Síndrome De Transfusão Feto-fetal: Neurodesenvolvimento De Lactentes Tratados Com Cirurgia A Laser

To assess the neurodevelopmental functions of survivors of twin-twin transfusion syndrome (TTTS) treated by fetoscopic laser coagulation (FLC), during the first year of life, comparing them to a control group; and to verify the influence of specific variables on neurodevelopment. Method: This was a prospective, longitudinal study. The sample comprised 33 monochorionic diamniotic twins who underwent FLC for treatment of TTTS and 22 full-term infants of single-fetus pregnancies. Bayley Scales of Infant and Toddler Development Screening Test were used for evaluation. Prenatal, perinatal and postnatal information were obtained. Results: There was an increased frequency of infants in the TTTS group with inadequate performance compared to the control group. The identified variables (fetal donor, low economic income and cardiorespiratory disease) negatively impacted expressive communication and fine motor skills. Conclusion: Although through follow-up is recommended in all TTTS survivors, particular attention is required for the high-risk group as defined in this study. © 2016, Associacao Arquivos de Neuro-Psiquiatria. All rights reserved.74430731

Obstetric Ultrasound Between The 11th And 14th Weeks: Beyond The Screening For Chromosomal Abnormalities [ultrassonografia Obstétrica Entre A 11a E A 14a Semanas: Além Do Rastreamento De Anomalias Cromossômicas]

This is a traditional (narrative) review with the objective of highlighting the contribution of obstetric ultrasonography (US) between the 11th and 14th week of pregnancy, commonly called first trimester anomaly scan. In addition to being used for the screening of chromosomal anomalies, US can be employed during this period to confirm or determine gestational age, evaluate fetal anatomy, diagnose malformations, screen major structural abnormalities and genetic syndromes, define the prognosis of pregnancy, diagnose and characterize multiple pregnancies, and screen preeclampsia and intrauterine growth restriction. The most important studies about this subject published between 1990 and 2010 in the Cochrane and PubMed libraries were included. The selected studies can be classified with scientific levels I to III.3314957Willocks, J., Donald, I., Campbell, S., Dunsmore, I.R., Intrauterine growth assessed by ultrasonic foetal cephalometry (1967) J Obstet Gynaecol Br Commonw., 74 (5), pp. 639-647Campbell, S., An improved method of fetal cephalometry by ultrasound (1968) J Obstet Gynaecol Br Commonw., 75 (5), pp. 568-576Sabbagha, R.E., Sheikh, Z., Tamura, R.K., dal Compo, S., Simpson, J.L., Depp, R., Predictive value, sensitivity, and specificity of ultrasonic targeted imaging for fetal anomalies in gravid women at high risk for birth defects (1985) Am J Obstet Gynecol., 152 (7 PART 1), pp. 822-827Manchester, D.K., Pretorius, D.H., Avery, C., Manco-Johnson, M.L., Wiggins, J., Meier, P.R., Accuracy of ultrasound diagnoses in pregnancies complicated by suspected fetal anomalies (1988) Prenat Diagn., 8 (2), pp. 109-117Saltvedt, S., Almström, H., Kublickas, M., Valentin, L., Grunewald, C., Detection of malformations in chromosomally normal fetuses by routine ultrasound at 12 or 18 weeks of gestation-a randomised controlled trial in 39,572 pregnancies (2006) BJOG., 113 (6), pp. 664-674Nicolaides, K.H., Azar, G., Snijders, R.J., Gosden, C.M., Fetal nuchal oedema: Associated malformations and chromosomal defects (1992) Fetal Diagn Ther., 7 (2), pp. 123-131Nicolaides, K.H., Azar, G., Byrne, D., Mansur, C., Marks, K., Fetal nuchal translucency: Ultrasound screening for chromosomal defects in first trimester of pregnancy (1992) BMJ., 304 (6831), pp. 867-869Pandya, P.P., Brizot, M.L., Kuhn, P., Snijders, R.J., Nicolaides, K.H., First-trimester fetal nuchal translucency thickness and risk for trisomies (1994) Obstet Gynecol., 84 (3), pp. 420-423Braithwaite, J.M., Morris, R.W., Economides, D.L., Nuchal translucency measurements: Frequency distribution and changes with gestation in a general population (1996) Br J Obstet Gynaecol., 103 (12), pp. 1201-1204Brizot, M.L., Carvalho, M.H., Liao, A.W., Reis, N.S., Armbruster-Moraes, E., Zugaib, M., First-trimester screening for chromosomal abnormalities by fetal nuchal translucency in a Brazilian population (2001) Ultrasound Obstet Gynecol., 18 (6), pp. 652-655Acácio, G.L., Barini, R., Pinto Jr., W., Ximenes, R.L., Pettersen, H., Faria, M., Nuchal translucency: An ultrasound marker for fetal chromosomal abnormalities (2001) Sao Paulo Med J., 119 (1), pp. 19-23Peralta, C.F., Falcon, O., Wegrzyn, P., Faro, C., Nicolaides, K.H., Assessment of the gap between the fetal nasal bones at 11 to 13 + 6 weeks of gestation by three-dimensional ultrasound (2005) Ultrasound Obstet Gynecol., 25 (5), pp. 464-467Dagklis, T., Borenstein, M., Peralta, C.F., Faro, C., Nicolaides, K.H., Three-dimensional evaluation of mid-facial hypoplasia in fetuses with trisomy 21 at 11 + 0 to 13 + 6 weeks of gestation (2006) Ultrasound Obstet Gynecol., 28 (3), pp. 