Eight-month-old twins from Hayward Heath, West Sussex, recently met the surgeon who saved their lives even before they were born. The BBC reports how their mother, Katerina Ahouansou, at six months pregnant, during a routine scan, uncovered a serious issue with their development and blood supply.

Doctors diagnosed the twins with twin-to-twin transfusion syndrome or TTTS. It is a condition where one twin received more blood and nourishment than the other due to uneven blood vessel distribution in the placenta. In case there is no medical intervention, it could be fatal for both the twins.

A Specialist Steps In

This is when Ahouansou was referred to Professor Kypros Nicolaides at King’s College Hospital in London. Professor Nicolaides is a pioneer in fetal medicine and he specializes in a laser procedure that redistributes blood supply between twins in cases of TTTS.

When Ahouansou was scanned, Nicolaides observed that one of the twins were significantly smaller than the other. "There was a very high chance that if we did not intervene, both twins could die," he recalled.

An Operation No Less Than A Miracle

The life-saving laser surgery was performed and within a week the doctors saw an improvement with the twin who was smaller in size. When the twins were born, they weighed 1.5kg and 1.7kg. To recognize the efforts by the surgeon, Ahouansou named them Kai Kypros and Asher Nicolas after Professor Kypros Nicolaides.

Ahouansou also expressed deep gratitude for the professor's expertise and called him "proof that miracles can be performed by people who are devotees to their profession."

Professor Kypros Nicolaides has been at King’s College Hospital since 1980 and is widely regarded as a leader in fetal medicine. His groundbreaking research and development of screening and surgical techniques have saved countless lives.

Through his dedication, Professor Nicolaides has given many families hope, demonstrating how medical advancements continue to improve survival rates for complex fetal conditions like TTTS.

More about Twin-to-twin Transfusion Syndrome

As per the John Hopkins Medicine, TTTS is a rare pregnancy condition that affects identical twins or other multiples. It happens in pregnancies where twins share one placenta and a network of blood vessels that supply oxygen and nutrients essential for development in the womb. These pregnancies are known as monochorionic.

Sometimes, the blood vessels in the placenta are unevenly distributed, causing an imbalance in blood flow between the twins. The donor twin loses more blood than it receives, leading to malnutrition and potential organ failure. Meanwhile, the recipient twin gets an excess of blood, putting strain on the heart and increasing the risk of cardiac complications.

Impact on the Donor Twin

The donor twin loses blood volume (hypovolemia), reducing kidney function and urine production. This leads to low amniotic fluid levels (oligohydramnios) or, in severe cases, a complete absence (anhydramnios). Without proper blood circulation, the donor twin faces cardiovascular issues, increasing the risk of death.

Impact on the Recipient Twin

The recipient twin experiences excess blood volume (hypervolemia), causing increased urination and excessive amniotic fluid (polyhydramnios). The overworked heart struggles to handle the surplus blood, leading to cardiovascular dysfunction, heart failure, and, in extreme cases, death.

Many people carry the thalassemia gene without knowing it because they may not have any symptoms. A simple carrier screening test before pregnancy can help couples understand risks and make informed decisions while planning parenthood.

Importance of Genetic Screening

Parenthood planning today is not only about financial preparation or healthy lifestyle changes, but also about understanding genetic health risks that can impact the child’s future. And one such condition that tends to go unnoticed is thalassemia carrier status.

Did you know? Many individuals discover they are carriers only after facing difficulties during pregnancy or after the birth of a child with thalassemia major.

What Is Thalassemia?

Thalassemia is an inherited blood disorder that affects the production of hemoglobin, the protein in red blood cells that carries oxygen throughout the body. People who are carriers usually live normal and healthy lives and may not experience major symptoms. Because of this, many remain unaware of their carrier status for years.

However, it becomes a matter of concern when both partners are carriers of the thalassemia gene. In such cases, there is a huge risk that the child may inherit thalassemia major, a severe condition that may require lifelong blood transfusions, regular hospital visits, medications, and continuous medical care.

Why Thalassemia Often Goes Undetected

These are some of the challenges faced by families: So, challenges are that the thalassemia carrier status is often detected very late. Mild tiredness or anemia may be ignored or mistaken for iron deficiency, and many will not seek help.

So, couples do not consider genetic testing before marriage or pregnancy because they feel healthy and have no family history of the disease. When a child is born with thalassemia major, families may face stress, anxiety, repeated hospital visits, financial burden, and long-term treatment responsibilities. The condition can also affect the child’s growth, immunity, and overall quality of life.

The Need For Awareness And Early Action

This is why screening is important for couples: Carrier screening is a simple blood test that helps identify whether a person carries the thalassemia gene. If one partner tests positive, the other partner is advised to get tested as well.

Early screening before pregnancy helps couples understand their risks and explore available options with proper guidance. Thalassemia carrier screening is a small step that can make a major difference in parenthood planning.

