Eight-month-old twins from Hayward Heath, West Sussex, recently met the surgeon who saved their lives even before they were born. The BBC reports how their mother, Katerina Ahouansou, at six months pregnant, during a routine scan, uncovered a serious issue with their development and blood supply.

Doctors diagnosed the twins with twin-to-twin transfusion syndrome or TTTS. It is a condition where one twin received more blood and nourishment than the other due to uneven blood vessel distribution in the placenta. In case there is no medical intervention, it could be fatal for both the twins.

A Specialist Steps In

This is when Ahouansou was referred to Professor Kypros Nicolaides at King’s College Hospital in London. Professor Nicolaides is a pioneer in fetal medicine and he specializes in a laser procedure that redistributes blood supply between twins in cases of TTTS.

When Ahouansou was scanned, Nicolaides observed that one of the twins were significantly smaller than the other. "There was a very high chance that if we did not intervene, both twins could die," he recalled.

An Operation No Less Than A Miracle

The life-saving laser surgery was performed and within a week the doctors saw an improvement with the twin who was smaller in size. When the twins were born, they weighed 1.5kg and 1.7kg. To recognize the efforts by the surgeon, Ahouansou named them Kai Kypros and Asher Nicolas after Professor Kypros Nicolaides.

Ahouansou also expressed deep gratitude for the professor's expertise and called him "proof that miracles can be performed by people who are devotees to their profession."

Professor Kypros Nicolaides has been at King’s College Hospital since 1980 and is widely regarded as a leader in fetal medicine. His groundbreaking research and development of screening and surgical techniques have saved countless lives.

Through his dedication, Professor Nicolaides has given many families hope, demonstrating how medical advancements continue to improve survival rates for complex fetal conditions like TTTS.

More about Twin-to-twin Transfusion Syndrome

As per the John Hopkins Medicine, TTTS is a rare pregnancy condition that affects identical twins or other multiples. It happens in pregnancies where twins share one placenta and a network of blood vessels that supply oxygen and nutrients essential for development in the womb. These pregnancies are known as monochorionic.

Sometimes, the blood vessels in the placenta are unevenly distributed, causing an imbalance in blood flow between the twins. The donor twin loses more blood than it receives, leading to malnutrition and potential organ failure. Meanwhile, the recipient twin gets an excess of blood, putting strain on the heart and increasing the risk of cardiac complications.

Impact on the Donor Twin

The donor twin loses blood volume (hypovolemia), reducing kidney function and urine production. This leads to low amniotic fluid levels (oligohydramnios) or, in severe cases, a complete absence (anhydramnios). Without proper blood circulation, the donor twin faces cardiovascular issues, increasing the risk of death.

Impact on the Recipient Twin

The recipient twin experiences excess blood volume (hypervolemia), causing increased urination and excessive amniotic fluid (polyhydramnios). The overworked heart struggles to handle the surplus blood, leading to cardiovascular dysfunction, heart failure, and, in extreme cases, death.

Pregnancy is often a time of joy and anticipation, but what if symptoms like loose stools, abdominal pain, and dizziness signal something far more dangerous? While morning sickness and fatigue are common, these signs could indicate an ectopic pregnancy—a life-threatening condition affecting about 2% of all pregnancies. Shockingly, over 90% of ectopic pregnancies occur in the fallopian tubes, where the fertilized egg implants outside the uterus, leading to potential rupture and severe internal bleeding. If left untreated, this condition can be fatal. So, how do you recognize the warning signs, and what should you do if you're at risk?

While some discomforts are normal, certain symptoms demand urgent medical attention. Have you been experiencing loose stools and abdominal pain during early pregnancy? These could be more than just digestive troubles—they might signal an ectopic pregnancy, a life-threatening condition requiring immediate care.

What is Ectopic Pregnancy?

An ectopic pregnancy occurs when a fertilized egg implants itself outside the uterus, most commonly in the fallopian tubes. These pregnancies cannot proceed normally because only the uterus can support fetal development. According to medical experts, about 1-2% of all pregnancies are ectopic, with over 90% occurring in the fallopian tubes. More rarely, ectopic pregnancies can develop in the ovaries, cervix, or even the abdominal cavity.

As the pregnancy progresses, the affected tube may rupture, leading to severe internal bleeding. This rupture is a medical emergency that demands immediate surgical intervention.

Dr. Monica Gupta, Consultant in Obstetrics and Gynecology, explains, "An ectopic pregnancy is a serious condition as the pregnancy cannot survive, and there is a significant risk of internal bleeding, which can be life-threatening."