261-265Falcon, O., Faiola, S., Huggon, I., Allan, L., Nicolaides, K.H., Fetal tricuspid regurgitation at the 11 + 0 to 13 + 6-week scan: Association with chromosomal defects and reproducibility of the method (2006) Ultrasound Obstet Gynecol., 27 (6), pp. 609-612Borenstein, M., Persico, N., Kagan, K.O., Gazzoni, A., Nicolaides, K.H., Frontomaxillary facial angle in screening for trisomy 21 at 11 + 0 to 13 + 6 weeks (2008) Ultrasound Obstet Gynecol., 32 (1), pp. 5-11Kagan, K.O., Wright, D., Valencia, C., Maiz, N., Nicolaides, K.H., Screening for trisomies 21, 18 and 13 by maternal age, fetal nuchal translucency, fetal heart rate, free beta-hCG and pregnancy-associated plasma protein-A (2008) Hum Reprod., 23 (9), pp. 1968-1975Maiz, N., Valencia, C., Kagan, K.O., Wright, D., Nicolaides, K.H., Ductus venosus Doppler in screening for trisomies 21, 18 and 13 and Turner syndrome at 11-13 weeks of gestation (2009) Ultrasound Obstet Gynecol., 33 (5), pp. 512-517Kagan, K.O., Cicero, S., Staboulidou, I., Wright, D., Nicolaides, K.H., Fetal nasal bone in screening for trisomies 21, 18 and 13 and Turner syndrome at 11-13 weeks of gestation (2009) Ultrasound Obstet Gynecol., 33 (3), pp. 259-264Kagan, K.O., Valencia, C., Livanos, P., Wright, D., Nicolaides, K.H., Tricuspid regurgitation in screening for trisomies 21, 18 and 13 and Turner syndrome at 11 + 0 to 13 + 6 weeks of gestation (2009) Ultrasound Obstet Gynecol., 33 (1), pp. 18-22Kagan, K.O., Staboulidou, I., Cruz, J., Wright, D., Nicolaides, K.H., Two-stage first-trimester screening for trisomy 21 by ultrasound assessment and biochemical testing (2010) Ultrasound Obstet Gynecol., 36 (5), pp. 542-547Kagan, K.O., Etchegaray, A., Zhou, Y., Wright, D., Nicolaides, K.H., Prospective validation of first-trimester combined screening for trisomy 21 (2009) Ultrasound Obstet Gynecol., 34 (1), pp. 14-18Cronin, P., Ryan, F., Coughlan, M., Undertaking a literature review: A step-by-step approach (2008) Br J Nurs., 17 (1), pp. 38-43Eccles, M., Mason, J., How to develop cost-conscious guidelines (2001) Health Technol Assess., 5 (16), pp. 1-69Whitworth, M., Bricker, L., Neilson, J.P., Dowswell, T., Ultrasound for fetal assessment in early pregnancy (2010) Cochrane Database Syst Rev, (4), pp. CD007058Caughey, A.B., Nicholson, J.M., Washington, A.E., First-vs second-trimester ultrasound: The effect on pregnancy dating and perinatal outcomes (2008) Am J Obstet Gynecol., 198 (6), pp. 703e1-703e5Bennett, K.A., Crane, J.M., O'shea, P., Lacelle, J., Hutchens, D., Copel, J.A., First trimester ultrasound screening is effective in reducing postterm labor induction rates: A randomized controlled trial (2004) Am J Obstet Gynecol., 190 (4), pp. 1077-1081Chang, T.C., Robson, S.C., Spencer, J.A., Gallivan, S., Identification of fetal growth retardation: Comparison of Doppler waveform indices and serial ultrasound measurements of abdominal circumference and fetal weight (1993) Obstet Gynecol., 82 (2), pp. 230-236Chang, T.C., Robson, S.C., Spencer, J.A., Gallivan, S., Prediction of perinatal morbidity at term in small fetuses: Comparison of fetal growth and Doppler ultrasound (1994) Br J Obstet Gynaecol., 101 (5), pp. 422-427Stratton, J.F., Scanaill, S.N., Stuart, B., Turner, M.J., Are babies of normal birth weight who fail to reach their growth potential as diagnosed by ultrasound at increased risk? (1995) Ultrasound Obstet Gynecol., 5 (2), pp. 114-118McGregor, S.N., Tamura, R.K., Sabbagha, R.E., Minogue, J.P., Gibson, M.E., Hoffman, D.I., Underestimation of gestational age by conventional crown-rump length dating curves (1987) Obstet Gynecol., 70 (3 PART 1), pp. 344-348Kramer, M.S., McLean, F.H., Boyd, M.E., Usher, R.H., The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations (1988) JAMA., 260 (22), pp. 3306-3308Gardosi, J., Vanner, T., Francis, A., Gestational age and induction of labour for prolonged pregnancy (1997) Br J Obstet Gynaecol., 104 (7), pp. 792-797Hadlock, F.P., Shah, Y.P., Kanon, D.J., Lindsey, J.V., Fetal crown-rump length: Reevaluation of relation to menstrual age (5-18 weeks) with high-resolution real-time US (1992) Radiology., 182 (2), pp. 501-505Hadlock, F.P., Deter, R.L., Harrist, R.B., Park, S.K., Estimating fetal age: Computer-assisted analysis of multiple fetal growth parameters (1984) Radiology., 152 (2), pp. 497-501Souka, A.P., Pilalis, A., Kavalakis, Y., Kosmas, Y., Antsaklis, P., Antsaklis, A., Assessment of fetal anatomy at the 11-14-week ultrasound examination (2004) Ultrasound Obstet Gynecol., 24 (7), pp. 730-734Ebrashy, A., El Kateb, A., Momtaz, M., El Sheikhah, A., Aboulghar, M.M., Ibrahim, M., 13-14-week fetal anatomy scan: A 5-year prospective study (2010) Ultrasound Obstet Gynecol., 35 (3), pp. 292-296Gembruch, U., Shi, C., Smrcek, J.M., Biometry of the fetal heart between 10 and 17 weeks of gestation (2000) Fetal Diagn Ther., 15 (1), pp. 20-31Huggon, I.C., Ghi, T., Cook, A.C., Zosmer, N., Allan, L.D., Nicolaides, K.H., Fetal cardiac abnormalities identified prior to 14 weeks' gestation (2002) Ultrasound Obstet Gynecol., 20 (1), pp. 22-29Taipale, P., Ammälä, M., Salonen, R., Hiilesmaa, V., Two-stage