Tables turn as Southeast Asian women choose Vietnam for fetal treatment expertise

Expectant mothers from Southeast Asian countries are now seeking hope for their unborn child from Vietnamese doctors.

In Vietnam, the first-ever laser surgery to ablate the blood vessels linking twin fetuses with twin-to-twin transfusion syndrome was successfully performed at Tu Du Hospital in Ho Chi Minh City in early 2016, with the support of Prof Dr Yves Ville, chairman of the department of obstetrics and fetal medicine at Necker-Enfants-Malades Hospital at the Paris University in France.

Without the intervention, the fetuses could have died at any time.

With twin-to-twin transfusion syndrome, a rare condition that affects identical twins who share a placenta and blood vessels, leading to an unequal exchange of blood and nutrients, some Vietnamese had to race against time and travel abroad to save their babies' lives.

Sadly, many lost both babies due to a lack of timely treatment.

For instance, a mother in HCMC, despite her efforts, arrived in Thailand in 2015 only to discover that her twin daughters had died in her womb. Refusing to bury her children abroad, she chose to endure the pain and returned to Vietnam to deliver her stillborn babies.

Professor Dr Nguyen Duy Anh of the National Hospital of Obstetrics and Gynecology said in the past the uterus was considered a "forbidden zone" that could not be interfered with.

But, thanks to scientific advances, doctors could now perform exploratory and corrective procedures inside the womb, he said.

Many medical facilities in Vietnam have focused on developing this field over the past decade, and doctors have gradually mastered advanced global techniques that allow interventions into nearly all organs of the fetus, opening up life-saving opportunities for conditions previously deemed incurable, he said.

Tu Du Hospital, after its first success in treating fetal diseases in 2016, now performs fetal blood transfusion (2017), laser endoscopy for umbilical cord ablation (since 2018), fetal bladder drainage via amniocentesis (2022), and fetal pleural drainage (2023).

Doctors perform surgical procedures on a fetus at Tu Du Hospital in HCMC. Photo courtesy of the hospital

In a groundbreaking cross-border medical effort, Vietnamese doctors performed a high-risk in-utero heart surgery on a 22-week-old fetus, saving the unborn child of a Singaporean woman with a history of more than a decade of infertility.

In early 2024 the hospital, in collaboration with Children's Hospital 1, performed Vietnam’s first fetal heart intervention for the first time anywhere in Southeast Asia.

This procedure, which, needless to say, requires highly skilled surgeons, is only performed in a few places worldwide.

Last month a pregnant woman from Singapore was sent to Vietnam for fetal heart intervention.

The patient, 41, was referred by KK Women's and Children’s Hospital of Singapore to Tu Du Hospital and Children's Hospital 1 due to the unavailability of this advanced procedure in Singapore.

The mother is expecting her first child in September this year, after more than 10 years of infertility, thanks to in vitro fertilization. Her pregnancy journey was difficult, with Singaporean doctors diagnosing the fetus with a severe congenital heart defect that posed a high risk of stillbirth.

Vietnamese doctors then performed the high-risk in-utero heart surgery on her 22-week-old fetus, and managed to save the child.

This was the ninth fetal cardiac intervention done in HCMC, and it was considered the most technically demanding to date due to the fetus's extremely early gestational age –weighing just 600 grams - and the severity of the condition, a rare and life-threatening condition known as aortic atresia.

"This is recognition in Southeast Asia of the high level of technical expertise in fetal medicine in Vietnam," Tang Chi Thuong, director of HCMC's Department of Health, said.

Vietnamese doctors skillfully perform various fetal interventions such as cord occlusion, laser endoscopy, fetal blood transfusion, amniotic fluid reduction, and biopsy of the placental tissue.

A cardiologist performs an ultrasound check on a newborn baby who had undergone fetal heart surgery as a fetus. Photo courtesy of the hospital

Tran Ngoc Hai, director of Tu Du Hospital, emphasized the importance of timely intervention inside the womb rather than wait for the baby to be born.

This is why Tu Du Hospital has focused on developing this field, he said.

"Without timely detection and treatment, thousands of children born with congenital defects will severely impact the quality of the population."

In 2023 Tu Du Hospital established the country’s first "European-standard" fetal intervention center, the PREIS School.

It also signed a partnership with a major Italian fetal intervention center to further adopt advanced techniques.

In Hanoi, the Obstetrics and Gynecology Hospital is set to launch a fetal medicine center in June for training, research and application of advanced techniques in pregnancy care.

Ha Anh Duc, director of the Ministry of Health’s department of medical service administration, spoke about the breakthroughs in obstetrics, from prenatal screening for congenital defects to surgery and minimally invasive interventions that have reduced mortality rates for both mothers and babies.

Many medical facilities also use AI and digital techniques in healthcare, enabling remote consultations, improving treatment quality and increasing access in remote areas.

This aligns with global trends, as fetal medicine enters a new era, regarded as a revolution in helping to dramatically reverse fetal conditions, with applications of AI, gene therapy, and stem cell science.

In a recent letter commending doctors at Tu Du Hospital and Children's Hospital 1 after their successful fetal heart intervention for the unborn child of the Singaporean woman on May 28, Minister of Health Dao Hong Lan praised their ability to master and successfully apply this technique, a "clear demonstration of the strengthening capabilities of Vietnam's healthcare system."

This achievement not only brings hope to thousands of pregnant women and families but also opens new pathways in diagnosing and treating complex conditions during the fetal stage and a significant step for Vietnam's healthcare sector, she said.

Experts said one major challenge in Vietnam is that the cost of fetal treatments, which range up to hundreds of millions of dong [VND100 million = US$3,840], is not covered by health insurance, making it unaffordable for some patients.

Anh at the National Hospital of Obstetrics and Gynecology suggested that health insurance should gradually cover these and all fetal intervention treatments to reduce the financial burden on families.

In advanced countries, health insurance covers 100% of fetal intervention costs, considering the fetus as a patient.