Pioneering surgery gives life

Doctor Tomasz Waśniewski
Tomasz Waśniewski, MD PhD, and his team performed a successful, pioneering surgery for suppressing labour in a twin pregnancy after the miscarriage of one, dead foetus. In this way, by delaying delivery for almost 12 weeks, he saved the life of the second foetus.

It was a long expected and very desired, but high-risk pregnancy. On 15 September last year, in week 18/19 of pregnancy, it was found that one of the twins - a boy - was dead. Usually the dead foetus stays in the mother’s body and undergoes mummification in a natural manner. This helps the other, living foetus, to stay in her womb until birth.

Birth is a certain death

In such a situation, miscarriage is very rare. Unfortunately, this time it started. At this stage of pregnancy, the foetus cannot survive outside the mother’s body. For the other, living twin, the birth was tantamount to death.

“In Poland and in Europe, we are able to save children born from week 24-25 of pregnancy," says Tomasz Waśniewski, MD PhD, assistant professor at the Department of  Obstetrics, Perinatology and Gynaecology of the UWM - the author of the pioneering surgery.

Therefore, to live, the second twin could not be born, at least for some time.

Doctor Tomasz Waśniewski had read in the professional literature about several cases of suppressing the delivery in situations similar to the one he had to deal with. But theory and practice are two different things. In Poland, it would be the second attempt to delay a delivery, and the first one involving such a long delay period.

First time in Poland

“I knew that my colleagues and I were able to carry out the procedure, but we needed the consent of the mother. Delivery suppression first of all implies the risk of serious complications, in extreme cases - the loss of fertility,and even the risk to life,” Doctor Waśniewski continues.

“We didn't have much time, as the miscarriage had already started. We explained the chances and risks to the patient and to her husband. They had to take a very courageous decision, because by stopping the delivery, the woman took a lot of risk. They made this decision. I was moved by their high determination and faith in the success of the entire endeavour.”

After a miscarriage of the dead foetus, doctors left its unseparated placenta in the uterine cavity and started to pharmacologically suppress uterine contractions. The idea was to keep the living foetus inside the mother’s womb, until it was able to live outside her body. The patient was administered medicines to reduce the risk of intrauterine infections and blood coagulation disorders. Her body responded very well to the treatment applied. 13 days after the miscarriage, with the second, living foetus remaining in her uterus, the woman returned home.

We gave her a chance for a good life

However, after almost 12 weeks, in week 30 of pregnancy, the anticipated complications occurred, as a result of which, on 27 November 2017, the team of Doctor Waśniewski had to perform an emergency Caesarean section. This time, little Patrycja, weighing1560 g, was ready to exist outside her mother’s body, but still too little to start “independent life of a full-term” newborn. She had to stay in the incubator almost until Christmas. She came home just before the end of the year, when she weighed already 2200 g.

Doctor Waśniewski does not deny that the pioneering procedure was a serious challenge to him.

“Before the labour suppression action, we didn’t have much time for emotions. I thought a lot about the surgery in the first week after the suppression. After the first week, we breathed a sigh of relief. Then, after the birth of little Patrycja, we followed her further development with great anxiety. She was born in week 30, and in prematurely born children, there is a great risk of the central nervous system damage, which consequently can lead to various neurological disorders. Our wonderful neonatologists led by Norbert Dera, MD PhD, assistant professor at our University, provided her with very professional treatment and we know already that little Patrycja is a healthy child. I am happy about it. We gave her a chance for a good life. The rest depends on her parents, and later on - on herself,” Doctor Waśniewski concludes.

Lech Kryszałowicz

Tomasz Waśniewski, MD PhD, is 49 years old. In 2015, he performed the first surgery in Poland consisting in “returning” an ovary to a woman after successful oncological treatment. In this method, before starting oncological treatment, doctors remove from the woman’s body an ovary or a part of ovarian tissue and freeze it. After successful treatment, they implant it again to the woman’s body. The organs start functioning, which makes it possible for the woman to get pregnant. For developing this procedure, Doctor Waśniewski was granted in 2014 the Polish Academy of Sciences award for “Innovation in Medicine”.