ultrasonography in screening for fetal anomalies at 13-14 and 18-22 weeks of gestation (2004) Acta Obstet Gynecol Scand., 83 (12), pp. 1141-1146Hernádi, L., Töröcsik, M., Screening for fetal anomalies in the 12th week of pregnancy by transvaginal sonography in an unselected population (1997) Prenat Diagn., 17 (8), pp. 753-759D'Ottavio, G., Mandruzzato, G., Meir, Y.J., Rustico, M.A., Fischer-Tamaro, L., Conoscenti, G., Comparisons of first and second trimester screening for fetal anomalies (1998) Ann N Y Acad Sci, 847, pp. 200-209Economides, D.L., Braithwaite, J.M., First trimester ultrasonographic diagnosis of fetal structural abnormalities in a low risk population (1998) Br J Obstet Gynaecol., 105 (1), pp. 53-57Whitlow, B.J., Chatzipapas, I.K., Lazanakis, M.L., Kadir, R.A., Economides, D.L., The value of sonography in early pregnancy for the detection of fetal abnormalities in an unselected population (1999) Br J Obstet Gynaecol., 106 (9), pp. 929-936Carvalho, M.H., Brizot, M.L., Lopes, L.M., Chiba, C.H., Miyadahira, S., Zugaib, M., Detection of fetal structural abnormalities at the 11-14 week ultrasound scan (2002) Prenat Diagn., 22 (1), pp. 1-4Chen, M., Lam, Y.H., Lee, C.P., Tang, M.H., Ultrasound screening of fetal structural abnormalities at 12 to 14 weeks in Hong Kong (2004) Prenat Diagn., 24 (2), pp. 92-97Souka, A.P., Pilalis, A., Kavalakis, I., Antsaklis, P., Papantoniou, N., Mesogitis, S., Screening for major structural abnormalities at the 11-to 14-week ultrasound scan (2006) Am J Obstet Gynecol., 194 (2), pp. 393-396Korenromp, M.J., Christiaens, G.C., van den Bout, J., Mulder, E.J., Hunfeld, J.A., Bilardo, C.M., Long-term psychological consequences of pregnancy termination for fetal abnormality: A cross-sectional study (2005) Prenat Diagn., 25 (3), pp. 253-260Wagner, N., Abele, H., Hoopmann, M., Grischke, E.M., Blumenstock, G., Wallwiener, D., Factors influencing the duration of late first and second-trimester termination of pregnancy with prostaglandin derivates (2011) Eur J Obstet Gynecol Reprod Biol., 155 (1), pp. 75-78Deprest, J.A., Flake, A.W., Gratacos, E., Ville, Y., Hecher, K., Nicolaides, K., The making of fetal surgery (2010) Prenat Diagn., 30 (7), pp. 653-667Souka, A.P., Snijders, R.J., Novakov, A., Soares, W., Nicolaides, K.H., Defects and syndromes in chromosomally normal fetuses with increased nuchal translucency thickness at 10-14 weeks of gestation (1998) Ultrasound Obstet Gynecol., 11 (6), pp. 391-400Atzei, A., Gajewska, K., Huggon, I.C., Allan, L., Nicolaides, K.H., Relationship between nuchal translucency thickness and prevalence of major cardiac defects in fetuses with normal karyotype (2005) Ultrasound Obstet Gynecol., 26 (2), pp. 154-157Faiola, S., Tsoi, E., Huggon, I.C., Allan, L.D., Nicolaides, K.H., Likelihood ratio for trisomy 21 in fetuses with tricuspid regurgitation at the 11 to 13 + 6 week scan (2005) Ultrasound Obstet Gynecol., 26 (1), pp. 22-27Falcon, O., Faiola, S., Huggon, I.C., Allan, L., Nicolaides, K.H., Fetal tricuspid regurgitation at the 11 + 0 to 13 + 6-week scan: Association with chromosomal defects and reproducibility of the method (2006) Ultrasound Obstet Gynecol., 27 (6), pp. 609-612Maiz, N., Nicolaides, K.H., Ductus venosus in the first trimester: Contribution to screening of chromosomal, cardiac defects and monochorionic twin complications (2010) Fetal Diagn Ther., 28 (2), pp. 65-71Nicolaides, K.H., de Figueiredo, D.B., (2004) O exame ultrassonográfico entre 11+ 0-13 + 6 semanas, , London: The Fetal Medicine FoundationSouka, A.P., Krampl, E., Bakalis, S., Heath, V., Nicolaides, K.H., Outcome of pregnancy in chromosomally normal fetuses with increased nuchal translucency in the first trimester (2001) Ultrasound Obstet Gynecol., 18 (1), pp. 9-17Michailidis, G.D., Economides, D.L., Nuchal translucency measurement and pregnancy outcome in karyotypically normal fetuses (2001) Ultrasound Obstet Gynecol., 17 (2), pp. 102-105Souka, A.P., Von Kaisenberg, C.S., Hyett, J.A., Sonek, J.D., Nicolaides, K.H., Increased nuchal translucency with normal karyotype (2005) Am J Obstet Gynecol., 192 (4), pp. 1005-1021Westin, M., Saltvedt, S., Almström, H., Grunewald, C., Valentin, L., By how much does increased nuchal translucency increase the risk of adverse pregnancy outcome in chromosomally normal fetuses? A study of 16,260 fetuses derived from an unselected pregnant population (2007) Ultrasound Obstet Gynecol., 29 (2), pp. 150-158Chaoui, R., Benoit, B., Mitkowska-Wozniak, H., Heling, K.S., Nicolaides, K.H., Assessment of intracranial translucency (IT) in the detection of spina bifida at the 11-13-week scan (2009) Ultrasound Obstet Gynecol., 34 (3), pp. 249-252Lachmann, R., Picciarelli, G., Moratalla, J., Greene, N., Nicolaides, K.H., Frontomaxillary facial angle in fetuses with spina bifida at 11-13 weeks' gestation (2010) Ultrasound Obstet Gynecol., 36 (3), pp. 268-271Benirschke, K., Kim, C.K., Multiple pregnancy. 