Postnatal outcomes and prognosis of fetal intra-abdominal solid masses diagnosed by prenatal ultrasound / 中华围产医学杂志

Objective:To investigate the clinical outcomes and prognosis of children who were prenatally diagnosed with solid space-occupying abdominal lesions by ultrasound.Methods:This study retrospectively enrolled 30 children with solid space-occupying abdominal lesions that were indicated by prenatal ultrasound at Children's Hospital of Fudan University from March 2015 to March 2021. Prenatal ultrasound findings, postnatal treatment, clinical outcomes, and prognosis were analyzed.Results:These subjects included 18 male and 12 female infants, with the median gestational age at the first sonographic diagnosis of 36 weeks (28 to 39 weeks). The intra-abdominal solid masses were postnatally confirmed to be located in liver, retroperitoneum, and gastrointestinal tract, which were hepatic hemangioma ( n=14), hepatoblastoma ( n=2), neuroblastoma ( n=6), abdominal teratoma ( n=4), adrenal hematoma ( n=1), adrenocortical adenoma ( n=1), hyperplasia of renal capillary ( n=1), and gastrointestinal teratoma ( n=1). The accuracy of prenatal ultrasound in detecting the location of masses was 73% (22/30) and which was 13/16 in detecting masses from liver and 9/14 in that outside the liver. Among the 30 cases, 73% (22/30) were benign tumors, and 27% (8/30) were malignant tumors (hepatoblastoma in two cases and neuroblastoma in six cases). Among 15 patients with benign tumors (hepatic hemangioma and adrenal hematoma) who received close follow-up or drug therapy, tumor/lesion regression occurred in 13 cases and the other two were observed with stable hepatic hemangiomas. Fourteen patients, including six with neuroblastoma, two with hepatoblastoma, five with teratoma, one with adrenocortical adenoma, and one with hyperplasia of renal capillary, had good prognosis after primary tumor resection or combined with postoperative chemotherapy. One hepatoblastoma case died after withdrawing treatment. The overall survival rate was 97% (29/30) with a median follow-up time of 24 months (4 to 60 months). Conclusions:Prenatal ultrasound has high accuracy in identifying the anatomic region of fetal solid space-occupying abdominal lesions. With close postnatal follow-up and proper treatment, most of the affected fetuses will have a good outcome and prognosis.

Feasibility and safety of fetal intravascular transfusion via the intrahepatic vein in the treatment of fetal anemia / 中华妇产科杂志

Objective:To investigate the feasibility and safety of fetal intravascular transfusion via the intrahepatic vein in the treatment of fetal anemia.Methods:This was a retrospective analysis of all fetuses requiring intrauterine transfusion (IUT) in the Shanghai First Maternity and Infant Hospital between January 2010 and December 2019. According to the different ways of IUT, they were divided into intrahepatic venous transfusion group and umbilical venous transfusion group, fetal outcomes and the incidence of procedure-related complications between the two groups were compared.Results:A total of 97 IUTs were performed on 48 fetuses. Among them, 16 cases were performed in the intrahepatic vein (31 transfusions), 32 cases were performed in the cord of the umbilical vein (66 transfusions).There were no significant differences between the two groups in age, labor history and the proportion of fetal hydrops before the first transfusion. In the intrahepatic venous transfusion group, the posterior placenta was 14/16, which was significantly higher than 78% (25/32) in the umbilical venous transfusion group ( P<0.01). The live-birth rates of the two groups were 13/16 and 75% (24/32). There was no significant difference between the two groups ( P>0.05). Before intrahepatic venous transfusion, the proportion of fetal hydrops was significantly higher than that of umbilical venous transfusion [55% (17/31) vs 24% (16/66), P<0.05]. Puncture success rate of intrahepatic venous transfusion and umbilical venous transfusion were both 100%. In the umbilical venous transfasion group, the incidence of needle slippage (5%, 3/66) and the abnormality of fetal heart rate (11%, 7/66) were higher than those in the intrahepatic venous transfasion group [0 and 3% (1/31)], but there were no significant differences between the two groups (all P>0.05). There were no cases of fetal loss within 24 hours, premature rupture of membranes, infection within 7 days and emergency cesarean section after IUT in both groups. Conclusions:Fetal intravascular transfusion via the intrahepatic vein is safe and feasible in the treatment of fetal anemia. But the requirements of puncture technique are relatively high, so it is recommended to be carried out in experienced fetal treatment center.

