Endoscopic placental laser coagulation in dichorionic and monochorionic triplet pregnancies

Objective: To report outcome of monochorionic (MC) and dichorionic (DC) triamniotic (TA) triplet pregnancies treated with endoscopic laser coagulation of communicating placental vessels for severe fetofetal transfusion syndrome (FFTS) and selective fetal growth restriction (sFGR). Methods: Laser surgery was performed at 18 (15-24) weeks gestation in 11 MCTA and 33 DCTA pregnancies complicated by FFTS and 14 DCTA pregnancies complicated by sFGR. Data from our study and previous reports were pooled using meta-analytic techniques. Results: Survival of at least one baby and survival among all fetuses was 97.0% and 72.7% in DCTA pregnancies with FFTS, 78.6% and 52.4% in DCTA pregnancies with sFGR and 81.8% and 39.4% in MCTA pregnancies with FFTS. In the combined data from our study and previous reports, the pooled survival rates in 132 DCTA pregnancies with FFTS were 94.4% and 76.1% and in 29 MCTA pregnancies with FFTS were 80.6% and 57.5%. Conclusions: Survival after laser surgery is higher in DC triplets with FFTS than those with sFGR and in DC than MC triplets with FFTS

Detection of Fetal Defects in First Trimester by Ultrasound Examination - Abilities and Limitations

The development of prenatal diagnostics in the recent years and the introduction of the new cell free DNA testing for chromosomal abnormalities raised the question about the effectiveness of the well-known First trimester screening. The need to reassess and to determine the efficacy of the 11-14 week scans in detecting fetuses with chromosomal abnormalities and structural defects arose again. Could the First trimester screening be abandoned and replaced by the new tests? In our practice we find that at 11-14 weeks some abnormalities are always detectable, some can never be and others are potentially detectable depending on their association with increased Nuchal translucency (NT). Fetal structural abnormalities can be classified as major or minor and of early or late onset. After the introduction of a national screening program the prenatal detection rates for all congenital anomalies has increased considerably. Especially anencephaly, gastroschisis and exomphalos are amenable for early detection (in the first trimester). The aim of this study was to determine the efficacy of 11-14 week scan in detecting fetuses with structural anomalies that are almost always detectable in the recent years

Meta-analysis of second-trimester markers for trisomy 21

ABSTRACT Objective To summarize by meta-analysis the accumulated data on the screening performance of secondtrimester sonographic markers for fetal trisomy 21. LR were, respectively: 5.83 (95% CI, for intracardiac echogenic focus; 27.52 (95% CI, 23.30 (95% CI, for increased nuchal fold; 11.44 (95% CI, 7.63 (95% CI, 3.72 (95% CI,) for short femur; 4.81 (95% CI,) for short humerus; 21.48 (95% CI, Method

Meta-analysis of second-trimester markers for trisomy 21

ABSTRACT Objective To summarize by meta-analysis the accumulated data on the screening performance of secondtrimester sonographic markers for fetal trisomy 21. LR were, respectively: 5.83 (95% CI, for intracardiac echogenic focus; 27.52 (95% CI, 23.30 (95% CI, for increased nuchal fold; 11.44 (95% CI, 7.63 (95% CI, 3.72 (95% CI,) for short femur; 4.81 (95% CI,) for short humerus; 21.48 (95% CI, Method

First Trimester Examination of Fetal Anatomy: Clinical Practice Guideline by the World Association of Perinatal Medicine (WAPM) and the Perinatal Medicine Foundation (PMF)

This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for precise standardization to implement the ultrasound evaluation of the fetus in the first trimester of pregnancy and improve the early detection of anomalies and the clinical management of the pregnancy. The aim is to present a document that includes statements and recommendations on the standard evaluation of the fetal anatomy in the first trimester, based on quality evidence in the peer-reviewed literature as well as the experience of perinatal experts around the world.info:eu-repo/semantics/publishedVersio

Risk of miscarriage after chorionic villus sampling.

