Going the distance to save the LeGrazie twins
Virtua Health employee and Moorestown resident Bridget LeGrazie had a relatively normal first pregnancy with now two-year-old daughter Mia. Soon after, LeGrazie and her husband Jesse were ready for another child. "I come from a large family, and Jesse and I both wanted more children," said LeGrazie.
Much to their surprise, they learned that their family of three would soon become a family of five.
With big brown eyes and thick brown hair, Mia was the first person to guess that LeGrazie was having twins. LeGrazie went for her first ultrasound when she was seven weeks pregnant. "During the ultrasound, I noticed the radiologist smiling," said LeGrazie. "I knew right away that Mia was right. The thought of having twins was really exciting because twins don't run in our families." Later, at 20 weeks, LeGrazie discovered the twins were identical girls.
A gut instinct
Midway through her second trimester, LeGrazie started feeling sick: "Very early on, I was having contractions and gaining a lot of weight, and my feet were so swollen I could barely walk on them."
LeGrazie knew something was wrong and called her physician. "People always tell you to go with your gut," she says. But, after she went through a number of ultrasounds, everything looked completely normal. "I started to think my symptoms were simply related to carrying twins," she says. After weeks with no symptom relief, LeGrazie was referred to Virtua maternal-fetal medicine (MFM) specialists Ronald Librizzi, DO,
and Shailen Shah, MD
. MFM doctors specialize in high-risk pregnancies, maternal and fetal testing, and fetal therapy. Drs. Librizzi and Shah also have advanced training in comprehensive, diagnostic ultrasound imaging of the fetus.
"We're also trained to really listen to our moms," says Dr. Librizzi, Virtua's chief of maternal-fetal medicine. "When Bridget consistently complained that something was wrong, we knew her instincts were right."
"At Virtua," says Dr. Shah, "we also use advanced ultrasound equipment to detect fetal abnormalities. Beside detecting the sex of the baby, ultrasounds reveal birth defects and fetal movement, the position of the placenta and the baby's heartbeat." Because of the high-tech equipment used, LeGrazie finally discovered what had been plaguing her.
An unexpected diagnosis
At 23 weeks into her pregnancy, LeGrazie was diagnosed with twin-to-twin-transfusion syndrome (TTTS). TTTS is a rare disease of the placenta, the organ that connects the mother to her babies and provides nourishment to the developing fetuses. TTTS only occurs in women who are pregnant with identical twins who share the same placenta; some identical twins do not share the placenta.
During the development of identical twins, it's common for blood vessels in the shared placenta to connect the circulation systems of the twins. In most cases, blood flows properly through these vessels. However, in TTTS, the blood flows unevenly, with one twin receiving too much blood (recipient) and the other receiving too little (donor).
"The effects of TTTS can be life-threatening," says Dr. Shah. "In some circumstances, the recipient twin may experience heart failure due to excess blood. In other cases, the donor may lose blood or necessary nutrients."
LeGrazie's symptoms suddenly made sense. Rapid weight gain, abdominal pain and tightness, and premature contractions are common for women with TTTS. She also experienced constant thirst and bulging on one side of her abdomen.
A life-saving decision
As nationally renowned MFM specialists, Virtua's team was able to connect the LeGrazies with expert Rubén A. Quintero, MD, a fetal surgeon from the University of South Florida. Quintero pioneered a laser surgery technique to treat TTTS, known as laser ablation. It is the only treatment known to cure TTTS. Other procedures such as removing amniotic fluid only reduce the symptoms.
"Laser ablation surgery uses a laser light to close the blood vessels on the surface of the placenta so that the babies' blood is no longer shared," says Dr. Librizzi. The surgery can only be performed up to 24 weeks, and it does carry risks. "I was diagnosed at 23 weeks, so Jesse and I had a very short time to make the biggest decision of our lives," says LeGrazie.
Within two days of the diagnosis, the LeGrazies were on a plane to Tampa to see Dr. Quintero. "When I first met Dr. Quintero, it was like meeting Superman. I knew he was going to be the man to save our babies."
The surgery only took 90 minutes, but waiting to learn the fate of the twins felt like forever. "You have to wait 24 hours after surgery to make sure that the blood supply to both babies is equal," said Dr. Librizzi. After the wait and extensive ultrasounds, they learned the surgery was a success. Soon after, they flew home to New Jersey to prepare for the arrival of their twins.
September 8: the twins are born
"During my first pregnancy, I just wanted to get through the nine months." says LeGrazie. "With the twins, every day was a gift. I just wanted to get through tomorrow, the next day and then the next." That final day came in the early morning hours of September 8, 2006, when LeGrazie was 31 weeks pregnant. After many sleepless nights, her water broke. "I got emotional when I started to go into labor," says LeGrazie. "I told Jesse 'let's do this.'"
LeGrazie delivered twin girls named Sophie and Anna at Virtua Voorhees. Because they were a few weeks premature, the babies remained in the neonatal intensive care unit (NICU) for nearly six weeks.
TTTS survivors Sophie and Anna
Sophie and Anna came home October 21, 2006. With bright blue eyes and facial features just like their mother, the babies are completely healthy. As they grow, the LeGrazies will have to look for any developmental problems related to TTTS.
"I look at them with so much joy and admiration," says LeGrazie. "Our daughter Mia is also in love with them. Our favorite thing is snuggling in bed together each morning."
There is hope for babies with TTTS. "I want pregnant women with identical twins to know the warning signs of TTTS," says LeGrazie. "More importantly, don't ignore your instincts, and make sure you go to a hospital like Virtua that gives you the care you need when the unexpected happens."
To learn more about TTTS, or to schedule an appointment with a Virtua maternal-fetal specialist, call 1-888-Virtua-3 (1-888-847-8823).
is a graduate of Jefferson Medical College in Philadelphia. He completed a residency in obstetrics and gynecology as well as a fellowship in maternal-fetal medicine at Thomas Jefferson University Hospital. Dr. Shah is board certified in maternal-fetal medicine and is specially trained to provide critical care to pregnant women. He has lectured nationally on the topic of high-risk pregnancies and was recently named a "Top Doc" by SJ Magazine.
Ronald Librizzi, DO,
graduated from the Philadelphia College of Osteopathic Medicine. He completed a residency in obstetrics and gynecology at John F. Kennedy Memorial Hospital in Stratford, NJ. He earned a fellowship in maternal-fetal medicine and perinatology at Pennsylvania Hospital in Philadelphia. Dr. Librizzi extends his expertise to others through leadership roles with professional organizations such as the Southern New Jersey Perinatal Cooperative and the New Jersey Maternal Fetal Medicine Society.