First-trimester uterine artery Doppler pulsatility index for prediction of preeclampsia in twin pregnancies: a prospective cohort study / 中华围产医学杂志

Objective:To investigate the value of first-trimester uterine artery Doppler pulsatility index (PI) in the prediction of preeclampsia (PE) in twin pregnancies.Methods:From April 2014 to October 2016, women with twin pregnancies undergoing Down's screening at 11 +0-13 +6 gestational weeks in Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine were recruited in this prospective cohort study. Bilateral uterine artery PI values were measured by Doppler ultrasound at the first trimester. Pregnancy outcomes and the incidence of PE were followed up. The participants were classified into four groups according to their pregnancy outcomes: early-onset PE (<34 weeks), late-onset PE (≥34 weeks), gestational hypertension and normal groups. Differences in the multiples of median of uterine artery PI (PI MoM) and rates of abnormal PI MoM (≥ P90) were compared among the four groups using the Kruskal-Wallis test, Chi-square test or Fisher exact test. The performance of uterine artery PI in the prediction of PE was evaluated using receiver operating characteristic (ROC) curve. Results:A total of 1 223 twin pregnancies were recruited and 185 of them were excluded for not meeting the eligibility criteria. The 1 038 cases enrolled successfully were 231 monochorionic diamniotic (MCDA) and 807 dichorionic diamniotic (DCDA) twin pregnancies. The incidences of early-onset PE, late-onset PE and gestational hypertension were 3.47% (36/1 038), 7.03% (73/1 038) and 2.79% (29/1 038), respectively. No significant difference was observed in PI MoM [ M( P25~ P75), 1.06 (0.80-1.32), 1.05 (0.75-1.30), 0.99 (0.73-1.23), 1.03 (0.80-1.27); χ2=0.396, P=0.941] or the rates of abnormal PI MoM [8.33% (3/36), 6.85% (5/73), 13.79% (4/29), 10.11% (91/900); Fisher's exact test, P=0.703] among the four groups. Furthermore, there was no significant difference in PI MoM between normal MCDA and DCDA twin pregnancies [1.04 (0.81-1.29) vs 1.03 (0.79-1.27), χ2=0.095, P=0.758]. The area under the ROC curve showed that first-trimester uterine artery PI had limited value in the prediction of early-onset PE (0.514, 95% CI: 0.413-0.615), late-onset PE (0.499, 95% CI: 0.428-0.570) and gestational hypertension (0.530, 95% CI:0.418-0.643) in twin pregnancies. Conclusion:First-trimester uterine artery PI has limited value in predicting early- or late-onset PE in twin pregnancies.

Safety and efficacy of radiofrequency ablation for twin reversed arterial perfusion sequence / 中华围产医学杂志

