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The Jerusalem Netletter 5772, Tevet, January 2012

By Barbara Sofer

How exciting to be writing the first 2012 Netletter. This is the year in which we are scheduled to celebrate Hadassah's Centennial Convention in Jerusalem. Please register today!

*LET THEM LIVE: SEPARATING A DANGEROUS BOND BETWEEN TWINS The story hit the news wires: Hadassah physician treats Palestinian woman and separates her twins with laser. In a few cases, the story was misreported. Here's the back story. The Hadassah story.

No one understands why a fertilized ovum splits in two and develops into identical (monozygotic) twins. This can happen as early as a day after fertilization. The sooner, the better. By five days after fertilization, the placenta and umbilical cord begin to form. If the egg splits very late, Siamese twins-usually a tragic condition-result. But even identical twins who aren't conjoined are in mortal danger if certain shared blood vessels begin to favor one twin over the other. TTTS, (twin-to-twin transfusion syndrome) happens in up to 25 percent of identical twins, and both twins may perish.

Often, twins who suffer from severe TTTS are aborted if discovered early enough in the pregnancy. Many of thosedelivered with severe TTTS die and others may be severely challenged. It's possible to separate the twins' linked blood vessels so that each one has only a direct connection to the placenta. But this complex procedure can only be done in an advanced medical center with both expert physicians and sophisticated equipment. There are few centers in Europe or Asia where this procedure can be successfully performed.

Hadassah Hospital is one such center.

Obstetrician and gynecologist Yuval Gielchinsky, a graduate of Hadassah-Hebrew University School of Medicine finished his residency at Hadassah Hospital four years ago. In addition to his medical degree, Dr. Gielchinksy earned a Phd in molecular biology. His prize-winning research suggests that a woman's stem cells may beneficially regenerate during pregnancy. After his residency, Dr.Gielchinsky was accepted for a Fellowship at King's College London. He wanted to study under Professor Kypros Nicolaide, a world-renowned expert in Fetal Medicine. He returned to Israel with the necessary expertise to divide TTTS babies. Donor Naomi Hochstein of Jerusalem provided the specialized ultrasound machine. Laser equipment was ordered. Two months ago, everything was in place. In London, Dr. Gielchinsky had become friends with Palestinian colleagues who were also training there. One day, he received a phone call from his friend Dr. Firas Jawdat of Al-Makassed Islamic Charitable Society Hospital in Jerusalem. A young woman from a Palestinian village near Ramallah was carrying 20 week-twins with TTTS. Dr. Jawdat didn't have the necessary equipment to divide them in his hospital. Could he bring her to Hadassah? Hadassah Hospital administration quickly approved the procedure. The Israel Civil Authority quickly approved the request. Dr. Jawdat, the young woman, and her mother came to Hadassah's Charlotte Bloomberg Mother and Child Center and met Dr. Gielchinsky for the first time.They speak only Arabic, but that isn't a problem at Hadassah Hospital where English and Arabic, as well as many other languages are spoken. In this case,Dr. Jawdat did most of the translation. Dr. Nili Yanai and Dr. Dan Vadim Valsky who work together with Dr. Gielchinsky and fetal anesthesiologist Dr. Yehuda Ginnosar were present. Under local anesthesia and with the guide of the ultrasound, a very small scope was inserted to the mother's uterus. This scope is connected to a camera so the operators can see on the screen the abnormal blood vessels that connect the twins on the placenta. A very thin laser fiber was inserted into the scope and enabled Dr. Gielchinsky to burn those vessels. At the end of the procedure, each baby had a connection to a separate part of the placenta. The procedure took 30 minutes and the mother was discharged one day later. The babies-little girls--are expected to develop normally. They will share the same DNA of course, but will have different fingerprints.

They owe their lives to Hadassah.

Says Dr. Gielchinsky, a sabra who served as a medic in the IDF:

"When I was in London, I always felt proud telling people that I came from Hadassah Hospital, with an entire international women's organization standing behind me. Just think-when we became a state, We already had a medical system because of the dedication of these women. As a physician who treats women, this is particularly inspiring. I had done a lot of these procedures in London, but I'm proud to have done the first in Jerusalem and to be able to provide this service to the people of our region."

Best from Jerusalem,
Barbara Sofer
Israel Director of Public Relations
Hadassah, the Women's Zionist Organization of America

Date: 1/5/2012 12:00:00 AM

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