- A multidisciplinary team of specialists performs procedures inside the uterus to resolve malformations, avoid serious sequelae or the death of the fetus.
- Among the complications successfully treated are twin-twin transfusion in twin pregnancies.
- The High Specialty Perinatal Surgery Clinic is located within the National Institute of Perinatology “Isidro Espinosa de los Reyes”.
As part of the current hospital infrastructure, Mexico has the first High Specialty Perinatal Surgery Clinic. In this place, pregnant women without social security have free access to procedures inside the uterus that allow complications to be resolved.
The head of the Department of Maternal Fetal Medicine, Sandra Acevedo Gallegos, reported that one of the problems is twin-twin transfusion syndrome. It can occur in up to 15 percent of twin pregnancies that share the same placenta. While with adequate intervention, more than 90 percent of cases survive.
The perinatal surgery It is also applied to correct specific fetal defects such as those of the neural tube, or diaphragmatic hernias. In both cases, the intervention improves survival and the response to definitive surgical management at birth.
Where is it located?
This clinic, located in the National Institute of Perinatology “Isidro Espinosa de los Reyes” (INPer) of the Ministry of Health, is equipped with state-of-the-art technology in charge of a multidisciplinary group of specialists and subspecialists.
One of the objectives of the clinic, stressed Acevedo Gallegos, is to reduce the morbidity and mortality associated with pregnancy and childbirth. In Mexico, just over two million births occur annually, of which nine thousand are twins that share a unique placenta with aberrant vascular connections between one and the other.
Of these twins, 12 to 20 percent have complications, and a significant percentage require intrauterine intervention to “laser close” the abnormal communications and prevent the death of one or both twins.
Other services that are performed
In the INPer Twin Pregnancy Clinic between four and six patients are evaluated daily, who are closely monitored to detect any problem in time and schedule the intervention. However, in many of these pregnancies neonatal complications are detected late, with the consequent risk of perinatal death.
Likewise, in Mexico, between one and two out of every thousand people born alive have a neural tube defect, that is, the lack of closure of the spinal column, which leaves neurodevelopmental sequelae. Therefore, most are unable to walk and present with bowel control problems requiring lifelong urinary catheterization. They must also receive multiple rehabilitation therapies.
The fetal intervention has the objective of correcting the defect and that the newborn person does not need to undergo surgery at birth. It may also reduce the need for intracranial valve placement to decrease excess cerebrospinal fluid in the brain.
Another problem that can occur is a hernia of the diaphragm, in which a portion of the diaphragmatic muscle is absent, which causes abdominal organs to move into the thorax and prevent the lung from developing properly.
When the defect is very large, the fetus has little chance of surviving to birth. Some are candidates for temporary occlusion of the fetal trachea that helps the lung expand and have a better chance of life after definitive repair of the defect.
He indicated that the timely diagnosis of this type of malformation translates into an increase in the quality of life and the integration into society on an equal footing for girls and boys.
The fetal surgery It is a procedure that is performed inside the uterus; however, not all patients are candidates for this type of intervention. Each case requires prior evaluation to guarantee that a real benefit will be obtained for the baby, the mother and the life projects of the families.
The specialist reported that one of the most frequent pathologies in twin pregnancies is twin-twin transfusion syndromewhich is when both fetuses share the same placenta, allowing one of them to send blood to the other constantly, producing life-threatening effects on both.
Acevedo Gallegos explained that since 1990, the INPer has carried out procedures such as amniocentes, intrauterine transfusions, placement of fetal catheters, and transabdominal and endovaginal villus biopsies. Likewise, in 2008 he performed the first photocoagulation intervention in the country at a public and private level.
Those who were intervened during the fetal stage in the High Specialty Perinatal Surgery Clinic, receive pediatric and neurodevelopmental follow-up. Inper is one of the few institutions where comprehensive management of the problem is carried out, which includes diagnosis, intervention in fetal life, delivery and neonatal care, and neurodevelopment monitoring.
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