Fetal Surgery Outcome Improves by Treating Mom with Medication

Monday, November 08, 2010

How can fetal surgeons provide the best care for the most common condition worldwide requiring fetal surgery? Not only by treating the fetus but also by giving medication to the mother, according to a new study from the Fetal Care Center of Cincinnati.

The study, published online in the American Journal of Obstetrics & Gynecology, shows improved survival rates for twin-twin transfusion syndrome complicated by cardiomyopathy by giving the mother a medication for hypertension prior to fetal surgery.

“Very few medications are given to mothers for the purpose of treating the fetus, and those drugs that do exist are often not very effective,” says Timothy Crombleholme, M.D., director of the Fetal Care Center of Cincinnati and the study’s lead author. “Treating hypertension in the fetus is a novel idea.”

In TTTS, the way in which blood flows through the connecting blood vessels on a shared placenta is unequal. As a result, the “donor” twin has slowed growth and decreased amniotic fluid, while the “recipient” twin has too much amniotic fluid and develops high blood pressure and a progressive form of heart failure. Without treatment, TTTS is fatal for at least 90 percent of twins, and both twins are at risk for severe complications.

Dr. Crombleholme analyzed 141 fetal surgeries for TTTS in which the mother was given nifedipine 24-48 hours before fetal surgery. In all these cases, fetal echocardiography had indicated that the recipient twin showed signs of heart muscle disease, which occurs in about 70 percent of TTTS cases. Nifedipine belongs to a class of medications called calcium channel blockers that are used to treat angina (heart pain) and high blood pressure and to treat preterm labor in pregnancy.

There was a significant increase in overall fetal survival in mothers treated with nifedipine compared to those who didn’t receive the medication (83 percent to 75 percent). The improved survival was entirely due to improved survival in the recipient twins; nifedipine treatment had no effect on donor twin survival, according to Dr. Crombleholme, who is also a surgeon at Cincinnati Children’s Hospital Medical Center, where the Fetal Care Center is located.

“The results of this study have changed the way mothers with TTTS are treated,” he says. “The Fetal Care Center of Cincinnati is now offering nifedipine to all mothers with TTTS complicated by cardiomyopathy caused by fetal hypertension.”

The Fetal Care Center of Cincinnati is a collaboration among Cincinnati Children’s, Good Samaritan Hospital and University Hospital. Since the Center was established in 2004, Dr. Crombleholme and his colleagues have performed more than 600 fetal surgeries for TTTS.

About Cincinnati Children’s

Cincinnati Children’s Hospital Medical Center is one of just eight children’s hospitals named to the Honor Roll in U.S. News and World Report’s 2010-11 Best Children’s Hospitals. It is ranked #1 for digestive disorders and highly ranked for its expertise in pulmonology, cancer, neonatology, heart and heart surgery, neurology and neurosurgery, diabetes and endocrinology, orthopedics, kidney disorders and urology. Cincinnati Children’s is one of the top two recipients of pediatric research grants from the National Institutes of Health. It is internationally recognized for quality and transformation work by Leapfrog, The Joint Commission, the Institute for Healthcare Improvement, the federal Agency for Healthcare Research and Quality, and by hospitals and health organizations it works with globally. Additional information can be found at www.cincinnatichildrens.org.