Published Feb 17, 2026 | 10:35 AM ⚊ Updated Feb 17, 2026 | 10:35 AM
Human foetus. Representative image. (iStock)
Synopsis: Doctors at a Hyderabad hospital delivered immunoglobulin directly into the foetus around its intestines. Under ultrasound guidance, they inserted a needle through the mother’s abdomen, through the uterine wall, and into the foetal abdominal cavity. They calculated the dose based on the baby’s estimated weight and injected the treatment.
The ultrasound screen showed a heart that had stopped fighting. At 22 weeks into her pregnancy, the mother watched as doctors pointed to chambers that barely squeezed, valves that leaked, and a rhythm that had slowed to danger. Her body had turned against her unborn child.
The woman carried an autoimmune condition that produces antibodies. These proteins had crossed through the placenta and latched onto her baby’s developing heart, triggering inflammation that thickened the heart walls and disrupted the electrical signals that govern each beat.
Doctors at Hyderabad’s Rainbow Children’s Heart Institute faced a problem: Treating the mother would dilute the medicine before it reached the baby. They needed to bypass her system entirely.
So they injected the treatment straight into the womb.
Picture a construction site where workers suddenly receive the wrong blueprints. In Sjögren’s syndrome and related conditions, the immune system produces antibodies anti-SSA and anti-SSB. These proteins normally target infections, but in autoimmune disease, they misidentify the body’s own tissues as threats.
During pregnancy, these antibodies slip through the placenta. They bind to proteins in the developing heart muscle and the cells that generate electrical impulses. The foetus responds with inflammation, and scar tissue forms. The heart muscle stiffens. Fluid accumulates in the chest cavity. The rhythm falters.
Dr Shweta Bakhru, one of the cardiologists who treated the patient, explained that mothers often feel nothing. “The disease progresses in the baby while the mother experiences no symptoms. By the time we detect it on ultrasound, the heart may have already sustained damage.”
Statistics paint a stark picture. Among mothers who carry these antibodies, two to five percent of their babies develop heart block, where electrical signals fail to travel properly through the heart.
When fluid builds up around organs or thick scar tissue forms on heart valves, mortality climbs to 20 or 30 percent.
Doctors have tried giving immunoglobulin to pregnant mothers for years. These antibodies work by blocking the harmful proteins and calming inflammation. But the approach carries flaws.
Dr Bhargavi Dhulipudi described the limitation: “When you give medicine to the mother, you must use large doses. Only a fraction crosses the placenta, and we cannot control how much reaches the baby or when it arrives. In cases where the heart deteriorates rapidly, we run out of time.”
The team decided to deliver immunoglobulin directly into the space around the baby’s intestines. Under ultrasound guidance, they inserted a needle through the mother’s abdomen, through the uterine wall, and into the foetal abdominal cavity. They calculated the dose based on the baby’s estimated weight and injected the treatment.
The baby’s lymphatic vessels absorbed the immunoglobulin. From there, it entered the bloodstream and circulated to the heart.
Within 10 days, the fluid around the heart drained. Within four weeks, the heart muscle regained its ability to contract. The heart rate climbed from a sluggish rhythm back to 150 beats per minute.
The hospital treated five babies using this method between September 2023 and April 2025. The cases arrived at the hospital between 21 and 27 weeks of pregnancy. Each baby showed heart muscle dysfunction, fluid accumulation, or abnormal rhythms.
One 30-year-old mother had lost a pregnancy before. Her new baby’s heart showed severe scarring and fluid around the valves. Doctors gave the treatment at 21 weeks. The scarring receded. The heart’s pumping fraction improved from 33 to 42 percent. She delivered a baby at full term who breathed and fed normally.
Another case involved a 29-year-old with arthritis and mouth sores. Her baby developed second-degree heart block, where only every other electrical signal reached the lower chambers. The first injection did not restore normal rhythm. Doctors repeated the procedure. Within a week, the baby’s heart resumed conducting every beat.
A 23-year-old with no symptoms carried antibodies from an undiagnosed condition. Her baby’s heart function measured just 19.5 percent of normal. After treatment, it jumped to 40 percent. The baby survived birth but died at seven months from pneumonia, a lung infection unrelated to the heart.
All five babies were born alive. Four remain stable today, their hearts pumping and conducting electricity within ranges that doctors consider reassuring.
The team measured heart function using ultrasound before treatment and again four weeks later. They tracked several parameters that engineers might recognise as performance metrics.
Fractional shortening measures how much the heart chamber shrinks during each beat. Think of it as the percentage change in diameter. Before treatment, one baby measured 22 percent. After treatment, it reached 32 percent.
