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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 script.”

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 Hermann Hospital.

“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!’”

Duffy Twins Family

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 pregnancy.”

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 of nutrients.”

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.

Duffy Twins Bundled

“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,” Crystal said.

“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 contractions.

“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 twins.”