Fetal intervention technique saves hundreds of babies

October 02, 2023 - 07:45
Using the world's tiniest needle with a diametre of only 0.3mm, doctors have to be careful in every movement. The small needle is absolutely safe to both fetus and mother but poses a challenge to doctors who perform the technique.
Ultrasound screening performed at the Fetal Intervention Centre, Hà Nội Obstetrics Hospital. — Photos courtesy of the centre

HÀ NỘI — Married for 13 years, Hồng (not her real name), born in 1985, and her husband are still waiting for a baby.

She miscarried five times between the 17th to 19th weeks of pregnancy and was determined by doctors to have several problems with her uterus, leading to its inability to support the fetus.

In this sixth pregnancy, holding another new hope inside the womb, she was diagnosed with a low amniotic fluid level at the 18th pregnancy week, reported the Dân Trí e-newspaper.

This is the condition in which the amniotic membrane cannot hold enough amniotic fluid, resulting in less fluid than normal for the gestational age. Oligohydramnios puts the fetus at risk of growth retardation, limb deformity, and, in the worst cases, stillbirth.

Visiting the Fetal Intervention Centre at Hanoi Obstetrics Hospital, she was prescribed amnioinfusion, a technique healthcare providers use to add amniotic fluid to the uterus.

Dr Nguyễn Thị Sim, in charge of the centre, said: "Amnioinfusion is a technique of introducing sterile isotonic fluid into the uterus to increase the volume of amniotic fluid for the fetus. This is an advanced obstetric technique.”

Before the technique was approved, in cases of insufficient amniotic fluid, when the fetus was too young to intervene, the doctor's only option was to terminate the pregnancy, she said.

Using the world's tiniest needle with a diameter of only 0.3mm, doctors have to be careful with every movement. The small needle is entirely safe for both the fetus and the mother but poses a challenge for doctors performing the technique.

Doctors at the Fetal Intervention Centre, Hà Nội Obstetrics Hospital, during surgery.

Dr Sim said: "We have to insert the needle until it passes the amniotic membrane but does not touch the fetus. Not passing the amniotic membrane will cause the muscle in the amniotic membrane to separate.

"Otherwise, if the needle penetrates slightly beyond the amniotic membrane, the fetus will develop oedema. If the needle penetrates the umbilical cord, the fluid will enter the blood vessels, which is very dangerous," she said.

An amniotic transfusion requires only one to two needles, but Sim mentioned that to perform it effectively, many years of training as a fetal interventionist are needed.

Feeling is the "guide" to move the needle. To reach its destination, the needle must pass through the muscle layer, the fat layer of the abdominal wall, the uterine muscle, and the amniotic membrane, Dr Sim explained.

"Each layer has a different resistance. The doctor must be aware of the needle's location at all times. This is the most challenging aspect of this technique," Sim said, likening it to "finding a needle in a haystack".

After 30 minutes, the doctors have successfully infused 500ml of amniotic fluid into the mother’s womb. The previously constricted space is now expanded, and the baby immediately becomes more active.

Doctors who offer hope

The Fetal Intervention Centre assists pregnant women with complications.

Sim noted: "The patients we see are all undergoing challenging pregnancies with issues such as polyhydramnios, oligohydramnios or twins with morphological or genetic abnormalities.

“All of these conditions directly threaten the health and life of the fetus."

The role of fetal intervention doctors is to identify appropriate medical solutions to save the fetus, even if there's only a glimmer of hope.

“Our mission is to uncover even the faintest rays of hope. With our expertise, we nurture this hope. The ultimate aim is to ensure the baby is born healthy,” Dr Sim said.

More than anyone else, the doctors and nurses at the centre recognise that they represent the last beacon of hope for distressed families on their long and arduous journey seeking healthy babies, she observed.

"Any positive update on the fetus's progress can uplift the entire family," Dr Sim said.

Advance the technique

A mother welcomes her twins thanks to the help of fetal intervention technique performed by doctors of Hà Nội Obstetrics Hospital.

At the Fetal Intervention Centre, nearly 150 pregnant women with oligohydramnios, like Hồng, have successfully gone through labour and fully experienced the joy of motherhood thanks to the amnioinfusion technique.

Professor Nguyễn Duy Ánh, director of Hà Nội Obstetrics Hospital, stated that fetal intervention is currently the most challenging obstetric technique. It is pivotal in saving the lives of numerous foetuses facing perilous pregnancy complications.

"In fetal medicine, the foetus is regarded as a patient. If the foetus has a condition that necessitates early intervention, fetal medicine techniques can treat it directly within the womb. This not only aids in saving the life of the foetus but also in preventing severe defects upon birth,” he said.

Such procedures would also enhance the quality of the population, as the rate of babies born with disabilities and sequelae from foetal diseases would significantly decrease, he added.

Hundreds of babies have been born at the hospital, owing to advanced fetal intervention techniques.

Doctors at Hà Nội Obstetrics Hospital are exploring numerous cutting-edge fetal intervention techniques, especially those that intervene directly in the foetal organs to treat diseases affecting the brain, heart, lungs, and kidneys.

They are keenly anticipating the incorporation of stem cell technology and gene therapy into fetal intervention.

Annually, there are thousands of cases in Việt Nam that require fetal intervention. If these are detected early and receive timely intervention, the outcomes don't have to be foetal deaths or unhealthy births, according to Professor Ánh.

In his opinion, fetal medicine embodies profound humanistic values. Many mothers may only have a single opportunity to become pregnant. Thus, safeguarding the baby holds immense significance for the entire family.

"Bearing children might be a family's sole opportunity. For instance, in cases of uterine rupture, the likelihood of the woman conceiving again is almost negligible. Or, there are those who, after undergoing fertility treatments, can't conceive when they're older.

“Safeguarding this rare chance and rekindling hope for these families is the unique joy and privilege of obstetricians like us," Professor Ánh said. — VNS