Advanced Fetal Therapy Offers Hope for Pune couple in a rare high risk twin pregnancy.

The other (abnormal)  twin had no heart, no head, risking the life of the healthy twin

Pune : In a remarkable example of advanced fetal medicine, a team of specialist doctors at Pune’s Noble Hospitals and Research Centre successfully performed a highly specialized fetal intervention procedure called Microwave Ablation to treat a rare and life-threatening complication in a monochorionic twin pregnancy, significantly improving the chances of survival for the healthy baby.

The procedure was led by Dr. Tejas Tamhane, Fetal Medicine Consultant, along with Dr. Santosh Sidid, Senior obstetrician, supported by a multidisciplinary team including Dr. Pankaj Goyal, Dr. Aditi Abnave, Dr. Neha Kolhe, the anaesthesia team,  and nursing staff.

The pregnancy involved identical twins sharing a single placenta, known as a monochorionic twin pregnancy. During a second-opinion ultrasound at 12 weeks of pregnancy, Dr. Tamhane diagnosed a rare condition known as Twin Reversed Arterial Perfusion (TRAP) Sequence, which occurs in approximately 1 in 35,000 pregnancies.

In TRAP sequence, one twin develops without a functioning heart and head, known as an acardiac twin, and survives by receiving blood supply from the healthy “pump twin.” This places enormous strain on the healthy baby’s heart and can lead to heart failure, excessive amniotic fluid, premature delivery or even the loss of both babies if left untreated.

Sharing details of the case, Dr. Tejas Tamhane said, “A 32-year-old woman from Pune was referred to us for a second opinion after an ultrasound scan. The scan revealed this rare complication. The couple initially believed that terminating the pregnancy might be the only option. After discussing the condition in detail and explaining that advanced fetal therapy could offer hope, they decided to proceed with treatment.”

The patient underwent serial ultrasound scans at 12 and 16 weeks, which confirmed that blood flow to the abnormal twin continued, increasing the risk to the healthy baby. Since blood flow can occasionally stop on its own, the medical team monitored the pregnancy before intervening.

Before the procedure, Dr. Tamhane and team performed amniocentesis, a prenatal diagnostic test in which a small amount of amniotic fluid is collected to evaluate the fetus for genetic disorders and chromosomal abnormalities. Once the results ruled out genetic abnormalities in healthy twin, the team decided to go ahead with fetal therapy using latest fetal intervention option of microwave ablation.

During the procedure, a specialized needle was inserted through the mother’s abdomen into the uterus under continuous high-resolution ultrasound guidance. The microwave probe was accurately positioned within the abnormal fetus, where controlled electromagnetic energy generated intense, localized heat to permanently seal the blood vessels supplying the abnormal twin. This stopped the  blood flow to abnormal fetus and relieved the excessive load on the healthy baby’s heart.

A post-procedure ultrasound confirmed complete cessation of blood flow to the acardiac twin with no complications. The patient was admitted on July 4, underwent the procedure on July 5 and was discharged in stable condition on July 6. She will continue with weekly follow-up scans to monitor the health of pregnancy.

“What makes such fetal procedures remarkable is that they are performed while the baby is still inside the womb,” said Dr. Tamhane. “Fetal medicine and fetal therapy have transformed the outlook for many complicated pregnancies that were once considered untreatable. These procedures demand specialized expertise, advanced imaging technology and close coordination among multiple specialties.”

Dr. Tejas Tamhane added that this is likely to be a first of its kind fetal intervention procedure for TRAP sequence using a microwave ablation technique in Pune city.  The successful intervention highlights how world-class fetal care is now available in Pune, reducing the need for families to travel to larger metropolitan centres for highly specialized treatments.

Dr. Divij Mane, Deputy Managing Director, Noble Hospitals and Research Centre, said, “The successful outcome reflects the expertise of our fetal medicine team, backed by a strong multidisciplinary approach and state-of-the-art infrastructure. Noble Hospitals remains committed to providing advanced maternal and fetal care, ensuring that patients have access to the latest life-saving treatments close to home.”

The treating team also expressed gratitude to the family for placing their trust in the doctors during what was an emotionally challenging journey. The successful intervention offers renewed hope for families facing complex fetal conditions and demonstrates the growing capabilities of fetal therapy in India.