Early Symptoms of Ectopic Pregnancy

The initial signs of an ectopic pregnancy can be subtle and may mimic early pregnancy symptoms, making detection challenging. However, there are key warning signs that should prompt immediate medical evaluation:

Vaginal bleeding: This may be light spotting or more pronounced bleeding that is different from a regular menstrual period.

Abdominal pain: Persistent or sharp pain in the lower abdomen or pelvis, often on one side.

Loose stools and bowel discomfort: Digestive disturbances, including diarrhea and rectal pressure, could be an indication of an advanced ectopic pregnancy.

Dizziness and fainting: Low blood pressure due to internal bleeding can cause episodes of lightheadedness or collapse.

Shoulder pain: This unusual symptom can occur if blood from a ruptured ectopic pregnancy irritates the diaphragm.

Dr. Gupta highlights, "Symptoms of ectopic pregnancy can be vague and difficult to differentiate from normal pregnancy, especially in early stages before tubal rupture begins." This is why women experiencing any of the above symptoms should seek medical evaluation without delay.

Who Is at Risk for an Ectopic Pregnancy?

While an ectopic pregnancy can happen to any woman, certain risk factors can increase the likelihood of this condition:

Previous ectopic pregnancy: A history of ectopic pregnancy significantly raises the risk of recurrence.

Pelvic inflammatory disease (PID): Infections can cause scarring in the fallopian tubes, hindering the passage of the fertilized egg.

Prior tubal surgery: Procedures such as tubal ligation (having the tubes tied) or surgeries for endometriosis may increase the risk.

Use of fertility treatments: Women who have undergone in vitro fertilization (IVF) have a higher chance of ectopic implantation.

Smoking: Tobacco use is linked to damage in the fallopian tubes.

IUD use at the time of conception: Although rare, an intrauterine device (IUD) in place during conception can increase the risk.

Maternal age over 35: Women over this age threshold have a slightly higher risk of ectopic pregnancies.

Interestingly, up to 50% of ectopic pregnancies occur in women with no known risk factors, emphasizing the need for vigilance among all pregnant individuals.

Why Ectopic Pregnancy Is a Medical Emergency?

A developing pregnancy requires space to grow, but fallopian tubes lack the ability to expand like the uterus. If an ectopic pregnancy continues undiagnosed, the tube can rupture, leading to severe internal bleeding, shock, and even death if left untreated.

Dr. Gupta explains, "In advanced stages, patients present with severe abdominal pain, fainting, anemia, a fall in blood pressure, and shock. If rupture occurs, immediate surgical intervention is necessary."

How Is an Ectopic Pregnancy Diagnosed?

Prompt diagnosis is essential in managing an ectopic pregnancy. Healthcare providers use the following approaches:

Pregnancy test: A positive pregnancy test combined with abnormal symptoms raises suspicion.

Pelvic examination: Doctors may detect tenderness, a mass, or abnormal fullness in the pelvis.

Ultrasound scan: A transvaginal ultrasound can confirm the absence of a pregnancy in the uterus and identify its location elsewhere.

Blood tests: Measuring levels of hCG (human chorionic gonadotropin) can help diagnose abnormal pregnancies.

Treatment Options for Ectopic Pregnancy

The course of treatment depends on the stage at which the ectopic pregnancy is diagnosed:

Medication: If detected early, methotrexate, a medication that stops cell growth, may be used to dissolve the ectopic tissue without surgery.

Surgery: If the condition has advanced or if rupture has occurred, emergency surgery is required to remove the pregnancy and repair or remove the affected fallopian tube. This is often performed laparoscopically (minimally invasive surgery).

Ectopic pregnancy is a life-threatening condition, and early diagnosis significantly improves outcomes. Any woman experiencing abnormal pain, bleeding, or gastrointestinal symptoms in early pregnancy should seek medical evaluation immediately.

Dr. Gupta stresses, "A suspicion of ectopic pregnancy should always be raised when a patient presents with abnormal bleeding or pain in early pregnancy. Delay in diagnosis can lead to severe complications."

Dr Monica Gupta is a Consultant Obstetrics and Gynaecology at Manipal Hospital, Bhubaneshwar In India

A recent study published in JAMA Network Open reveals that pregnant individuals facing food insecurity are at a higher risk of complications such as preeclampsia and gestational diabetes. The analysis, based on data from over 19,300 pregnant Kaiser Permanente Northern California members, found that those receiving food assistance did not face the same increased risks. The findings highlight the importance of food assistance programs in ensuring better maternal and infant health outcomes.

