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Patient thanks clinicians for saving twins before birth

“Miracle” is not a word that Ginger and Neil Blythin use lightly. But when it comes to their twins, Evelyn and Rachel, it’s the only word they say that can describe how their daughters were saved at Mount Sinai Hospital before they were born.

Ginger was 20 weeks pregnant when she learned during a regular ultrasound that something was wrong. Her obstetrician in Hamilton explained that her twins had twin-to-twin transfusion syndrome (TTTS). Within 90 minutes, Ginger was at Mount Sinai to see the Canadian experts in the field, maternal-fetal medicine specialist Dr. Greg Ryan and the hospital's Fetal Medicine Unit team, who kept the clinic open that evening to take on the emergency case.

Blythin Family Photo

Neil and Ginger Blythin with their four children;

William, Keira, and identical twins Evelyn and Rachel

In Canada, TTTS affects about 250 sets of identical twins each year, putting the lives of both twins at high risk before they are born. TTTS is usually identified during ultrasound between 14 and 30 weeks of pregnancy.The fetuses share a single placenta in which some blood vessels are linked, so one twin gets much more blood and nutrients than the other.  This also results in one fetus producing too much amniotic fluid while the other produces too little.

The most effective treatment is surgical removal of the abnormal blood vessels in the placenta. The surgeon positions endoscopic instruments in the uterus under ultrasound guidance so that a laser beam can seal off the culprit blood vessels in the placenta.  When Dr. Ryan pioneered the treatment in Canada in 1998, survival of affected babies went from about 10 per cent to approximately 80 per cent. “Unfortunately, many TTTS cases go undiagnosed each year,” he says. In all cases of pregnancy with identical twins, “they should be followed with ultrasound every two weeks from about 16 weeks gestation onwards.”

The surgical team of Drs. Ryan, Johannes Keunan, and Ali Al-Ibrahim performed the delicate procedure when the twins were at 23 weeks gestation. In addition, they withdrew 3 litres of extra amniotic fluid from the larger twin’s amniotic sac.  By that stage one twin was much smaller than the other. The family felt comforted, knowing they were “in the best possible hands,” says Neil, who also acknowledges the expert, compassionate care they received from technologists and nurses. After surgery, Dr. Ryan gave the couple a photo of the twins in utero. “That was very special,” says Ginger.

Dr. Greg Ryan

Dr. Greg Ryan, maternal-fetal medicine specialist at Mount Sinai Hospital.
Dr. Ryan performs in-utero procedures for fetal heart abnormalities, lung tumors and TTTS.

The babies were delivered four weeks later on June 3 by emergency c-section in Hamilton. Evelyn weighed two pounds 12 ounces and Rachel weighed 11.6 ounces. The twins spent months in two NICUs at local hospitals before heading home with their parents and siblings.

The family is so very grateful, says Ginger. “When it comes to Dr. Ryan and the Fetal Medicine Unit team, it’s hard to express how lucky we feel. We were with the very small team of people in the world who make these miracles happen.”

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