This Nan Shanghai prenatal diagnosis center relayed intrauterine first aid, but the pregnancy with twins was diagnosed as "acardiac fetus"
"Don't worry, the fetus is fine and its development is consistent with its gestational age."
"I will have regular prenatal check-ups and wait for the delivery with peace of mind."
In the clinic of Fengxian Branch of China Welfare Institute International Peace Maternal and Child Health Hospital, pregnant woman Mao finally smiled with relief after hearing the words of the prenatal doctor. At the end of last year, Ms. Mao, who lives in Pudong, went to the local community health service center for a check-up due to physical discomfort and discovered that she was pregnant with twins. The sudden news made her family overjoyed.
"When I first learned that they were twins, I thought about it every day and hoped that they would be a pair of twins, a boy and a girl." Recalling the scene at that time, Ms. Mao still smiled inadvertently on her face. As the gestational age increased, Ms. Mao went to the National Maternity and Infants Fengyian Hospital for prenatal check-up at the beginning of this year. However, when she was 12 weeks pregnant, she was told after a routine NT examination that the fetus was abnormal. One fetus had no head or heart reflexes.
"Doctor, what does this mean? Does it mean that the baby cannot be saved?" Ms. Mao was frightened by the result and hurried to the hospital's prenatal diagnosis center for further diagnosis based on the doctor's advice. After learning about Ms. Mao's condition, Wang Yanlin, deputy director and prenatal diagnosis expert, and his team immediately conducted a more detailed examination and finally determined that she suffered from twin reverse arterial perfusion sequence syndrome.
TRAPs is a serious complication that occurs in identical twin pregnancies with an incidence of approximately 1%. The main manifestation of this disease is that one of the twins develops and loses its normal shape and has no fetal heartbeat, and the blood supply to the fetus is continuously extracted, resulting in the normal fetal development or death of the blood supply.
"To put it simply, Ms. Mao has an acardiac fetus in her belly, that is, a fetus with a congenital lack of heart. Its blood supply comes from another fetus that develops normally, that is, a 'pumping fetus.' A normal fetus will "dual-purpose". The cardiac load gradually increases and may eventually lead to heart failure. If not treated and intervened in time, 50% to 70% of 'pumping babies' will die. Therefore, TRAPs is a critical and serious fetal disease." Wang Yanlin. Explain, “In this case, intrauterine treatment is required as soon as possible.”
After giving Ms. Mao and her family a detailed explanation of the surgical plan and related possibilities, and obtaining their consent, Wang Yanlin's team began preparations to perform radiofrequency ablation fetal reduction surgery on acardiac fetuses under ultrasound guidance. This treatment plan will use a radiofrequency needle with a diameter of 2 mm to locate the position of the acardiac fetus through ultrasound guidance, accurately coagulate the blood vessels from the "pumping fetus" in the "acardiac fetus", block the blood supply, and thereby reduce the survival rate of the normal fetus. Increase to 80% to 90%.
In the case of pregnant women, the radiofrequency needle will penetrate the peritoneum, uterus and other organs under ultrasound guidance and enter the inside of the acardiac fetus, and then the radiofrequency needle tip will open an umbrella-shaped structure to ablate the fetal mass. "Generally for this disease, clinical treatment will be carried out after 16 weeks of pregnancy and when the fetus is slightly larger to ensure the safety of the pregnant woman and the fetus. This pregnant woman was only 13 weeks of gestation at the time, and the maximum diameter of the acardiac fetus was only 3.5 centimeters. ." Wang Yanlin said. However, due to the special situation of Ms. Ma, if she does not receive immediate treatment, it may lead to the death of a normal fetus in the womb. "It's like a small fish that moves erratically in a pond. You have to use a harpoon to hook the fish's heart without hurting the fish's body. At the same time, due to the small gestation period of pregnant women, it is also very easy for premature rupture of membranes to occur, leading to miscarriage."
On the one hand, normal fetuses are continuously "blood drawn", which is precarious and life-threatening; on the other hand, pregnant women with small gestational ages and small fetal masses are at high risk. This is a task that requires extremely high accuracy, strength, and speed from medical staff. High precision treatment. Fortunately, with the tacit cooperation of Wang Yanlin's team, the intrauterine treatment for TRAPs was successfully completed and the blood transfusion vessels between the twins were successfully blocked. The acardiac fetuses will gradually shrink and disappear due to lack of blood oxygen supply. After Ms. Mao went through multiple follow-up examinations and prenatal checkups, they all showed that the fetus was developing normally and that she would be giving birth to a new life in more than one month.
Wang Yanlin introduced that since the opening of the National Maternity and Infant Fengxian Campus in September 2022, nearly 1,100 cases of intrauterine treatment and interventional diagnosis such as fetoscopic laser surgery for twin-twin transfusion syndrome, such as amniocentesis, chorionic villus biopsy, and umbilical vein puncture, have been completed. For example, nearly 200 twins were delivered, effectively filling the gap in professional prenatal diagnosis and treatment services in Fengxian and surrounding areas, and has become the largest prenatal diagnosis center and fetal medicine center in South Shanghai.
