SA's first in utero double-shunt baby

Breakthrough procedure performed by foetal surgical unit opens new doors

Friday, August 2 2013

The chances of baby Timothy John Hugh Clarke surviving after developing a rare condition known as Hydrops fetalis in his mother’s womb were slim. The condition is an accumulation of fluids in one or more of the body’s major cavities around the lungs, heart and abdomen, leading to severely restricted lung development and severe cardiac failure.

However, today – just twelve days after his birth –Timothy, South Africa’s latest miracle baby, who was born at Netcare Parklands Hospital on 22 July 2013, is getting ready to spend his first night at home with his delighted parents.

With the prognosis of survival being poor, a multidisciplinary foetal surgical unit drawing on the experience of doctors and specialists from Netcare Parklands, Netcare Umhlanga and Netcare Kingsway Hospital, provided Timothy’s parents with the option of having a double shunt in utero procedure performed on their son. Having had a history of three failed pregnancies, the Clarkes decided that the doctors could proceed with this revolutionary procedure, the double–shunt version of which had never been performed in South Africa before and possibly even the world.

“I asked the surgical team who was to perform the operation whether they trusted their skill,” says Timothy’s dad, John Clarke. “When they said ‘yes’, I was greatly comforted. It was good to know that our experience will help others in a similar situation.”

Although the team conducting the surgery could rely on the experience and knowledge gained from performing six previous pinhole surgeries, there was no instance that they knew of in which a bilateral shunt procedure had been performed. “We had a very spirited discussion about performing this surgery,” reflects Dr Ismail Bhorat, a specialist in foetal medicine, who was one of the doctors involved in Timothy’s delivery and assisted with the double shunt procedure. “We realised with a double shunt we were going into uncharted waters but the critical condition Timothy was in required us to think out of the box and potentially change the medical fraternity’s understanding of foetal physiology and the uterus’ healing potential. With permission obtained from the Clarkes we performed the surgery.”

The tenacity and bravery of the team, which comprised Dr Mahesh Bhana, gynaecologist and obstetrician at Netcare Kingsway Hospital; Dr Desmond Sankar, gynaecologist and obstetrician at Netcare Parklands Hospital; Dr Ayob Mitha, paediatrician at Netcare Parklands Hospital; Dr Samad Shaik, paediatric surgeon at Netcare Parklands Hospital and Dr Bhorat paid off with Timothy’s birth last month.   

Timothy, who was operated on 15 June, 2013 when his mother was 31 weeks pregnant, was delivered via caesarean section at 37 weeks. According to Dr Bhorat, “Timothy is a ‘healthy’ baby who entered the world weighing 2,65 kilograms.” John Clarke and his wife Suzanne said they are overjoyed at the birth of their child. “Thanks to the outstanding doctors and the revolutionary procedure used we are able to celebrate the birth of our son,” says John Clarke.

Timothy’s case differed from the previous pinhole surgeries performed by the foetal unit in that he had a bilateral pleural effusion.  According to Dr Bhorat, who practices at Netcare Umhlanga Hospital, this involves the build-up of fluid on the posterior and anterior layers of tissue that line the lungs and chest. The build-up of fluid places pressure on the baby’s chest cavity and can cause breathing problems and prevent the heart from pumping properly.

The double pinhole surgery, which involved the insertion of a shunt on the posterior and anterior of Timothy’s chest, was necessary to drain the bilateral fluid that had been building up. Dr Bhorat says the bilateral pinhole surgery performed on the foetus was a complete success and showed results almost immediately, allowing the baby’s lungs to expand. The foetus’ heart, which before the surgery was displaced by the weight of the fluid, also quickly returned to its correct position.

Dr Bhorat points out that the procedure involves using ultrasound to remotely steer the needle through the mother’s abdomen and uterine wall and into the foetus’ chest cavity. He says the operation is very intricate and has to be undertaken with the greatest care. The needle is very sharp and the surgeon has to be sure to avoid nerves and organs while navigating. The shunt was clamped as little Timothy was removed from the womb to ensure that he did not breathe air through it. He was immediately ventilated after birth to encourage regular breathing.

Netcare Parklands Hospital general manager, James van Vught, said he was moved by the experience. “It was an incredible collaboration between doctors and specialists from various Netcare hospitals. Such teamwork will allow babies in a similar situation as Timothy’s to be saved in the future,” he adds. “Our maternity staff and doctors strive to provide parents-to-be with the best possible birthing experience. With this operation I believe we achieved this.”



Issued by : Martina Nicholson Associates (MNA) on behalf of NetcareParklands Hospital
Contact : Martina Nicholson, Graeme Swinney
Telephone : (011) 469 3016
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