FETAL CARE AND NEONATOLOGY
BAD CONNECTIONS
FAST WORK WITH A LASER SAVES
TWINS’ LIVES
Meet Mila & Ciela
Nicole Shore had enough to worry about when she and her
husband Ari found out they were having twins. New car, maybe
even a new house; the logistical challenges of going suddenly
from one kid to three. She worried about what would happen
after she delivered, not before.
“We just thought we were having a
natural pregnancy,” she says.
But when the contractions came on
hard at 22 weeks, she worried. She
went to her doctor, who ordered
The process
an ultrasound. “I went to get the
is astonishingly
results and they said, you need
to make an appointment with
meticulous.
Timothy Crombleholme [M.D.]
If Dr. Crombleholme’s
immediately. Like, don’t mess
laser overlooks even
around,” she says.
a single vessel, the
TTTS persists.
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Within the two weeks since her
previous ultrasound, Nicole’s
twins had developed twin-to-twin
transfusion syndrome (TTTS). Mila,
the larger of the two, was getting
an overwhelming share of amniotic
fluid and placental blood, causing
her system to work overtime to
process it; the smaller, Ciela, lacking
fluid and blood, had withered. “Ciela
was wrapped in the amniotic sac like
cellophane,” says Nicole.
The problem is vascular connections
in the placenta that allow the twin
fetuses to share blood. It’s these
connections that let the imbalance
develop. “The mortality rate for this
condition is extraordinarily high
without treatment, approaching
100 percent for both twins,” says
Dr. Crombleholme, Director of the
Colorado Fetal Care Center at
Children’s Hospital Colorado.
The most effective treatment
method, Dr. Crombleholme told
Nicole, was also potentially the
riskiest: fetoscopic laser ablation,
Twins Mila and Ciela Shore wishing they were big enough for dad Ari to push them on the swings, like sister Eyla.
Until then, they're hanging out with mom Nicole.
in which the surgical team uses
a laser to eliminate the vascular
connections between twins.
Dr. Crombleholme and his team begin
by mapping out, one by one, the
hundreds of vessels on the placenta,
marking each spot they intersect
— typically between three and 60
connections. Then Dr. Crombleholme
inserts a fetoscope into the amniotic
cavity through a three-millimeter
incision, zaps each connection with a
laser, and seals it off.
The process is astonishingly
meticulous. If Dr. Crombleholme’s
laser overlooks even a single
vessel, the TTTS persists. The
operation fails. Success demands
both precision and speed. When
Dr. Crombleholme started doing
the operation 20 years ago, it
took about 10 to 20 minutes to
complete. Not long, but survival
has everything to do with timing.
A procedure of under five minutes
results in a 92 percent survival rate
for the donor twin — the smaller
of the two, and the one less likely
to survive. At 10 minutes that
rate falls to 78 percent. Today, Dr.
Crombleholme averages two and a
half minutes.
“Our survival rates are the best in
the world,” he says.
Whether to do the surgery or
not wasn’t hard for Nicole and
Ari to decide.
Front Porch photo by Laura Mahony Photography
“My husband and I didn’t even talk
about it,” Nicole says. “We just
looked at each other and knew we
had to get it done.”
It worked. Mila and Ciela were
born at 32 weeks gestation.
Weighing less than three pounds,
both spent about a month in the
Neonatal Intensive Care Unit at
Children's Colorado for stabilization
and management.
Now nearly two years old, they're
thriving — nothing about them
suggests the life-threatening trauma
they went though before they were
born. “Healthy, happy,” Nicole says.
“They’re great.”
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