Tiến bộ trong y học bào thai: can thiệp thành công cứu sống thai nhi mắc khối u nhau thai khổng lồ

A fetus was rescued alive directly from the mother's womb thanks to an extremely rare and complex interventional procedure, successfully performed for the first time at the University Medical University Hospital of Ho Chi Minh City (BV ĐHYD). This is an important milestone, confirming the hospital's professional competence in the field of fetal medicine – obstetrics, a specialty that is still very new in Vietnam.

A young pregnant woman, in her first pregnancy, came for a check-up at BV ĐHYD when the fetus was at 28 weeks with symptoms of shortness of breath and fatigue. Through fetal cardiac ultrasound, PGS Dr. Lê Minh Khôi – Head of the Original Cardiovascular Imaging Unit discovered a critical condition: “The fetus has pericardial effusion, severe heart failure, and at the same time a massive fetal tumor. This tumor proliferates blood vessels, increasing the blood flow to the fetal heart, leading to circulatory overload and heart failure. This is a dangerous clinical situation, pushing the fetus into a ‘a thousand pounds hanging by a hair’ state.”

Meanwhile, the fetus is only 28 weeks old, which is a premature threshold that carries many risks if born early. Dr. Trần Nhật Thăng – Head of the Obstetrics Department said: “Preterm birth at this stage can lead to serious complications such as neonatal infection, brain hemorrhage, necrotizing enterocolitis. However, after daily monitoring of the progression, we found that we could not delay any further.”

Facing the urgent situation, the hospital quickly established a specialist council comprising doctors from obstetrics, cardiology, imaging diagnosis – vascular intervention, and functional departments, under the direct direction of the Board of Directors. The entire team unanimously chose

A young pregnant woman, first pregnancy, came for examination at ĐHYD Hospital when the fetus was at week 28 with symptoms of shortness of breath and fatigue. Through fetal heart ultrasound, PGS TS BS. Lê Minh Khôi – Head of the Cardiovascular Imaging Department discovered a critical condition: “The fetus has pericardial effusion, severe heart failure, and at the same time a huge intrauterine tumor. This tumor proliferates blood vessels increasing blood flow to the fetal heart, leading to circulatory overload and heart failure. This is a dangerous clinical situation, pushing the fetus into a ‘hanging by a thread’ state.”

Meanwhile, the fetus is only 28 weeks old, which is a premature threshold with many risks if born early. TS BS. Trần Nhật Thăng - Head of Obstetrics Department said: “Preterm birth at this stage can lead to serious complications such as neonatal infection, intracranial hemorrhage, necrotizing enterocolitis. However, monitoring the progression daily, we find that we cannot delay any further”.

Facing the urgent situation, the Hospital quickly established a specialist council consisting of doctors from obstetrics, cardiology, imaging diagnosis - vascular intervention and functional departments, under the direct direction of the Board of Directors. The entire team unanimously chose the approach: Intervene to occlude the blood vessels feeding the intrauterine tumor with the goal of relieving pressure on the fetal heart and extending the pregnancy by at least 4 weeks.

PGS TS BS. Võ Tấn Đức - Head of Imaging Diagnosis Department said: “Usually, intravascular interventions are performed under X‑ray guidance. However, in this case, to protect the fetus from radiation exposure, the entire procedure must be performed under ultrasound guidance. Inserting a needle through the abdominal wall into the pregnant uterus to locate and accurately access the main blood vessel of the tumor requires very high precision, seamless coordination and the extensive experience of the intervention team”.

Initially, the team used a coil (a small metal spring) to block the tumor's vessels. However, due to the high blood flow, the flow could not be completely stopped. Faced with this situation, the team made a pivotal decision to use biological glue to fill the gaps around the coil and the vessels. This procedure requires near‑absolute precision, because if the biological glue follows the blood flow into the fetus's heart or brain, the risk of blocking critical vessels is very high and could lead to death.

