"For Me, I Cannot Give Up on a Patient Just Because They Are Not Yet Born"

Dr. Yuval Gialchinsky (50) is one of the most intriguing and perhaps also one of the bravest doctors in Israel today. He is a specialist in obstetrics and has specialized in fetal medicine with the field's pioneer, Professor Kypros Nicolaides, from whom he learned in London. Just before completing his specialization and returning to Israel over a decade ago, he watched Professor Nicolaides perform an intrauterine surgery - one of the first of its kind in the world. During the surgery, Professor Nicolaides inserted a camera into the womb, allowing viewers to see the fetuses up close. "It was breathtaking," recalls Dr. Gialchinsky, "I immediately knew this was what I wanted to do."

Gialchinsky, who last year moved from Hadassah Hospital to Beilinson, currently performs various treatments and surgeries on unborn fetuses in the country, aiming most of the time to save their lives and allow the mother to complete the pregnancy properly. To do this, he ensures to be available at all hours of the day, to treat fetuses diagnosed with problems requiring urgent care. "One cannot give up on a patient just because they are not yet born," says Dr. Gialchinsky. We certainly agree with him.

Many parents are informed during pregnancy, to their sorrow and anxiety, that the fetus in the womb suffers from a defect that could lead to death or a particularly severe deformity that will severely impact their life. The doctors usually recommend that parents abort. The experience in these situations is very difficult. No parent dreams at night of raising a child with a severe defect... but how can one give up on a soul coming into the world? On a child?

Dr. Guy Gialchinsky currently provides a solution that fills parents with hope in many cases. Many parents come to Gialchinsky as a last resort before deciding on an abortion, in a final attempt to save their child. Many pregnancy complications can be resolved through Dr. Gialchinsky's treatment, with numerous breathtaking stories of fetuses granted life thanks to his work told word of mouth.

For example, Dr. Gialchinsky performed a complex surgery on a fetus suffering from a giant tumor in the lung. The woman was in her 28th week of pregnancy when Dr. Gialchinsky entered with a needle into the single blood vessel feeding the tumor and cut it off - to prevent the tumor from developing further. Two weeks after the treatment, a follow-up examination showed that the tumor had completely dissolved and disappeared. The lung, which hadn't developed properly earlier due to the tumor, grew and developed to the appropriate size. This treatment was the first of its kind in the country and among the few worldwide.

In one of the more complex treatments performed by Dr. Gialchinsky, a truly breathtaking event occurred. The patient, in her 22nd week of pregnancy, discovered that the fetus in her womb suffered from severe anemia. Anemia in the womb can be caused by various reasons, but the result is the same - if the fetus doesn't have enough blood, it may die in the womb. Today, fetal anemia can be easily detected through a simple ultrasound that checks the blood flow rate in the fetal vessels. The treatment Dr. Gialchinsky performs is complex - yet relatively routine in his day as a doctor - involving penetration into the womb with a thin needle, similar to the procedure done in amniocentesis. The doctor administers an anesthetic to the fetus's leg so it won't move during the treatment, then injects a blood transfusion into the fetus's body, depending on the condition - into the abdominal cavity, the umbilical cord, or directly into the heart. This treatment is performed several times throughout the pregnancy in fetuses suffering from anemia. However, in this particular case, Dr. Gialchinsky saw that the fetus was in a critical condition and decided to inject the blood directly into the fetus's heart. During the injection, the fetus's heart stopped beating.

(photo: shutterstock)

Dr. Gialchinsky knew he had to act quickly, as in such a situation there are only a few minutes before irreversible damage occurs to the fetus. He began massaging the fetal heart using the ultrasound probe, and in a split-second decision, heeded a colleague's suggestion to inject the fetus with adrenaline, as is done in cases of cardiac arrest in adults. The physician hurried to bring an adrenaline dose, and Dr. Gialchinsky injected it directly into the fetal heart. The heart began to beat again.

This incredible event happened about 6 years ago, and the girl, who doesn't know the doctor who saved her life, is now attending kindergarten, healthy and whole. Since that event, Dr. Gialchinsky prepares an adrenaline dose for every fetal treatment he conducts - just in case.

Not Everything is Rosy

The results aren't always as good and wonderful. Fetal medicine is a very delicate subject. The months during which the fetus stays in the womb are critical months for it, says Dr. Gialchinsky. Everything can end in a second, heaven forbid. The results, he emphasizes, "are black and white. Either the treatment is successful and the fetus lives - or it doesn’t." Among the many stories Dr. Gialchinsky shares, there are, unfortunately, quite a few stories that did not end well - where the treatment failed, or partially succeeded, and the baby didn't survive. However, without these treatments, many babies would not survive, with certainty. Dr. Gialchinsky's treatments give them a chance at life - and in many cases, indeed actual life.

