Imperial College and the University of Cambridge with the support of Genesis Research Trust, alongside Action Medical Research, The Isaac Newton Trust, have been conducting research into an early-stage feasibility study, involving sheep, which suggests High Intensity Focused Ultrasound, a technique already used for treating some cancers, could help a condition called Twin-Twin Transfusion Syndrome (TTTS).

TTTS occurs in about one in seven identical twin pregnancies and means that one of the babies grows much larger than the other due to abnormal blood cells within the placenta.

Some identical twins share a placenta, which provides the babies with equal amounts of oxygen and nutrients, carried in the blood. However in TTTS the shared placenta contains abnormal blood vessels that cause more blood to flow to one baby, leaving the other deprived of oxygen and nutrients.

This can affect both twins potentially causing premature birth, disability, or result in the death of one or both babies.

Extreme cases can be treated with laser treatment, which destroys the abnormal blood vessels so that each baby has a better chance of obtaining oxygen and nutrients.

Dr Christoph Lees, senior author from the Department of Surgery and Cancer at Imperial: “Twin-Twin Transfusion Syndrome can have tragic consequences, and in severe cases results in one tiny twin, while the other is very large – and begins to squash its sibling in the womb. Unfortunately, the little baby often does very badly – and in some cases the condition results in the loss of both twins.

“Yet at the moment the only option we have for these serious cases – laser treatment – carries risk of premature birth or miscarriage. Furthermore, the laser can sometimes not reach some abnormal vessels deep in the placenta.”

The new study found that High Energy Focused Ultrasound (HIFU) used on sheep could be used to selectively destroy abnormal blood vessels, enabling it to split the placenta without having to use an invasive technique such as the laser treatment.

The results showed the technique was successful, and could destroy blood vessels without damage to the foetus. The researchers used the HIFU probe against the wall of the uterus, through an incision in the abdomen – and carried out further experiments to show the procedure works through the skin.

Dr Lees added: “Although this is very early-stage research, it shows the procedure can successfully destroy blood vessels in the placenta – and could potentially stop abnormal blood flow between twin babies. We now hope to continue developing this HIFU procedure, translate these findings to humans, and work towards human trials.”

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*credit to Kate Wighton, Communications and Public Affairs, Imperial College London.

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