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.

A new study published in The Lancet Obstetrics, Gynaecology, & Women's Health has revealed an alarming rise in infertility rates among women aged 35 years and older.

The analysis, based on the Global Burden of Disease Study 2023, found that global female infertility could affect nearly 80 million women aged 35–49 by 2036 if current trends continue.

In 2023, an estimated 53.60 million women aged 35–49 were affected by infertility. Nearly 54 million women in this age group sought fertility care, including fertility testing and assisted reproductive technologies such as in vitro fertilization (IVF).

Asia Bears Highest Burden

According to the study, Asia has the highest need for fertility care particularly East Asia reported the highest regional burden, while Australasia has the lowest. At country level, the Central African Republic had the highest reported burden, while Nepal had the lowest.

Although disparities between low- and high-income regions have narrowed, the burden is shifting toward high-income settings, where women are more likely to delay pregnancy and seek fertility testing and treatment.

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The researchers said, "This shift reflects broader social and economic changes, including delayed family planning and greater access to fertility services in some affluent regions".

"Advanced-age female infertility represents a growing global health challenge. Despite improved regional equity, low-SDI countries continue to face significant burdens. This necessitates implementing tailored public health strategies and prioritizing resource allocation to mitigate future burdens," said the researchers from China, Hong Kong, and Singapore in the paper.

To address the rising demand, the authors called for

• expanding and integrating fertility services into primary health care, reducing financial barriers to treatment,
• using innovative delivery methods,
• mobile health tools,
• improve equitable access to fertility care.

Infertility A Growing Global Health Concern

The World Health Organization defines infertility as the failure to achieve a clinical pregnancy after 12 months of regular unprotected intercourse.

Approximately 8–12 per cent of reproductive-aged couples worldwide experience infertility, with the burden disproportionately affecting women aged 35–49 years.

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The study noted that this higher risk is largely biological, driven by age-related declines in ovarian reserve and oocyte quality, which reduce natural fertility, increase miscarriage risk, and lower the success rates of assisted reproductive technologies (ART).

As populations age and socioeconomic transitions continue, the number of women exposed to advanced-age infertility risk is increasing, making it an increasingly important public health issue.

How Was The Study Conducted?

The researchers analyzed data from the Global Burden of Disease (GBD) 2023 study to provide what they describe as the first comprehensive assessment of infertility among women aged 35–49 across 204 countries and territories.

Since 1990, both the age-standardized prevalence rate and disability-adjusted life years (DALYs) attributable to infertility have risen steadily, by 0.45 per cent and 0.47 per cent every year, respectively.

The study projects that infertility cases in women aged 35–49 will continue to rise, reaching nearly 80 million by 2036 in the absence of targeted interventions.

The researchers also found a 23.10% reduction in the relative disparity in infertility-related DALYs between low- and high-Socio-demographic Index (SDI) regions since 1990, indicating progress in equity while highlighting persistent structural gaps in access to care.

A 20-month-old toddler from West Bengal who suffered from recurring urinary tract infections (UTIs) for six months was eventually diagnosed with cystinuria, a rare inherited metabolic disorder that causes recurrent kidney stone formation.

About The Case

The diagnosis came after the toddler experienced persistent UTIs over a period of six months. After multiple episodes of infection couldn’t be solved despite treatment, the doctors discovered the rare condition.

Initially, the doctors believed that it could be vesicoureteral reflux, a condition in which urine flows backward from the bladder towards the kidneys.

However, more investigations revealed an unusual kidney stone caused by cystinuria, an inherited disorder that leads to excessive amounts of the amino acid cystine in urine.

As cystine dissolves poorly in urine, it can crystallise and form stones, which may block urine flow, trigger recurrent UTIs, and damage the kidneys if left untreated for a long time. Doctors at a Bengaluru hospital treated the child using a minimally invasive procedure to remove the stone.

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What Is Cystinuria?

Usually, the kidneys reabsorb cystine after filtering blood. In individuals with cystinuria, this process does not work well.

Large amounts of cystine pass into the urine. As cystine does not dissolve in urine, it forms crystals and eventually stones in the kidneys.

The condition is caused when the child inherits one faulty gene from each parent. Parents who carry one altered gene usually have no symptoms themselves.

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Symptoms & Treatment

Unlike most kidney stones, which are more common in adults, cystinuria presents during childhood or adolescence. Parents must look out for the following symptoms in their children:

• Recurrent urinary tract infections

• Pain while passing urine

• Blood in urine

• Abdominal or flank pain

• Kidney stones at an unusually young age

• Difficulty passing urine if stones obstruct the urinary tract

Although cystinuria has no cure, effective treatment and management can reduce stone formation and protect kidney function. It includes:

• Drinking large amounts of water to dilute urine and reduce the formation of stones

• Reducing salt intake

• Limiting consumption of excessive animal protein

• Medications that make urine less acidic (urine alkalinisation)

• Drugs that reduce cystine stone formation in severe cases

• Surgical or minimally invasive procedures to remove stones when necessary

Parents must seek medical attention when the child faces the following:

• Two or more UTIs within six months or repeated infections over a year

• Recurrent fever without an obvious cause

• Intense pain during urination

• Blood in the urine

• Difficulty in gaining weight

• Persistent irritability

• Recurrent abdominal or back pain

While most recurrent UTIs are caused by common anatomical or behavioural factors, persistent or unusual infections can occasionally point to rare inherited disorders like cystinuria that warrant medical attention.

Early diagnosis and timely treatment can help prevent permanent kidney damage and significantly reduce the frequency of stone formations.

Hypertension or high blood pressure is an increasingly common problem among children and adolescents; many children may not have any obvious signs or symptoms in the early phase. It is said that hypertension in children is a “silent condition,” and therefore, it is of paramount importance that doctors, parents, and teachers are aware of it to detect the condition early.

Symptoms Of High Blood Pressure In Children

While some kids might not have any symptoms at all, there are some signs that shouldn't be overlooked. Recurrent headaches or morning headaches, especially headaches in the back of the head, may occasionally be a sign of high blood pressure. Symptoms can be dizziness, blurred vision, flashers, loss of energy for no known reason, nausea, vomiting, difficulty breathing during exercise, chest pain, palpitations, or frequent nosebleeds for no obvious reason.

There can also be changes in a child's behaviour or physical appearance in the school environment that teachers might observe. Children with high blood pressure often experience headaches, frequent visits to the sick room for weak or dizzy spells and ask to go out of class to rest. Sometimes, symptoms such as difficulty in concentration, sudden drop in school performance, irritability, changes in mood or appearing unusually withdrawn are associated with underlying health problems, such as hypertension.

Some children may be more tired, winded or unwell from sports or physical activity than others and avoid it. These symptoms can be missed and dismissed as stress, poor sleep or lack of interest in studies or sports. Such symptoms may be overlooked and blamed on stress, sleep deprivation or low interest in studies or sports.

Leading Causes & Prevention

Doctors think obesity, poor diet, excessive salt intake, poor sleep, low exercise, and watching too much screen time are all factors that are driving up hypertension rates in kids and teens. Other kidney disease, heart disease, hormone imbalances, or family history can also contribute in some children.

Regular blood pressure checks on children's routine visits are very significant because many children with hypertension may be asymptomatic, experts say. Prompt diagnosis and treatment can prevent complications with the heart, kidneys, brain and eyes in the long term.

It is important that parents and teachers do not shrug off repeated complaints of headaches, fatigue, dizziness or vision problems as insignificant. Early medical assessment can be important in safeguarding a child's long-term health.

By Dr Vaibhav Meshram, Paediatrician, Ruby Hall Clinic