Twins in Life-Threatening Condition in the Womb Safely Treated with ‘Fetoscopy’

"Increasing Twin Pregnancies... Even Fatal Complications Can Be Fully Cured with Early In-Utero Treatment"

▲ Professor Mi-Young Lee (far left) and Professor Hye-Sung Won (center) from the Fetal Treatment Center at Asan Medical Center perform a fetoscopic surgery to treat Twin-to-Twin Transfusion Syndrome.

In her 7^th year of marriage, 38-year-old Ms. Hong became pregnant with twins after multiple rounds of in vitro fertilization. At 20 weeks of pregnancy, she experienced abdominal pain, prompting an examination that revealed she was suffering from Twin-to-Twin Transfusion Syndrome (TTTS). This condition occurs when abnormal blood vessels within the placenta cause blood to be transfused from one fetus to the other. One twin was experiencing growth restriction while the other suffered from excess amniotic fluid, leading to decreased cardiac function and endangering both babies. Upon the referral of her physician, Ms. Hong sought treatment at the Fetal Treatment Center of Asan Medical Center, where she underwent an emergency fetoscopic surgery. Following a successful one-hour procedure, the condition of the fetuses improved dramatically, and Ms. Hong was able to deliver healthy female identical twins at 35 weeks of pregnancy.

With rising maternal age and advancements in assisted reproductive technologies leading to an increase in twin pregnancies, the incidence of Twin-to-Twin Transfusion Syndrome (TTTS) is also on the rise. Fortunately, advancements in fetal therapy techniques have made it possible to treat this life-threatening condition effectively in utero, often resulting in a complete recovery.

The Fetal Treatment Center of Asan Medical Center has been actively performing fetoscopic surgeries to address TTTS and recently reached a milestone in Korea with 300 cases treated.

TTTS occurs in approximately 10-15% of identical twin pregnancies and is caused by abnormal blood vessel connections within the placenta. This condition leads to one twin One fetus suffering from growth restriction and amniotic fluid deficiency due to a lack of blood, while the other fetus experiencing compromised heart function due to excess blood. Without treatment, TTTS can be fatal for both twins.

Before the advent of fetoscopy, treatment options were limited to repeatedly draining excess amniotic fluid from the over-hydrated fetus to temporarily improve the mother’s symptoms and fetal condition and prevent premature labor.

Fetoscopic surgery is the most effective and fundamental treatment method for saving both fetuses by blocking the blood flow connection between them.

First, to eliminate the blood vessels connecting the two fetuses, a fetoscope is inserted through the mother’s umbilicus to access the uterus. Next, while observing the condition of the blood vessels, a laser is used to coagulate the blood flowing between the vessels to block the blood flow connection between the fetuses. This process takes approximately 30 minutes. After the laser treatment is completed, excess amniotic fluid is drained to reduce pressure, a 15-minute procedure. The entire treatment usually is completed within an hour.

At the Fetal Treatment Center of Asan Medical Center, the survival rate of fetuses following recent fetoscopic treatments exceeds 89%, demonstrating world-class treatment outcomes. The incidence of amniotic fluid rupture or premature labor within 14 days after surgery is very low, at less than 2%.

Professor Hye-Sung Won, the Director of the Fetal Treatment Center at Asan Medical Center, stated, “Fetoscopy for TTTS has demonstrated high success rates and has become a safe and established surgical procedure since its introduction in Korea.”

She further added, “As a result of our efforts to save even a single life, Asan Medical Center has achieved a record of 300 fetoscopic procedures. During this process, we have also led the way in the selection of new medical technologies and the expansion of insurance coverage. Recognizing the importance and value of fetal treatment, we expect that the expansion of coverage will allow many more lives to be born healthy in the future."

The Fetal Treatment Center at Asan Medical Center, the first of its kind in Korea, opened in 2004 and is celebrating its 20th anniversary this year. It conducts over 4,500 precision ultrasounds annually, diagnosing and treating fetal anomalies, and managing both pre- and post-natal care. To date, the Center boasts extensive experience in fetal treatment, including 300 fetoscopy procedures, 657 fetal shunt surgeries, 248 radiofrequency ablation procedures, and 219 fetal transfusions.

For treatments and progress after birth, the Fetal Treatment Center collaborates with specialists in the Department of Pediatrics, Division of Pediatric Cardiology, Division of Pediatric Surgery, Division of Pediatric Cardiac Surgery, Department of Plastic Surgery, Division of Pediatric Urology, Division of Pediatric Orthopedic Surgery, and Division of Pediatric Neurosurgery. The Center conducts early prenatal counseling to ensure smoother neonatal care after birth.