Laser for Twin-Twin Transfusion Syndrome (TTTS) What other fetal therapies are available at Apollo

Monochorionic twins have a high frequency of Centre for Fetal Medicine?

placental vascular shunts that may lead to one
twin (donor) overperfusing the other (recipient).
Complications include oligohydramnios and
growth restriction in the donor alongwith polyhy-
dramnios and hydrops fetalis in the recipient (twin
twin transfusion syndrome) which eventually
leads to fetal death in more than 90% cases. Selec-
tive Laser photocoagulation of anastamosing
vessels is the treatment of choice (Level I evidence)
for TTTS with significantly better neurodevelop-
mental outcomes as compared to serial amniore-
duction. Laser is performed under local anaesthe-
sia and requires overnight stay in the hospital.
Laser cord coagulation or radiofrequency ablation
for Twin Reversed Arterial Perfusion (TRAP)/Acar-
diac twin
Fetal Therapy
Vesico-amniotic shunt for lower unrinary tract
obstruction (LUTO)
Although evidence is still conflicting regarding
benefit of vesico-amniotic shunts in LUTO, it may
offered in carefully selected patients.
Laser coagulation of feeding vessel for chorioangi-
oma, pulmonary sequestration
A conscious effort has been made to keep the cost
of all these procedures as low as possible so that
its benefits can be extended to a wider population.

Indraprastha Apollo Hospitals,

Sarita Vihar, Delhi Mathura Road,
New Delhi-110076
Ph : +91-11-2987 1090/91,
Email : assistance@apollohospitalsdelhi.com
What is Fetal therapy? Selective reduction in discordant anomalies
Fetal therapy includes interventions that aim at In case one of the twins has an abnormality and the
correcting or treating a fetal anomaly or condition other twin is normal, one of the twins is ‘reduced’ for
which if left untreated would invariably result in the sake of the normal twin. In Dichorionic twins, it is
intrauterine fetal demise. done transabdominally by instilling intracardiac KCL
Is it available in our country? in the affected twin under ultrasound guidance.
Yes, fetal therapy for selected fetal conditions is Selective reduction in Monochorionic twins requires
available at Apollo Centre Fetal Medicine at bipolar cord coagulation (BCC) or radiofrequency abla-
Indraprastha Apollo Hospitals, Delhi. The depart- Selective fetal reduction for higher order multifetal tion (RFA) under ultrasound guidance.
gestation
ment was first of its kind in North India and was
The incidence of higher order multifetal pregnancy is
started in the year 2006. There is a well experi-
increasing due to assisted reproduction techniques
enced multidisciplinary team involved in the care
(ART) as well as increasing maternal age. The pros-
of these high risk pregnancies and include Fetal
pect of losing a wanted pregnancy to miscarriage Pleural effusion: The major causes of morbidity and
Medicine, Neonatology, Paediatric Cardiology, Pae-
from intervention needs to be weighed against the mortality in antenatally diagnosed isolated pleural
diatric surgery, Paediatric neurology, Genetics and
risk of extreme prematurity. Selective reduction is effusion are pulmonary hypoplasia and prematurity.
Haematology. For all interventions, mothers are
routinely offered at ACFM. More than 80 reductions Thoracoamniotic shunting allows continuous drain-
counselled extensively by appropriate specialists
have been performed till date with pregnancy loss age of fetal pleural effusion allowing the lungs to
with regard to the nature of the condition, possible
rates comparable to published literature (5-6%). expand and thereby allowing the pregnancy to
risks and benefits, alternative treatments, and
continue. When the pregnancy is 28 weeks or more,
potential outcomes.
serial therapeutic fetal pleurocentesis allows contin-
For what conditions is fetal therapy available? uation of pregnancy till 34 weeks when neonatal
The most common conditions for which fetal outcomes are significantly improved.
interventions are considered are:
Intrauterine transfusion (IUT) for Fetal anemia
Fetuses at risk of fetal anemia are followed up
with serial ultrasound for MCA PSV Dopplers to
detect fetal anemia. The most common cause in
our country remains Rh isoimmunisation. Intra-
uterine transfusion is associated with more than
90% survival with no long term neurodevelopmen-
tal sequelae in this otherwise lethal condition.
More than 50 successful IUTs have been
performed at ACFM.