In the first of its kind endoscopic technique, fetal surgeon Dr. Ruben Quintero from the University of South Florida at Tampa General Hospital performed an in utero laser ablation of vasa previa, making delivery of the baby safe and successful:
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…
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).
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.
Case report: In utero laser treatment of type II vasa previa (.pdf) The Journal of Maternal-Fetal and Neonatal Medicine, December 2007; 20(12): 847-851
Press release: USF fetal surgeon treats rare prenatal condition with laser surgery for first time …
