Miracle twins given a ten per cent chance of survival have celebrated their first birthday after having surgery while they were still in the womb.
Sherrie Foulger, 32, and her fiancé Craig Armstrong, 30, were told their babies had twin-to-twin transfusion syndrome (TTTS) at a 16 week scan. The condition causes one twin to receive more blood than the other, and doctors warned the babies were unlikely to survive the pregnancy.
The only option was a risky surgery which could have left either one, or both of the boys, Roma and Reeve Armstrong, brain damaged. Surgeons wheeled Miss Foulger in for the pioneering operation when she was 21 weeks pregnant.
After being born naturally at 29 weeks, the boys, from Ilkeston, Derbyshire, have suffered no long-term health complications.
Cargo worker Miss Foulger, who has two children Theo Francis, 12, and Troy Francis, eight, from a previous relationship, said: ‘We never thought we’d get to the point we’re at now. We’d go for weekly scans and I’d be so anxious not knowing if they would be alive or dead. Now the boys are thriving. They’re crawling around and holding themselves up and eating well.’
At her 16 week scan, Miss Foulger and Mr Armstrong, a groundworker, found out the twins had TTTS. The condition occurs in around 15 per cent of monochorionic diamniotic (MCDA) twins – identical twins that share the placenta which account for around two thirds of identical twins, according to the NHS.
It causes abnormal blood vessel connections to form in the placenta and prevent blood from flowing evenly between the babies. Diverted blood flow from one ‘donor’ twin goes to to the other ‘recipient’ twin.
This leads to an enlarged bladder and excessive amounts of amniotic fluid, and in most cases, one twin becomes dehydrated, which affects its growth, and the other develops high blood pressure which can lead to heart failure.
Miss Foulger said: ‘It broke my heart when they told me they had it. It absolutely petrified me. We read up on it and all you think is “I’m going to lose my babies”. I broke down – I thought I’d lose one, if not both of them.’
Around 300 twins die from the condition every year in the UK, while 6,000 babies are affected annually in the US.
At 18 weeks pregnant the couple were referred to a top consultant at Birmingham Women’s Hospital and, at 21 weeks, medics discovered the fluid around Roma was 11cm while Reeve’s was below one centimetre. This meant Roma’s heart was struggling and the only option was pioneering but risky laser ablation surgery.
The surgery, routine for TTTS babies on the NHS, involves finding the blood vessels connecting the twins and closing them off to help the blood flow evenly. The couple were told that without the surgery, there was a high chance the babies would die. But after the surgery, there was a 60 per cent chance of one of them surviving.
Miss Foulger said: ‘Even if they did survive there was a possibility they would have been starved of oxygen and end up brain damaged. I had local anaesthetic and was awake the whole time with Craig beside me. I’d never seen so many doctors. There were about 35 people in the room while it was happening. It’s an amazing thing medics do. They drained two litres of fluid.’
A week later Miss Foulger had a 4D scan and an MRI scan to identify if there was any brain damage to either twin, but thankfully both were fine and arrangements were made for delivery at 32 weeks. However, at 29 weeks and four days, Miss Foulger’s waters broke, as babies with TTTS are often born premature.
The pair were born naturally the same day – Roma first weighing 3lb 2oz and Reeve 27 minutes later weighing 2lb 13oz. Both babies had an oxygen mask to help them breath and feeding tubes. They were also given umbilical venous catheters, a tube going into their umbilical cord that allows fluids and medicines to be given without having to frequently replace an intravenous (IV) line.
Miss Foulger said: ‘When they were born, they were whisked off and taken to the neo-natal intensive care unit. They lifted them up to show us their faces but we weren’t allowed to hold them. It was such a mix of emotions. It felt like they came so quickly. We were happy they were alright but scared because we didn’t know what was going to happen.’
She added: ‘They looked so vulnerable with tubes coming out of them, we couldn’t do anything to help them. Although Reeve was the smaller twin he’s always been stronger. I could hold Reeve after four days and Roma after five or six days, so then could have double cuddles. It felt like the best thing holding them both. I’d sit there for hours not moving. I wouldn’t put them down.’
The twins spent 40 days at three different hospitals before being allowed home in May last year. The pair have since attracted 11,000 followers to their Instagram page, which Miss Foulger set up to create memories and help other parents going through the same thing.
Miss Foulger said: ‘I burst into tears when I first brought them home. I couldn’t believe it was happening – I was so overwhelmed with emotion. First they’d had TTTS, then there was the laser surgery, then them being born prematurely – it felt like everything that could have happened had done so. But we’ve been so lucky and blessed. Roma is really laid back and Reeve is the cheeky mischief maker. They get on really well and light up when they see each other. It’s amazing the bond they have because of all they’ve been through.’
You can follow the twins’ adventures on Instagram.
WHAT IS TWIN-TWIN TRANSFUSION SYNDROME?
Twin-twin transfusion syndrome is a rare but serious condition that can occur in identical pregnancies when twins share a placenta. Abnormal blood vessel connections form in the placenta and prevent blood from flowing evenly between the babies.
One twin then becomes dehydrated, which affects its growth. The other develops high blood pressure and produces too much urine.
This leads to an enlarged bladder and excessive amounts of amniotic fluid, which can put a strain on the twin’s heart, leading to heart failure. Without treatment, TTTS can be fatal for both twins.
The condition occurs in about around 15 per cent of identical twins who share a placenta, according to the charity Tamba. Around 300 twins die from the condition every year in the UK, while 6,000 babies are affected annually in the US.
Draining excess amniotic fluid can help to improve blood flow. If this is not enough, laser surgery is used to seal shut abnormal blood vessels and permanently disconnect them.
The surgeon then drains excess fluid. Even when treated successfully, most TTTS babies are born premature.
However, the majority go on to have long, healthy lives.
Source: Cincinnati Children’s hospital
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