Cloudnine team (From right – Dr. Pallavi Vasal, Dr. Shreyasi Sharma & Dr. Manish Balde) with the baby after successful delivery
City-based Cloudnine Hospital had successfully delivered the fetus that received Gurgaon’s first-ever vesico-amniotic shunt insertion. The vesico-amniotic shunt insertion procedure was done on the fetus at 25 weeks of gestation by Dr. Shreyasi Sharma, Fetal Medicine Consultant at Cloudnine Hospital, Sector 47, Gurgaon. After 12 weeks since the procedure, the pregnant mother had delivered the baby without any complications. A multidisciplinary team involving doctors across Fetal Medicine, Obstetrics & Gyneacology, and Pediatrics & Neonatology specialities coordinated for realizing this successful outcome.
In this intervention involving the insertion of a vesico-amniotic shunt, the fetal medicine specialist directly operated on the unborn fetus in the mother’s womb. A vesico–amniotic shunt is a tube that is inserted into the unborn baby’s urinary bladder and drains the baby’s urine directly into the pregnancy sac containing the amniotic fluid. This procedure was necessitated as the baby had a condition called lower urinary tract obstruction where the baby is unable to pass urine because of obstruction in the urinary system (at urethra). In this condition, urine gets accumulated in the urinary bladder resulting in kidney damage. Not proceeding with the intervention would have resulted in serious and irreversible kidney damage.
Dr. Shreyasi Sharma performing the vesico-amniotic shunt insertion
The diagnosis of lower urinary tract obstruction in the fetus was first made at 24 weeks (6 months) of pregnancy. In the follow-up scans, further deterioration was observed as the urine was leaking into the baby’s abdomen. To avoid any fatal outcome, Dr. Shreyasi Sharma immediately performed the vesico-amniotic shunt insertion at 25 weeks of pregnancy.
Explaining the procedure that culminated in a successful pregnancy, Dr. Shreyasi Sharma, the operating physician, has commented, “To put it plainly, the procedure involved the insertion of a small pipe between the bladder of the unborn fetus and the pregnancy sac so that any excess fluid accumulation in the bladder gets drained into the pregnancy sac. This helps in decompressing the urinary bladder. Unlike open surgery, the procedure is technically challenging as a small structure has to be precisely placed in the right position and orientation under ultrasound guidance only, while the fetus continues to be in the mother’s womb.”
Newborn baby with the intact vesico-amniotic shunt (in red square inset)
Commenting on the procedure, Dr. Pallavi Vasal, Consulting Obstetrician has said, “Since the conclusion of the vesico-amniotic shunt insertion, there was a remarkable improvement in all vital parameters of the pregnancy with normal fetal growth. The delivery has been smooth and uneventful. Currently, the mother and the child are under constant observation and have been doing well.”
Outlining the further course of action, Dr. Sanjay Wazir, Director – Paediatrics & Neonatology at Clounine Hospital, said “The baby will undergo surgery in a few days to correct the obstruction and the shunt will also be removed as part of the surgery.”