Pune (Voice news service):- A ‘Bipolar cord occlusion procedure followed by in-utero cord transection’ performed by a team of fetal medicine specialists at KEM Hospital, Pune helped reduce ongoing complications in the pregnancy of Monoamniotic twins. A team of doctors treating this case comprised of Dr Manikandan K, a fetal surgeon and fetal medicine consultant at KEM Hospital, Pune, Dr Shweta Gugale, Fetal Medicine Expert along with Gynaecologist Dr Xerxes Coyaji – Medical Director at KEM Hospital and Dr Shreepad Karhade HOD & Associate Consultant – Fetal Medicine at KEM Hospital, Dr Ashwini Jaybhaye and Dr Pooja Pable.
Dr. Shweta Gugale, Fetal Medicine Expert at KEM Hospital, Pune said that the expectant mother, a nurse from peripheral areas in Satara District was diagnosed with Monoamniotic twins with one baby who was severely growth-restricted and abnormal doppler on ultrasound imaging in the 21st week of pregnancy.
Monochorionic twins are a rare complicated situation where both babies are at risk of fatality. Fetal intervention procedures can help save the normally developing baby. Both foetuses occupy the same sac and share a single placenta. The diagnosis is made by ultrasound imaging. Due to one placenta, these babies have a vascular connection called anastomosis and blood flows from one baby to another and vice-versa. Dr Shweta Gugale added that in this case, one baby was extremely small while the other baby was developing normally. The small one had a depleting blood supply which would eventually stop. But due to the vascular connection, the normally developing baby would start giving its blood to the other one. But this would also eventually stop ultimately leading to total pregnancy loss. The cord entanglement worsens the situation. The normally developing baby is also at high risk and if a Bipolar cord occlusion procedure is not performed on the small co-twin, then the chances of survival of the normal twin become very low in such a situation, experts coagulate the cord near the abdomen (stop the blood supply to the small baby) with bipolar forceps and cut the cord to avoid further entanglement with fetoscopic laser procedure.
The clinical management of these pregnancies is challenging, there is a high risk of unexpected fetal death (up to 15–20%) and or a high risk of brain injury in the surviving co-twin. Dr. Shweta Gugale added that the option of therapeutic intervention was discussed with the family. The procedure (Bipolar cord occlusion with laser transection of the umbilical cord of the abnormal twin) was done in two stages, the first involved coagulation of the umbilical cord of the abnormal twin until cessation of blood flow and the second involved Fetoscopy guided laser cord transection which is performed in a spot between the two coagulated areas. This results in a sacrifice of the abnormal twin hence increasing the chances of survival of co-twin.
The first 24 hours are extremely crucial for the co-twin. A Doppler post-24-hour observation was normal. The mother was called in the next week and the neuro, heart scan and Doppler of the baby were normal and the normal healthy pregnancy continues.
Dr Shreepad Karhade HOD & Associate Consultant – Fetal Medicine at KEM Hospital said that addressing such rare and complicated cases requires a tertiary setup with a multidisciplinary approach. The team in this case included experts from Obstetrics and Neonatal Departments with the prime role of the Fetal Medicine Department.
He added that KEM Hospital, Pune has state-of-the-art facilities at the Tata Centre for Reproductive Health which include Fetal Medicine, a speciality twin unit, ART and genetics all under one roof and has given benefits to many patients. Till date, we have done around 25 fetal interventions in complicated cases with good results which demonstrate our expertise in handling high-risk cases like intrauterine fetal blood transfusion, radiofrequency ablation, interstitial laser ablation, fetoscopic laser ablation of blood vessel anastomosis, fetoscopic bipolar cord occlusion and cord transection, intrauterine partial exchange transfusion, fetal reduction etc.
Dr Shweta Gugale said that apart from the procedure itself, the most challenging part is counselling the family. To our knowledge and according to published medical literature, this is probably the third case in India involving such two staged interventions in Monoamniotic twins.
The Assisted Reproductive Technology (ART) / In-Vitro Fertility (IVF) Centre at KEM Hospital provides advanced comprehensive fertility treatment with cutting-edge technologies. This department has helped countless couples achieve their dreams of becoming parents. A team of the best fetal medicine specialists, fertility experts, embryologists, endoscopy consultants, and others ensure the best outcomes and help patients achieve healthy and successful pregnancies.
Patient-centric and compassionate care, renowned experts, state-of-the-art infrastructure, affordable prices and easy access to other multispecialty units make it convenient for couples seeking ART treatments for infertility and fetal problems.
