Nearly a thousand twins saved by surgery in the womb

After nearly 6 years, Tam Anh General Hospital has saved nearly a thousand children with this syndrome. Surgery to save fetuses by transfusing blood in the uterus is still a difficult technique in the world, but doctors at Tam Anh General Hospital have completely mastered it, raising the success rate to over 90% and are honored to be named one of the few centers for fetal medicine in the world.

The baby was saved and born healthy thanks to a twin blood transfusion surgery in the womb.

HISTORICAL TWIN TRANSFUSION SURGERY

In early 2018, Ms. Ho Thi Huyen Trang (28 years old, from Nghe An) was 17 weeks pregnant with twins and was diagnosed with severe twin-to-twin transfusion syndrome. One fetus had almost no amniotic fluid, the other fetus had polyhydramnios and heart failure, large heart size, pericardial effusion, and pulmonary artery stenosis. The prognosis for both fetuses was very poor.

As an obstetrician, Trang understands better than anyone that her two children's lives are hanging by a thread. Even though she only has 1% hope, Trang still seeks help from Master - Doctor Dinh Thi Hien Le, Tam Anh General Hospital - a leading expert in obstetrics, a teacher of many obstetricians like Trang.

Master Dinh Thi Hien Le, senior doctor at the Obstetrics and Gynecology Center of Tam Anh General Hospital, Hanoi, performed an ultrasound for Ms. Huyen Trang before surgery.

"As a challenge, we had just been equipped with the most modern equipment for twin transfusion surgery, and the doctor had just returned from intensive training in France, but we didn't expect the first case to be so difficult," Dr. Hien Le recalled.

The results of the examination and ultrasound showed that the two fetuses were large, the amniotic fluid was not clear, the blood vessels were large, and the surgical field was narrow. The placenta covered the entire front surface, completely blocking the normal entrance of the endoscope. In particular, the endoscope had to "enter" the amniotic sac through a path of only about 1 mm. If the correct entrance was not chosen carefully, it could hit the blood vessels on all three sides. If the surgery failed, all three mothers and children could die right on the operating table.

"In front of me are three lives in my hands. Risks on the operating table are always something no doctor can dare to commit to. As a pioneer at a time when there were not many supporters, I was under enormous pressure," said Dr. Hien Le.

The normal surgical path was blocked by the placenta, so Dr. Hien Le decided to choose a special entrance to access the blood vessels that nourish the fetus and had to perform the surgery in a kneeling position to find a suitable position to insert the instrument for the clearest observation. After more than 1 minute of exploration, the endoscope entered the amniotic sac, observed all the blood vessels and performed the cutting and burning of the blood vessels connecting the two fetuses, successfully preventing twin-to-twin blood transfusion. Dr. Hien Le and the team burst into tears of happiness.

At 1:30 p.m. on July 18, 2018, 4 months after the surgery, Trang's family welcomed two healthy baby boys into the world with overwhelming happiness, ending a 36-week pregnancy journey with many hardships and storms.

The success of the first twin transfusion surgery performed by Dr. Hien Le and colleagues at Tam Anh General Hospital in Hanoi not only brought luck to Ms. Trang and her three children, but also brought hope to thousands of twin transfusion cases that can be treated right in Vietnam without having to go abroad for treatment, and opened the first pages of history for the Vietnamese fetal medicine industry. The case was then published by Dr. Hien Le in a prestigious journal of Obstetrics and Gynecology in the world.

In March 2018, Master - Doctor Dinh Thi Hien Le performed the first twin blood transfusion surgery in Vietnam.

NEW ERA OF FETAL MEDICINE IN VIETNAM

According to Dr. Hien Le, before 2018, in Vietnam, there was no unit that applied laser surgery to intervene in fetuses to treat twin-to-twin transfusion syndrome. While the world was 15 years ahead. Therefore, every year in Vietnam, thousands of fetuses with twin-to-twin transfusion syndrome die because they are not treated. Even doctors who witness it are heartbroken. Some cases spend billions of dollars to go abroad for treatment, but language barriers, procedures, and racing against time... sometimes fail.

