Georgie?’ Ella asked. ‘And have you timed them?’
‘I’m not sure—I think I’m getting twinges or something, but it doesn’t hurt as much as I expected and they’re all over the place. But, Ella, my tummy feels weird,’ Georgina said. ‘It’s all tight and shiny. My back aches. And I feel as if I’ve put on half a stone overnight.’
Alarm bells rang in the back of Ella’s head. She didn’t want to worry Georgina, but this didn’t sound like the beginnings of labour. It sounded like a complication—and, given that Georgina was carrying four babies, this could be a very tricky complication. ‘Would you mind baring your tummy for me so I can have a look?’ she asked, keeping her voice light and cheery.
‘Of course,’ Georgina said, and pulled up her top while she leaned back against the pillows.
Georgina’s abdomen definitely looked tight and shiny, as she’d said. But Ella wasn’t sure this was labour. She had a nasty feeling that one of the quads might be in trouble.
‘As soon as Charlie gets here,’ Ella said, ‘we’ll have a look on the ultrasound and see if they’re all waving at you this time.’
Georgina smiled, but Ella could tell that the young mum-to-be was panicking.
‘I’ll take your blood pressure while we’re waiting for Charlie,’ she said.
At least Georgina’s blood pressure was normal, but Ella would be a lot happier once she’d monitored all the babies.
Just then, Oliver walked in with Jennie, pushing the portable scanner. Ella’s heart skipped a beat when she saw him.
‘Sorry, Charlie’s in Theatre. Will I do?’ he asked.
Provided they could keep their private life out of it, yes. ‘Georgie, this is Oliver Darrington, our Assistant Head of Obstetrics,’ Ella said. ‘Oliver, this is Georgie. She’s twenty-eight weeks and she’s expecting quads.’
‘Congratulations,’ Oliver said, smiling at her.
‘Thank you,’ Georgina said.
‘Georgie thinks she might be in labour,’ Ella said. ‘Her blood pressure’s fine, but we need to do a scan to see what the babies are up to.’
‘OK. I’m sorry, Georgie, our gel’s a bit cold,’ Oliver apologised. ‘May I?’
‘Sure.’
Once the scan of the babies was on the screen, Ella spotted the problem immediately. The two girl quads were fine, but the two boys were definitely struggling; one of them had a lot of amniotic fluid in the sac, while the other had very little and was practically stuck against the wall of Georgie’s womb. The bigger boy twin had a full bladder; Ella couldn’t see the smaller twin’s bladder, but if her suspicions were right it wasn’t full.
‘Oliver, can we have a quick word?’ she asked, not wanting to worry Georgina by discussing her fears in front of her.
‘Sure. Would you excuse us a moment, Georgie?’ Oliver asked with a smile.
Georgie nodded.
‘Jennie, perhaps you can get Georgie a drink and make her comfortable for the next couple of minutes?’ Ella asked.
‘Thanks,’ Georgina said. ‘I have been feeling a bit thirsty, the last day or two.’
It was another maternal sign for twin-to-twin transfusion, Ella knew, and her misgivings increased. She waited until they were outside the room and the door was closed before she turned to Oliver. ‘I’ve been Georgie’s named midwife since day one and Charlie’s her named doctor—the quads have all been doing just fine, and Georgie was only in for a scan last week,’ Ella said. ‘When she told me her symptoms this morning and I examined her, I wondered if it might be twin-to-twin transfusion.’
‘Good call. The scan pretty much proved that,’ Oliver said.
‘But how could it happen so fast? Everything was fine last week. I’ve kept a really close eye on her because obviously with carrying quads she’s a high-risk mum.’
‘She’s in her last trimester,’ Oliver said, ‘so it’s an acute form of the condition rather than a chronic one—and acute TTT can happen practically overnight.’
‘So what are the options?’ Ella asked. ‘I’ve seen less than half a dozen cases of TTT in my career. Do we deliver the babies early, or do you put a hole in the membrane between the twins, or could you do laser surgery on the placenta to separate their bloodstreams?’
‘It’s a difficult call,’ Oliver said. ‘If you put a hole in the membrane so the twins share one sac, there’s a risk of entangling the umbilical cords, and that’s something I’d rather do at an earlier stage than Georgina’s at. This has all happened really quickly, so there’s a possibility that the recipient quad has a heart problem, because the excess blood and fluid will have put strain on his heart.’ He frowned. ‘I’d like to call Juliet Turner in.’
‘Juliet Turner?’ Ella asked.
‘She’s a neonatal specialist surgeon and she’s got a fabulous reputation for her work in utero. She might be able to operate on the quads if need be.’
‘What aren’t you telling me?’
‘She’s in Australia,’ Oliver admitted.
‘So it’ll be at least a day before she can get here—if she agrees to come,’ Ella pointed out. ‘And you’re just expecting the poor woman to drop everything and travel halfway round the world to come and treat Georgie’s babies?’
‘Juliet’s a professional.’
‘Surely there’s someone closer than Australia?’ Ella asked.
‘Juliet’s the best,’ Oliver said simply, ‘which is the whole point of Teddy’s. We can keep Georgina and the babies comfortable until she gets here.’
Ella was about to say that Juliet Turner might already have commitments which prevented her from rushing all the way from Australia to Cheltenham, but Oliver had the kind of stubborn expression that told her he’d talk the surgeon into changing any commitments for the sake of Georgina and the quads.
‘OK,’ she said. ‘And I guess that gives Leo—the quads’ dad—a chance to get here from New York. Let’s tell her together.’
She went back in with Oliver and sat on the bed, taking Georgina’s hand.
‘Everything’s not all right, is it?’ Georgina asked. ‘What’s happening to my babies?’
‘It’s something called twin-to-twin transfusion,’ Ella explained. ‘You know you’ve got two sets of identical twins.’
‘Two boys and two girls—Graham, Rupert, Lily and Rose,’ Georgina said.
‘Lovely names,’ Oliver said. ‘Two of my nieces are called Lily and Rose.’
‘What’s wrong with them?’ Georgina asked.
‘Lily
