The ISUOG Safety Committee has recognised the significant potential for using HIFU in the treatment of TTTS, and reflects on safety considerations.
ISUOG Safety Committee member Prof. Christoph Lees is the lead researcher of the study published in The American Journal of Obstetrics and Gynecology (AJOG). Prof. Lees commented that the procedure, which used high-powered sound waves to detect and treat the rare and serious condition, twin-twin transfusion syndrome (TTTS), is ‘very promising’.
A recent article from the BBC shares the hopeful story of how this research has been able to save the lives of twins Nancy and Margo who were subsequently born healthy, and now age four, are soon to start school.
The ISUOG Safety Committee have issued a response, supporting the feasibility of the use of high-intensity focused ultrasound (HIFU) and reflecting on safety considerations:
Safety aspects of prenatal ultrasound are a mainstay for ultrasound practitioners worldwide. ISUOG endorses the safe use of prenatal ultrasound by monitoring and reporting on the proposed use of ultrasound that may pose safety concerns throughout gestation.
TTTS is among the most common complications of monochorionic twin pregnancy as well as one of the most common indications for in-utero surgical treatment. In-utero surgery has been proposed for a variety of conditions characterised by poor prognosis in terms of survival and/or disability and is itself acknowledged as a risk factor for complications. This is a result of inflammatory pathways triggered by the procedure which consists of inserting medical trocars through the maternal abdomen interrupting the integrity of the uterine wall and fetal membranes.
High intensity focused ultrasound (HIFU) is an emerging non-invasive technique proposed for the treatment of uterine fibroids and, more recently, for the treatment of TTTS in monochorionic twin gestations. Despite tremendous challenges, feasibility of utilising HIFU for the treatment of TTTS was recently demonstrated. Early results published in the American Journal of Obstetrics & Gynecology on its use for the treatment of pregnancies complicated by TTTS show a high survival rate with a promising safety profile in continuing pregnancies. While HIFU is noninvasive, there remains a potential for adverse effects including maternal skin burns as a result of poor coupling, and those can be mitigated with careful planning. From a conceptual perspective HIFU represents a major innovation in Fetal Medicine representing the first ultrasound technique proposed for treating as well as for safety purposes. The recently published early results on this innovative and pioneering technology, with its promising success rates and safety, attest to the feasibility of HIFU for the treatment of TTTS and warrant further investigation.
Access ISUOG safety statements.
Access ISUOG Practice Guidelines (updated): role of ultrasound in twin pregnancy.