1 (1973) N Engl J Med., 288 (24), pp. 1276-1284Chauhan, S.P., Scardo, J.A., Hayes, E., Abuhamad, A.Z., Berghella, V., Twins: Prevalence, problems, and preterm births (2010) Am J Obstet Gynecol., 203 (4), pp. 305-315Sebire, N.J., Snijders, R.J., Hughes, K., Sepulveda, W., Nicolaides, K.H., The hidden mortality of monochorionic twin pregnancies (1997) Br J Obstet Gynaecol., 104 (10), pp. 1203-1207Sperling, L., Kiil, C., Larsen, L.U., Qvist, I., Schwartz, M., Jorgensen, C., Naturally conceived twins with monochorionic placentation have the highest risk of fetal loss (2006) Ultrasound Obstet Gynecol., 28 (5), pp. 644-652Savvidou, M.D., Karanastasi, E., Skentou, C., Geerts, L., Nicolaides, K.H., Twin chorionicity and pre-eclampsia (2001) Ultrasound Obstet Gynecol., 18 (3), pp. 228-231Bajoria, R., Wee, L.Y., Anwar, S., Ward, S., Outcome of twin pregnancies complicated by single intrauterine death in relation to vascular anatomy of the monochorionic placenta (1999) Hum Reprod., 14 (8), pp. 2124-2130Pharoah, P.O., Adi, Y., Consequences of in-utero death in a twin pregnancy (2000) Lancet., 355 (9215), pp. 1597-1602Adegbite, A.L., Castille, S., Ward, S., Bajoria, R., Prevalence of cranial scan abnormalities in preterm twins in relation to chorionicity and discordant birth weight (2005) Eur J Obstet Gynecol Reprod Biol., 119 (1), pp. 47-55Adegbite, A.L., Castille, S., Ward, S., Bajoria, R., Neuromorbidity in preterm twins in relation to chorionicity and discordant birth weight (2004) Am J Obstet Gynecol., 190 (1), pp. 156-163Fusi, L., McParland, P., Fisk, N., Nicolini, U., Wigglesworth, J., Acute twin-twin transfusion: A possible mechanism for brain-damaged survivors after intrauterine death of a monochorionic twin (1991) Obstet Gynecol., 78 (3 PART 2), pp. 517-520Burn, J., Disturbance of morphological laterality in humans (1991) Ciba Found Symp, 162, pp. 282-296Glinianaia, S.V., Rankin, J., Wright, C., Congenital anomalies in twins: A register-based study (2008) Hum Reprod., 23 (6), pp. 1306-1311El Kateb, A., Ville, Y., Update on twin-to-twin transfusion syndrome (2008) Best Pract Res Clin Obstet Gynaecol., 22 (1), pp. 63-75Peralta, C.F.A., Ishikawa, L.E., Passini Jr., R., Bennini Jr., J.R., Nomura, M.L., Rosa, I.R., História natural das gestações gemelares monocoriônicas diamnióticas com e sem transfusão feto-fetal (2009) Rev Bras Ginecol Obstet., 31 (6), pp. 273-278Shetty, A., Smith, A.P., The sonographic diagnosis of chorionicity (2005) Prenat Diagn., 25 (9), pp. 735-739Sepulveda, W., Sebire, N.J., Hughes, K., Odibo, A., Nicolaides, K.H., The lambda sign at 10-14 weeks of gestation as a predictor of chorionicity in twin pregnancies (1996) Ultrasound Obstet Gynecol., 7 (6), pp. 421-423Sepulveda, W., Sebire, N.J., Hughes, K., Kalogeropoulos, A., Nicolaides, K.H., Evolution of the lambda or twin-chorionic peak sign in dichorionic twin pregnancies (1997) Obstet Gynecol., 89 (3), pp. 439-441Kagan, K.O., Gazzoni, A., Sepulveda-Gonzalez, G., Sotiriadis, A., Nicolaides, K.H., Discordance in nuchal translucency thickness in the prediction of severe twin-to-twin transfusion syndrome (2007) Ultrasound Obstet Gynecol., 29 (5), pp. 527-532Maiz, N., Staboulidou, I., Leal, A.M., Minekawa, R., Nicolaides, K.H., Ductus venosus Doppler at 11 to 13 weeks of gestation in the prediction of outcome in twin pregnancies (2009) Obstet Gynecol., 113 (4), pp. 860-865Matias, A., Montenegro, N., Loureiro, T., Cunha, M., Duarte, S., Freitas, D., Screening for twin-twin transfusion syndrome at 11-14 weeks of pregnancy: The key role of ductus venosus blood flow assessment (2010) Ultrasound Obstet Gynecol., 35 (2), pp. 142-148Quintero, R.A., Morales, W.J., Allen, M.H., Bornick, P.W., Johnson, P.K., Kruger, M., Staging of twin-twin transfusion syndrome (1999) J Perinatol., 19 (8 PART 1), pp. 550-555Robyr, R., Boulvain, M., Lewi, L., Huber, A., Hecher, K., Deprest, J., Cervical length as a prognostic factor for preterm delivery in twin-to-twin transfusion syndrome treated by fetoscopic laser coagulation of chorionic plate anastomoses (2005) Ultrasound Obstet Gynecol., 25 (1), pp. 37-41Salomon, L.J., Nasr, B., Nizard, J., Bernard, J.P., Essaoui, M., Bussieres, L., Emergency cerclage in cases of twin-to-twin transfusion syndrome with a short cervix at the time of surgery and relationship to perinatal outcome (2008) Prenat Diagn., 28 (13), pp. 1256-1261Peralta, C.F.A., Ishikawa, L.E., Bennini, J.R., Braga, A.F.A., Rosa, I.R.M., Biondi, M.C., Ablação dos vasos placentários com laser para tratamento da síndrome de transfusão feto-fetal grave: Experiência de um centro universitário no Brasil (2010) Rev Bras Ginecol Obstet., 32 (5), pp. 214-221Plasencia, W., Maiz, N., Bonino, S., Kaihura, C., Nicolaides, K.H., Uterine artery Doppler at 11 + 0 to 13 + 6 weeks in the prediction of preeclampsia (2007) Ultrasound Obstet Gynecol., 30 (5), pp. 742-749Pilalis, A., Souka, A.P., Antsaklis, P., Daskalakis, G., Papantoniou, N., Mesogitis, S., Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler and PAPP-A at 11-14 weeks' gestation (2007) Ultrasound Obstet Gynecol., 29 (2), pp. 135-140Akolekar, R., Zaragoza, E., Poon, L.C., Pepes, S., Nicolaides, K.H., Maternal serum placental growth factor at 11 + 0 to 13 + 6 weeks of gestation in the prediction of pre-eclampsia (2008) Ultrasound Obstet Gynecol., 32 (6), pp. 732-739Poon, L.C., Kametas, N.A., Pandeva, I., Valencia, C., Nicolaides, K.H., Mean arterial pressure at 11(+0) to 13(+6) weeks in the prediction of preeclampsia (2008) Hypertension., 51 (4), pp. 1027-1033Poon, L.C., Karagiannis, G., Leal, A., Romero, X.C., Nicolaides, K.H., Hypertensive disorders in pregnancy: Screening by uterine artery Doppler imaging and blood pressure at 11-13 weeks (2009) Ultrasound Obstet Gynecol., 34 (5), pp. 497-50

