Pune: Doctors at the King Edward Memorial Hospital (KEM) in Pune performed a rare surgery recently, using lasers to cut off blood supply to a weaker foetus that was feeding off the healthier one.
The beams were directed at the blood supply cord inside the uterus to ensure the healthy baby survived, the doctors said.
The mother is a nurse from Satara district who was found carrying monoamniotic twins in an ultrasound taken during the 21st week of pregnancy. The scan showed that one baby was severely “growth-restricted” with an abnormal blood supply.
“Since both babies were sharing an amniotic sac, most doctors would’ve recommended termination of pregnancy to prevent harm during delivery. But she didn’t want to because this was her first pregnancy. So she came to us at 23 weeks,” said Dr Shweta Gugale, foetal medicine expert at KEM.
‘Monoamniotic twins’ are rare and both are at risk of death. But foetal intervention procedures can save the normally developing baby. In this condition, both foetuses occupy the same sac and share a single placenta. Due to one placenta, such babies have a vascular connection called anastomosis and blood flows from one baby to another and vice-versa.
Dr Gugale said there have been only three such cases in the country in which specialists used lasers and bipolar cautery to save one foetus and ‘reduce’ the other.
“The second foetus will naturally shrink and come out as a membrane during delivery of the healthy fetus,” Dr Gugale said.
The surgery at KEM took place on Sept 5. But it was not until later in October that doctors could confirm the healthy foetus was growing normally with the weaker one shrinking. Dr Xerxes Coyaji, KEM’s medical director, said their surgery was indeed a rare one.
He said: “It had two stages. The first involved coagulation of the umbilical cord of the abnormal twin until cessation of blood flow and the second involved laser cord transection, which is performed in a spot between the two coagulated areas. This results in a sort of sacrifice of the abnormal twin, for the co-twin’s survival.”
Dr Manikandan K, a foetal surgeon at KEM said: “In these pregnancies, there is high risk of unexpected foetal death [up to 15–20%] or a high risk of brain injury in the surviving co-twin. So the option of therapeutic intervention was discussed with the family.”
