A very rare coincidence at Rabin Medical Center - Beilinson Hospital in Israel: a triplet pregnancy with a life-threatening and extremely rare blood-flow complication ended with a successful cesarean delivery. At 26 weeks of pregnancy, two of the three fetuses underwent a complex, life-saving fetal surgery. Remarkably, this is the second time in the same family that twins with the same complication have undergone the exact same procedure.
Avishag Davidov, a 27-year-old makeup artist, and her husband Michael, 34, were surprised to discover that she was carrying a unique triplet pregnancy: a girl and two identical boys sharing one placenta. During the pregnancy, the boys were diagnosed with Twin-to-Twin Transfusion Syndrome (TTTS), a condition that endangered their lives. They were saved through a rare and complex in-utero laser surgery to separate the blood vessels connecting the twins. The procedure was performed by Dr. Yuval Gielchinsky, a fetal medicine specialist and Director of the Fetal Medicine Unit at Rabin Medical Center, and Dr. Kinneret Tenenbaum-Gavish, Head of the Twin Clinic.
In Avishag’s family, this was not the first intrauterine surgery. Twenty years ago, her mother Ilana was pregnant with identical twins (Avishag’s brothers) who also developed TTTS, and she underwent the procedure in Belgium.
“TTTS is a dangerous complication that can occur in identical twins sharing a single placenta. In this condition, their blood vessels are connected within the placenta, and one fetus transfers blood to the other. They share a common circulatory system, which leads to an imbalance - one fetus receives too much blood while the other receives too little,” explains Dr. Gielchinsky, who performed the surgery on Avishag.
During the procedure, a thin camera and a laser fiber are inserted through the abdominal wall into the amniotic sac, and the connecting blood vessels between the twins’ circulatory systems are sealed. In the case of triplets, the surgery is significantly more complex due to the limited access to the uterus and the need to protect the third fetus.
“The syndrome develops in about 20% of identical twin pregnancies and can worsen rapidly, threatening the fetuses’ lives within days or weeks. Therefore, women carrying such pregnancies must be monitored every two weeks at a specialized identical-twin clinic, such as the one we have at Rabin Medical Center’s Fetal Medicine Unit.”
The triplets are now in good condition and, following delivery, received care at a neonatal intensive care unit.
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