remember that,’ she said lightly.
He hadn’t taken more than a mouthful before his bleeper sounded. He glanced down at the display and raised an eyebrow. ‘What do you know about TOPS?’
‘Twin oligohydramnios-polyhydramnios sequence—also known as twin-to-twin transfusion syndrome,’ she said.
‘Good. I prefer to call it twin-to-twin transfusion—it’s more of a parent-friendly explanation. We’re needed downstairs in the antenatal clinic,’ he said. ‘Now.’
THEY left their unfinished coffee and headed for the ground floor. Gemma Burton, one of the midwives, gave them the case notes and directed them to room two. Nic scanned them swiftly, gave them to Lucy to do the same, knocked on the door and introduced them both to Molly Drake.
‘How have you been feeling?’ he asked, sitting next to her and holding her hand.
‘OK—but then last week I started to feel a bit breathless. And I look like a house—I’m only seventeen weeks and I look like I’m going to deliver any day,’ she said. Her faced was pinched with anxiety. ‘I know I’m having twins but I never expected to be this big. And my tummy’s felt really tight in the last day or so.’
‘Would you mind if I examined you?’ Nic asked.
‘No. I just want to know, are my babies all right? The midwife said she wanted the consultant to see me…’
‘Hey, we always take extra special care of our mums having twins, so you’d get to see me a lot more often than mums of single babies anyway,’ Nic said reassuringly. ‘But, yes, I’m a bit concerned that you’ve put on weight very quickly and you’re breathless. I’d like to do a scan to see what’s going on, if I may?’
Molly nodded.
It didn’t take long for Nic to do the scan and see that his worst fears were realised. One twin was much bigger than the other. It had a full bladder, whereas the other twin’s bladder was empty, and the smaller twin seemed almost stuck to the wall of the placenta—which, he knew, meant that it had much less amniotic fluid in the sac surrounding it.
‘Is everything all right?’ Molly asked.
Nic held her hand again. ‘There’s a bit of a problem, but the good news is that we can do something about it. You have something called TTTS or twin-to-twin transfusion syndrome.’
‘What’s that?’
Nic gestured at Lucy. ‘Over to you, Lucy.’
‘It’s something that happens when identical twins share the same placenta,’ Lucy said. ‘Their blood vessels form a link in the placenta—most of the time that isn’t a problem, but sometimes the link isn’t balanced properly, so one twin ends up donating blood to the other. The babies are perfectly normal—the problem’s in the placenta. We don’t know exactly why it happens, but it might be to do with how late the fertilised egg splits to create two embryos. It happens in around one in a thousand pregnancies.’
‘And that’s what’s wrong with my babies?’ Molly asked.
Lucy nodded and turned the ultrasound screen so that Molly could see it. ‘You can see on the scan here that one twin’s a lot bigger than the other. If we measure their lengths, it looks as if this one’s a week older than his twin, even though we know he’s not. The bigger twin has too much blood going round his system, so his heart has to work harder, and he produces more amniotic fluid—that’s the bag of fluid the baby lives in—so he wees more and his bladder’s full. The smaller twin is anaemic and has less amniotic fluid surrounding him; he doesn’t grow as well and his bladder’s usually empty.’
‘Are they going to be all right? What—what can do you do to stop it?’
‘There are quite a few options,’ Nic said. ‘We can do something called amnioreduction—that means draining some of the fluid from around the bigger twin, which gives the smaller twin more space in the womb and will make you feel a lot more comfortable. It also reduces the chance of you going into premature labour. If we do that, it takes about an hour and we drain off two to three litres of fluid. I’d also like you to stay in hospital for a day or so, so we can monitor you, and then you can go back home, as long as you promise to stay in bed and take it easy for a few days.’ He squeezed her hand. ‘Though if you do take this option, we might need to repeat it later in your pregnancy, depending on how things go with the twins.’
‘There’s also something called a septostomy, where we make a little hole in the membrane that separates the twins and the fluid balances out between the sacs—we often do that at the same time as an amnioreduction,’ Lucy said. ‘Or we can send you to a hospital in London for laser treatment, which will break the joined blood vessels and stop the blood going from one twin to the other—it won’t hurt them and they’ll be able to grow normally. There’s another new treatment being tested at the moment which involves high-frequency ultrasound therapy—the same sort that’s used to treat kidney stones—though again if you choose this we’ll have to send you to a centre in London, as we can’t do it here.’
‘And the babies will both be all right?’
‘We’ve caught you relatively early, which is a good sign,’ Nic said. ‘If they both survive, the smaller twin should catch up on growth after the birth. But at this stage I can’t guarantee they’ll both be fine.’
‘So they might die?’
‘I know it’s a horrible thing to have to consider, but there’s a possibility you might lose one or both of them. I can’t quote any odds at this stage, and we’ll monitor you a lot more often than we’d usually plan and make sure we do everything we can to keep your babies safe,’ Nic reassured her. ‘There are two other options you need to think about, and I’m afraid they’re not very pleasant, but you need to know all the facts before you can make a decision. Some parents opt to have a termination now, because they feel the odds are stacked too high against them. I know it’s an unbearable thing to think about, but if you decide that’s what you want, we’re not going to judge you or criticise you.’
‘We’re here to give you the facts and to support you, whatever decision you make,’ Lucy said. ‘We’re on your side.’
‘I…’ Molly was clearly close to tears and Lucy handed her a tissue.
‘The other option, if we find that the procedures don’t work and the twin-to-twin transfusion is getting worse, is that we might be able to save one twin at the expense of the other,’ Nic said. ‘I know it sounds callous, but it’s a question of weighing up the risks.’
‘But you and your partner really need to discuss it and decide what you want,’ Lucy added.
‘George isn’t here,’ Molly said. ‘He’s away in the States on business. He said he’d change his meetings if I needed him here today, but I thought this’d be just…well, a routine visit.’
‘I know.’ Lucy brought a chair to the other side of the bed and held Molly’s other hand. ‘And this must have come as a shock to you. Is there anyone we can call to be with you?’
Molly shook her head. ‘I’m not on good terms with my parents, and George’s mum panics at the least little thing—she’s the last person I need fluttering round me. I just…’ She bit her lip hard. ‘Twins. When we found out, we never thought we’d cope. We’d just got used to the idea and started getting excited about it, and now this!’
‘Take your time,’ Nic said. ‘I’d like to start treatment in the next twenty-four hours—but if you want to talk to your husband or a friend first, discuss it with them, that’s fine.’
‘Would you explain the options to my husband?’ Molly asked Lucy.
‘Of