Twins with rare condition undergo in-utero laser procedure to save their lives under the direction of the Sentara EVMS Fetal Care Center.

Sentara & EVMS launch Sentara EVMS Fetal Care Center

EVMS surgeons perform in-utero procedures at Sentara Norfolk General Hospital

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Crystal Springer, 27, was pregnant with twins when she learned one of them was killing the other. They were diagnosed with a rare condition called Twin Twin Transfusion Syndrome (TTTS), in which one of the fetuses was giving up most of its blood and nutrients to the other through communicating blood vessels on the placenta. TTTS affects about 15 percent of twins in the womb.

Crystal and her husband, Nick, a sailor on USS Eisenhower, were stunned when a routine sonogram at her doctor’s office 22 weeks into her pregnancy led to a same-day visit with Jena Miller, MD, an EVMS Maternal-Fetal Medicine specialist.  Dr. Miller recommended a laser procedure performed in-utero to separate the blood vessels. It would be the first of its kind for the new Sentara EVMS Fetal Care Center at Sentara Norfolk General Hospital.

“Every day, you live in fear,” said Springer, who said Dr. Miller was up front and honest about the risks. “We could lose one or both of them during the procedure,” Springer recalled. “They could have still been premature and there were concerns about brain damage and heart problems as a result of the condition.”  Doing nothing meant one or both of the twins would likely die.

Dr. Miller performed the first TTTS procedure at Sentara Norfolk General Hospital on Dec. 9, 2013. Though she had performed the procedure many times, this was her first with EVMS, but Springer trusted her knowledge, skill and compassion.

“We got really lucky,” said Springer. Identical twin sisters Ella and Anna were born prematurely at 32 weeks gestation on Feb. 21, 2014, one minute, one pound and one inch apart. They spent six weeks in the special care nursery at Sentara Norfolk General Hospital, growing stronger each day as EVMS physicians and the hospital care team monitored their progress. Both have gone home and are expected to develop normally.

"This collaboration brings important services to the Hampton Roads region and to Virginia,” says Alfred Abuhamad, M.D., chair of EVMS obstetrics and gynecology. “Combining EVMS’ maternal-fetal medicine expertise and Sentara’s world-class facilities and care team means that women with complicated pregnancies have access to outstanding care.”

The center, located on the Eastern Virginia Medical Center campus in Norfolk, provides in-utero treatment for many fetal conditions once considered life threatening or treatable only after birth. It is the only site of care in Virginia, and one of few on the East Coast, offering laser therapy for TTTS. The nearest sites performing TTTS procedures are in Baltimore and Charlotte.

“Our partnership provides the opportunity to capitalize on the unique strengths of Sentara and EVMS, to offer an unparalleled level of care in our region,” said Kurt Hofelich, president of Sentara Norfolk General Hospital. 

The center offers a range of routine and advanced services, including fetal endoscopic surgery, fetal transfusion, amniocentesis, amnioinfusion, fetal echocardiography and genetic counseling. The team — led by Dr. Miller, who also is an EVMS assistant professor of obstetrics and gynecology, and supported by a highly trained staff — works collaboratively with referring physicians and families to coordinate treatment plans and to explain short- and long-term outcomes.

The center is the first in the state — and one of the few on the East Coast — to provide in-utero laser treatment for TTTS, a condition that affects 15 percent of identical-twin pregnancies and can be fatal for one or both babies.

“EVMS is proud to build on our strong relationship with Sentara Healthcare, to bring a new level of care to families in Hampton Roads and beyond,” says Richard Homan, M.D., president and provost of EVMS and dean of the School of Medicine.