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  1 / 1831 MEDLINE  
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PMID:28454700
Autor:Akkermans J; de Vries SM; Zhao D; Peeters SHP; Klumper FJ; Middeldorp JM; Oepkes D; Slaghekke F; Lopriore E
Endereço:Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: j.akkermans@lumc.nl.
Título:What is the impact of placental tissue damage after laser surgery for twin-twin transfusion syndrome? A secondary analysis of the Solomon trial.
Fonte:Placenta; 52:71-76, 2017 Apr.
ISSN:1532-3102
País de publicação:Netherlands
Idioma:eng
Resumo:BACKGROUND: The introduction of the Solomon technique for the treatment of twin-twin transfusion syndrome (TTTS) increased placental exposure to laser energy. This study aims to identify the impact of power and energy used in laser treatment on placental tissue and pregnancy outcome. METHODS: Pictures of all dye-injected placentas since the start of the Solomon trial were analyzed. Placental damage was scored using a grading system including visual scar depth and affected proportion of the vascular equator. Parameters analyzed included laser power and total energy, gestational age (GA) at laser, GA at birth, laser-to-delivery interval and preterm prelabor rupture of membranes (PPROM). RESULTS: We included 122 cases in the analysis. More placental damage occurred more often in the Solomon group (42%) compared to the selective group (15%) (p < 0.001). In multivariate analysis, more placental damage was associated with higher laser energy (regression coefficient B 0.002) but not with higher power setting (regression coefficient B -0.442). More damage was associated with earlier GA at birth (regression coefficient B -0.167), higher incidence of PPROM <32 weeks (regression coefficient B 0.003) and a shorter laser-to-delivery interval (regression coefficient B -0.168). CONCLUSIONS: Placental damage is positively associated with more laser energy but negatively associated with higher power setting. More placental damage was associated with a lower GA at birth, shorter laser-to-delivery interval and higher PPROM rate. Whether these results should lead to a change in surgical technique requires more research, both further ex-vivo experiments on human placentas and clinical studies.
Tipo de publicação: JOURNAL ARTICLE


  2 / 1831 MEDLINE  
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PMID:29417679
Autor:Quintero R; Chmait RH
Endereço:USFetus Research Consortium, Miami, Los Angeles, USA.
Título:Re: Monochorionic diamniotic twin pregnancy with selective fetal growth restriction Type II: sonographic and fetoscopic findings of poor prognosis.
Fonte:Ultrasound Obstet Gynecol; 51(2):280, 2018 02.
ISSN:1469-0705
País de publicação:England
Idioma:eng
Tipo de publicação: LETTER; COMMENT


  3 / 1831 MEDLINE  
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PMID:28460542
Autor:Verbeek L; Slaghekke F; Sueters M; Middeldorp JM; Klumper FJ; Haak MC; Oepkes D; Lopriore E
Endereço:a Division of Neonatology, Department of Pediatrics , Leiden University Medical Center , Leiden , The Netherlands.
Título:Hematological disorders at birth in complicated monochorionic twins.
Fonte:Expert Rev Hematol; 10(6):525-532, 2017 06.
ISSN:1747-4094
País de publicação:England
Idioma:eng
Resumo:INTRODUCTION: Monochorionic twins are at risk of severe complications including twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS) and acute peripartum TTTS. The pathophysiology is based on inter-twin blood transfusion through placental vascular anastomoses. Areas covered: This review focuses on the incidence, management and outcome of neonatal hematological complications at birth in TTTS, TAPS and acute peripartum TTTS. Expert commentary: Hematological disorders are often present at birth in monochorionic twins and include acute or chronic anemia, polycythemia and thrombocytopenia. Routine measurement of complete blood counts in all complicated monochorionic twins is strongly recommended. Increased awareness on these disorders and correct diagnostic tests will lead to prompt and adequate management at birth.
Tipo de publicação: JOURNAL ARTICLE; REVIEW; TWIN STUDY


