A Tiny Beam of Light and a Camera Saved My Unborn Twins…
FETOSCOPOFFER
AT 20 weeks pregnant, a routine scan revealed that Margaret Kershaws unborn twins were suffering from the potentially fatal Twin- to-Twin Transfusion Syndrome. Their lives were saved, however, by Professor Fergal Malone, of Dublins Rotunda Hospital, who successfully performed Irelands first ever Fetoscopy surgery within the womb. Here, Margaret, 35, a bank official from Clonsilla, Dublin, tells how Professor Malone saved the lives of her twin sons, Ryan and Dylan now four months with his pioneering work. She says:
LIKE all parents to be, my husband and I were delighted when we found out I was expecting. I come from a family of 13, and had always wanted children of my own. And being told we were having identical twins, which run in my family, was the icing on the cake.
At 16 weeks pregnant, I was warned that identical twin pregnancies, in which twins share one placenta, put us at risk of Twin-to-Twin Transfusion Syndrome.
This occurs when abnormal blood vessels in the placenta transfuse too much blood into one baby while the other baby is left with too little blood.
One thrives, the other deteriorates. All I could do was hope it didnt happen to me.
But I began to think something might be wrong just before Christmas.
I was about 19 weeks pregnant and I started to feel very big and uncomfortable one of the symptoms of Twin-to-Twin Transfusion Syndrome.
An ultrasound scan days before New Years Eve revealed that while one twin was big and thriving, surrounded by ample amniotic fluid, the other was very small, and weak, with little amniotic fluid surrounding it.
This confirmed that Twin-to-Twin Transfusion Syndrome was occurring. My husband and I were both really upset and frightened when we were told the news and from there, everything happened very quickly. There was no possibility of leaving the situation to progress if you dont do anything, there is a 90 per cent risk of losing both the babies. One posposibility was to drain some amniotic fluid from the larger twin.
But that would have needed to be done regularly throughout the pregnancy and wouldnt help the smaller twin at all.
Then Professor Fergal Malone told us our only other option was to allow him to perform a Fetoscopy operation using new in-utero operating technology, which had literally arrived at the hospital a few weeks earlier.
We were told we would be the first people to use it, but he assured us he was fully trained and knew what he was doing. radical life-saving surgery was previously only available in a handful of centres in Europe and had we been in this situation a month earlier, we would have been put on a plane to a hospital in London for treatment.
THE risk however was that the procedure itself could bring on premature labour and if that happened, we could still lose both babies.
My husband and I talked through our options and decided to put our faith in Professor Malone. Because of the New Year and the fact the equipment needed to be sterilised, we had to wait for a week for our operation. That week was the longest week of my life.
We didnt celebrate the New Year and barely went out at all. At this point, we had no idea whether the babies would make it or not. I couldnt face talking to anyone as I knew theyd ask about my pregnancy and I just didnt know what to say.
The operation was carried out on January 4 and I was in hospital for one night. It was done under local anaesthetic, so I was awake throughout. I couldnt see what was happening as a screen was put up between myself and Dr Malone.
All I could feel was some gentle tugging. I had the opportunity to watch the operation unfolding on a television screen, but I couldnt face doing that in case something went wrong.
Instead, I kept my eyes firmly on the clock and I know for a fact that the operation lasted exactly 40 minutes.
As soon as Dr Malone put his instruments down, he was able to tell me that the operation had been a success and that already, the smaller baby had begun to thrive. When we heard this, both Derek and I cried tears of joy.
The rest of the pregnancy went smoothly and I went into labour on April 11. I was re-admitted to the hospital for a caesarean and thankfully, both twins were born healthy. Incredibly, there wasnt even a significant difference in their weight: Dylan was 4lbs 12oz and Ryan was 4lbs 11oz.
Now, the day we thought wed lose the twins seems a long way away and were just enjoying being parents to two perfect baby boys.
PROFESSOR Fergal Malone, from the Rotunda Hospital, says:
ABOUT one third of all twin pregnancies are identical and up to one quarter of these identical twins can develop Twin-to-Twin Transfusion Syndrome. In a country like Ireland, we expect to see around 50 cases a year.
It occurs when twins start to receive different amounts of blood and nutrients in the womb as a result of abnormal blood vessels on the placenta they share. If nothing is done about the condition, then in 90 per cent of cases, both babies will die one because it is starved of nutrients, the other from heart failure as a result of excess nutrients.
Of the ten per cent that do survive the condition, half end up with severe brain damage.
Twin-to-Twin Transfusion Syndrome is the most serious complication to hit any twin pregnancy. The condition is not life- threatening for the mother.
UNTIL recently, weve had to fly all expectant mothers with the condition to London for treatment, and weve been anxious to invest in the equipment to carry out Fetoscopy for over a year.
From a patients point of view, to be told there is something wrong with your pregnancy and to then have to travel to a city in a different country that you may never have been to before only adds to the stress.
The Rotunda Hospital invested in the equipment just before Christmas and were now the only place in Ireland equipped to carry out a Fetoscopy.
The equipment essentially comprises tiny versions of the cameras and lasers used in keyhole surgery, no bigger than 2mm thick. Such miniature equipment is a huge advance, as to get to the babies you must pierce a hole in the uterus.
If normal, larger keyhole surgery instruments were used for such a task, it would result in bleeding and ultimately miscarriage. During the operation on Margaret, I made a tiny incision in her abdomen, through which I inserted a miniature video camera and a tiny laser.
The camera sends a magnified image from inside the body to a video monitor, giving me a close-up view of my every move.
While watching the monitor, I enter the uterus and locate the babies. Then, I study the placenta to locate the abnormal blood vessels that are responsible for the syndrome.
Thankfully, the vessels are easily identifiable they are blue worm-like structures that wind across the surface of an otherwise pink placenta.
Using a laser, I then send a beam of energy into these structures, which seals them off.
The situation the babies are in is resolved instanteously, which is fascinating to watch. On screen, we could see the heart of the small baby grow and start beating strongly, and its surrounding sac fill with amniotic fluid.
This surgery however is not without risk. In about one third of cases, both babies will die, despite it being carried out successfully, because too much damage has already been caused. And on rare occasions, despite the tiny instruments we use, miscarriage can still occur.
My advice to anyone expecting identical twins is to insist on being scanned every four weeks, especially around weeks 16-20 of your pregnancy, as that is when this situation is often identified.
Now that we have the technology, I expect to be carrying out around 50 of these operations a year here at the Rotunda.
Once the babies are born, its important to monitor them closely for the first few weeks, in case brain damage occurred in the womb.
Thankfully, in Margarets case, both of her babies are very healthy and Im confident that thanks to Fetoscopy, her twins have been saved.
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