Objective:To assess the safety and efficacy of radiofrequency ablation (RFA) in the treatment of twin reversed arterial perfusion (TRAP) sequence.Methods:This was a retrospective study of all TRAP sequence cases treated by RFA in Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, between January 1, 2012, and December 31, 2018. Perioperative complications, short- and long-term perinatal outcomes, and maternal complications were analyzed by analysis of variance, Kruskal-Wallis test, Chi-square test, or Fisher's exact test. Results:(1) This study recruited 59 pregnant women with an average age of (28.4±4.0) years. The mean gestational age at TRAP sequence diagnosis was (17.0±4.1) weeks, and 23 (39.0%) were diagnosed before 16 weeks. (2) The 59 cases consisted of 45 (76.2%) monochorionic diamniotic (MCDC) twins, five (8.5%) monochorionic monoamniotic (MCMA) twins, four (6.8%) monochorionic triamniotic (MCTA) triplets and five (8.5%) dichorionic triamniotic (DCTA) triplets. Fifty-four cases (91.5%) were acardius acephalus, four (6.8%) were acardius anceps, and one (1.7%) was acardius amorphous. (3) Preterm premature rupture of membranes (PPROM) was a leading complication following RFA with an overall incidence of 25.4% (15/59). PPROM before 28 and at 28-34 gestational weeks occurred in seven (11.9%) and five (8.5%) cases, respectively, leading to fetal loss in six cases. The cumulative incidence of PPROM within one week, two weeks, and one month after RFA was 5.1% (3/59), 6.8% (4/59) and 10.2% (6/59), respectively. No chorioamnionitis, blood transfusion due to hemorrhage, placental abruption, sepsis, bowel perforation, or other maternal complications were reported during or after the procedure. (4) No abnormalities of the nervous system were found in any fetus on postoperative MRI during pregnancy. The mean interval from treatment to delivery was (14.9±7.1) weeks. Twelve pump twins (20.3%) were lost after RFA, while the other 47 (79.7%) were delivered and survived until 28 days after birth, including 18 premature infants and 29 full-term infants. Eight premature infants were admitted to the neonatal intensive care unit (NICU). Intraventricular hemorrhage, neonatal respiratory distress syndrome (NRDS), and NRDS complicated by necrotizing enterocolitis occurred in three different babies who recovered after appropriate treatment. (5) Of the 59 patients, 56 (94.9%) received intrauterine interventions after 16 gestational weeks, and the survival rate of the pump twins was 78.6% (44/56). Three patients (5.1%) received intrauterine interventions before 16 weeks of gestation with all pump twins survived. (6) Of the 45 MCDA twins, 37 (82.2%) survived and were born at a mean gestational age of 38.0 (26.5-41.0) weeks. Three out of the five MCMA twins survived with the median gestational age at birth of 33.5 (32.0-37.0) weeks. Of the nine triplets, seven survived and delivered at the median gestational age of 37.1 (29.2-40.0) weeks. (7) The needle pierced through the placenta during RFA in 23 (39.0%) cases, but not in the rest 36 (61.0%) cases. After excluding four cases opting for pregnancy termination, statistical analysis showed no significant difference in the incidence of PPROM or intrauterine death, or the 28-day survival rate of the pump twins when comparing those cases with the needle going or not going through the placenta. (8) At the final follow-up (December 2019), 47 surviving pump infants were growing normally without any severe neurological sequelae.Conclusions:RFA appears to be a relatively safe and reliable technique in the treatment of TRAP sequence to improve the perinatal outcomes of pump twins.

Prenatal diagnosis of fetal 1p32p31 microdeletion syndrome: a case report / 中华围产医学杂志

We hereby reported a fetus with abnormal head shape, ventricular septal defect, gallbladder enlargement, low-set ears and local umbilical cord glial edema at 22 and 25 weeks of gestation ultrasound scan. A 15.318 Mb heterozygous microdeletion on chromosome 1p32.1p31.1, arr[GRCh37]1p32.1p31.1(61,279,239-76,597,189)×1, was indentified by chromosomal microarray analysis. The chromosome karyotype of the fetus was 46,XY,del(1)(p32.1p31.1). Therefore, this case was diagnosed as 1p32p31 microdeletion syndrome and proved to be a de novo variation based on routine G-banding analysis and chromosomal microarray analysis of the normal parents. This syndrome might present with abnormalities in the head shape, kidney, bladder and central nervous system. The couple decided to terminate the pregnancy after genetic counseling concerning the possible poor outcomes of the fetus.

