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OBJECTIVE: Monochorionic (MC) triplet pregnancies are extremely rare and information on these pregnancies and their complications is limited. We aimed to investigate the risk of early and late pregnancy complications, perinatal outcome and the timing and methods of fetal intervention in these pregnancies. METHODS: This was a multicenter retrospective cohort study of MC triamniotic (TA) triplet pregnancies managed in 21 participating centers around the world from 2007 onwards. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anomalies, twin-to-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of live birth, intrauterine demise, neonatal death, perinatal death and termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention. RESULTS: Of an initial cohort of 174 MCTA triplet pregnancies, 11 underwent early TOP, three had an early miscarriage, six were lost to follow-up and one was ongoing at the time of writing. Thus, the study cohort included 153 pregnancies, of which the majority (92.8%) were managed expectantly. The incidence of pregnancy affected by one or more fetal structural abnormality was 13.7% (21/153) and that of TRAP sequence was 5.2% (8/153). The most common antenatal complication related to chorionicity was TTTS, which affected just over one quarter (27.6%; 42/152, after removing a pregnancy with TOP < 24 weeks for fetal anomalies) of the pregnancies, followed by sFGR (16.4%; 25/152), while TAPS (spontaneous or post TTTS with or without laser treatment) occurred in only 4.6% (7/152) of pregnancies. No monochorionicity-related antenatal complication was recorded in 49.3% (75/152) of pregnancies. Survival was apparently associated largely with the development of these complications: there was at least one survivor beyond the neonatal period in 85.1% (57/67) of pregnancies without antenatal complications, in 100% (25/25) of those complicated by sFGR and in 47.6% (20/42) of those complicated by TTTS. The overall rate of preterm birth prior to 28 weeks was 14.5% (18/124) and that prior to 32 weeks' gestation was 49.2% (61/124). CONCLUSION: Monochorionicity-related complications, which can impact adversely perinatal outcome, occur in almost half of MCTA triplet pregnancies, creating a challenge with regard to counseling, surveillance and management. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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AIM OF THE STUDY: In this study, antibacterial and antibiofilm potential of sulphated polysaccharides (SPs) extracted from Chlamydomonas reinhardtii (Cr) was evaluated against Neisseria mucosa, Escherichia coli, Streptococcus sp. and Bacillus subtilis. METHODS AND RESULTS: Antibacterial potential of Cr-SPs was evaluated by agar-cup diffusion, time-kill and colony-forming ability (CFU), minimum inhibitory and bactericidal concentration assays. Antibiofilm potential was evaluated by biofilm inhibition, eradication, extracellular-DNA, metabolic activity and microscopy assays. Cr-SPs at 0·5 mg ml-1 showed 34·52, 48·6, 66·1 and 55·6% reduced CFU in B. subtilis, Streptococcus, N. mucosa and E. coli respectively. Minimum inhibitory concentration of Cr-SPs was as low as 480 µg ml-1 for Streptococcus, N. mucosa and 420 µg ml-1 for B. subtilis and E. coli. At 1 mg ml-1 , Cr-SPs showed 50% biofilm inhibition, whereas 4-8 mg ml-1 showed 100% inhibition. Cr-SPs also effectively dissolved preformed biofilms. Dose-dependent reduction in extracellular DNA revealed that Cr-SPs interacts with the extra polymeric substance of the biofilm and destroys them. Light microscopy reconfirmed the above results. CONCLUSION: Cr-SPs not only inhibited biofilm formation but also effectively dissolved preformed-biofilms. SIGNIFICANCE AND IMPACT OF THE STUDY: The current study showed the promising potential of Cr-SPs as antibiofilm agents. Further validation will help in developing Cr-SPs as natural antibiotics against biofilm-causing bacteria.