The results far exceeded expectations; after the intervention, the blood flow to the fetal heart decreased rapidly, the tumor shrank, and the fetal heart condition recovered. The pregnancy continued to be maintained not

only until the 32‑week mark as initially expected, but extended to 39 and a half weeks and resulted in a safe birth, without any emergency intervention. Currently, the baby is less than 4 months old, in stable health, developing well and is being followed up regularly after birth.

Sharing the challenging journey, Ms. T.N.B (born 1995, residing in Ho Chi Minh City) emotionally said: “When I was informed about the critical condition of the fetus, although the doctors explained in detail, I could not hide my anxiety and fear because this was a technique being applied for the first time and carried many risks. But I told myself that if I didn’t try, I might later regret it. Therefore I trusted the medical team and decided to accompany the intervention plan. I would like to express my deepest gratitude to the doctors of the University Medical and Pharmacy Hospital of Ho Chi Minh City. The dedication, solid expertise and courageous spirit of the doctors gave my child a chance to live. I hope this successful case will open new advances for fetal medicine in Vietnam, giving many other families hope like ours today.”

Associate Professor Dr. Nguyen Hoang Bac – Hospital Director remarked: “This is not only a professional success, but also evidence of the solidarity, resilience and a heart full of responsibility of medical professionals. We did not choose the easy path; we chose the right one. The success of multidisciplinary cooperation has contributed to the development of fetal medicine in Vietnam.”

With close coordination, proactive spirit, and dedication, the medical staff of ĐHYD Hospital have affirmed the mission of preserving life—from the most fragile moments of the beginning.

Approach: Intervening to block the feeding blood vessels of the tumor within the fetus with the goal of relieving pressure on the fetal heart and extending the pregnancy by at least 4 weeks.

Associate Professor Dr. Võ Tấn Đức - Head of the Imaging Department said: “Usually, endovascular interventions are performed under X‑ray guidance. However, in this case, to protect the fetus from radiation exposure, the entire procedure had to be performed under ultrasound guidance. Inserting a needle through the abdominal wall into the pregnant woman's uterus to locate and precisely access the main blood vessel of the tumor requires extremely high accuracy, seamless coordination, and the extensive experience of the intervention team.”

Initially, the team used a coil (a small metal spring) to block the tumor’s blood vessel. However, due to the large blood flow, the flow could not be completely stopped. Facing this situation, the team made a pivotal decision to use a bio‑glue to fill the gaps around the coil and the vessel. This maneuver requires near‑absolute precision, because if the bio‑glue follows the blood flow into the fetal heart or brain, the risk of blocking critical vessels is very high and could result in death.

The results far exceeded expectations; after the intervention, blood flow to the fetal heart decreased rapidly, the tumor shrank, and the fetal heart condition recovered. The pregnancy continued to be maintained without

only reaching 32 weeks as initially expected, but extending to 39 and a half weeks, resulting in a safe birth without any emergency interventions. Currently, the baby is less than 4 months old, in stable health, developing well, and is being followed up regularly after birth.

Sharing about the challenging journey, Ms. T.N.B (born 1995, residing in Ho Chi Minh City) emotionally said: “When I was informed about the critical condition of the fetus, although the doctors explained it thoroughly, I could not hide my worry and fear because this was a technique being applied for the first time, and it carried many risks. But I told myself that if I didn't try, I might regret it later. Therefore I trusted the medical team and decided to go along with the intervention plan. I would like to extend my most sincere thanks to the doctors of Ho Chi Minh City University of Medicine and Pharmacy Hospital. The dedication, solid expertise, and courageous spirit of the doctors gave my child a chance to live. I hope this successful case will open new advances for fetal medicine in Vietnam, helping many other families gain hope like we do today.”

Associate Professor, PhD, Dr. Nguyễn Hoàng Bắc – Hospital Director assessed: “This is not only a professional success, but also a testament to the spirit of unity, resilience, and a heart full of responsibility of medical professionals. We do not choose the easy path, we choose the right one. The success of multidisciplinary collaboration has contributed to the development of fetal medicine in Vietnam.”

With close cooperation, proactive spirit, and dedication, the medical team of the University of Medicine and Pharmacy Hospital has affirmed the mission of preserving life—from the most fragile moments of the beginning).