Lucknow: Twin with no head, heart operated in womb in PGI

LUCKNOW: A baby, which was growing with an abnormal, headless and heartless conjoined twin inside her mother's womb and would have eventually died, was saved by doctors at the Maternal and Reproductive Health Department at Sanjay Gandhi Postgraduate Institute of Medical Sciences.
According to doctors, the extremely rare kind of complicated pregnancy is said to be seen in just one among of 3-4 lakh expectant mothers in the country.
Doctors said that surgical intervention was necessary to save both the mother and the child.
The problem
Elaborating about the case, Prof Mandakini Pradhan, head of department, said: "A 5.5-month pregnant woman was referred to us about three-and-a-half months ago. Reports suggested that she was carrying twins. A deeper look however revealed that one of the two twins had not developed properly." Adding that the undeveloped twin - which was without a head or heart (called Acardiac twin) - was drawing blood and nutrients from the normally developing baby. In the process of sharing between the twins, the functioning of the normal baby's heart was being affected adversely. It had infact brought her on the brink of heart failure."
Noteworthy, in a normal pregnancy, the head and heart of a fetus start developing in the sixth week.
The dilemma
Doctors said that surgical intervention was necessary to save both the mother and the child. The undeveloped chunk was posing severe threat to the life of the healthy baby.
"The challenge was to prevent normal baby's heart failure while ensuring that the baby stays inside the womb for at least 8 to 10 weeks. This was further complicated by the fact that we could not perform any procedure under general anaesthesia to save the baby's life," explained Prof Pradhan.
In short, whatever intervention was to be made had to be performed inside the mother's womb.
The solution
The team of doctors - including Prof Pradhan, Dr Amrit, Dr Indu Lata, Dr Neeta and Dr Sangeeta - decided to snap the connection between the twins. For this, they used a medical procedure called Radiofrequency Ablation (RFA).
"In this procedure, a unique medical needle-like device is used to pass on medium frequency electrical current to targeted area for various purposes. In this case, the tissues supplying blood to the abnormal area were burnt. This immediately saved the healthy baby from suffering a heart failure. Thereafter, the pregnancy was regularly monitored till the mother developed labour pain and a cesarean section was conducted for child birth," said Dr Pradhan.
RFA is also undertaken by surgeons to get rid of tumors, interventional cardiologists to treat arrhythmia (irregular beating of heart) besides other specialists.
The happy home
The efforts delivered fruits with the birth of a healthy baby girl early on Wednesday.
The parents - Ankita and Nishant Pandey - and their relatives heaved a sigh of relief thereafter.
Sharing his experience with TOI, Nishant said: "The testing time went by in restless days and sleepless nights. I feel happy that our patience and trust on the doctors paid off."
The family also said that given the circumstances, they had no option but to take the risk.
"The baby would have died and it could have impacted my wife's health. So we decided to go with whatever option was available. In fact, I can say that there was hardly any choice to make," added Nishant who belongs to UP's Ambedkarnagar district.
Baby's uncle Mayank Mishra assisted in care giving and distributed sweets among hospital staff to share his joy.
Over 30% of all pregnancies are complicated
Experts at the SGPGI revealed that around 30% of all pregnancies belong to 'complicated' category. Failure to diagnose the cause of complication at hospitals leads to loss of life of mother, child or both. This reflects on country's maternal and infant/child mortality rate as well. However, a good 80% of the complicated pregnancies can be saved. In the remaining 15-16%, the life of the mother can be saved. Underlying medical conditions such as mother with heart disease, diabetes, history of surgery and frequent abortions make a pregnancy complicated. The problems appear as heart diseases, anaemia, thyroid disorder in the fetus. The specialists at SGPGI urged gynaecologists to refer extremely complicated cases to them.