Prenatal diagnosis for a pedigree affected with Wolf-Hirschhorn syndrome due to a subtle chromosomal translocation / 中华医学遗传学杂志

OBJECTIVE@#To make molecular diagnosis of an infant affected with severe developmental delay and multiple birth defects, assisting prenatal diagnosis for the second pregnancy.@*METHODS@#Standard G-banded karyotyping was performed for the fetus and his parents. Single nucleotide polymorphism array (SNP array) was used to detect submicroscopic chromosomal aberration. Fluorescence in situ hybridization (FISH) was employed to determine the parental origin of the aberration.@*RESULTS@#Both the proband and the fetus harbored a 5.4 Mb distal 4p deletion and a 6.9 Mb distal 6q duplication. FISH confirmed that the mother has carried a balanced translocation involving 4p and 6q.@*CONCLUSION@#The unbalanced chromosomal aberration in the proband and the fetus were both derived from the mother. Both patients showed a Wolf-Hirschhorn syndrom phenotype and partial phenotype of 6q trisomy. SNP array combined with FISH are essential for the detection of cryptic chromosomal aberrations which may be missed by coventional karyotyping analysis.

Perinatal outcomes of thoraco-amniotic shunting for severe primary fetal hydrothorax / 中华妇产科杂志

Objective To evaluate the safety and perinatal outcomes of thoracoamniotic shunting in the treatment of fetuses with severe primary hydrothorax. Methods 22 cases of suspected severe primary fetal hydrothorax which underwent thoraco-amniotic shunting in Shanghai First Maternity and Infant Hospital,Fetal Medicine Unit and Prenatal Diagnosis Center from January 2012 to December 2017 were analyzed retrospectively. Hydrothorax associated with structural or chromosomal abnormalities, infections and immune fetal hydrops were excluded. Results Totally ,28 shunts were placed in 22 fetuses. The median gestational age at TAS was 31.3 weeks. Preterm membrane rupture within 7 days after the procedure occurred in 9.1％(2/22) cases. Catheter displacement occurred in 18％(4/22) cases. The interval from shunting to delivery was 26.0 days. One fetus ended in induced abortion; 21(95％,21/22) babies were born alive, and their median gestational age at delivery was 34.4 weeks. 62％(13/21)newborns required ventilator supports; 4 neonatal deaths were attributed to pulmonary hypoplasia. The overall perinatal survival rate was 81％(17/21). The perinatal survival rate with hydrops and without hydrops were 10/13 and 7/8 respectively. Conclusion Thoraco-amniotic shunting is a safe procedure for intrauterine therapy and could improve the perinatal outcomes of severe primary fetal hydrothorax.

Prenatal diagnosis of three cases of fetal skeletal dysplasia resulting from loss of heterozigosity of short stature homeobox gene / 中华围产医学杂志

Objective To analyze the genotype-phenotype correlation in fetal skeletal dysplasia,and to investigate the methods of prenatal diagnosis and genetic counseling.Methods From May 2016 to November 2017,three gravidas whose fetuses were diagnosed with short stature homeobox (SHOX) gene deficiency were recruited from those receiving invasive prenatal diagnosis and single nucleotide polymorphismarray (SNP-array) due to fetal structural abnormalities detected by prenatal ultrasound scan in Shanghai First Maternity and Infant Hospital,Tongji University School of Medicine.Fetus 1 and 3 were singleton pregnancies and fetus 2 was twin pregnancy.Amniotic fluid cells were isolated and analyzed by karyotyping and SNP-array.Peripheral blood samples were collected from their parents and also analyzed by SNP-array.Results All three fetuses were diagnosed with fetal skeletal dysplasia based on second trimester ultrasound findings showing the lengths of femora,humeri,tibiae,fibulae,ulnae and radii length below the 5th percentile of corresponding gestational age.Karyotypes of the three fetuses were normal.SNP-array examination showed that each case had 1 to 2.5 Mb deletion in the pseudoautosomal region of the short arms of sex chromosomes,including SHOX gene.Their skeletal dysplasia were all caused by SHOX haploinsufficiency.Microdeletions of fetus 1 and 3 were inherited from their mothers,while that of fetus 2 was inherited from the father.After genetic counseling,two singleton gravidas decided to terminate their pregnancies and the twin pregnant one underwent selective reduction.Conclusion Prenatal ultrasound,in combination with SNP-array,offers fast and efficient detection of fetal skeletal dysplasia due to SHOX gene deficiency.

