After a Year of Surprises, Houston Family Rings in 2015 with Happy and
Healthy “Miracle Twins”
“It’s a cliché, but we were in the city of love,” Crystal
Duffy said, describing the dinner where she and her husband – over a bottle of
champagne and a très French meal – had decided they wanted another child.
It was the fall of 2013 and Crystal’s husband Edward had
surprised her with one of her lifelong dreams – a trip to Paris. He’d even
arranged to have their parents look after their 18-month-old daughter, Abigail.
“It was the trip of a lifetime; at times, I felt like we were living in a movie
The Duffy’s fairytale continued even after they returned home
to Houston, when Crystal found out she was pregnant just a few weeks later.
“We were ecstatic. This was another dream come true,” she
said. “Ed and I could hardly wait to tell Abigail she’d be a big sister.”
At the seven-week mark, however, Crystal began experiencing
painful cramps accompanied by strong pelvic pressure and heavy bleeding.
Prepared for the worst, she immediately contacted her physician Paul Cook,
M.D., with The OB/GYN Center of Houston affiliated with Children’s Memorial
“I remember that Dr. Melhem of the OB/GYN Center performed
an ultrasound and then looked at me and asked, ‘Was this a spontaneous
pregnancy?’” Crystal recalled. “I was so confused, and then he pointed to the monitor
and said, ‘Look – there are two heartbeats here – you’re having twins!’”
The ultrasound also revealed a blood clot in Crystal’s
uterus, which was the cause of some of the cramping and bleeding. She was
placed on bed rest for a month with hopes that the clot would reabsorb itself –
which is exactly what happened.
“I was so terrified of losing these babies; I cannot
describe how grateful we were when we heard we were in the clear,” Crystal
said. “Our prayers had been answered and I could finally relax and enjoy the
At 12 weeks, the Duffys received even more surprising news.
They were having identical twin girls.
Overwhelmed with joy, Crystal set to work preparing for what
would soon be a very full house.
Between shopping for matching outfits, building a custom closet for the
nursery, and finishing up home-improvement projects, she felt healthy,
energetic and excited for their rapidly expanding family.
But at 22 weeks, Crystal’s physicians found something
concerning – a routine ultrasound revealed an abnormal amount of fluid around
one of the twins.
“I was panicking,” Crystal said. “I knew the twins could be
in danger, especially after I saw how seriously my physicians took the news.”
Twin-to-Twin Transfusion Syndrome
After targeted tests, Crystal was diagnosed with Twin-to-Twin
Transfusion Syndrome (TTTS), a serious condition that affects 10 to 15 percent
of identical twins who share a placenta. TTTS occurs when the blood vessel connections
between the two twins produce an imbalance, or uneven sharing of the blood. In
these cases, blood from one twin (the donor) is pumped to the other twin (the
recipient), requiring the heart of the donor twin to do extra work to support
the recipient twin; in addition, the recipient twin receives too much blood
while the donor twin does not get enough.
This unequal sharing of blood can cause severe health issues
for both babies. The amniotic fluid level can be high in the recipient twin and
low in the donor twin. The donor twin may also become anemic due to the lack of
blood flow, and the recipient twin can develop heart failure from having the
burden of pumping so much extra blood. If left untreated, the condition is
often fatal for both babies.
Crystal’s obstetrician immediately referred her to
maternal-fetal specialist Kenneth Moise, M.D., co-director of The Fetal Center
at Children’s Memorial Hermann Hospital and professor in the department of
Obstetrics, Gynecology and Reproductive Sciences and the department of
Pediatric Surgery at UTHealth Medical School. Because Crystal’s condition had
already advanced to Stage III TTTS, Dr. Moise determined that the best
treatment for her was laser ablation surgery.
Laser ablation surgery aims to interrupt the blood flow in
the vessels that connect the twins through the insertion of a small telescope
and a laser device into the uterus. Once the abnormally connected vessels are
identified, the surgeon uses the laser to coagulate or seal the vessels. Laser
ablation surgery is the recommended therapy for the more advanced stages of
TTTS and can be performed between 16 and 26 weeks gestation. Survival of at
least one twin is seen in approximately 90 percent of cases, with survival of
both in 70 to 75 percent of cases. Without treatment, TTTS can result in the
death of both twins in greater than 90 percent of cases.
“Each placenta is unique like a fingerprint,” Dr. Moise
described. “So we won’t really know how many of these connecting vessels are
imbalanced until we can see the area through the scope. We basically create a
map of the placenta and once we find what we call the ‘equator’ – a theoretical
plane where these vessels are located, we’ll work through pattern recognition
techniques to find the vessels that are sending nutrients and blood one way to
one twin, but are not returning to the other twin. We seal these abnormal
vessels so they are no longer functional, thus recreating a balanced exchange
Dr. Moise consulted with the Duffy’s about the surgery,
advising them to act quickly. It was then scheduled for the very next morning.
