13th June 2019
‘Every bump is a mystery . . .’ Professor Anna David, Fetal medicine consultant
One muggy August day in 2015, I sat in a large treatment room at the end of a corridor in central London, watching as consultant obstetrician George Attilakos placed a knife in a kidney dish on a small wheeled table. Together with midwives Ignacio Rosas and Georgina Fox, he laid out everything he needed for the invasive procedure he was about to perform on a woman seventeen weeks pregnant with twins: gauze, syringes, needles, large sterile dressings and plastic and metal tubes. The floor around the bed was covered in paper towels. At three o’clock, the patient walked in, wearing a hospital gown. Emma was twenty-eight, and, in the world outside, a cheerful, robust office manager and mother of a
The surgery she was here to have – fetoscopic laser treatment, burning the blood vessels in her placenta to disconnect her twins, who had developed twin-to-twin transfusion syndrome– is one of the more intense procedures the fetal medicine unit of University College Hospital (UCH) undertakes, and is not done lightly.
Emma and her partner Tom, a taxi driver, from north London, had had a complicated pregnancy. At four months, a scan revealed one twin had acrania – the baby was developing without a skull and wouldn’t survive after it was born. Emma and Tom were sent here, one of Britain’s leading fetal medicine centres, which treat the most problematic pregnancies. Then, on this overcast day, the doctors told them there was a ‘time bomb’ in Emma’s womb.
Blood vessels in the twins’ shared placenta were giving one baby too much blood and the other too little, which meant the twin without acrania was likely to die, too. Laser treatment has many risks but gave an 80 per cent chance that the well baby would survive – there was simply no other option. Doctors treat forty cases of twin-to-twin transfusion syndrome each year here, one of only a few hospitals in Britain to do this.
Emma lay on the bed with an absorbent towel tucked in to her pants. Naturally a chatty, confident person, she was breathing deeply: ‘I’m really nervous.’ She was draped from neck to toe, only her belly exposed. The doctor and midwives tried to be reassuring – ‘Most women afterwards say it’s not as bad as they think,’ said Mr Attilakos, gowning up – but Emma radiated anxiety as she was handed a pair of dark glasses to protect her eyes from laser rays. She moaned and sang to herself. Then she sighed: ‘I don’t want to see anything,’ and squeezed her eyes shut. Continue reading here…