This is an archived article that was published on sltrib.com in 2008, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
A Utah doctor recently traveled to Colorado to help a pregnant woman considering terminating one of her twin girls so the other could live.
Instead, Robert Ball and his partner Michael Belfort eventually performed a risky surgery they are now promoting in Utah. And they saved both babies.
"It's really one of those happy endings that wasn't supposed to have one," says the overjoyed Inglewood mother, Shannon Gimbel, who had lost a previous twin pregnancy. "How do you thank doctors for making you a mom when you never thought you would be?"
Call Ball and Belfort Utah's globe-trotting fetus fixers.
The two doctors have started a program at St. Mark's Hospital to treat a condition called Twin-to-Twin Transfusion Syndrome (TTTS) with laser surgery while the babies are still in the womb.
It is the only hospital in the Intermountain West that does the in-utero surgery. But Ball and Belfort, who specialize in high-risk pregnancies, won't force parents to travel to Utah for it. The pair have permission to operate in six other states, from Virginia to Colorado, and are working on adding a seventh.
St. Mark's parent company, HCA Hospital Corporation of America, pays for their travel. Insurance typically covers the surgery, they say.
The two train doctors at each hospital they visit and are setting up telemedicine links so they can watch and guide future surgeries.
"There's a whole load of patients who wouldn't even think of getting on a plane," says Ball, who trained and worked at the University of California, San Francisco - dubbed the birth place of fetal surgery. "Unless they happen to live within driving distance of one of the [other] centers, they are out of luck. That kind of spurred us on."
The disease occurs among identical twins, affecting about 1,500 pregnancies a year. Due to abnormal blood vessels in the shared placenta, one twin gets too much blood, creates too much amniotic fluid and can develop heart failure. The "donor" twin produces too little fluid and doesn't grow correctly.
Without treatment, one or both babies can have a 90 percent chance of dying. But even the surgery can't always save both twins: there's a 50 percent chance of losing one baby and a 15 percent chance of losing both.
The goal of the laser surgery is to stop the twins' blood exchange. The mother is given a spinal anesthetic, like an epidural, and is awake as doctors insert a fiber-optic scope in her uterus and close the common blood vessels with a laser.
The skill is in finding the right vessels. Get it wrong and the babies can be deprived of oxygen.
The more common treatment, using a needle to remove excess amniotic fluid, is even riskier.
Of the seven surgeries the St. Mark's team performed in 2007, two women delivered twins and another two are still pregnant with twins. One lost both babies due to premature birth. And two patients each lost one baby.
"We'd love to have two healthy survivors but given the situation that's not always something we can count on," says Ball.
"The other option is no survivors," adds Belfort, who also teaches maternal-fetal medicine at the University of Utah.
Even when the surgery is a success, there is at least a 5 percent chance that the survivors will have brain injuries.
Despite the surgery, Traci Meyer, of Bountiful, lost one of her daughters. Ally's heart was failing before the procedure and never recovered. But Lucy survived, and Meyer credits Ball and Belfort.
Before the surgery, the girl was surrounded by nearly no amniotic fluid - she looked like she was wrapped in Saran Wrap, her mother recalls. Her kidneys weren't working and her growth was stunted.
Because Lucy was born almost three months premature, due to the disease, she will likely have mental or physical disabilities. Meyer has no regrets.
"She's just doing fantastic. She's getting bigger every day. She's smiling," she said. "We just are so lucky that [the program] is here in Utah. We have three other children. I don't know we could have left them [to travel out of state] to have the surgery."
Gimbel, from Colorado, decided to take the gamble, as she puts it. If she didn't, one of her twins would likely have died from heart failure and taken the other one with her. During the first ultrasound after surgery, she held her breath until the nurse spotted two heartbeats.