Assoc. Dr. Atanas Shterev: We operated on the baby's congenital hernia while still in the mother's womb

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Assoc. Dr. Atanas Shterev: We operated on the baby's congenital hernia while still in the mother's womb
Assoc. Dr. Atanas Shterev: We operated on the baby's congenital hernia while still in the mother's womb
Anonim

A unique for Bulgaria surgery on the fetus already in the mother's womb and a new test for prenatal diagnosis of genetic anomalies was announced by Assoc. Dr. Atanas Shterev. Here are the details especially for the readers of "Doctor".

Prof. Shterev, when should pregnant women take a prenatal test to detect genetic abnormalities of the fetus?

- The algorithm at work is that every pregnant woman visits a women's consultation at least 10-12 times. Unfortunately, in many settlements in the country, women's consultation is broken as a system. Twice, the pregnant woman should be sent for ultrasound and biochemical screening - the early screening is between the 9th and 11th weeks, and the late one is between the 18th and 22nd weeks. About ten people in our country are certified for fetal screening and most of them are in Sofia. After they find abnormalities, a consultation with a geneticist follows, and only then does the family decide to do various tests. In Bulgaria, there are already six types of genetic tests, working by examining fetal DNA in the blood of the pregnant woman.

The decision to terminate the pregnancy is made by the family, but this must be done by the 20th week at the latest. Or a decision is made for intrauterine manipulation that will allow the fetus to be viable at birth. In many countries, a diagnosis of Down syndrome does not mean termination of pregnancy. In the US, the mother receives government assistance to raise this child and is then given a lifetime pension because such children die relatively early. This does not happen in our society. The conditions in Bulgaria suggest that in almost every case with Down syndrome

to terminate the pregnancy

It is safe for the mother to do this early so she can have another pregnancy afterwards.

Why did you introduce the new Harmony test in your hospital?

- The use of Harmony Test in our hospital has two important reasons. It is certified and has a high level of reliability - it determines with accuracy 99% the presence of Down's syndrome in the fetus, 98% of Edward's syndrome and 97% of Patau's syndrome. It is also twice as cheap as all the others. The use of this test is part of our idea to create and develop a unit for fetal invasive diagnostics and therapy to treat the fetus already in the mother's womb. One of the pioneers in this field of medicine is Prof. Kipros Nikolaidis, with whom Dr. Petya Chaveeva from our hospital specialized in London for three years. - What surgeries do you perform? - We have performed several surgeries on babies in the womb and we hope they are born alive and he althy. Recently, Dr. Chaveeva performed an operation to separate the anterior placenta, which is a very difficult and heavy manipulation. On Oct. 30, he inserted a balloon into the trachea of an unborn baby with a congenital diaphragmatic hernia to close it and help lung development. Congenital diaphragmatic hernia has a frequency of 1 in 2500 births. When the diaphragmatic hernia is large, only about 20% of babies survive at birth.

This fetal surgery gives a good outlook for our little patients after they are born. For making this

unique for Bulgaria intervention

we were assisted by the Italian Dr. Nicolo Persico, who also specialized in fetal morphology and therapy in London under Prof. Nicolaidis.

What is congenital diaphragmatic hernia surgery?

- We enter the cavity of the uterus, then with a mini-invasive fetoscope we open the baby's mouth, insert an endoscope, on the tip of which a very small balloon is placed. Before that, however, an anesthetic is injected into the baby's forearm to stop it from moving. Otherwise, you cannot work with the fetoscope. Naturally, the baby is sedated with a certain dose according to its weight. The uterine wall is pierced, the fetoscope is inserted into the trachea and closed with the balloon. Thus, the fluid that is produced by the lungs does not go outside, but stretches them and counteracts the abdominal organs that have entered the chest. Otherwise, these abdominal organs will press on the lung and prevent its development. And with an underdeveloped lung, the baby cannot survive.

What are the prospects for this pregnancy?

- Two weeks after the operation, the patient is feeling well and we have a good response of the fetal lungs.

In the 34th week of our unborn patient, a new manipulation should be done and the balloon removed. The alternative is to burst the balloon at birth to prevent the baby from suffocating. We have arranged with Dr. Maslarska from "Tokuda" hospital, where there is resuscitation for newborns, for the child to be born there. We plan to have Dr. Chaveeva pop the balloon in the trachea. After the child's condition is stabilized for 24 hours, he will be transferred to "Pirogov", where we have an appointment with Dr. Georgiev from Children's Surgery. He will perform a diaphragmatic hernia repair. Medicine is a team activity of many specialists - anesthesiologists, pediatricians, geneticists, surgeons, but the first in this chain is the specialist in fetal medicine.

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