Study Reveals Link Between Food Insecurity and Pregnancy Complications

The study examined pregnant individuals who were screened for food insecurity—defined as running out of food or worrying about running out due to financial constraints. Key findings include:

• 14% (about 2,700 participants) experienced food insecurity during pregnancy.
• 7.6% (1,470 participants) received food assistance while pregnant.
• Higher rates of gestational diabetes (10.9% in food-insecure individuals vs. 7.9% in those without food insecurity).
• Increased risk of preeclampsia (8.1% vs. 6.3%).

Other complications such as preterm birth and neonatal ICU admission were also more common in food-insecure pregnancies.

No significant link was found between food insecurity and gestational hypertension or Caesarean delivery.

How Does Food Insecurity Affect Pregnancy?

Poor Nutrition and Diet Quality

Lack of access to nutritious food may lead to an unbalanced diet, increasing the risk of pregnancy-related conditions like gestational diabetes and high blood pressure disorders.

Inconsistent Eating Patterns

Skipping meals or irregular eating habits can affect blood sugar regulation and overall maternal health.

Psychological and Physical Stress

The stress of worrying about food availability can contribute to inflammation, hormonal imbalances, and other health risks during pregnancy.

Food Assistance Can Reduce Health Risks

Unlike food-insecure participants, those who received food aid did not experience the same increase in complications. This suggests that food assistance programs play a crucial role in mitigating the health effects of food insecurity.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was the primary source of food assistance for study participants. In 2022, WIC provided benefits to 6.31 million pregnant and postpartum individuals, infants, and children, according to the U.S. Agriculture Department.

Recommendations: Improving Food Security in Pregnancy

Experts emphasize the need for better screening and policy improvements to address food insecurity among pregnant individuals. The study suggests:

• Routine screening for food insecurity during prenatal visits.
• Increased funding and accessibility for food assistance programs like WIC.
• Public health initiatives to ensure pregnant individuals have consistent access to nutritious food.

Food insecurity during pregnancy is linked to increased risks of gestational diabetes, preeclampsia, and other complications. However, food assistance programs can help reduce these risks, emphasizing the importance of expanding access to such resources. Ensuring that all pregnant individuals have access to adequate nutrition is essential for improving maternal and infant health outcomes.

A good news for all, especially the doctors and the kids. While the society's shift to cashless transactions has transformed everyone's day to day life. People are now able to make payments faster and no one has to worry about keeping the change. However, there's another benefit to it too. It is a health benefit! Now, there are way fewer cases of kids swallowing coins. It has reduced the need for medical procedures to remove them, reports BBC.

The study recently published in The Annals of Royal College of Surgeons of England looked at the hospital records in England over the past two decades. It also found a significant decline in procedures to remove foreign objects from children's throats, airways, and noses, with nearly 700 fewer cases by 2022.

Historically, coins had accounted for over 75% of objects that children under 6 would swallow. However, the data from the UK Payments Markets Survey show that card payments began to outpace cash in 2010. The researchers noticed the decline in the cases of kids swallowing coins during the same period. This is what suggested a link between fewer coins being in circulation and fewer accidents happening like that.

An open-access web version of the study, released in June 2024, analyzed data from 2012 to 2022. The key findings included:

• A 29% drop in foreign-body removal procedures, from 2,405 cases to 1,716
• 195 fewer procedures to remove swallowed objects, dropping from 708 to 513
• 484 fewer cases of objects being removed from noses, from 1,565 to 1,081
• 10 fewer procedures involving the respiratory tract, from 132 to 122

ENT surgeon Ram Moorthy, a member of the Royal College of Surgeons of England, praised the findings. "It is positive that fewer children are swallowing coins," he said. "This study shows how new technology can make children safer in ways we didn't intend."

What Could Have Been The Other Factors?

While the shift to cashless payment is of course a major factor in decline in such emergency cases, researchers also believe that there could be other things too that may have played role. These include:

• Childproofing the household items
• Safety campaigns that have raised awareness among parents
• An improved parental supervision which made them understand better on choking hazards

These measures have helped to reduce not just the incidents of swallowing coins, but also other objects that would often get lodged in their noses and airways.

Are There New Dangers?

While the number of cases of kids who swallowed coins may have gone down, the dangers are still there. With the growth of more and more technology, the toys are no longer simple. They run on battery and have features and elements like magnets, which are also easy for kids to swallow. In fact small button batteries can cause severe internal burns if swallowed. It can also lead to life-threatening complications within hours.

Furthermore, magnets can also be powerful neodymium magnets which can attract each other inside the body and can often pinch and damage the internal tissues.

According to NHS data from 2010 to 2016, removing foreign objects from ears and noses costs hospitals in England around £3 million per year. Children are responsible for the majority of these cases:

95% of objects removed from noses involved children

85% of objects removed from ears were from children

Among adults, cotton buds (used for ear cleaning) are the most common foreign object that requires medical removal.