Foetus: The new patient
A chubby 18-month-old Vivek darts around his Khar home, fidgeting with everything in sight, a mischievous glint in his eyes. His parents Srinivas and Ashwini Chunduru chide him but also indulgently call him a WMD (weapon of mass destruction).
Life would have been different if it weren’t for advances in medical technology that made it possible to treat Vivek when he was still a foetus in Ashwini’s womb.
Ashwini (29) was 22 weeks pregnant when tests revealed that the foetus was severely anaemic: the haemoglobin level had plummeted and water was accumulating in the body. After doctors at a major hospital offered no solution, the couple, which had lost their first child due to a pregnancy complication, gave up hope.
But a sophisticated procedure changed everything. Foetal medicine specialist Dr Chander Lulla pushed a special needle through Ashwini’s abdominal skin, guided it into her uterus and then to the umbilical cord with the help of real-time ultrasound imaging.
The needle was connected to a tube and the foetus was given blood transfusion. The procedure was done under local anaesthesia and was repeated twice over the next two months. “Vivek weighed a healthy 2.3 kg at birth,” said Srinivas, a senior executive.
Vivek is among the countless babies whose life has been saved in recent times thanks to procedures done while he was still in his mother’s uterus.
The introduction of 3D and 4D ultrasound scans, and sophisticated equipment have made it possible for doctors to diagnose foetal anomalies and perform certain corrective procedures like giving blood transfusions or draining the excess amniotic fluid without disturbing the pregnancy.
Dr Lulla, who is attached to Jaslok Hospital, performs two to three such interventions every week. “In all these cases, the child would have died in the uterus, if we did not intervene,” he said.
Certain foetal conditions are also being treated by administering medicines to the mother.
Take the case of Amruta Kumar (37). An echocardiogram in the third month of pregnancy revealed that the foetus’ heart was beating too fast.
Doctors at Lilavati Hospital put the Santacruz resident on medication to reduce her heart rate so it would, in turn, slow down the foetus’ heart rate. “We hospitalised Kumar and constantly monitored her and the foetus so we could alter the dose of medicines accordingly,” said senior gynaecologist Dr Kiran Coelho.
Kumar’s son Aastik turned two recently. “His survival was like a medical miracle. We had conceived after 15 years of marriage and couldn’t be happier,” said Kumar’s husband Gopa.
Foetal interventions may be the only option sometimes but they are not risk-free. “The procedure can cause miscarriage in one in 200 cases,” said Dr Lulla.
Dr Shantala Vadeyar from Kokilaben Hospital said it is important to know when not to intervene.
“Some conditions are self-limiting or can be corrected after birth so one should not take the risk,” she said.