Fetal Brain Lesion Associated With Spontaneous Twin Anemia-polycythemia Sequence

[No abstract available]426721722Mari, G., Deter, R.L., Carpenter, R.L., Rahman, F., Zimmerman, R., Moise, Jr.K.J., Dorman, K.F., Blackwell, S.C., Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses (2000) N Engl J Med, 342, pp. 9-14Slaghekke, F., Kist, W.J., Oepkes, D., Pasman, S.A., Middeldorp, J.M., Klumper, F.J., Walther, F.J., Lopriore, E., Twin anemia-polycythemia sequence: Diagnostic criteria, classification, perinatal management and outcome (2010) Fetal Diagn Ther, 27, pp. 181-190Lopriore, E., Slaghekke, F., Kersbergen, K., De Vries, L., Drogtrop, A., Middeldorp, J., Oepkes, D., Benders, M., Severe cerebral injury in a recipient with twin anemia-polycythemia sequence (2013) Ultrasound Obstet Gynecol, 41, pp. 702-706Lewi, L., Jani, J., Blickstein, I., Huber, A., Gucciardo, L., Van Mieghem, T., Doné, E., Deprest, J., The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy a prospective cohort study (2008) Am J Obstet Gynecol, 199, pp. e1-e8. , 514Lopriore, E., Slaghekke, F., Middeldorp, J.M., Klumper, F.J., Oepkes, D., Vandenbussche, F.P., Residual anastomoses in twin-to-twin transfusion syndrome treated with selective fetoscopic laser surgery: Localization, size, and consequences (2009) Am J Obstet Gynecol, 201, pp. e1-e4. , 6

Elaboration And Validation Of Longitudinal Reference Intervals Of Fetal Weight With A Sample Of The Brazilian Population [elaboração E Validação De Intervalos De Referência Longitudinais De Peso Fetal Com Uma Amostra Da População Brasileira]

PURPOSES: To elaborate models for the estimation of fetal weight and longitudinal reference intervals of estimated fetal weight (EFW) using a sample of the Brazilian population. METHODS: Prospective observational study. Two groups of patients were evaluated: Group EFW (estimation of fetal weight): to elaborate (EFW-El) and validate (EFW-Val) a model for the prediction of fetal weight; Group LRI (longitudinal reference intervals): To elaborate (LRI-El) and validate (LRF-Val) conditional (longitudinal) percentiles of EFW. Polynomial regression analysis was applied to the data from subgroup EFW-El to elaborate a model for the estimation of fetal weight. The performance of this model was compared to those of previously published formulas. Linear mixed models were used for the elaboration of longitudinal reference intervals of EFW using data from subgroup LRI-El. Data obtained from subgroup LRI-Val were used to validate these intervals. RESULTS: Group EFW consisted of 458 patients (EFW-El: 367; EFW-Val: 91) and Group LRI consisted of 315 patients (LRI-El: 265; LRI-Val: 50). The model obtained for EFW was: EFW=-8.277+2.146xBPDxACxFL-2.449xFLxBPD2. The performances of other models were significantly worse than those obtained with our formula. Equations for the prediction of conditional percentiles of EFW were derived from the longitudinal observation of patients of subgroup LRI-El and validated with data from subgroup LRI-Val. CONCLUSIONS: We described a method for customization of longitudinal reference intervals of EFW obtained using formulas generated from a sample of the Brazilian population.3410466472Chang, T.C., Robson, S.C., Spencer, J.A., Gallivan, S., Identification of fetal growth retardation: Comparison of Doppler waveform indices and serial ultrasound fetal measurements of abdominal circumference and fetal weight (1993) Obstet Gynecol., 82 (2), pp. 230-236Chang, T.C., Robson, S.C., Spencer, J.A., Gallivan, S., Prediction of perinatal morbidity at term in small fetuses: Comparison of fetal growth and Doppler ultrasound (1994) Br J Obstet Gynaecol., 101 (5), pp. 422-427Stratton, J.F., Scanaill, S.N., Stuart, B., Turner, M.J., Are babies of normal birth weight who fail to reach their growth potential as diagnosed by ultrasound at increased risk? (1995) Ultrasound Obstet Gynecol., 5 (2), pp. 114-118Deter, R.L., Harrist, R.B., Hadlock, F.P., Poindexter, A.N., Longitudinal studies of fetal growth with the use of dynamic image ultrasonography (1982) Am J Obstet Gynecol., 143 (5), pp. 545-554Larsen, T., Petersen, S., Greisen, G., Larsen, J.F., Normal fetal growth evaluated by longitudinal ultrasound examinations (1990) Early Hum Dev., 24 (1), pp. 37-45Gallivan, S., Robson, S.C., Chang, T.C., Vaughan, J., Spencer, J.A., An investigation of fetal growth using serial ultrasound data (1993) Ultrasound Obstet Gynecol., 3 (2), pp. 109-114Owen, P., Ogston, S., Conditional centiles for the quantification of fetal growth (1998) Ultrasound Obstet Gynecol., 11 (2), pp. 