www.irishhealth.com
(http://www.irishhealth.com/article.html?id=24982)
Twin surgery shows world-class outcomes
Treats identical twins while still in the womb
Oct 08, 2015
Deborah Condon
A study that assessed the first 100 cases involving cutting-edge surgery used on unborn
twins in Ireland has found that outcomes are as good here as in leading international foetal
medical centres.
The surgical procedure is carried out on twins in the womb who have a condition called twinto-twin transfusion syndrome (TTTS).
This is a life-threatening complication found in identical twin pregnancies. In those affected,
abnormal blood vessels in the shared placenta lead to blood being transferred
disproportionately from one twin to the other. If left untreated, one or both babies will die in at
least 90% of cases.
The procedure used to treat TTTS involves technology known as fetoscopic laser ablation.
This involves putting a small camera called a fetoscope into the mother's womb, via the
abdomen. A laser fibre is then used to find and remove the abnormal blood vessels between
the babies.
Separate circulation is restored in each twin and complications, such as restricted growth
and heart failure, are reduced. The overall survival rate of babies undergoing this procedure
is 75%.
While TTTS cannot be prevented, it can be detected and treated.
"It is critically important that pregnant women have an ultrasound examination before 12
weeks gestation to confirm twins, and to confirm whether or not both babies share one
placenta. For mothers with twins that share a placenta, it is essential that they have
ultrasound examinations at least every two weeks from 16 weeks gestation onwards, so that
the features of TTTS can be discovered in time to allow life-saving foetal surgery," explained
the study's senior author, Prof Fergal Malone.
The study of the first 100 cases of this procedure to be carried out in Ireland showed worldclass outcomes.
"Our study of these first 100 cases performed in Ireland demonstrates that our specialist
obstetricians remain at the cutting edge of global developments in foetal surgery. We are
achieving outcomes for Irish mothers and babies that are as good as those available in the
world's other leading foetal medical centres," Prof Malone said.
Twins who require this procedure are placed under the care of a single foetal surgical team
from the Rotunda and the National Maternity Hospital in Dublin, which acts as a national
referral centre for all 19 obstetric units in the country.
Prof Malone is the chairman of the Royal College of Surgeons in Ireland's (RCSI's)
Department of Obstetrics and Gynaecology at the Rotunda Hospital. The study was carried
out by researchers from the RCSI, the Rotunda and the National Maternity Hospital and its
findings are published in the European Journal of Obstetrics and Gynaecology and
Reproductive Biology.