MGM Healthcare Saves High-Risk Preterm Twins with Rare Pregnancy Complications

Chennai, Nov 25: Experts at MGM Healthcare achieved a breakthrough in obstetrics, gynaecology, and neonatology by saving the lives of 28-week preterm twins diagnosed with a rare complication known as Monochorionic Diamniotic (MCDA) pregnancy – a condition in which the babies share a common placenta (blood supply) but have separate water sacs. This condition led to Twin-to-Twin Transfusion Syndrome (TTTS), where one twin receives excess blood flow while the other receives too little.

The parents, residents of Ambur – the father a software engineer and the mother an architect – had earlier consulted other hospitals in Bengaluru, where they were informed that only the larger twin was likely to survive, as the smaller baby’s condition in the womb was extremely critical. They were also advised that an in-utero laser intervention would be required.

However, the medical team at MGM Healthcare, led by Dr. A. Jaishree Gajaraj, Head of Obstetrics & Gynaecology, Dr. N. Chandra Kumar, Senior Consultant & HOD – Paediatrics & Neonatology, and Dr. Radhika Ramesh, Senior Consultant, Fetal Medicine ensured that both babies were safely delivered without any in-utero surgical interventions.

The twins were delivered through a lower-segment caesarean section. After nearly two months of specialised care in the Neonatal ICU, they showed remarkable improvement. The baby who weighed 1,115 grams at birth and the other who weighed 720 grams had grown to 2,040 grams and 1,500 grams respectively by the time of discharge.

In her comments, Dr. Jaishree Gajaraj explained that the twins were sharing a common placenta, and their TTTS condition had caused one twin to become volume-overloaded while the other was volume-depleted – due to abnormal blood vessel communication between them. This severely affected their growth and survival prospects after birth. These complications were identified during routine antenatal check-ups in Bengaluru, where the doctors warned that the smaller twin’s condition in the uterus was critical and the chances of survival were low. However, the parents were determined to save both babies. When the pregnancy reached a stage where it was no longer safe for the smaller twin to remain in utero, they approached us. We were confident that in-utero surgery was not necessary. With close monitoring of both the mother and the babies, we were able to safely deliver the twins through a lower-segment caesarean section.

Dr. Radhika Ramesh said, “Although we identified the circulatory imbalance between the twins early, the real challenge was closely monitoring their individual blood flow to determine the safest moment for delivery. Through continuous Doppler flow studies, we were able to assess when further intrauterine stay could become harmful and precisely time the delivery to give both babies the best chance of survival.”

Dr. Chandra Kumar noted that the babies remained in the NICU for 55 days. “During this period, both required respiratory support for 20 days due to premature lungs, received blood products to treat anaemia and coagulopathy – a condition in which the blood does not clot normally, and were given parenteral nutrition through a central line, meaning nutrition delivered directly into the bloodstream when they were too premature to tolerate feeds. By the time of discharge, the larger twin had reached a healthy weight of 2,040 grams, while the smaller twin was discharged at 1,500 grams. Despite the limited hope offered elsewhere, both babies survived with an intact outcome.”