[Pregnancy outcome after fetoscopic laser photocoagulation for twin-twin transfusion syndrome: experience of an emerging center from China].

OBJECTIVE: To evaluate pregnancy outcomes after selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS). METHODS: A total of 33 cases of TTTS were treated by SFLP in Shanghai First Maternity and Infant Hospital from January 2012 to August 2013. Clinical data on perinatal outcomes, fetaland maternalcomplicationswere recorded and retrospectively analyzed. RESULTS: (1) The mean gestational age for SFLP was (22.0 ± 2.3) weeks, the mean time for SFLP was (86 ± 32) minutes, the mean gestational age for delivery was 33(+6) weeks, the gestational age between SFLP and delivery was (9 ± 5) weeks. (2) The perinatal survival rate 28 days after the delivery was 70% (46/66). The survival rate was 52% (17/33) for both twins, 36% (12/33) for one twin, 88% (29/33) for at least one twin. Of all the survival twins, there were 21 donor twins (64%, 21/33) with the mean birth weight at delivery was (1 805 ± 523) g and 25 recipient twins (76%, 25/33) with the mean birth weight (2 214 ± 600) g. (3) There were 4 cases at TTTS stage I, 9 at TTTS stage II, 11 at TTTS stage III, 9 at TTTS stage IV; the survival number for at least one twin was 4, 7, 10, 8 respectively; the total survival rate was 7/8, 12/18, 68% (15/22), 12/18 respectively. (4) Four cases had both twins demises. 3 fetuses had special fetal complications with 2 of them developing twin anemia-polycythemia sequence (TAPS). Two cases had preterm premature rupture of membrane (PPROM) within 3 weeks after SFLP. (5) Placental injections were performed in 7 cases with SFLP after delivery. Residual anastomosis was identified in one case. CONCLUSION: As an emerging center, our study demonstrated favorable fetal outcomes with less maternal complications after SFLP for TTTS.

Motivations for undertaking DNA sequencing-based non-invasive prenatal testing for fetal aneuploidy: a qualitative study with early adopter patients in Hong Kong.

BACKGROUND: A newly introduced cell-free fetal DNA sequencing based non-invasive prenatal testing (DNA-NIPT) detects Down syndrome with sensitivity of 99% at early gestational stage without risk of miscarriage. Attention has been given to its public health implications; little is known from consumer perspectives. This qualitative study aimed to explore women's motivations for using, and perceptions of, DNA-NIPT in Hong Kong. METHODS AND FINDINGS: In-depth interviews were conducted with 45 women who had undertaken DNA-NIPT recruited by purposive sampling based on socio-demographic and clinical characteristics. The sample included 31 women identified as high-risk from serum and ultrasound based Down syndrome screening (SU-DSS). Thematic narrative analysis examined informed-decision making of the test and identified the benefits and needs. Women outlined a number of reasons for accessing DNA-NIPT: reducing the uncertainty associated with risk probability-based results from SU-DSS, undertaking DNA-NIPT as a comprehensive measure to counteract risk from childbearing especially at advanced age, perceived predictive accuracy and absence of risk of harm to fetus. Accounts of women deemed high-risk or not high-risk are distinctive in a number of respects. High-risk women accessed DNA-NIPT to get a clearer idea of their risk. This group perceived SU-DSS as an unnecessary and confusing procedure because of its varying, protocol-dependent detection rates. Those women not deemed high-risk, in contrast, undertook DNA-NIPT for psychological assurance and to reduce anxiety even after receiving the negative result from SU-DSS. CONCLUSIONS: DNA-NIPT was regarded positively by women who chose this method of screening over the routine, less expensive testing options. Given its perceived utility, health providers need to consider whether DNA-NIPT should be offered as part of universal routine care to women at high-risk for fetal aneuploidy. If this is the case, then further development of guidelines and quality assurance will be needed to provide a service suited to patients' needs.

Arabin cerclage pessary in the management of cervical insufficiency.