OBJECTIVE: To estimate the risk of miscarriage associated to chorionic villus sampling (CVS). METHODS: This was a retrospective cohort study performed in eight fetal-medicine units in Spain, Belgium and Bulgaria. Two populations were included: first, all singleton pregnancies attending to their first-trimester assessment in Murcia, Spain, and second, all singleton pregnancies having a CVS following first-trimester assessment at any of the participating centers. We used propensity score matching analysis to estimate the association between CVS and miscarriage. We compared risks of miscarriage of CVS and non-CVS groups after propensity score matching (1:1 ratio). This procedure creates two comparable groups balancing the maternal and pregnancy characteristics that lead to CVS, in a similar way in which randomization operates in a randomized clinical trial. RESULTS: The study population consisted of 22,250 participants in the non-CVS group and 3,613 in the CVS group. The incidence of miscarriage in the CVS group was 2.1% (77/3,613), which was significantly higher than the 0.9% (207/22,250) in the non-CVS group (p <0.001). The propensity score algorithm matched 2,122 CVS cases with 2,122 non-CVS cases including 40 (1.9%) and 55 (2.6%) miscarriages in the CVS and non-CVS groups, respectively (OR 0.72 [95% CI 0.48 to 1.10]; p = 0.146). However, we found a significant interaction between the CVS risk of miscarriage and the risk of aneuploidies, suggesting a different effect of the CVS for different baseline characteristics in such a way that, when the risk of aneuploidies is low, the risk after CVS increases (OR 2.87 [95% CI 1.13 to 7.30]) but when the risk is high, the risk after CVS is paradoxically reduced (OR 0.47 [95% CI 0.28 to 0.76]), presumably due to prenatal diagnosis and termination of major aneuploidies that would have otherwise resulted in spontaneous miscarriage. CONCLUSIONS: The risk of miscarriage in women having a CVS is about 1% higher than in women without CVS, although this excess risk is not entirely due to the invasive procedure but to some extent the demographic and pregnancy characteristics of the patient undergoing CVS. After accounting for these risk factors and confining the analysis to low-risk pregnancies, CVS seems to increase the risk of miscarriage about three times above the patient's background-risk. Although this is a substantial increase in relative terms, in pregnancies without risk factors, the risk of miscarriage after CVS will still remain low and similar to or slightly higher than that of the general population. For example, if her risk of aneuploidy is 1 in a 1,000 (0.1%), her risk of miscarriage after CVS will increase to 0.3% (0.2% higher)

Management of preterm labor: Clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation

: This practice guideline follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world, with the goal of improving the management of preterm labor. In fact, this document provides further guidance for healthcare practitioners on the appropriate use of examinations with the aim to improve the accuracy in diagnosing preterm labor and allow timely and appropriate administration of tocolytics, antenatal corticosteroids and magnesium sulphate and avoid unnecessary or excessive interventions. Therefore, it is not intended to establish a legal standard of care. This document is based on consensus among perinatal experts throughout the world in the light of scientific literature and serves as a guideline for use in clinical practice

Risk of Fetal Loss After Chorionic Villus Sampling in Twin Pregnancy Derived from Propensity Score Matching Analysis

Objective: To estimate the risk of fetal loss associated with chorionic villus sampling (CVS) in twin pregnancy, using propensity score analysis. Methods: This was a multicenter cohort study of women with twin pregnancy undergoing ultrasound examination at 11-13 weeks' gestation, performed in eight fetal medicine units in which the leadership were trained at the Harris Birthright Research Centre for Fetal Medicine in London, UK, and in which the protocols for screening, invasive testing and pregnancy management are similar. The risk of death of at least one fetus was compared between pregnancies that had and those that did not have CVS, after propensity score matching (1:1 ratio). This procedure created two comparable groups by balancing the maternal and pregnancy characteristics that lead to CVS being performed, similar to how randomization operates in a randomized clinical trial. Results: The study population of 8581 twin pregnancies included 445 that had CVS. Death of one or two fetuses at any stage during pregnancy occurred in 11.5% (51/445) of pregnancies in the CVS group and in 6.3% (515/8136) in the non-CVS group (P < 0.001). The propensity score algorithm matched 258 cases that had CVS with 258 non-CVS cases; there was at least one fetal loss in 29 (11.2%) cases in the CVS group and in 35 (13.6%) cases in the matched non-CVS group (odds ratio (OR), 0.81; 95% CI, 0.48-1.35; P = 0.415). However, there was a significant interaction between the risk of fetal loss after CVS and the background risk of fetal loss; when the background risk was higher, the risk of fetal loss after CVS decreased (OR, 0.46; 95% CI, 0.23-0.90), while, in pregnancies with a lower background risk of fetal loss, the risk of fetal loss after CVS increased (OR, 2.45; 95% CI, 0.95-7.13). The effects were statistically significantly different (P-value of the interaction = 0.005). For a pregnancy in which the background risk of fetal loss was about 6% (the same as in our non-CVS population), there was no change in the risk of fetal loss after CVS, but, when the background risk was more than 6%, the posterior risk was paradoxically reduced, and when the background risk was less than 6%, the posterior risk increased exponentially; for example, if the background risk of fetal loss was 2.0%, the relative risk was 2.8 and the posterior risk was 5.6%. Conclusion: In twin pregnancy, after accounting for the risk factors that lead to both CVS and spontaneous fetal loss and confining the analysis to pregnancies at lower prior risk, CVS seems to increase the risk of fetal loss by about 3.5% above the patient's background risk. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.info:eu-repo/semantics/publishedVersio

Meta-analysis of second-trimester markers for trisomy 21

ABSTRACT Objective To summarize by meta-analysis the accumulated data on the screening performance of secondtrimester sonographic markers for fetal trisomy 21. LR were, respectively: 5.83 (95% CI, for intracardiac echogenic focus; 27.52 (95% CI, 23.30 (95% CI, for increased nuchal fold; 11.44 (95% CI, 7.63 (95% CI, 3.72 (95% CI,) for short femur; 4.81 (95% CI,) for short humerus; 21.48 (95% CI, Method