USA TODAY US Edition

Con­joined twins, born locked in em­brace, suc­cess­fully sep­a­rated

Com­pli­cated surgery is a first in Michi­gan

- Kris­ten Jor­dan Shamus

DETROIT – Sara­beth and Amelia Ir­win were locked in an em­brace when they were born at 11:06 a.m. on June 11, 2019.

Con­joined from their chests to their bel­lies, the iden­ti­cal twins’ arms wrapped around each another as they were care­fully lifted from their mother’s womb at Michi­gan Medicine’s Von Voigt­lander Women’s Hos­pi­tal in Ann Ar­bor, said Dr. Mar­cie Tread­well, di­rec­tor of Michi­gan Medicine’s Fe­tal Di­ag­no­sis and Treat­ment Cen­ter.

About 14 months later, the twins re­turned to Ann Ar­bor, where they un­der­went an 11-hour surgery Aug. 5 at C.S. Mott Chil­dren’s Hos­pi­tal, be­com­ing the first known set of con­joined twins to be suc­cess­fully sep­a­rated in Michi­gan.

“They’re so rare,” said Tread­well, ex­plain­ing that just 1 in 100,000 to 1 in 250,000 preg­nan­cies in­volve con­joined twins. Few sur­vive de­liv­ery, and even fewer live long enough to be dis­charged from the hos­pi­tal and go home, like Sara­beth and Amelia did.

Two teams of sur­geons – one for each girl – and more than a dozen other med­i­cal staff spent months plan­ning how they would safely sep­a­rate Sara­beth and Amelia, giv­ing them a chance at in­de­pen­dent lives.

“Other than tak­ing our word for it, you would al­most never know that they were con­joined,” said their fa­ther, Phil Ir­win, just a few weeks af­ter the first-of-its-kind surgery.

Their mom, Alyson Ir­win, smiled, and said, “They’re do­ing great.”

But nei­ther Alyson nor Phil could ever have dreamed they would be able to say that about their twins when they first dis­cov­ered they were con­joined in Fe­bru­ary 2019.

A con­cern­ing ul­tra­sound

Some­thing about the preg­nancy was dif­fer­ent, but Alyson, 33, couldn’t pin­point what it was.

The Ir­wins looked for­ward to the 20-week pre­na­tal ap­point­ment. They were ea­ger to see ul­tra­sound images of their grow­ing baby. They agreed they wouldn’t find out the gen­der, and in­stead wanted to let it be a sur­prise at de­liv­ery.

None of their pre­vi­ous pre­na­tal doc­tor’s vis­its gave them any inkling that they were hav­ing twins or that they might be con­joined.

The ul­tra­sound tech­ni­cian moved the wand around on Alyson’s belly, but then quickly ex­cused her­self to get the doc­tor.

“It may have been five min­utes, but it seemed like for­ever,” be­fore the doc­tor came into the room, Phil said. “That’s when we found out they were con­joined.”

Their doc­tor re­ferred them to a high­risk ob­ste­tri­cian, and within 24 hours the Ir­wins were in Ann Ar­bor, meet­ing with Tread­well at Michi­gan Medicine.

“I tend to al­ways try to be hope­ful, but I also have to be re­al­is­tic,” said Tread­well, who also is a pro­fes­sor of ob­stet­rics and gyne­col­ogy at the Univer­sity of Michi­gan. “Giv­ing peo­ple false hope is not par­tic­u­larly help­ful for any­one.”

Another ul­tra­sound and a later MRI showed that the twins each had their own arms and legs. The girls were joined at the chest and ab­domen, Tread­well said.

Ab­sorb­ing the news was hard for the Ir­wins.

But soon af­ter, glim­mers of hope be­gan to shine through.

Dr. Ge­orge My­chaliska, a pe­di­atric and fe­tal sur­geon at Mott, met the Ir­wins in March 2019.

“Even at that time, we had pretty good pre­na­tal imag­ing, which in­di­cated that they re­ally had all sep­a­rate or­gans, ex­cept a liver was fused in the mid­line,” My­chaliska ex­plained.

“I told them sep­a­ra­tion of the two ba­bies seemed pos­si­ble but much more eval­u­a­tion and plan­ning would be re­quired . ... I didn’t want to be too op­ti­mistic be­cause this was (go­ing to be) a re­ally long jour­ney for us. We had never done it be­fore. But I do remember be­ing very hope­ful with the fam­ily, that it’s some­thing that cer­tainly was pos­si­ble.”

It was hope the couple des­per­ately needed.

Not an or­di­nary C-sec­tion

Although the plan was to per­form a ce­sarean sec­tion be­tween 35 and 36 weeks, Tread­well said the ba­bies were show­ing signs of dis­tress at 34 weeks.

Amelia and Sara­beth shared an um­bil­i­cal cord, which Tread­well said, had “a lot of dif­fer­ent blood ves­sels in it, more than what you nor­mally would see.”

A 3D model of the twins was made to sim­u­late the de­liv­ery, and a team of doc­tors, nurses and other staff was as­sem­bled.

