Dr. Petya Chaveeva: We already have 16 intrauterine operations

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Dr. Petya Chaveeva: We already have 16 intrauterine operations
Dr. Petya Chaveeva: We already have 16 intrauterine operations
Anonim

Dr. Petya Chaveeva is a gynecologist and specialist in fetal medicine, works at Shterev Hospital in Sofia. He specialized for 3 years in London at the Institute of Research and Fetal Medicine at the Royal College. She travels twice a month to the English capital to exchange the latest practices with colleagues from around the world in the field of fetal medicine. We talk with Dr. Chaveeva about the possibilities of prenatal diagnostics and intrauterine operations

Dr. Chaveeva, the Bulgarian gives birth at an increasingly late age, after 30. Does this increase the risk of chromosomal and genetic diseases?

- Genetic diseases run in families, and chromosomal ones can happen to anyone. Indeed, nowadays we are faced with a higher age of mothers and accordingly we have to be more careful, to do a precise study. Yes, older maternal age predisposes the fetus to chromosomal disorders, but this does not exclude the younger generation. If Down syndrome is about 30 to 50% in pregnant women from 35 to 40 years old, then the other 50% is in pregnant women from 15 to 35 years old. Down syndrome has a frequency of 1:500 and is a socially significant disease. Therefore, it is extremely important to have a screening test during the first trimester of pregnancy. Based on blood tests and ultrasound, we assess the mother's individual risk of giving birth to a child with Down syndrome - trisomy 21. But we may also detect other chromosomal diseases. The combined screening test also includes trisomy 13 - Patau and trisomy 18 - Edward's syndrome. During the first trimester of pregnancy, we must exclude the most common chromosomal diseases and evaluate the development of the fetal organs (11-17th week of gestation). If everything is fine, the patient's next visit to us should take place during the 19-23rd gestational week (second trimester) to find out

are the baby's organs normal -

brain, heart, limbs, kidneys, gastrointestinal tract, skeletal system. Only then can we ensure that there are no structural defects that would require surgery immediately after birth or that would be associated with an adverse pregnancy outcome.

In Bulgaria, are prenatal examinations by a specialist in fetal medicine covered by the Fund?

- Unfortunately, no. According to the model in modern he alth care systems in Western Europe, fetal medicine specialists perform three specialized examinations. This ensures that no chromosomal disease or structural defects in the fetus are missed. I categorically believe that fetal morphology should be part of the women's consultation, and the He alth Insurance Fund should pay for the examinations. Every pregnant woman should have the opportunity to go through a specialist in fetal medicine for free.

What deviations in fetal development can medicine intervene in? You have experience with intrauterine operations

- In the past, a large part of the defects could not be intervened during pregnancy. But the development of medicine and equipment now allows intrauterine fetal surgery to be performed. It requires a large multidisciplinary team and very good equipment. We performed the first intrauterine operation in Bulgaria in 2014. It was for a multiple pregnancy, identical twins with transfusion syndrome. This complication means different hemodynamics in the two babies.

No fetal surgery,

pregnancy is doomed over 90%

Either the woman gives birth prematurely, or both twins die. The intrauterine operation is performed with the instrument fetoscope. With it, we penetrate the uterine cavity and look for abnormal blood vessels on the surface of the placenta, which are shared between the two twins and cause the transfusion syndrome. The aim of intrauterine surgery is to cut off the abnormal blood supply between the two babies by using laser energy to coagulate the vessels on the surface of the placenta. This way the babies no longer share blood with each other.

How is this pair of twins feeling today and what other intrauterine surgeries are you doing?

- We have done 13 laser ablations so far. Some of these women have already celebrated a year and a half of their children, others - a year. They come to celebrate together, so we know what happens to these children. I just had a laser ablation three weeks ago, so I have a pregnant one that I'm currently monitoring.

The other type of prenatal surgery that we apply successfully is on fetal diaphragmatic hernia. This is a defect in which the internal organs rise from the abdominal cavity into the thoracic cavity and press on the lungs. The earlier in utero this defect occurs, the greater the risk that the lungs will not develop. When we insert a balloon into the fetal trachea, we allow the fluid produced in the lungs to fill and expand them. Thus, we stop the organs from the abdominal cavity from going up and create good conditions for the surgeons to intervene after us when the baby is born. So far we have two cases of diaphragmatic hernia. One baby is already one year old and the other is eight months old.

In total, we have performed 16 intrauterine operations in our clinic. We have a team prepared to operate on fetal aortic stenosis when we find such a case.

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