  4 / 1831 MEDLINE  
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PMID:28455084
Autor:Donepudi R; Mann LK; Wohlmuth C; Johnson A; Bebbington MW; Moise KJ; Boudreaux DS; Gardiner H; Papanna R
Endereço:Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, UTHealth, University of Texas Health Science Center at Houston, Houston, TX.
Título:Recipient umbilical artery elongation (redundancy) in twin-twin transfusion syndrome.
Fonte:Am J Obstet Gynecol; 217(2):206.e1-206.e11, 2017 08.
ISSN:1097-6868
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Chronic hypertension in adults causes arterial lengthening in major arteries, but the effects of early fetal hypertension on the twin-twin transfusion syndrome recipient's vascular architecture remains unknown. OBJECTIVE: We hypothesize that arterial cord redundancy is related to recipient hypertension and subsequent heart failure. Our objectives were to: (1) establish a 3-dimensional color Doppler ultrasound method of measuring umbilical arterial length relative to its corresponding venous segment in the umbilical cord using artery vein angle; (2) compare recipient artery vein angle to gestational age-matched controls; and (3) test the association of artery vein angle with recipient heart failure. STUDY DESIGN: We compared 3 groups prospectively: twin-twin transfusion syndrome pregnancies undergoing fetoscopic laser surgery (preoperatively) and 2 groups of gestational age-matched controls: uncomplicated monochorionic-diamniotic twin pregnancies and healthy singletons. Using a 3-dimensional color-Doppler volume image of 5 cm of cord near the placental insertion, we traced the umbilical artery and vein producing umbilical artery:vein length, (artery vein index) and measured the artery vein angle between umbilical artery and vein. Correlation of artery vein angle to twin-twin transfusion syndrome stage, maximum vertical pocket, umbilical arterial indices, ductus venosus Doppler, and brain natriuretic peptide were performed. We used pulsed-wave and tissue Doppler to measure tissue Doppler velocities and indexed cardiac output and correlated these with artery vein angle. Comparative statistics, including multivariable linear regression, examined the relationship between umbilical arterial Doppler indices and artery vein angle. RESULTS: Artery vein angle and artery vein index correlated significantly (R , 0.86; P < .0001), hence, artery vein angle was used for analysis. Mean artery vein angle was 33.1 ± 31.5 degrees in recipients (n = 44), 9.5 ± 6 degrees in monochorionic-diamniotic (n = 11; 22 fetuses), and 8.9 ± 8.3 degrees in singleton controls (n = 16) (P < .001). An artery vein angle ≥26 degrees (>95th percentile for controls) was measured in 52% recipients. Artery vein angle was higher in twin-twin transfusion syndrome stage 3R vs 1 (P = .001). Artery vein angle increased with increasing umbilical arterial pulsatility index (P < .001), and decreased with increasing resistance index (P = .02) after adjusting for gestational age. Interrater agreements to categorize abnormal artery vein angle values was 95% (P < .001). Abnormal ductus venosus Doppler and elevated recipient amniotic fluid N-terminal pro-brain natriuretic peptide/protein levels correlated significantly with artery vein angle. Abnormal artery vein angles were associated with decreased indexed cardiac output, lower tissue Doppler velocities, higher right-sided Tei indices, and severe tricuspid regurgitation. CONCLUSION: Umbilical arterial lengthening occurs in 52% of recipients and is associated with abnormal Doppler flows, low systolic tissue Doppler velocities, reduced cardiac output, and elevated markers of cardiac failure. This may reflect chronicity and severity of hypertension in the recipient fetus. Further research is needed to explore the mechanisms of elongation and long-term implications.
Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
Nome de substância:0 (Peptide Fragments); 0 (pro-brain natriuretic peptide (1-76)); 114471-18-0 (Natriuretic Peptide, Brain)


  5 / 1831 MEDLINE  
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PMID:28355685
Autor:Wang XJ; Li LY; Wei Y; Zhao YY; Yuan PB
Endereço:Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
Título:[Clinical outcome and placenta characteristics of spontaneous twin anemia-polycythemia sequence].
Fonte:Zhonghua Fu Chan Ke Za Zhi; 52(3):153-158, 2017 Mar 25.
ISSN:0529-567X
País de publicação:China
Idioma:chi
Resumo:To investigate the clinical outcome and placental characteristics of spontaneous twin anemia-polycythemia sequence (sTAPS). Twelve cases with sTAPS delivered in Peking University Third Hospital from May 2013 to August 2016. The data of ultrasound characteristics, gestational age at delivery, and 1 minute Apgar score were analyzed, retrospectively. Placental superficial vascular anastomoses, placental territory discordance and the ratio of umbilical cords insertion distance to the longest placental diameter were also analyzed. (1) Only 1 case of sTAPS was diagnosed prenatally, the others were diagnosed postnatally because the fetal middle cerebral artery(MCA) doppler was not measured regularly. Five cases were complicated with selective intrauterine growth restriction (sIUGR). The median gestational age at delivery was 32.8 weeks (31-37 weeks) . The pregnancies were terminated because 3 cases were sIUGR type â… , 1 case was sIUGR type â…¡, 1 case was sIUGR type â…¢, 2 cases were fetal distress, 2 cases were severe pre-eclampsia, 2 cases were premature rupture of membrane, 1 case was fetal hydrops with abnormal doppler waveforms of ductus venouses. (2) When 5 sIUGR cases were excluded, there was no difference between the twins in birth weight [1 797 g (940-2 620 g) , 1 648 g (980-2 500 g) ; P=0.688]. The hemoglobin (Hb) level in all donor was significantly lower than recipient (P=0.000) and the inter-twin Hb difference was 147.6 g/L (84.0-216.0 g/L). While the reticulocyte percentage in donor was significantly higher than recipient (P=0.013) and reticulocyte percentage ratio was 3.60 (1.04-7.50). Five donor newborns had neonatal asphyxia, including 1 severe asphyxia, while no asphyxia happened in the recipient twins. (3) Arterio-arterial (A-A) anastomoses, veno-venous (V-V) anastomoses, arterio-venous (A-V) anastomoses were found in 3, 1 and 11 placentas, respectively. The total number of anastomoses was 2 (1-5) and the total diameter was 1.1 mm (0.4-2.1 mm), including 0 (0-1) A-A anastomoses with 0.2 mm (0.0-0.9 mm) in diameter and 2 (0-5) A-V anastomoses with 0.7 mm (0.0-2.1 mm) in diameter. The placental territory discordance was 0.17 (0.02-0.40) and the ratio of umbilical cords insertion to the longest placental diameter was 0.82 (0.34-0.99). The pathogenesis of sTAPS might result from slow and chronic blood transfusion from donor to recipient through a few minuscule vascular anastomoses in the placenta. In all monochorionic twins, especially sIUGR cases, MCA doppler should be monitored closely in the second and third trimester, in order to diagnose and manage sTAPS in time.
Tipo de publicação: JOURNAL ARTICLE; TWIN STUDY