110-117Johnsen, S.L., Rasmussen, S., Wilsgaard, T., Sollien, R., Kiserud, T., Longitudinal reference ranges for estimated fetal weight (2006) Acta Obstet Gynecol Scand., 85 (3), pp. 286-297Hadlock, F.P., Harrist, R.B., Sharman, R.S., Deter, R.L., Park, S.K., Estimation of fetal weight with the use of head, body, and femur measurements: A prospective study (1985) Am J Obstet Gynecol., 151 (3), pp. 333-337Woo, J.S., Wan, C.W., Cho, K.M., Computer-assisted evaluation of ultrasonic fetal weight prediction using multiple regression equations with and without the fetal femur length (1985) J Ultrasound Med., 4 (2), pp. 65-67Birnholz, J.C., An algorithmic approach to accurate ultrasonic fetal weight estimation (1986) Invest Radiol., 21 (7), pp. 571-576Hsieh, F.J., Chang, F.M., Huang, H.C., Lu, C.C., Ko, T.M., Chen, H.Y., Computer-assisted analysis for prediction of fetal weight by ultrasound: Comparison of biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) (1987) Taiwan Yi Xue Hui Za Zhi., 86 (9), pp. 957-964Shinozuka, N., Okai, T., Kohzuma, S., Mukubo, M., Shih, C.T., Maeda, T., Formulas for fetal weight estimation by ultrasound measurements based on neonatal specific gravities and volumes (1987) Am J Obstet Gynecol., 157 (5), pp. 1140-1145Rosati, P., Arduini, M., Giri, C., Guariglia, L., Ultrasonographic weight estimation in large for gestational age fetuses: A comparison of 17 sonographic formulas and four models algorithms (2010) J Matern Fetal Neonatal Med., 23 (7), pp. 675-680Bennini, J.R., Marussi, E.F., Barini, R., Faro, C., Peralta, C.F., Birth-weight prediction by two-and three-dimensional ultrasound imaging (2010) Ultrasound Obstet Gynecol., 35 (4), pp. 426-433Deter, R.L., Evaluation of intrauterine growth retardation in the fetus and neonate: Are simple-minded methods good enough? (1995) Ultrasound Obstet Gynecol., 6 (3), pp. 161-163Altman, D.G., Hytten, F.E., Intrauterine growth retardation: Let's be clear about it (1989) Br J Obstet Gynaecol., 96 (10), pp. 1127-1132Robinson, H.P., Fleming, J.E., A critical evaluation of sonar "crown-rump length" measurements (1975) Br J Obstet Gynecol., 82 (9), pp. 702-710Yudkin, P.L., Aboualfa, M., Eyre, J.A., Redman, C.W., Wilkinson, A.R., New birthweight and head circumference centiles for gestational ages 24 to 42 weeks (1987) Early Hum Dev., 15 (1), pp. 45-52Lees, C., Albaiges, G., Deane, C., Parra, M., Nicolaides, K.H., Assessment of umbilical arterial and venous flow using color Doppler (1999) Ultrasound Obstet Gynecol., 14 (4), pp. 250-255Grannum, P.A., Berkowitz, R.L., Hobbins, J.C., The ultrasonic changes in the maturing placenta and their relation to fetal pulmonic maturity (1979) Am J Obstet Gynecol., 133 (8), pp. 915-922Liu, R.X., Kuang, J., Gong, Q., Hou, X.L., Principal component regression analysis with SPSS (2003) Comput Methods Programs Biomed., 71 (2), pp. 141-147Ludbrook, J., Multiple comparison procedures update (1998) Clin Exp Pharmacol Physiol., 25 (12), pp. 1032-1037Pitman, E.J.G., A note on normal correlation (1939) Biometrika., 31 (12), pp. 9-12Verbeke, G., Molenberghs, G., (2009) Linear mixed models for longitudinal data, , New York: Springe

Longitudinal Reference Intervals Of Maternal-fetal Doppler Parameters [intervalos De Referência Longitudinais De Parâmetros Doplervelocimétricos Materno-fetais]

PURPOSE: To create longitudinal reference intervals for pulsatility index (PI) of the umbilical (UA), middle cerebral (MCA), uterine (UtA) arteries and ductus venosus (DV) in a Brazilian cohort. METHODS: A longitudinal observational study performed from February 2010 to May 2012. Low risk pregnancies were scanned fortnightly from 18 to 40 weeks for the measurements of PI of the UA, MCA, DV and UtA. Linear mixed models were used for the elaboration of longitudinal reference intervals (5th, 50th and 95th percentiles) of these measurements. PI obtained for the placental and abdominal portions of the umbilical artery were compared by the t-test for independent samples. Two-sided p values of less than 0.05 were considered statistically significant. RESULTS: A total of 164 patients underwent 1,242 scans. There was significant decrease in PI values of all vessels studied with gestational age (GA). From the 18th to the 40th week of pregnancy, the median PI values of UA (abdominal and placental ends of the cord), MCA, DV and the mean PI of the UtA ranged from 1.19 to 0.74, 1.33 to 0.78, 1.56 to 1.39, 0.58 to 0.41, and 0.98 to 0.66, respectively. The following equations were obtained for the prediction of the medians: PI-UA=1.5602786 - (0.020623 x GA); Logarithm of the PI-MCA=0.8149111 - (0.004168 x GA) - [0.02543 x (GA - 28.7756)2]; Logarithm of the PI-DV=-0.26691- (0.015414 x GA); PI-UtA = 1.2362403 - (0.014392 x GA). There was a significant difference between the PI-UA obtained at the abdominal and placental ends of the umbilical cord (p<0.001). CONCLUSIONS: Longitudinal reference intervals for the main gestational Doppler parameters were obtained in a Brazilian cohort. These intervals could be more adequate for the follow-up of maternal-fetal hemodynamic modifications in normal and abnormal