Increasing awareness and encouraging timely testing can help families make informed decisions and reduce the burden of severe thalassemia in future generations. So, it is imperative to go for timely screening as advised by the expert and improve the quality of life.

Preeclampsia is usually discussed as a pregnancy complication, but the risk does not end automatically after childbirth. Delivery is an important part of treatment, but it is not an instant cure. A woman can still develop postpartum preeclampsia in the days or weeks after delivery, even if her blood pressure was normal during pregnancy.

The risk is highest soon after childbirth, but it can remain for up to six weeks. This period needs close attention because the mother is recovering, sleep-deprived, caring for a newborn, and may mistake warning signs for normal post-delivery discomfort. This is when the condition can become dangerous if symptoms are missed.

The warning signs of postpartum preeclampsia should be taken seriously. A severe headache, blurred vision, seeing spots, swelling of the face or hands, pain below the ribs, nausea, vomiting, breathlessness, chest pain, reduced urination, sudden weight gain, or very high blood pressure should be checked urgently.

If postpartum preeclampsia is not treated in time, it can lead to seizures, known as eclampsia, and may also cause stroke, fluid in the lungs, acute liver or kidney injury, and, in rare severe cases, hepatic subcapsular hematoma, which is bleeding beneath the capsule of the liver, or intracranial bleeding, also called brain hemorrhage. In the most severe cases, it can be fatal.

The reassuring part is that the condition is treatable when identified early. Treatment may include blood pressure medicines such as labetalol, nifedipine, or amlodipine, magnesium sulphate if there is a risk of seizures, and diuretics in selected cases where there is fluid overload. Many of these decisions can be safely planned even if the mother is breastfeeding, but treatment should always be guided by her treating doctor.

The responsibility should not fall only on the mother. Families need to watch her health with the same seriousness with which they attend to the newborn. As a precaution, blood pressure checks should continue at home or during scheduled visits, especially in the first few weeks after delivery. Postpartum follow-ups should not be missed, prescribed medicines should be taken properly, and self-medication should be avoided, particularly painkillers or over-the-counter drugs unless approved by the doctor. If symptoms worsen, or if there is headache, breathlessness, chest pain, visual disturbance, or swelling, she should be taken back to the hospital without delay.

A history of preeclampsia also remains important after recovery because it can increase the woman’s future risk of chronic hypertension, heart disease, stroke, and kidney disease. Postpartum care should never be treated as a formality. It is an essential part of protecting the mother’s recovery, her future pregnancies, and her long-term health.

Bone marrow transplant (BMT), also known as hematopoietic stem cell transplant, is regarded as a lifesaving and even curative therapy. It is important to note that no surgery is required; rather, stem cells are transfused from a bag, like a blood transfusion.

BMT has revolutionized the treatment of several severe pediatric disorders, including thalassemia major, severe aplastic anemia, immunodeficiency disorders, high-risk blood cancers, and certain neurological and metabolic disorders such as metachromatic leukodystrophy and mucopolysaccharidoses (MPS). Despite major progress in transplant science, many still see BMT as a last resort. This can have a high effect on the survival rate, recovery process, and overall quality of life.

Why Are Bone Marrow Transplants Delayed?

One big reason for postponing transplant decisions is the belief that BMT should only be considered after all standard therapies have failed. There is also limited awareness about the excellent outcomes and curative potential of BMT in many benign pediatric disorders when performed early.

Children often go through repeated chemotherapy cycles, frequent blood transfusions, or long-term supportive care before anyone seriously discusses transplant. While this therapy may help in stabilizing the condition temporarily, it can cause lasting damage to the organs, increase the risk of infections, and affect the immune system, making transplant surgeries risky and less successful.

Delays Can Reduce Success Of Transplant

For instance, in children with thalassemia major, years of blood transfusions can lead to iron overload, which harms the heart and liver, reducing their ability to handle intense transplant conditioning. Likewise, in diseases like MPS, metachromatic leukodystrophy, where the disease has progressed, role of BMT becomes guarded.

Why Early Referral And Timely Treatment Matters

In addition to medical hesitation, systemic and emotional barriers also cause delays. The long-standing belief that a fully matched donor is essential has also changed significantly, with recent years witnessing remarkable growth and success in haploidentical (half-matched) donor BMTs. There are challenges related to awareness and affordability in India. The fear of risks such as graft-versus-host disease, infection, or death from transplant surgery results in parents adopting a "wait and see" attitude until their child’s health deteriorates further.

It is ironic that lack of awareness and accessibility to pediatric bone marrow transplant specialists are also among the factors that can cause delay in proper diagnosis and referral. Yet, the wait could put the children’s lives at greater risk due to the damage caused by chemotherapy and other forms of treatment.

Modern medical professionals emphasize that BMT does not have to be used only as a “last resort” treatment but can be administered in a timely manner to provide a cure for the patient.