International Standards for Fetal Care by Apollo Hospital Delhi

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Laser for Twin-Twin Transfusion Syndrome (TTTS)
Monochorionic twins have a high frequency of
placental vascular shunts that may lead to one
twin (donor) overperfusing the other (recipient).
What other fetal therapies are available at
Apollo Centre for Fetal Medicine? Laser cord
coagulation or radiofrequency ablation for Twin
Reversed Arterial Perfusion (TRAP)/Acar- diac
twin
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.
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_at_apollohosp
italsdelhi.com
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What is Fetal therapy? Fetal therapy includes
interventions that aim at correcting or treating
a fetal anomaly or condition which if left
untreated would invariably result in
intrauterine fetal demise. Is it available in our
country? Yes, fetal therapy for selected fetal
conditions is available at Apollo Centre Fetal
Medicine at Indraprastha Apollo Hospitals,
Delhi. The depart- ment was first of its kind in
North India and was
Selective reduction in discordant anomalies In
case one of the twins has an abnormality and the
other twin is normal, one of the twins is
reduced for the sake of the normal twin. In
Dichorionic twins, it is done transabdominally
by instilling intracardiac KCL in the affected
twin under ultrasound guidance. Selective
reduction in Monochorionic twins requires
bipolar cord coagulation (BCC) or radiofrequency
abla- tion (RFA) under ultrasound guidance.
Selective fetal reduction for higher order
multifetal gestation
The incidence of higher order multifetal
pregnancy is increasing due to assisted
reproduction techniques (ART) as well as
increasing maternal age. The pros- pect of
losing a wanted pregnancy to miscarriage from
intervention needs to be weighed against the
risk of extreme prematurity. Selective reduction
is routinely offered at ACFM. More than 80
reductions have been performed till date with
pregnancy loss rates comparable to published
literature (5-6).
started in the year 2006. There is a well experi-
enced multidisciplinary team involved in the
care of these high risk pregnancies and include
Fetal Medicine, Neonatology, Paediatric
Cardiology, Pae- diatric surgery, Paediatric
neurology, Genetics and Haematology. For all
interventions, mothers are counselled
extensively by appropriate specialists with
regard to the nature of the condition, possible
risks and benefits, alternative treatments, and
potential outcomes. For what conditions is fetal
therapy available? The most common conditions
for which fetal interventions are considered are
Pleural effusion The major causes of morbidity
and mortality in antenatally diagnosed isolated
pleural effusion are pulmonary hypoplasia and
prematurity. Thoracoamniotic shunting allows
continuous drain- age of fetal pleural effusion
allowing the lungs to expand and thereby
allowing the pregnancy to continue. When the
pregnancy is 28 weeks or more, serial
therapeutic fetal pleurocentesis allows contin-
uation of pregnancy till 34 weeks when neonatal
outcomes are significantly improved.
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.