Placental laser surgery for severe previable feto-fetal transfusion syndrome in triplet gestation.

Information on feto-fetal transfusion syndrome (FFTS) in higher-order multifetal gestation is limited. We report outcomes of 10 triplet pregnancies treated by fetoscopic laser occlusion of the chorioangiopagous vessels (FLOC). The study period was August 1992 to August 2008. Inclusion criteria were gestational age < or =25 weeks and ultrasound confirmation of monochorionicity in at least one twin set and FFTS. Treatment included FLOC, exit amnioreduction, and cerclage when indicated. Hospital records, placental pathology, neonatal course, and long term follow-up of the mother and infants were reviewed. There were eight triamnionic dichorionic and two triamnionic monochorionic triplets. Mean maternal age was 29.8 years, and five conceived following in vitro fertilization. FFTS stage at treatment was > or =II in all cases, at a mean gestational age 20.9 +/- 2.2 weeks. Two patients required immediate rescue cerclage, and all 10 had hypoproteinemia and anemia. Mean age at delivery was 31.2 +/- 3.4 weeks, with a mean birth weight 1568.4 +/- 498 g for the live-born fetuses. Twenty-three (77%) fetuses survived, with at least one fetus surviving in 9 (90%) cases. Cerebral ultrasound imaging and neurological examination were normal in all neonates, and clinical follow-up has remained normal at 67.5 +/- 56 months for the group. FLOC is feasible in dichorionic and monochorionic triplet pregnancy complicated by FFTS. Outcomes are comparable to our experience with twins, namely improved perinatal survival and neonatal morbidity when compared with alternative treatments.

Antenatal fetal surveillance in pregnancies complicated by fetal gastroschisis.

OBJECTIVE: The purpose of this study was to determine if antenatal fetal surveillance should be considered in pregnancies complicated by fetal gastroschisis, and if so, what gestational age should testing begin. STUDY DESIGN: During an 18-year period, all pregnancies delivered of a newborn that had gastroschisis were identified. Numerous data parameters were collected, including gestational age at delivery, birthweight, indication for delivery, antenatal testing results if performed, and neonatal outcome. Fetal compromise was defined as stillbirth or moderate to severe arterial cord blood gas acidosis at the time of delivery (pH < 7.10). RESULTS: During the study period, 84 pregnancies complicated by fetal gastroschisis were delivered from 117,564 gestations. Antenatal testing was performed in 58 cases (69%). Of the 26 (31%) without antenatal testing, 17 had an antenatal diagnosis of gastroschisis and in 9, the diagnosis was made on the day of delivery. In the 17 with an antenatal diagnosis, there were 2 stillbirths (29(4/7) and 31(3/7) weeks' gestation) and 1 was delivered with a moderate to severe arterial cord blood gas acidosis at 29(5/7) weeks' gestation. An additional case of moderate to severe arterial cord blood gas acidosis occurred in the 9 cases where the diagnosis was made on the day of delivery. Of the 58 pregnancies with antenatal surveillance, there were no stillbirths and no cases with a moderate to severe arterial cord blood gas acidosis. Of these 58 cases, 22 (38%) were delivered based on an abnormal testing result. Of the 84 total cases, 32 (38%) had birthweights < 10th percentile, and of these, 16 (19%) had birthweights < 3rd percentile. CONCLUSION: Based on these data, antenatal fetal surveillance may be warranted in pregnancies complicated by fetal gastroschisis beginning at a gestational age of 28 to 29 weeks. Fetal testing between the thresholds of viability up to 28 weeks' gestation would be controversial.

The effect of a prolonged time interval between antenatal corticosteroid administration and delivery on outcomes in preterm neonates: a cohort study.

OBJECTIVE: This study was undertaken to determine whether the neonatal benefit of a single complete course of antenatal corticosteroids diminishes when delivery is remote from administration (> 14 days). STUDY DESIGN: This retrospective 2 center cohort trial included women who received a single complete course of antenatal corticosteroids and delivered a viable singleton infant between 26 and 34 weeks of gestation. Patients were divided into 1 of 2 groups on the basis of the interval from first corticosteroid dose to delivery (2-14 days and > 14 days). Neonatal outcomes among treatment groups were stratified by gestational age at delivery (< 28 weeks, > or = 28 weeks). Regression models were used to control for potential confounders. RESULTS: Three hundred fifty-seven pregnancies were included, of which 98 women delivered at > 14 days after antenatal corticosteroids. Neonates at > or = 28 weeks of gestation and who delivered at > 14 days after antenatal corticosteroids were more likely to require surfactant therapy (60% vs 48%; p = .02) and to require ventilatory support for > 24 hours (58% vs 46%; P = .02). Differences in outcomes between groups remained in regression models that were controlled for confounders. There was no significant difference between treatment groups for neonates who delivered at < 28 weeks of gestation. Rates of survival without chronic lung disease and intraventricular hemorrhage were similar between groups. CONCLUSION: A time interval of > 14 days between the administration of antenatal corticosteroids and delivery is associated with an increased risk for ventilatory support and surfactant use in neonates who deliver at > 28 weeks of gestation.

Anterior lingual thyroglossal cyst: antenatal diagnosis, management, and long-term outcome.

OBJECTIVE: To describe the long-term outcome of a large anterior lingual thyroglossal duct cyst, diagnosed antenatally by ultrasound that completely obstructed the oral cavity and had almost completely replaced the anterior two-thirds lingual musculature. METHODS: Longitudinal observation. RESULTS: Anticipated airway obstruction at birth did not occur. Complete cyst removal occurred at day 2 of life with a rim of lingual muscle observed present only on the left side. Complete and safe oral feeding was achieved by day 11 of life. Progressive muscle mass development and function with mild asymmetry was observed during sequential assessments. Vigorous speech therapy was started at age 7 months achieved 80-100% intelligible speech with minimal misarticulations at age 33 months. CONCLUSION: This case demonstrates the remarkable compensatory ability of the tongue to achieve almost normal function with minimal anterior musculature that is critical to deglutition and articulation. Early speech therapy appears key to improving functional outcomes of speech. A strong central nervous system basis for suckle development is suggested by the rapid development of a safe and effective suckle and swallow soon after cyst resection and in spite of in utero tongue fixation.