  6 / 1831 MEDLINE  
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PMID:28281301
Autor:Gil Guevara E; Pazos A; Gonzalez O; Carretero P; Molina FS
Endereço:The Center for Fetal, Cellular and Molecular Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Título:Doppler assessment of patients with twin-to-twin transfusion syndrome and survival following fetoscopic laser surgery.
Fonte:Int J Gynaecol Obstet; 137(3):241-245, 2017 Jun.
ISSN:1879-3479
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: To investigate fetal-survival rates following laser surgery for twin-to-twin transfusion syndrome (TTTS) and the impact of Doppler analysis. METHODS: The present retrospective single-center study included data from patients with pregnancies exhibiting TTTS treated with fetoscopic laser surgery between January 1, 2007, and December 31, 2016. Perinatal outcomes were examined and variables were compared between the donor and recipient fetuses that survived and died, respectively. RESULTS: There were 86 pregnancies exhibiting TTTS treated with fetoscopic laser surgery included in the study. The median length of pregnancy at the time of surgery was 21.1 weeks. Both twin fetuses and at least one fetus survived in 61 (71%) and 73 (85%) pregnancies, respectively. Among recipient fetuses, ductus venosus a-wave anomalies (P=0.026), shorter cervical length (P=0.044), and a greater than 25% discrepancy in the estimated weight of the twin fetuses (P=0.045) were associated with reduced survival. CONCLUSION: Among pregnancies exhibiting TTTS, laser surgery was associated with significant dual-fetus survival. Preoperative ductus venosus anomalies were associated with lower survival among recipient fetuses, and 1-week postsurgical ultrasonography data demonstrated lower survival among recipient fetuses with persistent anomalous ductus venosus compared with normalized ductus venosus.
Tipo de publicação: JOURNAL ARTICLE


  7 / 1831 MEDLINE  
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PMID:28272225
Autor:Li Q; Wu XH; Zhang WS
Endereço:Department of Obstetrics and Gynecology, Xiang-Ya Hospital, Central South University, Hunan, Changsha, China.
Título:A new method for selective reduction in TRAP sequence with a contraindication to fetoscopic surgery: A case report.
Fonte:Medicine (Baltimore); 96(10):e6250, 2017 Mar.
ISSN:1536-5964
País de publicação:United States
Idioma:eng
Resumo:RATIONALE: The preferred method for multifetal pregnancy reduction (MFPR) is a transabdominal intrathoracic or intracranial injection of potassium chloride (KCl). However, in monochorionic multiple pregnancies (MMPs), especially in monoamnionic multifetal pregnancies, selective feticide by this method is often associated with miscarriage of the remaining fetuses. Selective fetal reduction in MMPs by blood flow ablation using radiofrequency ablation or fetoscopic laser surgery may improve survival of the remaining fetus. Although often successful, MFPR by these methods is contraindicated in cases of twin reversed arterial perfusion (TRAP) sequence in triplet pregnancies complicated by polyhydramnios or anterior placenta, as it is difficult to locate the ablation target. PATIENT CONCERNS: 2 cases were admitted to Xiangya Hospital, Central South University with triplet pregnancies at 23 or 21weeks of gestation. DIAGNOSES: Case 1 was a 29-year-old woman with a triplet pregnancy in 2 distinct amniotic sacs and 1 fetus with multiple malformations. Case 2 was a 32-year-old woman who was identified as a triplet pregnancy with TRAP sequence with an acardiac/acephalic twin and anterior placenta. INTERVENTIONS: Both of the 2 cases were underwent a new method for MFPR involving fine needle amniotic fluid aspiration and injection of hypertonic sodium chloride (10% NaCl) into the Wharton jelly of the umbilical cord. OUTCOMES: The 2 cases resulted in selective feticide and the birth of the remaining infants from the triplet pregnancies. All infants were healthy at birth and the 2-year follow-up. LESSONS: The new approach provided a safer, more accessible, and more cost-effective method for MFPR in MMPs with a contraindication to fetoscopic surgery compared to radiofrequency ablation and fetoscopic laser surgery.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  8 / 1831 MEDLINE  
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PMID:27914652
Autor:Nassr AA; Shamshirsaz AA; Belfort MA; Espinoza J
Endereço:Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Egypt. Electronic address: Ahmed.nassr@bcm.com.
Título:Spontaneous resolution of mirror syndrome following fetal interventions for fetal anemia as a consequence of twin to twin transfusion syndrome.
Fonte:Eur J Obstet Gynecol Reprod Biol; 208:110-111, 2017 Jan.
ISSN:1872-7654
País de publicação:Ireland
Idioma:eng
Tipo de publicação: CASE REPORTS; LETTER


