Manipal Hospital Bangalore has launched ‘Specialised Twin Pregnancy’ services. A poster exhibition was also held to show case the services of the Foetal Medicine and OBG Ultrasound unit and emphasise the importance of monochorionic twin pregnancies and twin to twin transfusion syndrome.
Present at the occasion, Dr Prathima Radhakrishnan, Consultant, Foetal Medicine, Manipal Hospital explained, “I’m glad to be associated with Manipal Hospitals, who have introduced the advanced Foetoscopic services which can save many babies’ lives and not waste pregnancies. Today, the foetus is treated as an individual patient who has a right to receive treatment. The multidisciplinary approach that is practiced in our set-up is undoubtedly a huge benefit to mothers, specifically those carrying twins. Timely interventions can help save fetal lives. Since the window of opportunity is small, it is recommended that all twin pregnancies should be dedicatedly scanned in such units with expertise to optimise the outcomes.”
Majority of the twin pregnancies are non-identical i.e. dichorionic and hence would require specialist care in a foetal medicine unit but not “interventions” as such. However, about 30 per cent of identical i.e. monochorionic twin pregnancies would develop complications due to unequal sharing of the placenta and half of them are severe enough to need therapeutic intervention to save the lives of at least one if not both the babies.
Twin-to-twin transfusion syndrome is a complication of disproportionate blood supply, resulting in high morbidity and mortality. Foetoscopic Laser ablation of placental vessels is performed when the condition is severe in monochorionic twin pregnancies. The mortality in this condition without treatment is almost 100 per cent. By performing a laser ablation of the placental vessels, it is possible to save at least one and sometimes both the babies. If the procedure is performed at the right time then the survival chances for both babies is much higher.
In the case of monochorionic multiple pregnancies with one abnormal foetus that compromises its co-twin, Foetoscopic cord ligation/coagulation may be performed. In the situation where one of the monochorionic twins has a lethal abnormality and dies whilst in the womb, there is a very high risk of brain damage to the normal one. However, if the blood supply in the umbilical cord to the abnormal fetus is shut off before its death (process of cord coagulation), the chances for the normal baby’s survival is very high and the risk of brain damage very low.
Dr Prathima Radhakrishnan ably supported by the team at Manipal Hospital, Bangalore has successfully performed 13 fetoscopic procedures since Aug 2010, for both local and outstation patients. Of the 13 pregnancies, one is ongoing. Of the remaining 12, 6 single and 2 sets of twins have been safely delivered.
Dr H Sudarshan Ballal, Chairman – Medical Advisory Board and Medical Director, Manipal Health Enterprises added,“Adding on advanced foetal intervention procedures like the foetoscopic services is a huge milestone in the development of the unit. At Manipal Hospitals, we do see a large number of twin pregnancies and over a period of time we have developed expertise in managing various types of complications. Foetal Medicine Unit at Manipal Hospital is the first hospital in country to offer this service according to the international protocols following formal training and expert review. Now it will be possible to perform advanced procedures at par with the Western countries.”
EH News Bureau