Sex chromosome aneuploidy screened by non-invasive prenatal testing from 35827 singletons: prenatal diagnosis and pregnancy determinations / 中华围产医学杂志

Objective To assess the positive predictive value (PPV) of fetal sex chromosome aneuploidy (SCA) identified by non-invasive prenatal testing (NIPT) and investigate families' acceptance of SCA fetus. Methods All suspected SCA cases screened by NIPT from singletons were reviewed in Prenatal Diagnosis Center of Shanghai First Maternity and Infant Hospital from April 1, 2015 to October 31, 2017. Maternal age, NIPT indications, prenatal diagnosis protocols, testing results and their pregnancy determinations were analyzed. Results NIPT was provided to 35827 singletons and 86 suspected SCA cases were identified out of 35823 successful ones, giving a positive detection rate of 0.24％. The average maternal age was (31.5±5.0) years. After genetic counseling, 20 patients declined prenatal diagnosis,the rest 66 cases proceeded with aminiocentesis and fetal chromosomal testing, of which 32 were cytogenetically diagnosed as SCA with the PPV of 48.5％ . The SCA fetus consisted of 25 sex chromosome trisomies (seven cases of 47,XXX, three cases of 47,XYY and 15 cases of 47,XXY), one monosomy X (45,X), three mosacisms (47,XXY/48,XXYY, 47,XXX/45,X, 45,X/46,XX, one for each) and three microdeletions/microduplications. Besides, two false positive NIPT cases were proved to be low level of maternal mosacism (45,X/46,XX, 5％ and 10％ for each). After genetic counseling, 17 out of 20 who declined prenatal diagnosis and 9 out of 32 who diagnosed fetal SCAs continued their pregnancies, with a combined proportion of continued pregnancy of 50％. Thirty-four pregnancies were also continued after exclusion of SCA. Interestingly, the proportion of continued pregnancy among those sex chromosomal trisomy fetuses was only 32％(8/25). Conclusions As a safe and rapid prenatal testing for common autosomal aneuploidies, NIPT could also identify some types of SCA, but with relatively low PPV. More long-term researches are required to determine its sensitivity and specificity. For some types of SCA with mild phenotypes, some family would continue the pregnancy. Therefore, limitations of NIPT should be appropriately explained during both pre- and post-testing counseling.

Clinical outcomes of non-immune hydrops fetalis in the era of intrauterine intervention: a single centered retrospective analysis / 中华围产医学杂志

Objective To investigate the pregnancy outcomes of non-immune hydrops fetalis (NIHF) in the era of intrauterine intervention. Methods We reviewed the medical records of 149 patients who were referred for NIHF and delivered at Fetal Medicine Unit, Shanghai First Maternity and Infant Hospital between March 2012 and March 2017. After systematic evaluation and consultation, 102 cases chose to terminate their pregnancies, 47 cases (31.5％) chose to continue their pregnancies, among which two cases were lost to follow-up. The rest 45 cases were divided into two groups according to whether they received intrauterine interventions or not, the intrauterine intervention group (n=18) and the control group (n=27), and the clinical characteristics and pregnancy outcomes were compared. Independent samples t-test or Kruskal-Wallis test, Chi-square test or Fisher exact test were applied for statistical analysis. Results The mean gestational age of the intervention group at diagnosis of NIHF was lower than that of the control group [26.5(23.4-30.0) weeks vs 30.3(29.0-32.0) weeks, χ2=7.427, P=0.006]. Compared with the control group, the intrauterine fetal death rate was slightly lower [25.9％(7/27) vs 1/18], the neonatal survival rate was slightly higher [37.0％(10/27) vs 11/18] in the intrauterine intervention group, although no statistically significance was observed (Fisher exact, P>0.05). In the intrauterine intervention group, the incidence of low Apgar score (<4) at both 1 and 5 min was 1/17 and 0/17, respectively, which was much lower than those of the control group [45％(9/20) and 35％(7/20), Fisher exact, both P<0.05]. Conclusions After overall prenatal evaluation, appropriate intrauterine interventions may improve the pregnancy outcomes in NIHF.

