These questions are difficult to answer, since such research requires blood samples from the baby before the diagnosis, something that is impossible in the vast majority of cases. However, in this particular case, the existence of a frozen umbilical cord sample allowed researchers to separate different populations of blood cells at birth and to study whether any of the chromosomal alterations detected in the tumor were already present during fetal development.
The study revealed that a translocation between chromosome 7 and 12 was already present in some hematopoietic stem cells in the umbilical cord. In contrast, the other chromosomal alteration, a trisomy of chromosome 19, was not present in the fetus, but was found in all tumor cells, suggesting that it contributes to increasing the malignancy of the leukemic cells.
“These data are highly relevant for understanding the development of a devastating disease, and the existence of this umbilical cord sample was crucial to be able for conducting a study that had been impossible until now in acute myeloid leukemia,” adds Talía Velasco, researcher at the Josep Carreras Institute and the University of Barcelona and co-leader of the study.
The condition increases chances for a uterine infection. Doctors may recommend ending the pregnancy, especially if water breaks before 24 weeks, when infant survival chances are slim.
Instead of abortion, doctors could monitor the patients and closely watch for signs of infection. But risks of severe maternal complications are greatly increased and chances of a successful birth are small, recent studies have shown.
ECTOPIC PREGNANCIES
Ectopic pregnancies are when a fertilized egg grows outside the womb, often in a fallopian tube. It happens in about 2% of U.S. pregnancies.
There is no chance for the embryo to survive, but it can cause the tube to burst, leading to dangerous internal bleeding.
Treatment for less severe cases may include medication that stops the embryo from growing, ending the pregnancy. Otherwise surgery is done, sometimes requiring removing the affected tube.
Doctors emphasize that treatment for ectopic pregnancies is not the same as an abortion.
Some politicians who oppose abortions have suggested that ectopic pregnancies could be reimplanted in the uterus, sometimes citing two unsubstantiated case reports published decades apart in medical journals. Experts say any such attempts would damage the embryo and could not result in a successful pregnancy.
To date, the surgeon could only resort to an ultrasound to guide the entrance to the uterus and the movement of surgical tools to the fetus. Now, a team of professionals from BCNatal, a consortium formed by Hospital Sant Joan de Déu and Hospital Clínic in collaboration with the team of M.A. González Ballester, ICREA research professor with the Department of Information and Communication Technologies (DTIC) at UPF, has developed for the first time, a system of three-dimensional surgical planning and navigation for fetal surgery that offers many advantages: greater precision for the surgeon, shorter operating time, and in the future, it is set to improve the results by making fetal surgery more accessible.
The system provides a virtual reconstruction of the placenta based on MRI and ultrasound. With this 3-D map of the placenta, before the procedure, the fetal surgeon has a much more accurate understanding of the status of the placenta and the umbilical cord, and can analyse which is the best entry point to the placenta to gain access to the fetus.
Once in the operating room, the surgeon uses a 3-mm endoscope especially designed for fetal surgery. “Fetoscopic” vision is very limited and therefore requires continuous guidance on its position within the uterus. Until now, this was done using ultrasound, but the new system allows additional 3-D navigation that gives information that was not available until now. This is because the endoscope incorporates a sensor at the tip that is detected by external antennae and, using complex algorithms and mathematical formulas, it allows synchronizing the virtual reconstruction of the placenta with the actual movements of the surgical instruments.
This is a major breakthrough, achieved for the first time for fetal surgery, and illustrates how new technologies will prove essential to achieve safer surgeries using systems that continuously assist the surgeon by minimizing risks
The new navigator is especially useful for extremely complex fetal surgeries such as those conducted to correct the twin-to-twin transfusion syndrome, which occurs in 10-15% of pregnancies involving monochorionic twins (that share the placenta). In these cases, one of the fetuses passes blood to the other constantly, almost always leading to the death of the twins. Fetal surgery can reverse the situation and achieve the survival of at least one of the fetuses in over 90% of cases.
“The new surgical GPS helps guide the surgeon and identify the best entry point, the exact location of the start of the umbilical cords and placenta blood vessels, so that surgery can be conducted more easily and with higher chances of success,” explains Miguel Angel González Ballester, project coordinator at UPF.
Today, at a press conference, the case was presented of twins who had recently undergone fetal surgery with this new surgical navigator.
So far in 2019, BCNatal has conducted a total of 20 fetal surgeries with this new system. The results of the technological innovations have been accepted in several international scientific journals dealing with bioengineering. This clinical innovation was presented at the world congress of fetal medicine in June this year and the first series is being prepared for publication.
According to Eduard Gratacós, director of BCNatal, “this is one of the research projects in technological innovations we have been working on for four years thanks to funding from the Cellex Foundation, and are opening the way to a new generation of techniques that will revolutionize how we perform fetal surgery and other surgeries requiring great precision that still depend greatly on the skill of the individual surgeon.”