$________ - MEDICAL MALPRACTICE - FAILURE TO DIAGNOSE AND TREAT TWIN-TO-TWIN TRANSFUSION SYNDROME IN IDENTICAL TWINS - DEATH OF WEAKER TWIN - PERMANENT NEUROLOGICAL INJURIES TO SURVIVING TWIN.

Delaware County

This was an obstetrics/radiology malpractice action in which the plaintiffs alleged that severe neurological injuries to one newborn and the death of the other were caused by the failure of the defendant physicians to diagnose and treat twin-to-twin transfusion syndrome (TTTS). TTTS is a phenomenon which occurs only in monochorionic (shared placenta) twin pregnancies when the arterial circulation of one twin is in communication with the venous circulation of the other twin through arteriovenous anastomosis. Blood is transfused from the donor twin to its recipient sibling such that the donor becomes growth restricted while the recipient develops circulatory overload with associated complications. The defendant disputed the cause of the neurological injuries to the surviving twin and maintained that even if diagnosed, there were no treatment options available for the fetuses.

The minor plaintiff’s mother was ten weeks pregnant when an ultrasound revealed a twin gestation. The plaintiff claimed that the first defendant radiologist was negligent in failing to report that the ultrasound showed only a single chorion (membrane) around the twin fetuses. A single chorion indicates identical twins which are at a higher risk for TTTS.

A second ultrasound performed eight weeks later was interpreted by the second defendant radiologist. The plaintiff argued that this radiologist also failed to identify the single chorion and also failed to report a large discrepancy in the twin’s abdominal circumferences and an amniotic fluid imbalance. The plaintiff argued that these signs and symptoms indicated developing TTTS which remained undiagnosed and untreated.

The plaintiff maintained that the defendant obstetricians deviated from the required standard of care in failing to take action to monitor and treat the evolving syndrome. The plaintiff’s experts contended that treatment options for TTTS include serial amnioreduction therapy (redistribution of amniotic fluid) and fetoscopic laser occlusion (surgery to separate the blood vessels that connect the twins).

A third ultrasound performed at 29 weeks gestation revealed the intrauterine fetal demise of the smaller twin. The plaintiff claimed that blood shunted from the surviving twin to the demised twin then caused the surviving twin to suffer hypoxia and resulting neurologic injury.

The minor plaintiff was a highly-functioning five-year-old girl at the time of settlement, but she exhibited significant neurologic injuries primarily affecting her motor skills. Although the minor plaintiff possesses a large vocabulary, her speech is difficult to understand due to the motor deficits. The minor plaintiff cannot walk nor feed herself without assistance. She is currently being mainstreamed into some regular educational classes at school. However, the plaintiff’s experts indicated that it is doubtful that the plaintiff will ever be capable of being gainfully employed or living independently.

The defendant radiologists maintained that the standards in place at the time in question did not require the radiologists to identify the number of chorions around the twin fetuses. Subsequent to the time in question, there was a change in the formal written standards regarding ultrasound interpretation which placed identification of the chorions within the scope of duty of the radiologist. The plaintiff maintained that general medical literature available at the time also established that the number of chorions should be identified on ultrasound and reported in the radiology report.

The defendant obstetricians argued that they relied on the radiology report which did not identify a single chorion. Some obstetricians contended that they interpreted the radiology report as showing two chorions which indicated fraternal twins not susceptible to TTTS.

The defendants’ experts opined that the minor plaintiff’s neurological injuries could have stemmed from any number of causes. The defense also denied that measures suggested by the plaintiff’s experts would have altered the child’s medical course.

The case was settled after jury selection for a total of $2.3 million.