Establishment of a new integrative mode of prenatal diagnosis and counseling for fetal cardiac anomalies and its efficiency / 中华围产医学杂志

Objective To explore a new mode of prenatal diagnosis and counseling for congenital heart disease (CHD) by interdisciplinary cooperation and the value of Grading scale of fetal echocardiography in disease management.Methods The Grading scale of fetal echocardiography and a new integrative service mode of prenatal diagnosis and counseling for CHD with multidisciplinary team,including obstetric sonographers,obstetricians,pediatric cardiologists and geneticists,was established.For pregnant women referred to prenatal clinic in Shanghai First Maternity and Infant Hospital from January 1,2011 to December 31,2012,counseling about the diagnosis,severity,treatment options and long-term prognosis would be provided based on detailed fetal echocardiography and the grading scales.The significance of such mode in the prenatal management of CHD was analyzed and the rate of pregnancy termination was compared by Fisher exact test.Result According to the Grading scale of fetal echocardiography,there were four categories:Class Ⅰ,minor anomalies probably without treatment requried; Class Ⅱ,simple defects with normal life quality following after-born therapy; Class Ⅲ,complex anomalies with reasonable life quality after treatment; Class Ⅳ,severe malformation requiring multiple stage surgical repair or with very poor prognosis.There were a total of 54 pregnancies confirmed to have fetal cardiac anomalies by echocardiography,among which 27 were terminated.The average age of pregnant women was (29±3) years old,the average gestational week was 28.0±3.8.The abortion rate in women with the fetuses diagnosed as Class Ⅳ CHD was 17/19,higher than that in Class Ⅰ,Ⅱ and Ⅲ (3/15,3/10 and 4/10,Fisher exact test,all P＜0.01).In 19 Class Ⅳ cases,only two twin pregnant women continued their pregnancies because the other fetuses were healthy.Abortion was conducted in all 7 fetuses associated with extra-cardiac,chromosome anomaly or genetic syndrome.Conclusion The establishment of new integrated mode of prenatal diagnosis and counseling for CHD and Grading scale of fetal echocardiography in a multidisciplinary manner could provide comprehensive and authentic information and ethical advices for the families.

