Multiple births -- twins, triplets or more -- raise high-risk concerns. With the increase in successful fertility management, the number of these challenging pregnancies is higher than ever before.
At the University of Maryland Medical Center, the Center for Advanced Fetal Care (CAFC) is an important resource for managing these complicated pregnancies. The Center’s perinatal team has gained a national reputation for providing state-of-the-art care for the unborn child.
Among the most challenging of twin complications is the complex disorder known as twin-to-twin transfusion syndrome (TTTS). This condition results from an unequal exchange of blood, nutrients, fluid volume and oxygen in a single placenta shared by identical twins.
In TTTS, one twin (called the donor) loses blood volume to the other (called the recipient). As the condition worsens, the donor becomes smaller, anemic, and dehydrated, losing kidney function while being stuck in an amniotic sac without amniotic fluid. At the same time, the recipient must cope with excessive blood and fluid volumes. The blood becomes extra thick as kidney function and amniotic fluid volume becomes excessive. The recipient twin's amniotic sac is overstretched, threatening premature labor.
If left untreated, progressive TTTS is often fatal to both twins, either before birth or from complications of prematurity. Treatment is complex and dangerous, as it must balance the competing needs of the twins and the mother. CAFC is one of a handful of centers in the country specializing in fetal surgery that uses intrauterine laser to separate the placenta into two parts, ending the communication between donor and recipient. This procedure is called fetoscopic laser occlusion of placental anastomoses and is revolutionizing management of this severe condition.
At the Center for Advanced Fetal Care, Dr. Baschat and the perinatal team provide state-of-the-art diagnostic services and treatments for high-risk pregnancies.
"In circumstances where the fetus is compromised, we have access to the most comprehensive resources, particularly for complex surgeries such as laser surgery within the uterus, for the successful treatment of TTTS," says Ahmet A. Baschat, M.B., B.Ch., associate professor of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine and director of the Laser Team at the Center for Advanced Fetal Care.
Dr. Baschat and his colleague, Christopher R. Harman, M.D., director of CAFC, are among the few surgeons in this country to perform intrauterine surgery for TTTS and other life-threatening fetal conditions. Together, they have over 35 years of experience in the evaluation and treatment of fetal abnormalities.