OBJECTIVE: To evaluate the use of Arabin cerclage pessary in the management of cervical insufficiency. METHODS: The pregnancy outcome of 20 women carrying singleton pregnancy referred for suspected cervical insufficiency and chose Arabin cerclage pessary for treatment from 2009-2011 were reviewed. Pregnancy outcome were analysed according to presence of risk factors, amniotic fluid sludge, cervical length and gestation at pessary insertion. RESULTS: At presentation, mean cervical length was 1.17 cm (range 0-2.33 cm), mean gestation at pessary insertion and delivery was 20.6 (12.9-26.1) weeks and 32.1 (14.7-40.1) weeks, respectively, and mean prolongation of pregnancy was 11.5 (0.5-25.2) weeks. Overall, 5 (25%) had fetal loss between 14.7-23.1 weeks, while 3 (15%) and 12 (60%) delivered before and after 34 weeks gestation, respectively with no perinatal mortality. Compared with women with cervical length <1.5 cm, all those with cervical length ≥1.5 cm had pregnancy prolonged for ≥49 days (100 vs. 54% p = 0.032) and 86% delivered beyond 34 weeks (86 vs. 46% p = 0.085). CONCLUSIONS: Arabin cerclage pessary appears to be optimal for treating women at high risk of cervical insufficiency with a cervical length of 1.5-2.5 cm, while it is an acceptable option for high risk women with cervical length <1.5 cm.

Breastfeeding initiation: is this influenced by maternal hepatitis B infection?

OBJECTIVE: To elucidate the effect of hepatitis B virus (HBV) infection on breastfeeding uptake in Chinese mothers in an endemic region. PATIENTS AND METHODS: A retrospective cohort study on 63 885 consecutive pregnant delivered between January 1997 and June 2008, were extracted from computerized database to examine the relationship between breastfeeding uptake and maternal HBV status, adjusted for demographic factors. RESULTS: A total of 6593 (10.3%) women were hepatitis B surface antigen (HBsAg)-positive, with an annual prevalence of around 10%. In the study period, 29 869 (46.8%) practised breastfeeding, and its prevalence ranged from 35.4 to 54.8% with an increasing trend throughout the years (p < 0.001). HBsAg-positive mothers had a significantly lower rate of breastfeeding (39.2 vs. 47.6% p < 0.001). Multiparas had higher incidence of HBV infection (10.9 vs. 9.8%, p < 0.001) and lower breastfeeding rate (42.2% versus 51.0%, p < 0.001) when compared with primiparas. Among those factors, maternal HBV infection had the strongest negative association with breastfeeding (adjusted odd ratio (aOR) = 0.726, 95% confidence interval (CI): 0.689-0.765). CONCLUSIONS: Our results suggested maternal HBV infection was one of the factors for the persistently low breastfeeding rate in Hong Kong over the past decades. To promote breastfeeding, it is necessary to generate definitive data on its safety regarding to mother-to-child transmission (MTCT) of HBV in order to allay the fear and anxiety in HBsAg-positive mothers.

Comparison of real-time three-dimensional echocardiography and spatiotemporal image correlation in assessment of fetal interventricular septum.

OBJECTIVE: To compare the role of real-time 3DE and STIC technology in assessment of the fetal IVS. METHODS: Fifty pregnant women with singleton pregnancies were invited to attend this study. All the fetuses were examined by both spatiotemporal image correlation and real-time three-dimensional echocardiography. There were totally six images of IVS obtained for each fetus: live xPlane image, live 3D image, multiplanar image and rendered image with the four-chamber view as the starting plane, multiplanar image and rendered image with the sagittal view of the fetal thorax as the starting plane. These images were grouped into six groups and randomized within each group for the further analysis. The images were scored and compared according to the image quality, the outline of the fetal IVS and motion artefact. The operator was also asked to judge whether VSD existed or not and the results were compared with the final diagnosis. The sensitivity, specificity, false positive percentage, positive likelihood ratio, false negative percentage and negative likelihood ratio of each group were also calculated. RESULTS: There were 15 cases with VSD and four cases without VSD in CHD fetus and 31 cases of normal fetus enrolled in this study. A total 300 images of the lateral view of fetal IVS were obtained and grouped into six groups. The image quality in the group of STIC with the four-chamber view as the starting plane is much worse than the group of STIC with the sagittal view as the starting plane and real-time three-dimensional echocardiography (P < 0.05). There were no significant differences in image quality between the group of STIC with the sagittal view as the starting plane and real-time three-dimensional echocardiography (P > 0.05). CONCLUSION: The image quality of real-time 3DE is similar to the images acquired by STIC from the sagittal view and superior to that obtained by STIC from the four-chamber view. However, real-time 3DE has no motion artefact, which has the potentials to improve the detection rate of fetal VSD.