Monochorionic monoamniotic twin pregnancy: a review of 17 cases / 中华围产医学杂志

Objective To review the diagnosis,monitoring,management and perinatal outcomes of monochorionic monoamniotic (MCMA) twin pregnancy.Methods From July 2010 to August 2013,there were 17 MCMA twin pregnancies diagnosed and delivered in Shanghai First Maternity and Infant Hospital.According to the MCMA management protocol,induced abortion,elective fetal reduction,and anticipant pregnancy were optional.For those anticipant pregnancies,fetal lung underwent maturation promotion at gestational weeks 28; hospitalization with 40 min/day continual fetal electronic monitoring and umbilical blood monitoring twice weekly at gestational weeks 28-30; 40 min continual fetal electronic monitoring twice daily and umbilical blood monitoring once every other day at gestational weeks 30-32; and 40 min continual fetal electronic monitoring three times daily and umbilical blood monitoring once daily at gestational weeks 32-34; and pregnancy ended on time.The presence of umbilical cord entanglement,congenital malformation,intrauterine fetal death,complications exclusive to monochorionic twins (e.g.selective fetal growth restriction,twin reversed arterial perfusion sequence and twin-twin transfusion syndrome) and the perinatal outcomes were retrospectively analyzed.Results Average maternal age of women with 17 MCMA twins was (29.0±2.7) years,and all were primiparas.They were diagnosed at (18.6± 5.5) weeks on average (11 +5-28+1 weeks).Umbilical cord entanglements were detected in all cases by ultrasonography and confirmed postnatally.There were three cases of complications specific to monochorionic twins,including two with selective fetal growth restriction and one with twin reversed arterial perfusion sequence.There were seven women with fetal congenital malformation; four of whom chose induced abortion; one case of anencephaly chose radiofrequency ablation fetal reduction,and the remaining two cases with congenital malformation and ten cases without chose anticipant pregnancy,and there were no abnormal ultrasonography signs during pregnancy.Among these 12 cases,intrauterine fetal death of both fetuses occurred in two cases at 16 and 21+1 weeks gestation and they were aborted.Intrauterine fetal death of a single fetus occurred in one case at 30+2 weeks gestation (another fetus was delivered by emergency cesarean section).There were a total of eleven live births delivered by cesarean section (four by emergency cesarean section) at a median gestational age of (32.7± 1.6) weeks.There were 20 live neonates with a mean birth weight of (1 850±496) g.Sixteen neonates were transferred to the neonatal intensive care unit and hospitalized for (37.9± 16.4) days.Nine neonates suffered from respiratory distress syndrome but were eventually cured.Conclusions MCMA twin pregnancy has high morbidity and mortality.Early ultrasonography helps to clarify the diagnosis and enhance the monitoring,thus improving the perinatal outcomes.

Perinatal outcomes following selective feticide by radiofrequency ablation in complex monochorionic ;pregnancies / 中华围产医学杂志

To assess the perinatal outcomes following selective feticide through radiofrequency ablation (RFA) in complex monochorionic pregnancies. Methods In this retrospective observational study, 34 cases of complex monochorionic pregnancies treated with RFA for selective feticide and delivered at the Shanghai First Maternity and Infant Hospital between January 1, 2012 and December 31, 2013, were included. Gestational age at RFA, the number of RFA cycles, maternal and fetal complications, gestational age at delivery, neonatal outcomes at 28 days after birth and neonatal development after birth were recorded. Fetal survival rate were defined as the number of survivors at 28 days after birth divided by the number of remaining fetuses after RFA. Factors affecting fetal survival rate were also analyzed. Statistical analysis was performed using Fisher's exact test. Results (1) The process for RFA:The gestatinal age for the procedure was (20.7±3.1) weeks(16+1-27+6 weeks). The successful rate of procedures was 100%(34/34) and the cycle number for RFA was 1-6 times. (2)Fetal complications and survival rate of remaining fetuses after RFA:there were six pregnant women suffering from premature rupture of membrane (PROM) before 28 weeks. Among those women, one had miscarriaged at 25 weeks, one chose to terminate at 26 weeks and the remaining four chose to continue the pregnancy. There were three remaining fetuses developing fetal severe anemia with hydrops after RFA. Two of them had fetal demises 2 days after the procedures and one chose to have termination. Another two cases with discordant fetal anomalies had fetal demises with unknown reasons one day after RFA. There were 27 remaining fetuses after RFA who survived until 28 days after birth. The mean gestational age at delivery was(36.4±4.1)weeks (26+4-40 weeks) and the mean birth weight was (2 913± 978) g (1 080-4 600 g). The overall fetal survival rate 28 days after birth was 79%(27/34). There were no abnormal findings in antenatal magnetic resonance imaging (MRI) four weeks after the procedure and no abnormal development of nervous system in the surviving neonates between 3 months old and 1.5 years old. (3) Factors affecting fetal survival rate :There were no significant differences identified in the rate of fetal severe anemia and fetal demise (2/15, 2/13 and 1/6), the rate of PROM before 28 weeks (1/15, 4/13 and 1/6) and survival rate of 28 days after birth (13/15, 10/13 and 4/6)among three groups with different gestational age (16+1-, 20- and 24-27+6 weeks) for RFA(all P>0.05). The indications for RFA included severe selective intrauterine growth restriction (50%, 17/34), discordant for fetal abnormalities(24%, 8/34) , twin reversed arterial perfusion sequence(18%, 6/34)and dichorionic or monochorionic triamniotic pregnancy (9%, 3/34). There were also no significant differences noted in the rate of fetal complications and fetal demise(3/17, 2/8, 0/6, 0/3), the rate of PROM before 28 weeks (3/17, 0/8, 2/6, 1/3)and survival rate of 28 days after birth among different groups (12/17, 6/8, 6/6, 3/3) with different indications for RFA(all P>0.05) . No significant differences observed in the rate of fetal complications and fetal demise(10% and 2/5)and the rate of PROM before 28 weeks (17%and 2/5)between two groups with different cycle numbers for RFA (<3 times and≥3 times, all P<0.05), while the group with cycle number ≥ 3 times had lower survival rate 28 days after birth than the group with cycle number<3 times for RFA (2/5 vs 86%, P<0.05). Conclusions RFA is one of effective and safe procedures for selective feticide in complex monochorionic pregnancies.

