TWIN CYPRIOT new-born girls will go down in medical history as only the second case of heterotopic twins to ever survive.
The baby girls were born healthy at Hadassah University Medical Centre in Jerusalem late last week after a lifesaving surgical intervention rescued them from almost certain death in the last trimester of their mother’s pregnancy.
The infants, named Maria Elena and Georgia Nicoletta, are only the second heterotopic twins in medical history to survive. This mean one embryo was growing inside its mother’s uterus and the other had developed with the placenta attached to the exterior of the uterus and the sigmoid colon. The first-ever case was in France 25 years ago.
A multidisciplinary team of 15 doctors worked in perfect synchrony to save 34-year-old Elsa Neocleous, whose body was described as a “ticking time bomb” as well as the babies born in their 28th week of gestation.
The girls’ father, Lucas, told The Jerusalem Post that the Hadassah team’s saving of his wife and daughters was a “miracle”. “We would not have come if we did not think they would save all of them,” he said.
“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… 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 deliver the third-trimester heterotopic pregnancy took three hours to prepare for and two hours to perform. If not done properly and in time, it would have ended in the death of all three, reports said. 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.
The procedure was paid for by the government of Cyprus.
Professor Neri Laufer, chairman of the department of obstetrics and gynecology at the Ein Kerem medical centre, said the girls were attached to respirators but doing very well, even though they were 12 weeks premature. The first to be born via Caesarean section after spending her gestation inside the womb was Maria Elena who weighed 970 grams at her birth on Thursday night. Her sister Georgia Nicoletta, 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.
Elsa Georgiou Neocleous and her 28-year-old husband Lucas were told by doctors at Makarios hospital that one twin was in the uterus and one outside. Because local doctors did not know how to save the mother and twins, they 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 five 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, the Jerusalem Post said. If left inside, the mother has a 10 per cent to 20 per cent risk of dying. If not, the fetuses face a 70 per cent to 95 per cent 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 told the Jerusalem Post 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.