Has improved health care provision impacted on the obstetric outcome in teenage women?

OBJECTIVE: To determine the obstetric outcome in teenage women managed in the recent decade with easily accessible health care provision. METHODS: In a retrospective cohort study, maternal demographics, underlying medical conditions, obstetric complications, preterm birth, type of labor, mode of delivery, and perinatal mortality were compared between 1505 women aged ≤ 19 years (study group) with 10,320 women aged 20-24 years (comparison group), who were carrying singleton pregnancies beyond 24 weeks of gestation and managed in our hospital between January 1998 and June 2008. RESULTS: The study and comparison groups accounted for 2.2% and 15.1% respectively of the total deliveries. Despite comparable health status and rates of other obstetric complications, teenage women was associated with birth <34 weeks (aOR 2.45, 95% CI 1.67-3.60), birth at 34-36 weeks (aOR 2.13, 95% CI 1.71-2.65), and reduced instrumental vaginal (aOR 0.62, 95% CI 0.50-0.77) and caesarean (aOR 0.79, 95% CI 0.64-0.97) delivery, without increase in perinatal mortality. CONCLUSIONS: Teenage women had increased preterm birth, despite improved health care provision, nutrition, and similar incidence of other obstetric complications, but the obstetric and perinatal outcome remained favorable.

External cephalic version does not increase the risk of intra-uterine death: a 17-year experience and literature review.

OBJECTIVE: To assess the risk of intra-uterine death (IUD) after external cephalic version (ECV). METHODS: In this retrospective cohort study, 1078 consecutive ECVs performed between January 1994 and March 2011 in an University teaching hospital were extracted from the computerized database to examine the risk of IUD after ECV. RESULTS: A total of 1078 consecutive ECVs were performed over the study period. The overall successful rate was 72.8%, the successful rate was 63.1% in nulliparous and 82.7% in multiparous, respectively (p < 0.001). There was no IUD identified within 24 h after the procedure and there was only one case of IUD (0.09%) that occurred 4 weeks after an uncomplicated ECV. CONCLUSIONS: ECV is a safe procedure that does not increase the risk of IUD within and after 24 h of enrollment irrespective of outcome of ECV. Our findings have important clinical implication in terms of patient counseling regarding the decision on term breech management.

Normal range of intracranial translucency (IT) assessed by three-dimensional ultrasound at 11 + 0 to 13 + 6 weeks in a Chinese population.

OBJECTIVES: To establish the reference range of intracranial translucency (IT) in the first trimester in a Chinese population. METHODS: In a prospective study from March 2007 to June 2007, three-dimensional (3D) volumes of the fetal profile in the mid-sagittal plane were recorded from 102 normal pregnancies screened for trisomy 21 by the combination of fetal nuchal translucency (NT) thickness, maternal serum free ß-human chorionic gonadotropin (ß-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11 + 0 to 13 + 6 weeks. 3D volumes were examined using multiplanar techniques. In the mid-sagittal plane the fourth ventricle presents as an (IT between the brain stem and choroid plexus. The anteroposterior diameter of IT in each case was measured. The relationship between IT with the other parameter was also examined. RESULTS: The IT at first trimester ranged from 1.35 to 2.6 mm. There was no significant association between IT with NT, and serum biochemistry. The intraobserver and interobserver agreement was assessed in 20 (19.6%) normal cases. Mean (SD) differences of two observers was -0.015 (0.132) mm (p > 0.05). For each observer, mean (SD) between the 2 paired measurements were -0.001 (0.097) mm, and 0.010 (0.085) mm, respectively (p > 0.05). CONCLUSIONS: In the first trimester, the reference range of IT in Chinese fetuses has been established. The assessment of IT is feasible and reproducible.