FROM TWINS WHO SHARE A PLACENTA TO GENETIC AND HEART DISORDERS, FETAL SURGERY SEEDS DRAMATIC ADVANCES.
The joy of expecting twins turned to panic after an ultrasound revealed severe Twin-to-Twin Transfusion Syndrome (TTTS). Blood was being shunted from one twin to the other through abnormal blood vessel connections in the shared placenta. The donor twin had become dangerously anemic and could die soon. The other had a 40% chance of death or severe neurological disability. The fetal medicine team at Mumbai Jaslok Hospital decided to save at least one child with a procedure called Radio frequency Ablation (RFA), which was performed in the womb at 23 weeks.
While fetal surgeries are not new, improved tests and imaging have made it possible for doctors to treat a variety of ailments in the womb for itself. “For one, prenatal testing has come a long way in detecting such abnormalities with high-resolution ultrasound and fetal MRI. Innovations in miniature surgical instruments, regenerative medicine ( to restore function in damaged organs and tissues) and 3D planning (using 3D imaging to create detailed fetus model) have together expanded fetal care possibilities.”
It has opened up “a remarkable frontier in maternal medicine, offering hope in situations that once seemed hopeless.” In cases like this, where TTTS poses grave risk to both babies, advanced procedures like RFA selectively seal blood vessels in the affected twin’s umbilical cord, giving the healthier twin a chance to thrive.”
BETTER CHANCES FOR MOTHER, CHILD:
While open fetal surgery (where the fetus is removed from the womb, operated upon and placed back) has not been performed in India so far, minimally invasive fetoscopic techniques have greatly reduced risks for both mother and unborn child. Two years ago, specialists at New Delhi’s All India Institute of Medical Sciences (AIIMS) performed a complex balloon dilation procedure on the “grape-sized” heart of a 28 week old fetus in just 90 seconds. The fetus had a closed main valve due to reduced blood flow which, if untreated, would have led to aortic atresia at birth — a rare condition where blood flow from the left ventricle to the body is interrupted.
Many other advanced interventions treat rare conditions affecting the unborn baby. “Complex procedures like intrauterine transfusion (IUT) treat severe fetal anemia caused by Rh isoimmunization (when mother’s blood is incompatible with baby’s) by transfusing blood directly to the fetus.”
In a pregnancy where each fetus has its own placenta, it’s too crowded to access each umbilical cord. And IUT in a single session is time-consuming, raising risks of preterm labor. “A real-time ultrasound showed their umbilical cords. A fine needle was inserted into the mother’s abdomen into the umbilical vein of each fetus, and donor blood was slowly transfused with ultrasound monitoring.” The triplets were delivered at 34 weeks. Postnatally, all three got intensive phototherapy and intravenous immunoglobulin to manage newborn jaundice. They were discharged within four days.
TINY INCISION, MAX RESULTS:
New-age prenatal screenings enable early detection of spina bifida (neural tube defect), corrective procedures for which include a tiny incision using a camera or through temporary uterine opening to repair t he fetal spine. “There’s also non-invasive fetal therapy that involves giving drugs to the fetus through the placenta.”
While genetic disorders like Down Syndrome and Spinal Muscular Atrophy (SMA) can be identified prenatally, most treatments happen after birth. The field of fetal surgery continues to advance, with ongoing research focused on enhancing procedural safety and efficacy.