“As you can imag­ine there’s chal­lenges with tak­ing care of two ba­bies that are at­tached. Where do you put IVs? And how do you help them breathe if they need help breath­ing? Those kinds of things,” Tread­well said.

The mod­els al­lowed Tread­well and her team to ac­cu­rately es­ti­mate how big the in­ci­sion in Alyson’s ab­domen would have to be.

June 11, 2019, dawned, and the Ir­wins made a 45-minute drive to Ann Ar­bor to fi­nally meet their baby girls, know­ing that as many as 60% of con­joined twins don’t sur­vive de­liv­ery, and even fewer live long enough to be dis­charged from the hos­pi­tal.

Amelia and Sara­beth de­fied those odds.

“I remember them briefly putting the girls on my chest. It was very sweet and spe­cial be­ing able to hold them and see them for the first time,” Alyson said. “It was just very sur­real. There was so much adren­a­line from ev­ery­thing that led up to that point.”

The girls weighed a healthy 9 pounds, 4.5 ounces to­gether – more than 4.5 pounds apiece.

Although the out­look was ex­cep­tion­ally good given the odds, Sara­beth and Amelia re­mained hos­pi­tal­ized for 85 days.

Plan­ning for sep­a­ra­tion

Dr. Steven Kas­ten, pe­di­atric plas­tic sur­geon at Mott, be­gan work­ing with the Ir­wins soon af­ter the twins were born to plan how they would cre­ate enough skin to be able to cover the ab­domens of both girls once they were sep­a­rated.

The girls un­der­went an ini­tial surgery to add tis­sue ex­panders on both sides of their bod­ies.

Just as they had been used to pre­pare for Sara­beth and Amelia’s de­liv­ery, the hos­pi­tal’s ra­di­ol­ogy team worked with bio­engi­neers to cre­ate 3D mod­els of the twins and their liv­ers and other body struc­tures to help the sur­geons sim­u­late what would hap­pen in the op­er­at­ing room.

My­chaliska led the sur­gi­cal team on Aug. 5, along with Kas­ten and pe­di­atric heart sur­geon Dr. Richard Ohye for a pro­ce­dure that they es­ti­mated could take as long as 16 hours, Phil said.

Sara­beth and Amelia shared a chest wall, but each twin had her own di­aphragm mus­cles, said My­chaliska. They had one small, shared ster­num bone that would have to be di­vided, and sep­a­rate liv­ers that were fused, he ex­plained. Although the twins had in­di­vid­ual hearts, they shared an outer mem­brane or pro­tec­tive sack, called the peri­cardium.

Both girls needed an ar­ti­fi­cial ster­num, which the car­dio­tho­racic team built out of ti­ta­nium bars to sta­bi­lize their chests, Kas­ten said. Gore-Tex fab­ric was used to place a patch over the holes in the peri­cardium around each of their hearts.

The first in­ci­sion was made at 11:19 a.m., My­chaliska said. And by 1:11 p.m., they had been sep­a­rated and placed at op­po­site ends of the op­er­at­ing room table while sur­geons be­gan re­con­struct­ing their chests and ab­domens.

Sara­beth came home from the hos­pi­tal first, in late Au­gust. Amelia fol­lowed soon af­ter.

Six weeks post surgery, Amelia and Sara­beth have match­ing scars that run down the cen­ter of their chests, form­ing a ques­tion-mark-like shape over their bel­lies that is likely to fade but might never com­pletely dis­ap­pear. They may need ad­di­tional surg­eries as they grow and their bod­ies de­vel­oped, but doc­tors are op­ti­mistic that Sara­beth and Amelia will grow up to be just like any other kids.

“Their out­look is re­ally quite good,” My­chaliska said, “es­pe­cially with their par­ents. Their par­ents are re­ally spe­cial peo­ple. They got the per­fect par­ents for be­ing con­joined twins. Not only be­cause of their com­mit­ment, love and sup­port, but be­cause they’re just very in­no­va­tive and op­ti­mistic peo­ple. I think that re­ally made a big dif­fer­ence.”

 ?? ERIC SEALS/USA TO­DAY NET­WORK ?? Amelia Ir­win reaches out to her twin sister Sara­beth Ir­win. Alyson and Phil Ir­win with their three kids, Kennedy Ir­win, 3, and twins Sara­beth and Amelia Ir­win,15 months, in Peters­burg, Mich., Sept. 12.
ERIC SEALS/USA TO­DAY NET­WORK Amelia Ir­win reaches out to her twin sister Sara­beth Ir­win. Alyson and Phil Ir­win with their three kids, Kennedy Ir­win, 3, and twins Sara­beth and Amelia Ir­win,15 months, in Peters­burg, Mich., Sept. 12.
 ?? IR­WIN FAM­ILY PHOTO ?? Amelia and Sara­beth un­der­went suc­cess­ful sep­a­ra­tion surgery, be­lieved to be the first of its kind in the state, on Aug. 5.
IR­WIN FAM­ILY PHOTO Amelia and Sara­beth un­der­went suc­cess­ful sep­a­ra­tion surgery, be­lieved to be the first of its kind in the state, on Aug. 5.

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