TTTS: How fetal intervention surgery improved the outcomes for our twin daughters


Even in the midst of the COVID-19 global pandemic, Natika Elam looked forward to so many exciting things in 2020. Last summer, she got married to the love of her life, and then a few months later, she and her husband, Alex, welcomed identical twin daughters, Avery Sofia and Blake Alexandra, into their family.

“Our girls are so precious,” Natika said. “They are 6-months old now, and they’re doing great. Avery is 14 pounds and Blake, our little peanut, is just over 13 pounds but definitely trying to catch up to her sister. While my pregnancy had a few ups and downs, we’re so blessed to see our babies thriving and growing.”

When Natika was 16-weeks pregnant, a routine ultrasound showed her amniotic fluid levels were off balance. Her OB/GYN suggested she come in for weekly scans so they could monitor her levels more closely. When she went in for her 20-week ultrasound, her doctor noticed a significant difference in the amniotic fluid levels between Avery and Blake. She quickly referred Natika to Texas Children’s Fetal Center® after her babies were showing early signs of Twin-Twin Transfusion Syndrome, or TTTS.

TTTS occurs in about 10 to 15 percent of pregnancies in which identical twins share unequal amounts of the placenta’s blood supply resulting in the two fetuses growing at different rates. The smaller (donor) twin pumps blood to the larger (recipient) twin. As a result, one twin ends up with too much blood and an oversupply of amniotic fluid which can cause serious health problems for both babies, if left untreated.

“Blake was the donor twin and Avery was the recipient twin,” Natika said. “As first-time parents, we were very stressed and anxious about this whole situation. Two days after my 20-week scan, we left our home in Atlanta and went to Houston to meet our fetal intervention team at Texas Children’s. When I arrived, I had an ultrasound, MRI and fetal echocardiogram to evaluate the progression and severity of the TTTS. Luckily, the echocardiogram results came back normal. I was in stage 1 TTTS, however, my doctors said Avery, the recipient, had progressed rapidly to stage III. After meeting with my fetal care team to discuss treatment options and the potential risks for each one, we moved forward with fetal intervention surgery.”

On Aug. 14, 2020, Natika underwent selective fetoscopic laser photocoagulation surgery, which is the standard of care for severe TTTS. Her maternal fetal medicine surgeon, Dr. Roopali Donepudi, performed this minimally-invasive surgical procedure that uses a small camera to identify abnormal blood vessel connections in the placenta and disconnects them using a laser. The procedure cauterizes the blood vessels, eliminating the disproportionate share of blood and fluid supply between Avery and Blake.

“After my surgery, we stayed in Texas for my one-week post-surgical follow-up appointment,” Natika said. “Everything looked good and my fluid levels were falling within the normal range. However, I needed to be on modified bed rest because I showed signs of chorioamnionic membrane separation where the amniotic sac separated from my uterus, which put me at risk for pre-term delivery. I received follow-up care from my doctors in Atlanta who were in close contact with my MFM team at Texas Children’s.”

At 31-weeks gestation, Natika delivered the couple’s twin daughters, Avery and Blake, via emergency C-section in Atlanta. Avery weighed 3 pounds, 11 ounces, and Blake weighed 2 pounds, 12 ounces. Today, they are 6-months-old. The Elams say their girls love to eat, play, laugh, coo and smile. They’re hitting their milestones and the couple says the twins bring so much joy to their family.

“When I see my beautiful daughters today, I am grateful to Dr. Donepudi and the maternal fetal medicine team at Texas Children’s for taking great care of me and my babies early on in my pregnancy. If it weren’t for the fetal surgery to reverse the progression of TTTS, I know Avery and Blake’s outcomes would have been very different. My advice to families facing TTTS is never put things off. If your doctor tells you, ‘You need to get this done, listen to them.’ I can’t thank Texas Children’s enough for saving my babies’ lives.” 

Click here to learn more about Twin-Twin Transfusion Syndrome and the innovations our Texas Children’s Fetal Center team uses to treat this condition and improve long-term patient outcomes.