Antenatal management and neonatal outcomes of monochorionic twin pregnancies in a tertiary teaching hospital: a 10-year review.

Monochorionic (MC) pregnancy is a high risk pregnancy with well-defined specific complications, such as twin-to-twin transfusion syndrome (TTTS) and twin anaemia-polycythaemia sequence (TAPS). Laser photocoagulation (LPC) is an effective treatment for both complications. In the current retrospective study, we determined the incidence of MC pregnancy complications in a tertiary care centre during a 10-year period. Single foetal death (FD) beyond 14 weeks' gestation was significantly higher when complicated by either TTTS, TAPS or selective foetal growth restriction (21.4%, 16.7% and 9.1% versus 1.6%, p<.001, p=.02 and p=.04, respectively). We also demonstrated that twins' weight discordance >20% is an independent risk factor for single or double FD after LPC. Consequently, prior to LPC, patients should be counselled that early diagnosis of TTTS, advanced Quintero stages and weight discordances >20% are potential risk factors for FD. Further studies are needed to identify additional risk factors for TTTS and TAPS outcome after LPC.Impact StatementWhat is already known on this subject? Monochorionic (MC) pregnancy is a high risk pregnancy with well-defined specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anaemia-polycythaemia sequence (TAPS). Laser photocoagulation (LPC) is an effective treatment for both complications.What the results of this study add? The results of the current study determined the incidence of MC pregnancy complications in a tertiary care centre in Brussels, and identified that twins' weight discordance >20% is an independent risk factor for single or double foetal death after LPC.What the implications are of these findings for clinical practice and/or further research? Prior to laser coagulation, patients should be counselled that early diagnosis of TTTS, Quintero stages 3 or 4 and weight discordances >20% are potential risk factors for foetal demise. Further studies are needed to identify additional risk factors for TTTS and TAPS outcome after LPC.

[Autotransfusion of cord blood erythrocytes in newborns with malformations requiring early surgical intervention].

PURPOSE: To evaluate the clinical efficacy of cord blood erythrocytes autotransfiusion for the correction of anemia in the intra-and postoperative periods in infants requiring early surgical correction of congenital malformations. METHODS: Washed autoemythrocytes from placental umbilical blood were transfused for correction of intra and post-operative anemias. Umbilical blood assembly was carried out after extraction of the child and navel intersection by the occluded mean by a vein puncture distal (placental) end of a navel by the drainage needle which is a part of special transfiusion system. Further blood in the marked containers was pitched in branch of gravitational surgery of blood where its centrifiugal separation on erythrocyte mass and plasma was made. Then concentrated red cells it was put on storage for 21 day in a cooler at temperature 40 °C. Directly ahead of autotransfusion concentrated red cells was exposed to washing out in sterile physiological solution and a filtration through the micromodular filter. Then the marked package with the washed erythrocytes was pitched in branch of surgery of newborns for the purpose offurther anttqtransfusion under indications. The transfusion autoerythrocytes was made according to reacting at the moment of carrying out of work to orders of Ministry of Health of the Russian Federation: to the Order of Ministry of Health of the Russian Federation from November, 25th, 2002 No 363 "About the statement of the Instruction on application of components of blood" and to the Order of Ministry of Health of the Russian Federation from April, 2nd, 2013 N 183n "About the statement of rules of clinical use of donor blood and (or) its components". RESULTS: Total 122 newborns received an autotransfiusion of washed erythrocytes of placental/umbilical cord blood for the correction of anemia in the department of neonatal surgery in the period from 2005 to 2013. 66 children who are in the first two weeks of life were performed surgical intervention for malformation of the gastrointestinal tract (gastorshizis (22), omphalocele (2). itestinal atresia (10), esophageal atresia or doubling (4)), congenital diaphragmatic hernia (15), space-occupying lesions (teratoma (6) and lymphangioma (3)) and other pathologies (adenomatous lung (1), the sequestration of the lung (2). ovarian cyst (1)). Control group consisted of39 infants operated on for similar malformations , which in the absence of prior communication harvested autologous red blood cells in the first three weeks of life sparkled donor erythrocytes. Inmost cases (57 newborns - 86.4%) of the amount harvested and transfused blood autokonmpo tov was sufficient for the relief ofanemia, despite the fact that the volume of transfused autoeritrotsitnoy mass per kilogram of body weight was almost two times lower than the amount of donor erythrocyte mass used in the comparison group. Additional donor transfusion of red blood cells in the group of children who had autotransfusion, it took nine newborns (13.6%). The main indications for repeated transfusions were clinical and laboratory signs of anemia, persisting after autotransfusion or resulting from repeated operations. After transfusion of washed autoerythrocytes value of clinical and biochemical. blood tests, urinalysis were within the age norm. Post-transfusion reactions in children who have received a transfusion autoerythrocytes not mentioned CONCLUSION: The use of placental/umbilical cord blood autoe,ythrocyvtes in children requiring early surgical correction of congenital malformations can significantly reduce the need for donor red blood cells. Autologous red blood cells use is a safe and effective alternative to transfusion of donor red blood cells.

Twin anemia polycythemia sequence from a prenatal perspective.

OBJECTIVES: To describe the prevalence, management and outcome of spontaneous twin anemia polycythemia sequence (TAPS) diagnosed in the prenatal period. METHOD: Retrospective analysis of 142 consecutive monochorionic twin pregnancies not diagnosed with twin to twin transfusion syndrome. TAPS cases were identified based on the presence of discordant middle cerebral artery peak systolic velocity (MCA-PSV) measurements and signs suggestive of a chronic intertwin transfusion imbalance: either an elevated reticulocyte count in the anemic twin or the presence of few small unidirectional anastomoses during fetoscopy or at postnatal placental examination. RESULTS: Three cases were identified, giving an estimated prevalence of 2%. Prenatal interventions were tailored to the characteristics of each case and consisted of intrauterine transfusion and interruption of the shared circulation by cord coagulation or laser separation. CONCLUSION: In monochorionic twin pregnancies, TAPS is an uncommon prenatal finding. Nonetheless, its incidence seems high enough to recommend screening for this disease by MCA-PSV measurements.