In a first in India, AIIMS uses rare op to treat fetal lung mass – ET HealthWorld

However, there are always exceptions. AIIMS, Delhi recently got a referral where a 27-week fetus suffering from BPS had a large lung mass that was causing a massive collection of fluid in the chest leading to compression of the heart and lungs.

Dr Vatsala Dadhwal, professor, maternal fetal medicine division, department of gynaecology and obstetrics, said usually in some cases, shunts are inserted to drain the fluid from the lungs so that compression on the heart can be removed to prevent heart failure. But this is a temporary measure, she said.

The other option is to burn the blood vessel supplying the tumour or abnormal lung tissue under ultrasound guidance inside the womb. “This is a technically demanding procedure requiring a high level of expertise. This procedure can be done by laser energy, which has been reported previously. The other technique which can be performed is the Radio-Frequency Ablation (RFA) that uses radiofrequency energy for ablating the vessel. We chose the latter to operate on the fetus as the vessel supplying blood to the tumour was quite big,” Dr Dadhwal said.

“Till date, the use of RFA for such a condition has been reported previously only in three cases of which only one baby has survived. Ours is the second successful case in the world,” the AIIMS professor said. “Ours is the first case of the same from India,” she added. AIIMS performed the surgery on December 23. The baby was delivered on February 5. “The day following the procedure, the fluid started decreasing. It disappeared completely by day seven and the lungs also expanded,” Dr Dadhwal explained. She further said that by the time of birth, the tumour had completely disappeared. “The baby was discharged in a healthy condition,” she added.

The AIIMS doctors said parents should be aware that many conditions of the fetus are amenable to treatment inside the womb. There are others wherein some temporary interventions can be done inside the womb and definitive management provided after birth so that the baby can survive in the womb till delivery. This knowledge should be used both by patients and the general physicians to refer patients to fetal medicine centres like AIIMS, New Delhi in time for possible treatment, they said.

The division of fetal medicine, AIIMS has been in existence since the 1980s and has been the first centre in the country to provide fetal interventions, both diagnostic and therapeutic.

AIIMS, New Delhi has been the first centre to start fetal blood transfusions in the country having performed more than 1,500 procedures so far. “We are probably performing the maximum number of such procedures in the world presently. In the last 10 years, we have started and perfected the procedures for managing complicated twin pregnancies that need treatment inside the womb using laser and radiofrequency ablation. We have also got experience of inserting shunts for draining fluids from bladder or the lungs and managing various fetal heart rate abnormalities inside the womb,” Dr Dadhwal said.