  9 / 1831 MEDLINE  
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PMID:27903320
Autor:Waszak M; Cieslik K; Skrzypczak-Zielinska M; Szalata M; Wielgus K; Zakerska-Banaszak O; Breborowicz G; Slomski R
Endereço:Department of Functional Anatomy,University School of Physical Education,Poznan,Poland.
Título:Effects of Intrauterine Environment on the Magnitude of Differences Within the Pairs of Monozygotic and Dizygotic Twins.
Fonte:Twin Res Hum Genet; 20(1):72-83, 2017 Feb.
ISSN:1832-4274
País de publicação:England
Idioma:eng
Resumo:The aim of this study was to determine the effects of intrauterine environment on the magnitude of intrapair differences in six somatic traits of monozygotic (MZ) and dizygotic (DZ) twins (1,263 pairs; 424 MZ twins and 839 DZ twins). Differences in intrauterine environments of MZ twins enforced division of the research material into four groups: (1) MZ-MC-TTTS - MZ twins from monochorionic (MC) pregnancies with twin-to-twin transfusion syndrome (TTTS), (2) MZ-MC (without TTTS)-MZ twins from MC pregnancies without TTTS, (3) MZ-DC-MZ twins from dichorionic (DC) pregnancies, and (4) DZ-DZ twins. The intrapair differences in all analyzed somatic traits, especially body weight and circumference of the chest, were the largest in the case of MZ twins from MC pregnancies with TTTS. DZ twins were the group presenting with the second largest intrapair differences in the analyzed traits. At the end of pregnancy, that is, in lunar months 9 and 10, the magnitude of intrapair differences in all traits of twins from this group was significantly greater than in MZ twins from both MC and DC pregnancies. Irrespective of the analyzed period, the least evident, statistically insignificant intrapair differences in the studied traits were documented in the case of MZ twins from MC pregnancies without TTTS and twins from DC pregnancies. These findings imply that the differentiating effect of intrauterine environment is associated with the occurrence of TTTS, rather than with chorionicity, as postulated previously.
Tipo de publicação: JOURNAL ARTICLE


  10 / 1831 MEDLINE  
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PMID:27894704
Autor:Oepkes D; Sueters M
Endereço:Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: d.oepkes@lumc.nl.
Título:Antenatal fetal surveillance in multiple pregnancies.
Fonte:Best Pract Res Clin Obstet Gynaecol; 38:59-70, 2017 Jan.
ISSN:1532-1932
País de publicação:Netherlands
Idioma:eng
Resumo:Multiple pregnancies occur either spontaneously or because of assisted reproduction techniques in 1-3% of pregnancies. The presence of more than one fetus in the womb is associated with a range of possible complications, both for the mother and fetuses. Early detection of these complications followed by timely and appropriate management will reduce the risk of adverse outcomes. The techniques, skills, and experience for timely detection of complications and managing them appropriately require sufficient training and exposure. Therefore, referral of women pregnant with more than one fetus to specialized clinics is preferable. One of the most essential elements of appropriate management of multiple pregnancies is early determination of chorionicity. Monochorionic and monoamniotic multiple pregnancies require additional surveillance for a whole range of specific complications that are unique to this group. Ultrasound and Doppler are the most important tools in the management of multiple pregnancies. This chapter will summarize the current best practice, in particular the use of ultrasound and Doppler, in the antenatal management of multiple pregnancies.
Tipo de publicação: JOURNAL ARTICLE; REVIEW



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