England Medical Center in Boston, who referred her to the team at the Rhode Island hospital. The two hospitals are collaborating on the fetal treatment program.

After meeting with Luks and Carr, Mrs. Campbell gave them the OK for the surgery at 23 weeks' gestation. She had her fears - after all, Luks had said they wouldn't know for sure if twin-to-twin transfusion syndrome was really the cause of the problem until they saw a reversal of the symptoms.

That came within 12 hours of the procedure, when the fetus whose growth had been stunted started making his own urine and moving. Ultrasounds showed that the fetus receiving a surfeit of blood showed less strain in the contraction of the heart muscles.

"Within hours we knew there was a major difference," Luks said.

The fetuses had been about four weeks apart in terms of size. By the time they were born prematurely Aug. 2 by Caesarean section, they were almost the same size - Alexander weighed 2.1 pounds and Christopher weighed 2.3 pounds.

The babies were delivered at 28.4 weeks after Mrs. Campbell's membranes ruptured -an occurrence that could be connected to the amniotic reductions Mrs. Campbell had gone through for the fetus receiving too much blood, or to the fetal surgery. Early rupturing of membranes is also more common in twins.

Baby Christopher was born with a stunted left leg that had to be amputated below the knee. Mrs. Campbell said a blood clot had formed in the leg, possibly due to Christopher's receiving so much rich, thick blood from his brother's side of the placenta.

Still, "we're lucky," Mrs. Campbell said. Tests of major organs and ultrasounds of the infants' brains show both twins are doing well.

Not scheduled to be released from the hospital until their due date of Oct. 21, the babies now open their eyes and respond to people's voices. "They certainly look at me," Luks said.

The first fetal surgery ever in Rhode Island was performed the first week of June, just a few weeks before the Campbell procedure.

In that case, one of the 22-week-old fetuses was already in bad shape and did die. The other baby, however, was born healthy Aug. 21 at 4 pounds. The parents named him Stephen, after Dr. Carr.

Twin-to-twin transfusion syndrome occurs in about 10 percent of identical twins sharing the same placenta. It's more life-threatening when it occurs early in the pregnancy rather than later on. If the syndrome is unaddressed, even a surviving twin can have heart or neurological damage.

An American doctor first performed the fetal operation that separates twin blood vessels in 1995. The Campbell babies are being weaned from ventilators and are fed mainly by tubes. Mrs. Campbell is staying with her older children in a suite at Ronald McDonald House in Providence.

Mrs. Campbell saie she is thrilled that the babies have the blond hair and blue eyes of her husband's side of the family.

Daughter Victoria is happy she's been allowed to hold one baby brother already but is already plotting on how to keep four brothers out of her room. "I'm going to hang a sign - 'No Little Boys!'Ÿ"

"They're salt of the earth, good people," Carr said about the Campbells. "It's really gratifying to salvage what is otherwise a hopeless situation."

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