Only second heterotopic twins in medical history to survive

Hadassah team saves Cypriot mother and twin girls - one growing inside and other outside uterus.

By JUDY SIEGEL
January 25, 2010 05:54
3 minute read.
Prof. Neri Laufer

neri laufer 311. (photo credit: Hadassah Hospital)

 
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Twin Cypriot baby girls - one growing inside their mother's uterus and the other having developed with the placenta attached to the exterior of the uterus and the sigmoid colon - have been born healthy at Hadassah University Medical Center in Jerusalem.
They were the second such case in the last 25 years. A multidisciplinary team of 15 doctors worked in perfect synchrony to save the 34-year-old mother, whose body was described as a "ticking time bomb" as well as the babies born in their 28th week of gestation.



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The excited father told The Jerusalem Post that the Hadassah team's saving of his wife and his daughters was a "miracle. We would not have come if we did not think they would save all of them," he said.



The government of Cyprus paid for the procedure, and he is staying in the meantime in the Ein Kerem Hotel attached to the hospital. "I am very happy with Hadassah and the level of Israeli medicine. We are very grateful. I don't know how to explain what I feel. We were very happy to come here," he added. "When our girls are big enough, we for sure want to visit again and see again the doctors and nurses, who were perfect."



Highly complex surgery to delivery the third-trimester heterotopic pregnancy took three hours to prepare and two more hours to perform. If not done properly and in time, it would have ended in the death of all three. Hadassah doctors studied the medical file of the first successful case in France from a decade ago and pulled together a skilled team that included two obstetricians, an angiologist, a urologist, intestinal and vascular surgeons, neonatologists and senior ultrasound and MRI scanning experts.



Prof. Neri Laufer, chairman of the department of obstetrics and gynecology at the Ein Kerem medical center, told The Post on Sunday that the girls are attached to respirators but doing very well, even though they are 12 weeks' premature. The first to be born via cesarean section after spending her gestation inside the womb weighed 970 grams at her birth on Thursday night and was given the name Marialena. Her sister Georgia Nicolleta, who spent the same period outside the womb and received nourishment when the placenta attached itself to the outside of her mother's uterus and colon, weighed 930 grams.



Laufer explained that factory worker Elsa Georgiou Neokleous and her 28-year-old husband Lucas learned at a late stage in a Cyprus hospital that one twin was in the uterus and one outside. Doctors did not know how to save her and the twins and contacted Israel, where Hadassah doctors agreed to handle the case despite the fact that in all of medical history, only two previous infants had survived such a procedure.





Laufer said that one embryo apparently escaped from one fallopian tube that had been cut during the in-vitro fertilization procedure carried out in Cyprus. In one percent of pregnancies, an embryo develops outside the uterus, and in 5 percent are there twins, one inside and one outside. This happens in one out of 300,000 cases of IVF. But in the vast majority of cases, heterotopic pregnancies are discovered during the first three months of pregnancy and terminated because of the danger to the mother's life. If left inside, the mother has a 10% to 20% risk of dying. If not, the fetuses face a 70% to 95% risk of dying in the mother's body during the second trimester; surviving into the third trimester is almost impossible.



During the open abdominal surgery to deliver them, an uninflated balloon was inserted into the mother's aorta just in case, to be inflated and stop blood from gushing out of any arterial hole that might have been made by the invasive placenta.



Laufer said that as one ovary remains normal and the uterus seems to be whole, the woman could very well be able to have additional children in the future with IVF.

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