The myocardial performance index combines the time the heart spends contracting and relaxing. Lower numbers indicate better efficiency. One baby’s index dropped from 1.2 to 0.41 after treatment.
Atrioventricular intervals measure the delay between the upper and lower heart chambers firing. One baby’s interval shortened from 160 milliseconds to 133 milliseconds, bringing the timing closer to the range where hearts pump most effectively.
The scarring on the heart valves, visible as bright areas on ultrasound, faded in all five cases. The fluid that had accumulated around the heart and in the chest disappeared.
Immunoglobulin acts through several pathways. The molecules bind to receptors on immune cells and prevent them from engulfing antibody-marked tissue.
They block proteins that trigger inflammation cascades. They interfere with the complement system, a collection of proteins that normally poke holes in bacteria but can damage healthy cells when misdirected.
When delivered directly to the foetus, immunoglobulin enters the lymphatic channels that drain the abdominal cavity. These channels merge into larger vessels that empty into veins near the heart. The concentration remains high because the medicine does not first dilute in the mother’s bloodstream.
Dr Nageswara Rao Koneti, another cardiologist on the team, noted that direct delivery allows for smaller doses: “We calculate one gram per kilogram of foetal weight. A 400-gram foetus receives 400 milligrams. Compare that to maternal dosing, where we might give 70 grams to a 70-kilogram mother, hoping a fraction crosses the placenta.”
The team published their findings in JACC: Case Reports, a journal that documents new techniques before larger studies confirm their value. The authors acknowledge multiple limitations.
Five cases cannot prove that the treatment works. All mothers also received dexamethasone, a steroid that crosses the placenta and reduces inflammation. The improvements might have come from the steroid alone or from both treatments working together.
Some heart blocks resolve without intervention. The two babies who regained normal rhythm after treatment might have recovered naturally.
The team followed the babies for six to twelve months after birth. A longer follow-up would reveal whether the hearts develop problems later or whether the treatment affected brain development, immune function, or growth.
Rainbow Hospital has now performed this procedure in multiple additional cases beyond the five published. The team reports similarly encouraging results but has not yet released data on those pregnancies.
The procedure carries risks. Inserting a needle through the abdomen can trigger contractions or introduce infection. It requires ultrasound machines that generate clear images and physicians trained to navigate needles through millimetre-scale targets.
Dr Dhulipudi emphasised that this remains a rescue therapy: “We reserve this for severe cases where standard treatment fails to stop deterioration. The baby must show signs of worsening heart failure or rhythm disturbance that threatens survival. We do not use this approach for mild disease or stable cases.”
Cardiologists, obstetricians, and maternal-foetal medicine specialists review each case together before proceeding. They weigh the risk of intervention against the risk of doing nothing.
Other groups have delivered immunoglobulin directly to foetuses for different conditions. Researchers have used it to treat congenital cytomegalovirus infections and severe anaemia caused by blood type mismatches. Those studies demonstrated that the foetus absorbs the medicine and that the procedure can be performed safely.
Rainbow Hospital appears to be among the first to publish results using this approach specifically for autoimmune heart disease. A handful of other centres worldwide have experience with interventions on foetal hearts, but most focus on structural defects or rhythm problems that do not involve the immune system.
Pharmaceutical companies are developing drugs that block antibodies from crossing the placenta in the first place. These medications, called FcRn inhibitors, bind to receptors that transport antibodies from mother to baby. Clinical trials are testing whether giving these drugs to mothers early in pregnancy can prevent heart damage before it starts.
Dr Koneti suggested these approaches could work in combination: “Prevention remains the goal. But when antibodies have already crossed, and the heart shows injury, direct treatment offers an option where we previously had few choices. These strategies may complement rather than compete.”
The team calls for larger studies that track outcomes across multiple centres. They propose registries where institutions record every case, successful or not, to build a clearer picture of which babies benefit and which complications occur.
Randomised trials face practical obstacles. The condition affects roughly two pregnancies per 10,000 among women with autoimmune disease. Severe cases that might qualify for foetal treatment occur even less frequently. Recruiting enough participants to draw firm conclusions would require years and coordination across countries.
For now, the five cases from Hyderabad represent what doctors call proof of concept: Evidence that an idea can work in practice, even if larger studies must still determine how well it works, how often it fails, and which patients benefit most.
The baby whose story opened this article was delivered at 36 weeks. Her heart beat in rhythm. Ultrasound at one year showed chambers that squeezed normally and valves that opened and closed without leaking. Her mother, who had watched the screen show a failing heart at 22 weeks, watched different images at 12 months: A toddler who ran and played, whose heart had recovered from an attack it never understood.
(Edited by Muhammed Fazil.)
