“ Do not google TTTS and go down the rabbit hole,” the nurse coordinator of the Fetal Treatment Program told her.
TTTS can occur in any twin pregnancy in which the twins share the placenta and when the blood vessels of the placenta develop abnormally. TTTS typically produces no symptoms in the mother.
Still, Morgan says she couldn’ t help but feel guilty.“ It was like walking around with a ticking time bomb,” she says. It was her first pregnancy, and there was nothing Morgan and her husband, Mike, could do that weekend other than try to understand what had happened.
A FIGHTING CHANCE The progression of TTTS is staged, based on doppler ultrasound findings. In Stage I, ultrasound shows a significant imbalance in amniotic fluid volume between the twins. In Stage II, the bladder in the donor twin becomes invisible, due to low urine production. In Stage III, umbilical vessels show abnormal signals. In Stage IV, hydrops fetalis( fluid accumulation) and heart failure develop in either twin.
TTTS does not necessarily progress linearly through stages, however. The condition may fluctuate between stages, improve spontaneously, or rapidly worsen. Therefore, deciding the timing and type of intervention is challenging for clinicians. Ultrasound also has limitations. A fetus cannot be physically examined, and clinicians need to infer the health of the twins based only on imaging findings.
“ It’ s frustrating, because you wish you could predict better,” Luks says.“ Ultrasound is fantastic, but it’ s not perfect. We think we understand what’ s going on, but we still don’ t.”
One of Morgan’ s twins was in Stage III cardiac failure with an invisible bladder. The other showed signs of fluid under her skin. Early interventions carry risks to both mother and babies, but delaying interventions risks disease progression and danger to the fetuses. Morgan and her husband faced a dilemma.
On Monday, Nov. 16, 2020, Stephen Carr, MD, their maternal-fetal medicine physician, gave Morgan and Mike three options: do nothing, which would leave little chance for the fetuses to survive; terminate the pregnancy; or undergo an ablation surgery. In this procedure, a surgeon would use a laser to close the placental blood vessels that were causing the imbalance. Brown’ s Fetal Treatment Program generally uses a conservative management approach, reserving the surgery for Stage II or higher. While this strategy risks intervening later, with more advanced disease, it minimizes unnecessary procedures and avoids exposing mothers and fetuses to potentially unnecessary risks.
Morgan learned that the surgery had a 60 to 70 percent success rate— that is, of both fetuses surviving. There was also a chance that only one of the twins would make it, yet Morgan would have to carry both in her womb for the remainder of the pregnancy. As happens in 10 to 15 percent of surgeries, both twins could perish, or Morgan could go into labor before the babies could survive outside the womb.“[ The odds are ] bittersweet,” Luks says. The doctors gave Morgan and Mike the night to decide.
Despite the risks, they decided to undergo the surgery.“ We wanted to give the girls a chance,” Morgan says.
The next morning, a Tuesday, Morgan and Mike drove to the hospital. They called family and friends along the way. Morgan remembers everything happening so fast that she and Mike had no time to tell everyone, nor to process their situation themselves. At the hospital, Mike was not allowed in the preoperative room because of COVID protocols, and Morgan was again left alone in a room full of strangers. Morgan saw the nurse who’ d cared for her the week before, carrying a cooler with blood in case Morgan suffered from excessive bleeding during surgery. In that instant, Morgan realized that if she bled out, not only her twins would die, but she would, too.“ I had only lived 27 years. I wanted to save my life,” she says.
Luks strode into the operating room. In case of an emergency, he told Morgan, they would have to perform a hysterectomy, which would leave Morgan unable to conceive biologically forever. He reassured Morgan that in the years that they had performed TTTS surgery, they had never had to do a hysterectomy. There had been one case in which they had to perform an emergency C-section, when one of the babies had become bradycardic( low heart rate).“ No one would feel at ease hearing that,” Morgan says,“ but I really appreciated that he was being completely honest.” She decided to put her life and reproductive capacity in Luks’ hands and signed the surgical consent.
“ How do you know when we are no longer at risk?” Morgan asked the nurse.“ When the girls are born,” the nurse said. The thought that anything could happen even after a successful surgery was daunting. Morgan imagined the faces of family and friends as the anesthesia took hold.
18 HEALTH DISCOVERIES @ BROWN l SPRING 2026