"Yolanda Martinez" was 26 years old in early May of 2009. She was believed to be 26 weeks into pregnancy when her unborn sons were diagnosed with twin-to-twin transfusion syndrome (TTTS).
What Is TTSS?
 |
| Grok AI illustration |
TTTS is typically detected during an ultrasound. The doctor will monitor the twins' conditions more carefully as the pregnancy progresses. If necessary, a minimally-invasive surgery can seal off the problematic blood vessels in the placenta and improve blood flow. This increases the chances that one or both twins will survive. Without treatment, 90% of twins die. With treatment, there is an 85% to 90% chance of saving at least one twin, and a 50% to 60% chance of saving both twins.
Another Thing to Consider
With Yolanda's case, though, there was another factor at work. Yolanda had been born with patent ductus arteriosus. This is a condition in which a blood vessel that typically closes at birth remains open. In Yolanda's case it was open 1.1 cm., or a bit less than half an inch.
If patent ductus arteriosus is diagnosed in infancy or early childhood, before it causes other problems, it can be corrected surgically. There is no record of why it was not corrected in Yolanda's case. She might not have shown any signs or symptoms until she was older and it didn't seem worth the risk to try to correct surgically.
Pregnancy is very risky for women with such a condition; according to studies cited in Yolanda's autopsy the mortality rate ranged between 25% and 50%. Many doctors recommend against pregnancy for women with this condition.
Yolanda either hadn't known how serious her heart condition was, or had considered having a baby worth the risk, because it wasn't until the TTTS diagnosis at an estimated gestation of 26 weeks that she opted to end the pregnancy.
A Decision Is Made
Ending Yolanda's pregnancy could have been done by inducing labor and taking the babies to the NICU. At 26 weeks, the babies would have been extremely preterm, but would have had close to a 90% chance of survival. But this pregnancy was not ended early due to Yolanda's severe health problems. It was done because the babies had a health problem. Laminaria were inserted into Yolanda's cervix to dilate it. To ensure that they would not be delivered alive, the babies were given potassium chloride injections into their hearts on May 4, 2009.
This raises an important question. Was Yolanda provided with any meaningful informed consent before her babies were executed in the womb with the same drug used to execute convicted murderers? Was she presented with the option of performing surgery that might save one or both babies? Was she given information about their chances of survival if delivered alive? Was she offered perinatal hospice, which would have connected her with other mothers who had faced the same situation? Or was she just told that her babies had a fatal condition and told that "termination of pregnancy" was the best choice? We'll never know.
We'll also never know if the diagnosis for the twins was correct, because their autopsy was performed at the hospital, rather than at the coroner's office. Thus the records aren't available to me.
Regardless of whose idea it was to kill the twins before inducing labor, Yolanda expelled the dead babies. But things did not go smoothly afterward. At about 4 pm on May 6, a procedure was performed to ensure that all pregnancy tissues (possibly retained placenta) were removed. However, Yolanda's condition deteriorated. She required intubation at 5:40 and her heart stopped. Doctors worked to revive her, but she was pronounced dead at 6:26 pm, and her husband was immediately notified.
The Autopsy Findings
The autopsy confirmed that Yolanda did indeed have a significant patent ductus arteriosus. Her heart was moderately enlarged. Her cause of death was "complications of pulmonary hypertension" as a consequence of "congenital heart disease," with "elective termination of pregnancy due to fetal congenital anomalies."
The autopsy noted that Yolanda's pregnancy had been miscalculated. Her twins had been only about 17 weeks of gestation and thus would have died even with the most intensive NICU care.
Would Pro-Life Laws Have Changed Anything?
If the only reason to end the pregnancy was because of twin-to-twin transfusion syndrome, prolife laws would have forbidden it. They wouldn't have mandated the placenta surgery that would have almost certainly saved at least one twin, but would have given Yolanda's doctors a strong reason to present it as an option.
Had she chosen that option, Yolanda would have been carefully monitored during the procedure, meaning that doctors would quickly notice and address any issues that arose. There is no record of how closely Yolanda was being monitored during and after her abortion, though the fact that it was performed in a hospital rather than a freestanding abortion facility indicates that she was at least being monitored more closely than a typical abortion patient would be. Thus it's impossible to determine whether her chances of survival would have been any better or worse if the procedure chosen had been TTTS surgery instead of abortion.
Had Yolanda not chosen that option, doctors still would have had the option to end the pregnancy with preterm delivery due to Yolanda's heart condition. Still, if they had been that concerned about her heart, they likely would have recommended to end the pregnancy far before it was estimated at 26 weeks. This could have been done in a method similar to a chemical abortion by administering the misoprostol to cause contractions without first administering the methotrexate to kill the baby. Because the termination would have been done with the intention of preserving Yolanda's life, not with the intention of killing the twins, it would have been done under close medical supervision, possibly even in a hospital setting, enabling doctors to quickly identify and treat any issues that arose.
Given her condition, Yolanda needed very intensive supervision from a cardiologist and a maternal-fetal medicine specialist in order to have a good chance of surviving her pregnancy. She might have died regardless of what course she and her doctors had chosen. But had she actually been 26 weeks into her pregnancy rather than only 17 weeks, her babies would have almost certainly have survived if delivered alive. Only one life would have been lost instead of three.
Sources:
No comments:
Post a Comment