In total, the surgical team lasered 11 blood vessels and drained an excess of
two liters of amniotic fluid from the recipient twin’s sac.
“The surgery went well, and it was very good that Dr. Cook
knew to monitor identical twins and to screen for excess fluid,” said Dr.
Moise. “What we are seeing is that these surgeries are very successful in
saving the lives of both twins, but the most important aspect is early
detection. It is crucial that all patients carrying twins be told what kind of
twins they have – fraternal or identical – at 10 to 12 weeks so that the
pregnancy can be managed properly. If a woman is carrying identical twins who
share a placenta, she needs to have an ultrasound every two weeks starting at
16 weeks. Laser ablation works, but we need to see the patient early enough to
detect the disease as soon as possible.”
After the surgery, Crystal was placed on bed rest at home to
recover. Later that week, she and Ed learned that despite the surgery’s
success, there was a further complication – specifically a small hole in the
membrane separating the twins. As a result, Dr. Cook believed there was a very
good chance that Crystal was now carrying Mono-Mono twins, meaning the girls
were in the same amniotic sac. This rare condition carries with it its own host
of potential complications, including umbilical cord entanglement and cord
compression. For the sake of Crystal’s – and the twins’ – health, Dr. Cook
decided to admit her to Children’s Memorial Hermann Hospital for bed rest and
strict monitoring, where she would stay for six to eight weeks or until the
twins were delivered.
“I remember loading up on magazines, snacks, pictures of
Abigail, a countdown calendar – even a lamp to make my room feel more like
home. I had no idea how I was going to successfully sit still for that long,”
“But then I met Sandra Uribe, a Maternal Fetal Medicine navigator
for Children’s Memorial Hermann Hospital. She arranged a support group for all
the ladies in antepartum, and it was so helpful meeting the other moms-to-be
that were in similar situations. It was also at this group where I was
introduced to Hannah, a music therapist who was completing her internship at
the hospital. She worked with me to find a creative outlet for everything I was
going through. One of the hardest things, I found, was being away from Abigail
for that long, so with Hannah’s help, I wrote and recorded a song about that.
It is so special to me, because not only did it help me pass the time, but it
was also so therapeutic in helping me process the stress, anxiety and
loneliness of going through my last month of pregnancy at the hospital.”
“We’re having some babies today”
On the evening of June 18, 2014, Crystal alerted her nurse
that something felt off. By the next morning, she was having full-blown
“They put me on magnesium to try to stop the labor,” Crystal
said. “But when Dr. Cook came back to check on me and saw that I’d dilated even
more, he just said, ‘It’s time – we’re having some babies today.’”
Dr. Cook and his colleagues were concerned that Crystal had
a condition called placental abruption – a rare and dangerous occurrence in
which the placenta detaches from the inner wall of the uterus. Completely
unrelated to her surgery or the TTTS, it was fortunate for Crystal that her
doctors kept her in the hospital for observation and continuous monitoring.
“Placental abruption can result in heavy bleeding and is one
of the primary causes of maternal mortality,” Dr. Cook explained. “That
possibility, combined with the contractions, meant it was time to deliver.”
Crystal was only 30 weeks and four days, but she reminded herself
how far they’d come since the laser ablation surgery, when she was only 23
weeks along. Leaning on her faith, Crystal remained calm while Dr. Cook and his
team prepped her for surgery and performed the C-section. A team of clinicians
stood by, ready to transport the girls to the NICU for care.
“I was so happy to hear them scream – their lungs were
certainly healthy! But it was hard not being able to see them and hold them
right away,” Crystal said. “Then, as soon as they left, I could sense something
was wrong in the OR. Ed was asked to leave and I heard one of the nurses say
something about a blood transfusion. Never, not once through all of this, did I
think for a second about my own life being in danger.”
“Crystal did great,” Dr. Cook recalled. “She experienced
some blood loss after the procedure, but we worked quickly to manage it and she
did very well after such a complicated pregnancy.”
Katherine Maria and Lauren Elizabeth each weighed 3 pounds
when they were born. They spent 38 days in the NICU and are now at home with
their parents and big sister.
“As I think back on all of it, I still can’t believe what
had to happen for us to all be here,” Edward said. “Crystal’s healthy and we
are blessed with two more daughters – each of them as happy and healthy as can
be, despite all the complications. It took not just one, but a string of
several miracles for them to emerge so healthy. They’re our little miracle