WHAT IS TWIN BLOOD TRANSFUSION AND HOW IS IT TREATMENT?

Twin-to-twin transfusion syndrome is a syndrome that often occurs when the mother is carrying identical twins, sharing the same placenta, but different amniotic sacs. This syndrome occurs in about 15% of cases of twins sharing the same placenta and accounts for a rate of 0.1 - 1.9/1,000 babies born.

This is an extremely serious obstetric complication because the connection between the blood vessels of the two fetuses in the placenta causes the blood of one fetus to be transferred to the other fetus. The fetus that gives blood is underdeveloped, has oligohydramnios, is weak, and gradually shrinks. The fetus that receives blood due to too much blood develops rapidly, leading to heart failure, fetal edema, polyhydramnios, enlarged bladder, polyuria, etc. In the case of twin-to-twin transfusion occurring before the 20th week of pregnancy, the risk of fetal death is almost 100% if not intervened promptly and with the right technique.

Therefore, laser surgery in stage II - IV, when the fetus is 16 - 26 weeks old, is considered the optimal method in treating twin-to-twin transfusion syndrome. It is an intra-amniotic endoscopy, using a laser to coagulate (block) the blood vessels in the placenta, preventing blood from one fetus from passing to the other, helping the two fetuses to continue to develop independently, thereby saving the lives of 1 or 2 fetuses.

In order to successfully perform the first twin blood transfusion surgery, 10 years ago, Dr. Hien Le had access to the first course in France, however, 10 years after returning to Vietnam, she did not have the equipment to perform this technique. It was not until 2017, when she returned to Tam Anh General Hospital, that Dr. Hien Le was encouraged by the hospital's leadership to go to France to study in-depth fetal intervention techniques at a leading hospital in Europe, personally guided by Professor Yves Ville (the first person in the world to perform fetal medicine intervention by endoscopy).

As soon as she returned to Vietnam, Dr. Hien Le started to implement the application of fetal intervention techniques at Tam Anh General Hospital, such as prenatal diagnosis through screening tests (ultrasound, amniocentesis, chorionic villus sampling, NIPT testing, genetic testing, etc.). And unexpectedly, as soon as everything was fully prepared, she promptly performed an emergency surgery on the pregnant woman Huyen Trang.

Since the historic twin transfusion surgery in March 2018, Dr. Hien Le and her colleagues have mastered many other fetal medicine techniques such as amnioinfusion, blood transfusion for anemic fetuses, bipolar cauterization of umbilical cord occlusion, pleural fluid drainage, surgery for hydrocephalus, treatment of diaphragmatic hernia, surgery for spina bifida, bladder drainage to save kidneys, etc. Many fetuses with diseases and poor prognosis that previously required termination of pregnancy have now been treated in the womb to develop and be born healthy.

Ms. Huyen Trang's family is completely happy and fulfilled after the two babies Ben and Jun were born healthy.

"Interventional treatment while still in the womb requires many factors, not only modern equipment as well as the experience and high skills of the surgeon, but also close coordination with the diagnostic imaging doctor, sterile operating room system, comprehensive infection control... Because the fetus in the womb is an inviolable environment, not to mention on a tiny fetus of only 400 - 500 grams deep inside the mother's body, observation and manipulation are extremely difficult, every manipulation must be delicate, if it fails there will be almost no chance to do it again...", said Dr. Hien Le.

After 6 years, hundreds of twin transfusions have been successfully operated on, with a success rate of over 90% - on par with the world. Nearly 1,000 fetuses have been saved, born healthy, saving hundreds of billions of dong for the families of the patients, because the cost of performing surgery in the country is only 1/10 of the cost of going abroad for surgery.

Currently, Dr. Hien Le still directly performs surgery and makes efforts to train, has more collaborators who are young doctors, researching and performing in-depth on this technique, opening up more opportunities for fetuses with blood transfusions and diseases during pregnancy to be treated early, right in Vietnam.

Source link: https://thanhnien.vn/cuu-gan-nghin-song-thai-nho-phau-thuat-trong-bung-me-185230829184452559.htm