The cases Dr. Gialchinsky handles are numerous and very diverse. For example, he treats identical twin cases sharing a placenta. In these cases, blood is often transferred from one twin to the other, causing only one to develop - with the other unable to survive. Dr. Gialchinsky uses a laser to divide the placental blood vessels into two parts, so each twin receives blood from a different part of the vessels, allowing both to develop. Similarly, there are instances where, in a twin pregnancy, one twin completely stops developing. Such a condition might cause the other fetus not to survive, but Gialchinsky severs the vessels linking the twins, so the second twin can survive and develop despite the first's demise. Additional procedures performed by Dr. Gialchinsky include inserting shunts into the fetal chests suffering from fluid accumulation around the lungs; performing cardiac catheterization for fetuses with valve stenosis, and more. Fetal medicine, explains Dr. Gialchinsky, is entirely different from pediatric or even neonatal medicine. "The essential systems of the fetus are adapted to life in water," explains Gialchinsky. "They also undergo rapid changes." Treating fetuses while still in the womb has an advantage, owing to the fetus's protected environment and the various systems surrounding it, like stem cells, enhancing its healing potential.

Dr. Gialchinsky states that many parents who approach him do so because they refuse to accept the doctors' recommendation for an abortion and want to fight for their fetus's life. "Some of my patients are religious, but not exclusively," says the doctor. "In some cases, the treatments are simple. We just need to reach those in need."

"It Seems Like Science Fiction"

Aside from life-saving treatments, Dr. Gialchinsky also performs particularly complex treatments that don't directly save lives but rather prevent severe disabilities in fetuses suffering from a defect known as "spina bifida." This is a condition where part of the spinal cord develops outside the body instead of within. Usually, babies with spina bifida experience paralysis in their legs and sometimes various cognitive issues as well. Despite a significant drop in cases due to increased folic acid intake during pregnancy, dozens of babies with this defect are born in Israel every year. Dr. Gialchinsky offers parents in this situation the option of an intrauterine surgery to correct the defect. This surgery is performed starting from the 24th week of pregnancy. During the surgery, the amniotic fluid is drained from the womb, which is replaced with carbon dioxide to facilitate work within the womb. The surgery is conducted by a multidisciplinary team of doctors, using tiny surgical tools inserted through four openings to repair the spine. The success of the surgery is assessed after birth, with the first sign of success being when the newborn moves their legs - proving there is no paralysis, although it doesn't verify that the entire issue is resolved.

Dr. Gialchinsky first heard about this surgery at a medical conference from Dr. Denise Lapa from Brazil, who developed it. This surgery has been in use for only the last five years. Gialchinsky says he felt it was a kind of science fiction. He approached Dr. Lapa at the end of the conference and asked to learn how to perform the surgery from her. She agreed immediately, and since then, the operation can be performed in the country at Dr. Gialchinsky's hands. Five fetuses in Israel have undergone this surgery, and although it’s difficult yet to predict how their future development will look, all show signs that they do not suffer from paralysis. Notably, no significant complications have arisen in any of the cases for the mother. Worldwide, in all cases where the surgery has been performed, no fetus has died as a result, and babies born post-surgery show significantly better developmental outcomes than those who underwent surgery only after birth.

Dr. Gialchinsky conducts these surgeries and treatments, many of which are also documented in incredible photographs and videos, courageously, despite some risk for himself. In recent years, the Supreme Court has expanded the grounds for lawsuits by parents who have a child born with some defect. In cases where any negligence on the part of the medical team is proven, such parents might be compensated with significant sums for most of the child's medical expenses, including rehabilitative and caring needs. Many doctors fear lawsuits, leading to an excess of complex medical tests and increased recommendations for pregnancy terminations. Statistics show that a fifth of the abortions performed in the last 25 years in the country occurred due to suspected fetal defect, with the abortion rate for this reason increasing by no less than 17 percent over the last two decades. This situation is absurd, claims Dr. Gialchinsky. "A doctor expected to protect the fetus is essentially declaring it has no right to exist," he says. "A doctor wanting to protect himself must 'cut' one way or the other, and any doubtful case is referred for pregnancy termination." Dr. Gialchinsky adds that many tests show genetic changes whose meanings doctors don't truly understand, so many fetuses whose pregnancies were terminated could have been born completely healthy. Dr. Gialchinsky takes shared responsibility for such fetuses with the parents. He provides them with a complete explanation of the treatment he can offer, including advantages and disadvantages, and whenever possible, gives them several days to decide so they can process the situation and make an informed decision. "It's enormous responsibility," concludes Dr. Gialchinsky, "but I feel there's no choice. You can’t see a person on the brink of death and not try to save them."

Considering abortion? Know someone at a crossroads?

Dear mother, we are here, at E.M.A.'s department of Hidabroot, to help you. Give your child another chance, don’t let their life end.

Contact E.M.A department – Free support, advice, and guidance for women considering ending pregnancies and abortion: Tel: 073-2221333, Mobile 052-9551591. Emailkalina@htv.co.il