pregnancies, a fact that still requires further validation.3513338Arduini, D., Rizzo, G., Normal values of Pulsatility Index from fetal vessels: A cross-sectional study on 1556 healthy fetuses (1990) J Perinat Med, 18 (3), pp. 165-172Alfirevic, Z., Neilson, J.P., Doppler ultrasonography in high-risk pregnancies: Systematic review with meta-analysis (1995) Am J Obstet Gynecol, 172 (5), pp. 1379-1387Papageorghiou, A.T., Yu, C.K., Cicero, S., Bower, S., Nicolaides, K.H., Second-trimester uterine artery Doppler screening in unselected populations: A review (2002) J Matern Fetal Neonatal Med, 12 (2), pp. 78-88Acharya, G., Wilsgaard, T., Berntsen, G.K., Maltau, J.M., Kiserud, T., References ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy (2005) Am J Obstet Gynecol, 192 (3), pp. 937-944Acharya, G., Wilsgaard, T., Berntsen, G.K., Maltau, J.M., Kiserud, T., Reference ranges for serial measurements of blood velocity and pulsatility index at the intra-abdominal portion, and fetal and placental ends of the umbilical artery (2005) Ultrasound Obstet Gynecol, 26 (2), pp. 162-169Kessler, J., Rasmussen, S., Hanson, M., Kiserud, T., Longitudinal reference ranges for ductus venosus flow velocities and waveform indices (2006) Ultrasound Obstet Gynecol, 28 (7), pp. 890-898Turan, S., Turan, O.M., Berg, C., Moyano, D., Bhide, A., Bower, S., Computerized heart rate analysis, Doppler ultrasound and biophysical profile score in the prediction of acid-base status of growth-restricted fetuses (2007) Ultrasound Obstet Gynecol, 30 (5), pp. 750-756Tarzamni, M.K., Nezami, N., Sobhani, N., Eshraghi, N., Tarzamni, M., Talebi, Y., Nomograms of Iranian fetal middle cerebral artery Doppler waveforms and uniformity of their pattern with other populations' nomograms (2008) BMC Pregnancy Childbirth, 8, p. 50Flo, K., Wilsgaard, T., Acharya, G., Relation between utero-placental and feto-placental circulations: A longitudinal study (2010) Acta Obstet Gynecol Scand, 89 (10), pp. 1270-1275Kaponis, A., Harada, T., Makrydimas, G., Kiyama, T., Arata, K., Adonakis, G., The importance of venous Doppler velocimetry for evaluation of intrauterine growth restriction (2011) J Ultrasound Med, 30 (4), pp. 529-545Berkley, E., Chauhan, S.P., Abuhamad, A., Doppler assessment of the fetus with intrauterine growth restriction (2012) Am J Obstet Gynecol, 206 (4), pp. 300-308. , Society for Maternal-Fetal Medicine Publications CommitteeKalache, K.D., Dückelmann, A.M., Doppler in obstetrics: Beyond the umbilical artery (2012) Clin Obstet Gynecol, 55 (1), pp. 288-295Tongprasert, F., Srisupundit, K., Luewan, S., Wanapirak, C., Tongsong, T., Normal reference ranges of ductus venosus Doppler indices in the period from 14 to 40 weeks' gestation (2012) Gynecol Obstet Invest, 73 (1), pp. 32-37Robinson, H.P., Fleming, J.E., A critical evaluation of sonar "crown-rump length" measurements (1975) Br J Obstet Gynaecol, 82 (9), pp. 702-710Hadlock, F.P., Harrist, R.B., Carpenter, R.J., Deter, R.L., Park, S.K., Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements (1984) Radiology, 150 (2), pp. 535-540Conclusions and recommendations on thermal and non-thermal mechanisms for biological effects of ultrasound (1998) Ultrasound Med Biol, 24 (SUPPL. 1), pp. S1-S58. , WFUMB Symposium on Safety of Ultrasound in MedicineRoyston, P., Wright, E.M., How to construct 'normal ranges' for fetal variables (1998) Ultrasound Obstet Gynecol, 11 (1), pp. 30-38Fieuws, S., Verbeke, G., Molenberghs, G., Random-effects models for multivariate repeated measures (2007) Stat Methods Med Res, 16 (5), pp. 387-397Young, I.T., Proof without prejudice: Use of the Kormogorov-Smirnov test for the analysis of histograms from flow systems and others sources (1977) J Histochem Cytochem, 25 (7), pp. 935-94

Maternal Complications Following Endoscopic Surgeries In Fetal Medicine [complicações Maternas Decorrentes Das Cirurgias Endoscópicas Em Medicina Fetal]

PURPOSE: to describe the maternal complications due to therapeutic endoscopic procedures in fetal Medicine performed at an university center in Brazil. METHODS: retrospective observational study including patients treated from April 2007 to May 2010 who underwent laser ablation of placental vessels (LAPV) for severe twin-twin transfusion syndrome (TTTS); fetal tracheal occlusion (FETO) and endoscopic removal of tracheal balloon in cases of severe congenital diaphragmatic hernia (CDH); LAPV with or without bipolar coagulation of the umbilical cord in cases of twin reversed arterial perfusion (TRAP) sequence. The main variables described for each disease/type of surgery were maternal complications and neonatal survival (discharge from nursery). RESULTS: fifty-six patients underwent 70 procedures: Severe TTTS (34 patients; 34 surgeries); severe CDH (16 patients; 30 surgeries), and TRAP sequence (6 patients; 6 surgeries). Among 34 women who underwent LAPV for TTTS, two (2/34=5.9%) experienced amniotic fluid leakage to the peritoneal cavity and seven (7/34=20.6%) miscarried after the procedure. Survival of at least one twin was 64.7% (22/34). Among 30 interventions performed in cases