Even as foetal medicine or perinatal medicine takes giant strides, professionals must pay attention to the ethical challenges, Yves Ville, chairman, Department of Obstetrics and Fetal Medicine at Necker-Enfants-Malades Hospital, Paris Descartes University, said.
There are clear guidelines for intervention as per the International Foetal Medicine Surgery Society, he stressed. The disease should be lethal if not treated in utero (in the uterus), despite the best possible antenatal care. It should also cause severe morbidity if not treated then, and must also have the effect of being partly corrective at least.
Sometimes, the life of a foetus can be saved, but may lead to severe disability post birth. Mothers and parents do not appreciate this, Prof. Ville said. Most importantly, the perinatologist must be able to validate foetal intervention versus correction after the baby is born.
He elaborated on the various advancements in foetal surgery over the years, focussing on monochorionic twins, foetal cytoscopy and twin-twin transfusion. Prof. Ville stressed that learning should not be at the expense of the mother and the foetus, highlighting the importance of competence in handling perinatal medicine.
Prof. Ville was speaking after inaugurating the foetoscopy and twin unit of Mediscan in the city on Wednesday.
He said discussions were on to initiate a fellowship in foetal diagnosis and therapy in association with Mediscan Systems.
S. Suresh, director, Mediscan, explained the process that went into rescuing a set of twins, born with a single placenta through foetoscopy.
When this happens, it is likely that there is an imbalance of blood supply for one of the twins, as in this case. So, one baby continues to be deprived of blood supply and nutrition, and the other continues to receive more than its usual share. In this condition, there can be accumulation of fluid around one and lack of fluid around the other. Both babies are therefore affected; the uterus becomes bigger; and there is a risk of preterm delivery.
On August 6, the twins were successfully delivered, 12 weeks after laser surgery was done in utero to correct this twin-twin transfusion syndrome. The life-saving procedure, which meant using a foetoscope and laser device to cut the blood vessel communications between the twins, was the result of a coordinated team effort between Mediscan Systems and Seethapathy Clinic& Hospital, Dr. Suresh said. A team consisting of foetal medicine specialists, a high risk obstetrician and neonatologists helped both twins survive and stay healthy.
Uma Ram of Seethapathy Clinic said the procedure would not have been possible but for co-ordinated team work and the tele-support from Prof. Ville's team from Necker-Enfants-Malades Hospital.
