ABSTRACT
OBJECTIVE: Fetoscopic laser photocoagulation of vascular anastomoses (FLP) is the essential choice in twin-twin transfusion syndrome (TTTS). We proposed that the modified sequential selective laser photocoagulation of communicating vessels (modified SQLPCV) to clarify the perinatal outcomes in TTTS. METHODS: The modified SQLPCV was designed with the following order: 1, artery-to-artery anastomoses; 2, venous-to-venous anastomoses; 3, artery-to-venous anastomoses from donor to recipient; and 4, artery-to-venous anastomoses from recipient to donor. The perinatal outcomes were present in TTTS patients who underwent the modified SQLPCV. RESULTS: A total of 203 women underwent modified SQLPCV. The mean pregnancy prolongation period was 83 days, and the mean gestational age at delivery was 33 weeks (range 23-40 weeks). There was a significantly lower rate of recipient fetal demise than donor fetal demise (4% vs. 13%; p < .01). The survival rate of zero and one were respectively 6% (13/203) and 19% (39/203). Two survivors were seen in 74% (151/203), and at least one survivor in 94% (190/203). Univariate and multivariate analysis showed that abnormal fetal Doppler measurements in donor were correlated with donor demise after surgery. CONCLUSIONS: The modified SQLPCV represents satisfactory outcomes for fetuses complicating with TTTS.
Subject(s)
Fetofetal Transfusion/embryology , Fetofetal Transfusion/surgery , Laser Coagulation/methods , Adult , Female , Fetal Death , Fetofetal Transfusion/mortality , Gestational Age , Humans , Pregnancy , Pregnancy Outcome , Risk Factors , Treatment Outcome , Ultrasonography, PrenatalSubject(s)
Fetofetal Transfusion/therapy , Pregnancy, Twin , Twins, Monozygotic , Female , Fetofetal Transfusion/diagnostic imaging , Humans , Infant, Extremely Low Birth Weight , Infant, Newborn , Infant, Premature , Oligohydramnios/diagnostic imaging , Placenta/pathology , Polyhydramnios/diagnostic imaging , Polyhydramnios/surgery , Pregnancy , Pregnancy Trimester, First , Ultrasonography, PrenatalABSTRACT
AIM: Cerebellar hypoplasia, particularly, trisomy 18, represents a chromosomal abnormality. However, morphological assessment of the fetal cerebellum is yet to be established. The purpose of this study was to produce reference values for the fetal transverse cerebellar diameter (TCD), anteroposterior cerebellar diameter (APCD) and the ratio of APCD to TCD (APCD/TCD ratio) in normal fetuses, compared with cases of trisomy 18. METHODS: This retrospective study included 266 normal singleton pregnancies resulting in term delivery at our institution from 2012-2013. Patients had received ultrasound examinations in the second trimester. TCD and APCD measurements were performed and then APCD/TCD ratio was calculated. Consequently, three cases of trisomy 18 were compared with reference values. RESULTS: Gestational age correlated with TCD (rs = 0.766, P < 0.0001) and APCD (rs = 0.61, P < 0.0001), but not with APCD/TCD ratio (rs = 0.070, P = 0.252). The median APCD/TCD ratio was 0.52 and the standard deviation was 0.05. In cases of trisomy 18, all TCD measurements were located within normal ranges. In contrast, both the APCD and APCD/ TCD ratio displayed lower values than that of normal fetuses. CONCLUSIONS: This study showed that not only TCD but also APCD correlated with gestational age, and APCD/TCD ratio indicated a fixed value (almost 0.5) in normal fetuses. Furthermore, APCD and APCD/TCD ratio were deemed useful indicators for cerebellar hypoplasia. In particular, the APCD/TCD ratio proved more convenient, without requiring individual evaluation of TCD and APCD.
