Leading the Treatment of a Rare Twin Syndrome


Jeff Ballinger

Numbers tell just a fraction of the true impact of Columbia’s Carmen and John Thain Center for Prenatal Pediatrics. The center is a leader in the tri-state area in referrals for complicated pregnancies requiring advanced fetal diagnosis and therapy and has earned a reputation for its success in cutting-edge treatments for conditions such as twin-twin transfusion syndrome, or TTTS.

TTTS is rare. Among identical twins who share a placenta, about 10% will develop the syndrome, in which the placental blood supply is shared unevenly, causing one twin to lose blood to the other. When diagnosed early in pregnancy, TTTS presents substantial risk for premature birth, serious illness for one or both twins, and loss of one or both twins. In severe cases presenting in the second trimester of pregnancy, the risk of losing at least one twin ranges from about 70% to 90% if left untreated.

The Center for Prenatal Pediatrics has flipped that figure to achieve a survival rate of greater than 80% for one or both twins through the use of fetoscopic laser surgery. With this procedure, a fetoscope (a narrow, elongated camera) is inserted into the uterus, allowing the abnormal placental vessels to be visually identified. The physician then uses laser energy to photocoagulate blood within the abnormal vessels, thereby interrupting the transfusion of blood from one twin to the other.

The center treats more patients with TTTS—over 30 per year—than any other New York medical center and is one of a select group of centers in the country that offer fetoscopic laser surgery. “We’ve built a robust program and developed a reputation not just for fetoscopic laser surgery, but also for the compassionate, thoughtful care that our team provides to women dealing with TTTS and other complicated twin pregnancies,” says Russell Miller, MD, the center’s medical director and the Sloane Hospital for Women Associate Professor of Prenatal Pediatrics (in Obstetrics & Gynecology).

The center attracts many patients for evaluation and care via word of mouth, social media, and physician referrals. Once patients present for care, the center’s specialists evaluate them and work to educate them and their families about pregnancy and available options. “When it comes to high-risk obstetrics and complicated pregnancies, it’s all about having options,” says Dr. Miller. “One thing I believe that we do really well as a team is help patients understand what’s going on with their pregnancies and the options that are available to them. Together, we figure out which option best fits their individual hopes, values, and expectations. Our group has been doing this for a long while, and I believe that our experience and dedication are key to providing outstanding care to our patients.”

Other members of the center’s fetoscopic laser surgery team are Lynn L. Simpson, MD, director of maternal-fetal medicine; Chia-Ling Nhan-Chang, MD, assistant professor of obstetrics & gynecology; and clinical coordinator Rosalie Ingrassia, RN, NP.


The Carmen and John Thain Center for Prenatal Pediatrics can be reached at 877-843-2229.