Featured Research

from universities, journals, and other organizations

Fetal Surgeon Shows For First Time That Laser Procedure May Treat Vasa Previa

Date:
January 3, 2008
Source:
University of South Florida Health
Summary:
A fetal surgeon successfully treated in utero a rare but potentially devastating prenatal condition, which, if undetected, is frequently deadly for newborns.

A University of South Florida fetal surgeon at Tampa General Hospital successfully treated in utero a rare but potentially devastating condition in which placental blood vessels block the birth canal and can rupture during labor, leaving the baby without vital blood and oxygen. If undiagnosed, the condition known as vasa previa is frequently deadly for newborns.

The case was reported by Ruben Quintero, MD, professor and director of the Division of Maternal-Fetal Medicine at USF Health, in the December 2007 issue of the Journal of Maternal-Fetal and Neonatal Medicine. Dr. Quintero used a laser to seal off the abnormally positioned fetal blood vessels connecting the two parts of a bilobed placenta. The procedure essentially removed the unprotected vessels crossing the cervical entrance to the birth canal beneath the baby, so that the vessels would not tear or break and cause rapid fetal hemorrhage.

"This is the first time laser therapy has been used to correct vasa previa," said Dr. Quintero, a pioneer in the field of minimally-invasive fetal surgery. "Patients have described this prenatal condition as a ticking time bomb waiting to go off. A patient with vasa previa lives with the constant worry that if her water breaks at any time, she may lose the pregnancy."

"Dr. Quintero has long been recognized for his excellence in innovation in fetal intervention. His successful in utero laser treatment of vasa previa is potentially a very important breakthrough because it may avert fetal hemorrhage," said Frank Chervenak, MD, chairman of the Department of Obstetrics and Gynecology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center. "This report must be followed by scientifically and ethically rigorous clinical investigation before being offered to patients as the standard of care."

Dr. Quintero is an expert at pinpointing abnormal placental vessels with an endoscope inserted through the abdominal wall and into the uterus. Using a selective endoscopic technique he developed, he had already performed hundreds of laser ablations of malfunctioning placental blood vessels to treat twin-to-twin transfusion syndrome.

Vasa previa occurs in about 1 in every 2,000 to 5,000 pregnancies. Despite advances in medical technology, the condition often goes undetected until it is too late and then an emergency caesarian section and aggressive resuscitation is required to save the baby. Vasa previa has a high death rate if it's not caught before labor, because many babies lose most or all of their blood supply within a few minutes when their mother's water breaks. A color Doppler ultrasound showing blood flow in the womb can help detect vasa previa, but unless a woman is identified as having a high-risk pregnancy, she typically does not get this more sophisticated test during pregnancy.

The 37-year-old patient described in the published report had an abnormal placenta with one smaller and one larger lobe linked by two exposed fetal vessels. Normally the blood vessels feeding the fetus are embedded in the placenta or umbilical cord, but in this case the vessels linked the two lobes. This would not necessarily be life-threatening if the unsupported vessels were positioned in other areas of the uterus -- but these vessels were caught between the fetus and the opening to the birth canal (cervix). Such exposed vessels are prone to tearing when the patient's amniotic membranes rupture, or they may be compressed between the baby and the walls of the birth canal during birth, cutting off oxygen to the baby.

There is no uniform standard of care for vasa previa. When the condition is diagnosed, physicians often manage it by recommending bed rest, hospitalizing the patient beginning at 7 months of pregnancy and scheduling an elective cesarean delivery before labor. However, Dr. Quintero suggests, the risk of fetal death might be substantially minimized if the unprotected vessels were ablated in utero. Laser treatment might eliminate prolonged hospitalization and the obligatory C-section, and allow the pregnancy to progress to term with a vaginal delivery, he said.

The patient described in Dr. Quintero's paper was counseled about management alternatives and elected to undergo laser surgery to seal the abnormal fetal vessels. The procedure was performed at Tampa General Hospital at about 23 weeks of pregnancy without complications, Dr. Quintero reported. However, the patient subsequently required a cesarean delivery at 27 weeks for ruptured membranes, which may have been prompted by the breech position of the fetus. After a stay in the neonatal intensive care unit, the infant was discharged and is thriving today at 9 months old.

"This case is a first step requiring more study to determine the effectiveness of the procedure and its risks," Dr. Quintero said. "But it demonstrates that, if an accurate diagnosis is made, something proactive may be done to treat vasa previa.

"It may provide physicians with justification and greater impetus to look for the prenatal diagnosis early, and hopefully save more babies."


Story Source:

The above story is based on materials provided by University of South Florida Health. Note: Materials may be edited for content and length.


Cite This Page:

University of South Florida Health. "Fetal Surgeon Shows For First Time That Laser Procedure May Treat Vasa Previa." ScienceDaily. ScienceDaily, 3 January 2008. <www.sciencedaily.com/releases/2007/12/071218101119.htm>.
University of South Florida Health. (2008, January 3). Fetal Surgeon Shows For First Time That Laser Procedure May Treat Vasa Previa. ScienceDaily. Retrieved August 21, 2014 from www.sciencedaily.com/releases/2007/12/071218101119.htm
University of South Florida Health. "Fetal Surgeon Shows For First Time That Laser Procedure May Treat Vasa Previa." ScienceDaily. www.sciencedaily.com/releases/2007/12/071218101119.htm (accessed August 21, 2014).

Share This




More Health & Medicine News

Thursday, August 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Possible Ebola Patient in Isolation at California Hospital

Possible Ebola Patient in Isolation at California Hospital

Reuters - US Online Video (Aug. 20, 2014) — A patient who may have been exposed to the Ebola virus is in isolation at the Kaiser Permanente South Sacramento Medical Center. Linda So reports. Video provided by Reuters
Powered by NewsLook.com
Raw: World's Oldest Man Lives in Japan

Raw: World's Oldest Man Lives in Japan

AP (Aug. 20, 2014) — A 111-year-old Japanese was certified as the world's oldest man by Guinness World Records on Wednesday. Sakari Momoi, a native of Fukushima in northern Japan, was given a certificate at a hospital in Tokyo. (Aug. 20) Video provided by AP
Powered by NewsLook.com
Do More Wedding Guests Make A Happier Marriage?

Do More Wedding Guests Make A Happier Marriage?

Newsy (Aug. 20, 2014) — A new study found couples who had at least 150 guests at their weddings were more likely to report being happy in their marriages. Video provided by Newsy
Powered by NewsLook.com
Ebola-Hit Sierra Leone's Freetown a City on Edge

Ebola-Hit Sierra Leone's Freetown a City on Edge

AFP (Aug. 19, 2014) — Residents of Sierra Leone's capital voice their fears as the Ebola virus sweeps through west Africa. Duration: 00:56 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins