Operation Is First Of Its Kind In India
Mumbai: When Surat-based professional Yunus Ashraf found out his wife Tabussum was carrying twins, he read every health issue on identical pairs. Little did the couple expect one of the severest and rare complications, the twinto-twin transfusion syndrome (TTTS), to affect their unborn children.
But fortunately for the Ashrafs, their twins became the first foetuses to undergo a laser correction for TTTS in India. On November 23, Tabussum (27) was wheeled into an operation theatre in Jaslok Hospital where doctors, using a foetoscope and laser rods, disconnected blood vessels joining the 20-week-old foetuses. The condition had so affected them that while one had too rapid growth, the other was starved of blood and nutrients. A fortnight after their surgical in-womb separation, both seem to be thriving. Foetal surgery, the most challenging and developing frontier of medicine, seems to have certainly arrived in India.
Thirteen weeks into her pregnancy, Tabassum was told there was a complication in her pregnancy as she was carrying identical twins who shared the placenta and many blood vessels branching out from the umbilical cord. After another five weeks, she was told one foetus had more fluid around it and more blood supply, while the other was almost starving. “Local doctors told us to terminate the pregnancy or face a high chance of miscarriage. But we did not want to give up. So we brought her to Jaslok Hospital,” said Yunus.
Doctors at Jaslok Hospital diagnosed Tabassum was suffering from TTTS. They asked the couple to go to a foetal medicine centre in the UK, one of the 10-odd centres across the world that offers treatment for the syndrome. “But the couple insisted on having the surgery here itself,” said Dr Chander Lulla, a radiology consultant in Jaslok Hospital who specialises in foetal medicine.
Doctors from Jaslok and one from Bangalore performed the laser surgery to disconnect blood vessels between the two. “The baby getting more blood (recipient) was developing a cardiac problem as it had alot of blood to pump. The other (donor) was almost malnourished and had no urinary bladder,” said Dr Sudeshna Ray, Jaslok gynaecologist. Doctors pushed in a two-millimeter-wide foetoscope in the womb to transmit images. “Through it we inserted the laser fibre to burn the shared blood vessels. By the next day, the donor was producing urine,” said Dr Lulla.
“Disconnecting shared blood vessels is ideal but more prevalent in US and UK. Obstreticians suggest termination of pregnancies, as patients have economic constraints. There is no surety the babies will survive,” said Dr Sameer Dikshit, foetal medicine consultant at BSES Hospital, Andheri.
Tabassum is normal. “She will deliver in April. The latest ultrasound revealed the donor baby was moving—not noticed before,” said Yunus.
A GRIP ON THE TWIN-TO-TWIN TRANSFUSION SYNDROME
It is a serious disorder that occurs in identical twins who share a placenta
It occurs when there is a connection in the two babies’ blood vessels
One baby (called the recipient) receives more blood flow, while the other (the donor) gets too little
The donor twin has slow growth and poor urinary output. Urine from the baby is the source of amniotic fluid, so there is little or no amniotic fluid for this twin
The recipient twin becomes overloaded with blood, putting a strain on the baby’s heart forcing it to pump more, which could lead to heart failure. This baby has too much amniotic fluid due to higher production of urine The condition occurs in about 15% of identical twins
But fortunately for the Ashrafs, their twins became the first foetuses to undergo a laser correction for TTTS in India. On November 23, Tabussum (27) was wheeled into an operation theatre in Jaslok Hospital where doctors, using a foetoscope and laser rods, disconnected blood vessels joining the 20-week-old foetuses. The condition had so affected them that while one had too rapid growth, the other was starved of blood and nutrients. A fortnight after their surgical in-womb separation, both seem to be thriving. Foetal surgery, the most challenging and developing frontier of medicine, seems to have certainly arrived in India.
Thirteen weeks into her pregnancy, Tabassum was told there was a complication in her pregnancy as she was carrying identical twins who shared the placenta and many blood vessels branching out from the umbilical cord. After another five weeks, she was told one foetus had more fluid around it and more blood supply, while the other was almost starving. “Local doctors told us to terminate the pregnancy or face a high chance of miscarriage. But we did not want to give up. So we brought her to Jaslok Hospital,” said Yunus.
Doctors at Jaslok Hospital diagnosed Tabassum was suffering from TTTS. They asked the couple to go to a foetal medicine centre in the UK, one of the 10-odd centres across the world that offers treatment for the syndrome. “But the couple insisted on having the surgery here itself,” said Dr Chander Lulla, a radiology consultant in Jaslok Hospital who specialises in foetal medicine.
Doctors from Jaslok and one from Bangalore performed the laser surgery to disconnect blood vessels between the two. “The baby getting more blood (recipient) was developing a cardiac problem as it had alot of blood to pump. The other (donor) was almost malnourished and had no urinary bladder,” said Dr Sudeshna Ray, Jaslok gynaecologist. Doctors pushed in a two-millimeter-wide foetoscope in the womb to transmit images. “Through it we inserted the laser fibre to burn the shared blood vessels. By the next day, the donor was producing urine,” said Dr Lulla.
“Disconnecting shared blood vessels is ideal but more prevalent in US and UK. Obstreticians suggest termination of pregnancies, as patients have economic constraints. There is no surety the babies will survive,” said Dr Sameer Dikshit, foetal medicine consultant at BSES Hospital, Andheri.
Tabassum is normal. “She will deliver in April. The latest ultrasound revealed the donor baby was moving—not noticed before,” said Yunus.
A GRIP ON THE TWIN-TO-TWIN TRANSFUSION SYNDROME
It is a serious disorder that occurs in identical twins who share a placenta
It occurs when there is a connection in the two babies’ blood vessels
One baby (called the recipient) receives more blood flow, while the other (the donor) gets too little
The donor twin has slow growth and poor urinary output. Urine from the baby is the source of amniotic fluid, so there is little or no amniotic fluid for this twin
The recipient twin becomes overloaded with blood, putting a strain on the baby’s heart forcing it to pump more, which could lead to heart failure. This baby has too much amniotic fluid due to higher production of urine The condition occurs in about 15% of identical twins
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