A rare diagnosis for a rare pregnancy

When Bren Brown was pregnant for the third time, she remembers having bouts of intense morning sickness. Already having two young boys at home, ages 5 and 3, she and her husband wanted to try for just one more, hoping to get a little girl this time. But this pregnancy was already starting off a little differently. She jokingly told her husband, Rogers, that terrible morning sickness could be a sign she was having multiples. Rogers shrugged off the comment, and so did she.

The Brown family hoped to complete their family by having a baby girl. They were surprised to learn triplets were on the way. Doctors at the Center for Maternal and Fetal Care helped them bring home three healthy girls.

Because Bren’s previous pregnancies went so well and she had no complications, she had decided to use midwives to deliver her third baby. Upon arrival for her ultrasound at the 10-week mark, the midwife did an ultrasound and right away noticed two sacs.

“I couldn’t believe it. There were two in there,” remembers Bren. As the appointment continued the midwife saw a third baby. She was shocked, and so was her husband. “We were expecting just one baby, and here we were about to have three. So, it was a huge surprise,” Bren recollects.

Midwives do not deliver multiples, so Bren would need to find another option. Understanding that carrying triplets put her at high risk, she knew she needed to find a maternal-fetal medicine doctor.

When she went to her first maternal-fetal medicine appointment, she was only 12 weeks along, so the doctor asked her to return in three weeks, when she would be 15 weeks. At that appointment, she received some upsetting news. The doctor told her that the situation for her babies, particularly for the third she had already named Caemlyn, was dire. Baby Caemlyn had no amniotic fluid and didn’t appear to have a bladder.

At this appointment, she was diagnosed with stage II twin-to-twin transfusion syndrome (TTTS), which meant there was an unequal sharing of blood and fluid across the babies’ sacks. Twin-twin transfusion syndrome affects approximately 5 to 15 percent of identical twin pregnancies and is extremely rare in triplet pregnancies.

The doctor told Bren there was nothing they could do and to come back for a follow-up appointment when she was 22 weeks along. If the babies survived until then they would discuss a referral for surgery. She was told that if the TTTS progressed to stage IV it would cause either death or defects in the brain or heart for one or all of her babies.

Determined to get a second opinion and fight for all three of her babies, Bren jumped online and found the Center for Maternal and Fetal Care at The Children’s Hospital of San Antonio.

“I called and told them I needed a consult for twin-to-twin transfusion syndrome. They asked me who was referring me, and I told them I was referring myself,” she said.

Upon hearing about Bren’s situation, Dr. Emma Rodriguez, a maternal fetal care specialist with the Center for Maternal and Fetal Care, agreed to see her and referred her to a top program in Houston. Doctors there looked at her scans and said it was too early to have a surgery since she was still only 15 weeks. The inner amnion and the outer chorion do not fuse until 16 weeks, so surgery before then would cause the amniotic sac to rupture.

Dr. Emma Rodriguez, a maternal-fetal specialist at The Children’s Hospital of San Antonio, monitored Bren’s pregnancy and guided her to an expert in fetal surgery in Houston to help ensure the Brown triplets received the care they needed before they were even born.

Rodriguez and her team saw Bren three times a week, wanting to get her to the required 18 weeks the program in Houston required for surgery. But, when Bren was about 17 weeks along, she became anxious and had a feeling that if she did not have surgery soon, all three of her babies would not make it.

So, she decided to drive from San Antonio to Houston alone, leaving her husband to look after their boys so she could meet Dr. Anthony Johnson, Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at McGovern Medical School at UTHealth and Co-Director of The Fetal Center at Children’s Memorial Hermann Hospital in Houston, to discuss her pregnancy and the possibility of a TTTS surgery. When his office did some initial tests, it was clear that baby Caemlyn’s condition had gotten worse and that she had progressed to stage III. They agreed it was time to do the surgery, and it couldn’t wait. They moved forward with the surgery that day.

“My husband and I talked to Dr. Johnson at length about the pros and cons and decided it was best to move forward,” said Bren. “Come to find out, if I had waited much longer, my other babies Avalyn and Brighlyn, wouldn’t have made it either, or there would have been lots of complications.”

Bren was right to trust her instincts. All three baby girls survived the surgery, and a few days later, Bren returned home to San Antonio.

Bren bravely trusted her instincts while pregnant with triplets. By self-referring herself to the Center for Maternal and Fetal Care and by later driving by herself to Houston to convince doctors there that one of her babies could not wait any longer to receive a life-saving surgery while still in utero.

After the surgery, Dr. Rodriguez and Dr. John Byrne would see Bren weekly and monitor her closely. Dr. Rodriguez wanted to get Bren to 32 weeks before performing a C-section. Aside from receiving an extra iron transfusion in preparation for a C-section, the rest of Bren’s pregnancy went smoothly.

On May 10, 2021, at her goal of 32 weeks, Bren had her C-section.

“Brighlyn came out first by her feet and I didn’t hear her cry but the other two cried right away,” remembers Brenlyn.  “They put the regular CPAP machine on them to see how they did and took them straight to the neonatal intensive care unit. When I was able to walk after my C-section recovery, I went down to the NICU and I was able to hold them which was amazing.”

The babies spent a little over a month in the NICU and reached all their goals including tolerating mom’s breast milk and gaining weight. Their siblings loved seeing pictures of their sisters and anxiously awaited their homecoming.   

“I don’t think they understand the magnitude of us bringing them home and what that will mean for them!” said Bren.

Baby Caemlyn, the one they were most concerned about, is the biggest of all three. All the babies were discharged on June 26 and Bren is excited to have her family together again.

“They seem to be doing well and are doing what babies do – sleeping, eating, and pooping,” said Bren.

Even though they weren’t planning for three more children, especially all at once, the Browns are excited about their new additions. They are grateful to Dr. Rodriguez and the entire team at The Children’s Hospital of San Antonio for making sure each triplet had a fighting chance to survive and join their family. It was through the dedicated monitoring of her pregnancy at the Center for Maternal and Fetal Care and the partnership with the fetal care team at Children’s Memorial Hermann and UTHealth that helped make sure these babies made it into this world safely.

“Dr. Rodriguez and Dr. Byrne took great care of me and everyone in the NICU took such good care of the girls,” said Brenlyn. “We just had a really positive experience here and I am super excited that everyone is now home and healthy.”

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