Placental characteristics in uncomplicated monochorionic diamniotic twin pregnancies / 中华围产医学杂志

Objective To investigate the association between placental sharing,vascular anastomoses,cord insertion and perinatal outcome in uncomplicated monochorionic diamniotic (MCDA) placentas.Methods Between January 1,2012 and July 31,2013,60 uncomplicated (seclective fetal growth restriction,twin anemia-polycythemia sequence and twin-twin transfusion dyndrome) MCDA placentas were studied.These uncomplicated MCDA placentas were divided into the placenta equally shared group with placental territory discordance (PTD) ＜0.25 and the placenta unequally shared group with PTD ≥ 0.25.Angioarchitecture,cord insertion type and the distance between two cord insertions were compared using the Chi-square test and nonparametric test.Results Mean maternal age was (30.3±4.1) years.There were 39 cases (65％) in the placenta equally shared group and 21 (35％) in the placenta unequally shared group.Vascular anastomoses were observed in all placentas,arterioarterial anastomoses in 58 placentas (97％),and venovenous anastomoses in 17 placentas (28％).The overall diameter and the maximum diameter of arterioarterial anastomoses in the placenta equally shared group were (0.19±0.11) cm and (0.18±0.09) cm,respectively,and were lower than those in the placenta unequally shared group [(0.27±0.11) cm and (0.27±0.12) cm,respectively] (T were-2.39 and-2.94,P＜0.05,respectively).No significant differences in the number,the overall diameter and the maximum diameter of venovenous anastomoses were observed between the two groups (all P＞0.05).The incidence of cord velamentous insertion and cord velamentous insertion plus cord marginal insertion were 14％ (11/78) and 42％ (33/78),respectively,in the placenta equally shared group,and were similar to those in the placenta unequally shared group [14％ (6/42) and 33％ (14/42),x2 were 1.00 and 0.43,P＞0.05,respectively].The mean distance between two cord insertions was shorter in the placenta unequally shared group than in the placenta equally shared group [(14.3±6.3) cm vs (18.2±6.0) cm,T=2.37,P＜0.05].Conclusions In cases with unequally shared placenta,the distance between two cord insertions is shorter and the diameter of arterioarterial anastomoses is larger,which may compensate for their unequal placental territories,leading to no complications in these MCDA twin.