In utero transfusions save baby twins Billie and Poppy

Gold Coast mum Marni has thanked the medical team at Mater Mothers’ Hospital for saving the lives of her unborn twins Billie and Poppy – by giving one a life-saving blood transfusion while still in her womb.

 

The now five-month-old sisters were diagnosed with Twin Anaemia Polycythaemia Sequence (TAPS), a rare condition in which blood flows unequally between twins who share a placenta and results in one fetus having a low blood count (anaemia) and the other fetus having a high blood count (polycythaemia). 

 

Both anaemia and polycythaemia can be harmful to the developing babies before and after birth. 

 

TAPS occurs in only 3 to 5 per cent of twin pregnancies where the babies share the same placenta.

 

The condition was diagnosed by doctors at Gold Coast University Hospital at 22 weeks into Marni's pregnancy and she was referred to the Mater Centre for Maternal Fetal Medicine at Mater Mothers’ Hospital for specialist care.

 

Shining a spotlight on World Prematurity Day (17 November), Marni, 43, said her “precious girls” arrived six weeks early on 14 June at Mater Mothers’ Hospital and spent 10 days in its Neonatal Critical Care Unit (NCCU).

 

Director of the Mater Centre for Maternal Fetal Medicine Dr Glenn Gardener cared for the unborn twin girls, performing two in utero blood transfusions on a “very anaemic” Poppy and an exchange blood transfusion on her polycythaemic sister Billie, at 29 and 32 weeks’ gestation.

 

A fetal blood transfusion or exchange transfusion is performed under ultrasound guidance by passing a needle through the mothers abdomen into the fetal umbilical cord. 

 

While blood is transfused into the cord of the anaemia twin, it is necessary to remove a small volume of blood from the cord of the polycythaemic twin.

 

“In some cases of TAPS we can perform in-utero laser surgery but due to the position of the shared placenta, this was not an option,” he said.

 

“In Marni’s case, to ensure her comfort she was given a local anaesthetic in her abdomen for the first procedure, and had an epidural for the second.”

 

Red blood cells from a donor whose blood type is compatible with the baby’s are sourced from the Australian Red Cross Lifeblood. 

 

First-time mum Marni, of Merrimac, said a team from the Mater Pathology Blood Bank was in attendance for each procedure “at the ready” to help save her unborn babies.

 

“It was so good to have the team there,” Marni said. 

 

“They tested the blood in real time. Because I am a negative blood type, they needed to match it to my blood type. Donated blood helped save my babies.”

 

Dr Gardener said the risks involved in performing an in utero blood transfusion included preterm birth, amniotic fluid leakage from the uterus and fetal infection.

 

He said both anaemia and polycythaemia can cause issues for each twin including heart failure and contribute to them not growing as well as their sibling. 

 

“Both Billie and Poppy were at risk of heart failure and even dying – without intervention they may not have survived in such good condition,” Dr Gardener said.

 

He said about eight sets of twins diagnosed with TAPS were cared for each year at Mater’s Centre for Maternal Fetal Medicine.

 

Marni said she felt “scared” knowing the risks involved in the procedure, but she was determined to give her daughters the best chance at life. At the same time, she was also grieving the loss of her mother after a short battle with cancer.

 

“Dr Gardener and his team were spectacular – they were so calm, confident and caring during our journey,” Marni said.

 

“They advocated for us and if it wasn’t for the team at Mater Mothers, our girls wouldn’t be here today.”

 

One week after having the second blood transfusion, one of the baby’s membranes ruptured and Marni was admitted to hospital for a round of antibiotics to prevent infection. 

 

But at almost 34 weeks’ gestation, her girls were born via a caesarean section, with Billie weighing 1.74kg and Poppy tipping the scales at 1.89kg.

 

After a tumultuous pregnancy journey, Marni said she was thrilled to have two happy and healthy baby girls in her arms now.