Saving Lives of Tiny Humans

            The daughter of a long-time friend delivered identical twin boys early today. As I understand it, the babies shared one placenta. They were in danger at one point, seemed to get better for a while, and birthed early to avoid further danger. Knowing of my friend’s concern for her grandbabies, an article by Tara Sander Lee immediately caught my eye. 


            It seems that identical twins who share one placenta sometimes develop a disease known as twin-to-twin transfusion syndrome. This is a life-threatening condition for one or both babies. It causes the small twin – known as the donor – to pump blood to the larger twin – known as the recipient. If the condition is not treated early enough and the disease becomes advanced, 80 percent to 100 percent of the babies die.


            The miracles of medicine make it possible for doctors to perform surgery on babies while they are in the womb. Dr. Ben Carson performed brain surgeries on pre-born babies, and other doctors perform other types of surgery on them. For identical twins with twin-to-twin transfusion syndrome, laser surgery is performed on the placenta to correct the defect. The laser surgery to correct the problem is somewhat new.

The first procedure used to treat twin-to-twin transfusion syndrome was pioneered and performed in 1988 by Dr. Julian E. De Lia in the United States. Opportunities for intervention have markedly improved since then, but the underlying goal has remained the same; namely stop progression of the disease and optimize outcomes for both babies.

Fast-forward 30 years, and this minimally invasive surgery – formally called fetoscopic laser ablation – is now the preferred treatment, particularly when the disease is identified in its early stages, for patients between 16- and 26-weeks’ gestation….

The advanced technology uses endoscopes (small fiber-optic guided instruments) and one small incision to seal off the blood connection between the twins. Mom and both babies are under anesthesia, and the entire operation lasts less than two hours and requires only a one- to three-day hospital stay.

            Increased surveillance is routine for women with twin pregnancies whose babies are at risk of developing twin-to-twin transfusion syndrome, but there are still women who do not receive this offer. Even though this “laser surgery has a proven record of saving both babies at all stages of the disease,” selective fetal reduction (or selective feticide) – termination of one baby – is still an option. Selective reduction is usually offered when there are serious problems with one of the babies. This procedure cuts the flow of cord blood to one baby, causing its death while trying to save the life of the other.

Studies have shown that selective fetal reduction offers no better outcome, with maximum survival of 50% for one twin, a rate much lower than laser surgery with a higher than 80% survival of one or both babies. And this termination procedure will guarantee 0% survival for at least one twin.

Furthermore, it can be hard to define which fetus has the worse prognosis….

A 2019 U.S. study reported that the majority of twin-to-twin transfusion syndrome patients referred to a single surgery center in California for fetal therapy underwent fetoscopic laser ablation (96.4%), but a small percentage still opted for selective feticide (0.8%). Of those patients that did not undergo any form of fetal therapy, 42.6% terminated both twins. Twin-to-twin transfusion syndrome is a particularly challenging and dynamic disease with progression that is often unpredictable. Some cases remain stable throughout pregnancy, or even regress, while others develop quickly with rapid deterioration of twins within days.

            It seems that time is the real enemies of such twins. Any delay between diagnosis and treatment can cause the women to become ineligible for fetal surgery and can be deadly for their babies. 


            When surgery can be done successfully on babies that are only 16-26 weeks gestation to save their lives and/or improve their health, it boggles my mind to think of the millions of babies that are aborted at that age. What kind of evil can convince a woman that it is better to kill her baby than to give them life?