Times of India
13 June 2011
BY Pushpa Narayan

Twin-Twin Transfusion Syndrome Occurs In 15% Of Cases
Having twins means double the joy for many couples, but not many are aware of the complications in some cases of such pregnancies.

One such is the twin-twin transfusion syndrome, where identical fetuses get unequal blood supply from the placenta, putting them at risk. Doctors at a Chennai centre are now using laser surgery with the help of French experts to save such lives.

Mediscan Systems doctors are trained in fetoscopy and tele-mentored by France-based experts every time a pregnant woman is taken to the theatre for the procedure. The machine, laser fetoscope, is used to operate inside a woman’s womb in case of twin-twin syndrome. In this condition, the pregnancy is lost if untreated as identical twins don’t get an equal supply of blood and nutrients.

“One baby misses out on the blood and nutrients. The other receives too much, but the tiny heart is under tremendous strain to pump so much blood,’said Mediscan managing director Dr S Suresh.

The procedure saved the twins, which Gayathri (name changed) was carrying. Three months ago, when she came for a scan at 20 weeks of pregnancy, doctors told her that the babies face the risk. She was taken to the Seethapathy Clinic and Hospital where a fetoscope was inserted into the uterus through a small incision in the abdomen. Seeing the placenta through the scope on a screen, doctors were able to see the blood vessels that caused the unequal flow. The laser fibre was then used to ‘burn’ the vessels, closing them off and cutting off supply. This way, the identical twins will draw blood independently though they share the same placenta.

The theatre was linked to Dr Yves Ville of Necker Hospital in Paris, an expert in the procedure, through video conferencing. “We wanted him to personally see the procedures and give us feedback,’said Dr Suresh, a general-surgeon and sonologist.

The procedure, so far done only in foreign countries, increases survival chances of both the fetuses by 40% and for one of them by 60%. Obstetrician-gynecologist Dr Jayashree Gajaraj of Apollo Hospitals said the procedure is cheaper in India. “The treatment for surgery abroad is 3 lakh. In Chennai, the cost is 70,000. We have lost several babies to this condition. Till now, women had to travel abroad for treatment,’said Dr Jayashree Gajaraj.

Though there is no data on the number of women who have lose their babies, medical literature suggests that 15% of pregnant women carrying identical twins suffer are at risk.

At Mediscans, 11 women from Mumbai, Ahmedabad, Chennai and rural villages of South Tamil Nadu underwent the surgery in the last couple of months. “In some, we saved both the babies; in some, we lost one. It’s a complicated procedure and needs expertise. It has to be done perfectly and quickly,’said Dr Suresh. Patients need adequate counselling about the procedure and the outcome. They would also require careful follow-up.

Twin Pregnancy
When twins are formed in the womb, they can be identical or non-identical. In non-identical twins, there are two placentas, one for each foetus. Identical twins share a placenta and the blood vessels between the identical twins are connected.

Twin-twin transfusion syndrome
Some women who develop this syndrome lose their pregnancy as the identical twins don’t get an equal supply of blood and nutrients from the placenta. One baby misses out on blood and nutrients, while the other gets too much of it which puts the foetus heart under strain. Babies are also at risk of cerebral palsy

Incidence:
Studies show that nearly 15% of women carrying identical twins develop twin-twin transfusion syndrome

Diagnosis:
Through routine ultrasound scans done during pregnancies

Treatment:
Doctors insert an equipment, fetoscope, through a small incision in the mother's stomach, penetrating the placenta. A camera mounted on the fetoscope guides doctors to blood vessels that cause the unequal flow. The scope then burns those vessels, closing them. The twins then draw blood equally through smaller vessels