health & wellness

DoubleTrouble

I

Twin to Twin Transfusion Syndrome
puts pregnancy at risk.

Ruthan Brodsky

leaving our two healthy children at home,"
Staci said. "We simply put all our trust
with the doctors. Crombleholme told us
my condition was worse than Beaumont
thought, but the good news was the twins
were physically sound:'
The laser surgery to shut off all of the
abnormal blood vessel connections on the
surface of the placenta shared by the twins
would put both babies at risk for early
delivery.
"The doctors gave each of us a binder of
material explaining everything about TTTS,"
Staci said. "I never opened it. I didn't want
to know more information. I just wanted to
focus on delivering healthy babies:'
In the meantime, Jamie was becoming
an expert on TTTS, reading everything he
could find about the condition, talking to
local doctors and calling the doctor who
invented the surgical procedure that would
be used on Staci.
"Last year I finally opened the binder
and read everything," Staci added. "If I
had read the information during my preg-
nancy, I don't know if I could have held it
together emotionally. There were so many
things that could have gone badly."

Contributing Writer

A

fter giving birth to two healthy
girls, Arielle in 2005 and Talia
in 2007, the next pregnancy for
Staci and Jamie Wittenberg was far more
challenging, demanding and often fright-
ening. In November 2008, two weeks after
Jamie was elected District Court Judge in
the city of Berkley, the couple learned Staci
was carrying twins.
"We planned a trip to Disney World
with our girls," Staci recalled. "It was our
chance to relax after the election campaign
and before Jamie started his new job. We
returned home and Dec. 31, I had my
11-week ultrasound and was told, 'It looks
like they may be identical twins"
Complications are evident in 10 percent
to 15 percent of a certain subset of identi-
cal twins who share the same placenta but
have their own amniotic sacs, according to
Dr. Richard Bronsteen,
Maternal-Fetal Medicine
and co-director of Fetal
Imaging, Beaumont
Hospital. "If the condi-
tion is misdiagnosed and
treatment does not take
place early, there is usu-
Dr. Richard
ally a high rate of fetal
Bronsteen
loss," he said.
It was close to
Valentine's Day when
Staci had her 19-week ultrasound. "When
the Beaumont ultrasound tech called a
doctor into the room, I knew something
wasn't right," she said.

Scary News

The ultrasound showed an imbalance
of fluid levels in the two sacs, one hav-
ing more than the other. Staci was put
on strict bed rest and told to return to
Beaumont in two days for a fluid recheck.
Fortunately, Staci's mother, Joan
Redisch, lived close by in Farmington
Hills, and Jamie's dad, Howard Wittenberg,
had recently decided to stay in Michigan
after helping with his son's campaign. Both
grandparents helped with the family so
that Staci could be on bed rest.
Her next check showed that the fluid
levels were even more out of balance. Staci
and Jamie met with Beaumont's high-risk
medical team, who informed them that
the pregnancy was showing signs of Twin
to Twin Transfusion Syndrome (TTTS).
The medical team had already con-
tacted the Fetal Care Center at Cincinnati
Children's Hospital, and arrangements
were made for a 7 a.m. appointment that
Friday. At the time, the Cincinnati Center

Back On Bed Rest

Staci and Jamie Wittenberg (with 2-month-old twins Maya and Brooke) and their
older daughters Arielle and Talia.

was the closest of three fetal surgery cen-
ters in the United States with the expertise
to perform a full range of fetal surgical
interventions. Today there is a fetal care
center in Ann Arbor.
The Wittenbergs arrived in Cincinnati
Thursday evening. Friday was a day of
medical tests. Staci met with Dr. Timothy
Crombleholme, founder of the center
(who now practices at Children's Hospital
Colorado), who diagnosed her with TTTS
Stage 3, a rare disease.
"Late Friday afternoon, we met in a con-
ference room to go over the test results,"
Staci said. "There were a dozen other doc-
tors in the room taking notes. Surgery was
scheduled for that Monday. We stayed at
a nearby hotel over the weekend, and all I
thought about was that we missed seeing
our eldest daughter as a flower girl for a
cousin's wedding. We knew nothing about
TTTS, and I was scared:'
TTTS can occur when identical twins
share a placenta. Within the shared placen-
ta are blood vessels that connect the blood
supply of the two fetuses, allowing blood to

flow between the twins. TTTS occurs when
the blood flow is unbalanced, and one twin
gets more fluid than the other because of
abnormal blood vessel connections.
The twin not getting enough fluid may
have brain issues, and the twin with too
much fluid may have heart issues. TTTS is
not an inherited or genetic condition and
is not caused by something the mother
or father has done or not done. However,
without treatment, it can be fatal for one
or both twins.
"To complicate matters, the ultrasound
also showed that one twin had a cystic
mass on her lower left lung called CPAM
Type II (Congenital Pulmonary Airway
Malformation)," Jamie said, "another
very uncommon circumstance. Dr.
Crombleholme immediately told us, 'This
baby needs to survive the surgery first and
then we'll tend to the lung:"

Risky Surgery

"Doctors were coming and going and there
were sick children all around us. It was
hard being there, not knowing anyone, and

The surgery was successful and after stay-
ing a day in the hospital, Staci and Jamie
returned home.
Staci wasn't talking much about her
pregnancy with her friends or family. "I
was frightened but determined to do what-
ever needed to be done to deliver healthy
babies," she said. "People asked me, 'How
can you be on bed rest and do nothing for
so long?' I told them that was my job. The
doctor told me I was an incubator until
I delivered the babies. He said my goal
was 30 weeks, but that didn't seem long
enough for me since I already had two
full-term babies. I was determined to stay
focused and overcome the challenge:'
Dr. Hamid Banooni,
Staci's obstetrician at
Beaumont Hospital,
and the Beaumont staff
worked with physicians
at the Fetal Care Center
to ensure proper follow
up, including frequent
ultrasounds.
Dr. Hamid
"I provided the
Banooni
Cincinnati Fetal Care
Center with informa-
tion about the follow-up ultrasounds, the
babies' growth and looked for signs of
possible trouble," Banooni said. "Signs of
trouble during a pregnancy are often very
subtle and difficult to detect, making it

Twins on page 52

April 24 • 2014

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