of CDH, there was amniotic fluid leakage into the maternal peritoneal cavity in one patient (1/30=3.3%) and premature preterm rupture of membranes after three (3/30=30%) fetoscopies for removal of the tracheal balloon. Infant survival with discharge from nursery was 43.8% (7/16). Among six cases of TRAP sequence, there was bleeding into the peritoneal cavity after surgery in one patient (1/6=16.7%) and neonatal survival with discharge from nursery was 50% (3/6). CONCLUSIONS: in agreement with the available data in literature, at our center, the benefits related to therapeutic endoscopic interventions for TTTS, CDH and TRAP sequence seem to overcome the risks of maternal complications, which were rarely considered severe.326260266de Lia, J.E., Cruikshank, D.P., Keye, W.R., Fetoscopic neodymium: YAG laser occlusion of placental vessels in severe twin-twin transfusion syndrome (1990) Obstet Gynecol, 75 (6), pp. 1046-1053Quintero, R.A., Hume, R., Smith, C., Johnson, M.P., Cotton, D.B., Romero, R., Percutaneous fetal cystoscopy and endoscopic fulguration of posterior urethral valves (1995) Am J Obstet Gynecol, 172 (1), pp. 206-309Bruner, J.P., Tulipan, N.E., Richards, W.O., Endoscopic coverage of fetal open myelomeningocele in utero (1997) Am J Obstet Gynecol, 176 (1), pp. 256-257Skarsgard, E.D., Meuli, M., Vanderwall, K.J., Bealer, J.F., Adzick, N.S., Harrison, M.R., Fetal endoscopic tracheal occlusion ('Fetendo-Plug') for congenital diaphragmatic hernia (1996) J Pediatr Surg, 31 (10), pp. 1335-1338Hecher, K., Hackelöer, B.J., Intrauterine endoscopic laser surgery for fetal sacrococcygeal teratoma (1996) Lancet, 347 (8999), p. 470Deprest, J., Gratacos, E., Nikolaides, K.H., FETO Task Group. Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia: Evolution of a technique and preliminary results (2004) Ultrasound Obstet Gynecol, 24 (2), pp. 121-126Hecher, K., Diehl, W., Zikulnig, L., Vetter, M., Hackelöer, B.J., Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid-trimester twin-to-twin transfusion syndrome (2000) Eur J Obstet Gynecol Reprod Biol, 92 (1), pp. 135-139Quintero, R.A., Comas, C., Bornick, P.W., Alen, M.H., Kruger, M., Selective versus non-selective laser photocoagulation of placental vessels in twin-to-twin transfusion syndrome (2000) Ultrasound Obstet Gynecol, 16 (3), pp. 230-236Senat, M.V., Deprest, J., Boulvain, M., Paupe, A., Winer, N., Ville, Y., Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome (2004) N Engl J Med, 351 (2), pp. 136-144Peralta, C.F.A., Ishikawa, L.E., Bennini, J.R., Braga, A.F.A., Rosa, I.R.M., Biondi, I.M.C., Ablação dos vasos placentários com laser para tratamento da síndrome de transfusão feto-fetal grave - experiência de um centro universitário no Brasil (2010) Rev Bras Ginecol Obstet, 32 (5), pp. 214-221Manrique, S., Munar, F., Andreu, E., Montferrer, N., de Miguel, M., López, G.V., Fetoscopic tracheal occlusion for the treatment of severe congenital diaphragmatic hernia: Preliminary results (2008) Rev Esp Anestesiol Reanim, 55 (7), pp. 407-413Jani, J.C., Nicolaides, K.H., Gratacós, E., Valencia, C.M., Doné, E., Martinez, J.M., Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion (2009) Ultrasound Obstet Gynecol, 34 (3), pp. 304-310Peralta, C.F.A., Sbragia, L., Bennini, J.R., Braga, A.F.A., Rousselet, M.S., Rosa, I.R.M., Fetoscopic endotracheal occlusion for severe isolated diaphragmatic hérnia: Initial experience from a single clinic in Brazil (2010) Fetal Diag Ther, , In pressSbragia, L., Tratamento das malformações fetais intraútero (2010) Rev Bras Ginecol Obstet, 32 (1), pp. 47-54Deprest, J., Jani, J., Lewi, L., Ochsenbein-Kölble, N., Cannie, M., Doné, E., Fetoscopic surgery: Encouraged by clinical experience and boosted by instrument innovation (2006) Semin Fetal Neonatal Med, 11 (6), pp. 398-412Golombeck, K., Ball, R.H., Lee, H., Farrell, J.A., Farmer, D.L., Jacobs, V.R., Maternal morbidity after maternal-fetal surgery (2006) Am J Obstet Gynecol, 194 (3), pp. 834-839Yamamoto, M., El Murr, L., Robyr, R., Leleu, F., Takahashi, Y., Ville, Y., Incidence and impact of perioperative complications in 175 fetoscopy-guided laser coagulations of chorionic plate anastomoses in fetofetal transfusion syndrome before 26 weeks of gestation (2005) Am J Obstet Gynecol, 193 (2), pp. 1110-1116Chang, J., Tracy Jr., T.F., Carr, S.R., Sorrells Jr., D.L., Luks, F.I., Port insertion and removal techniques to minimize premature rupture of the membranes in endoscopic fetal surgery (2006) J Pediatr Surg, 41 (5), pp. 905-909Robyr, R., Boulvain, M., Lewi, L., Huber, A., Hecher, K., Deprest, J., Cervical length as a prognostic factor for preterm delivery in twin-to-twin transfusion syndrome treated by fetoscopic laser coagulation of chorionic plate anastomoses (2005) Ultrasound Obstet Gynecol, 25 (1), pp. 37-41Robyr, R., Lewi, L., Salomon, L.J., Yamamoto, M., Bernard, J.P., Deprest, J., Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-twin transfusion syndrome (2006) Am J Obstet Gynecol, 194 (3), pp. 796-803Yamamoto, M., Ville, Y., Laser treatment in twin-to-twin transfusion syndrome (2007) Semin Fetal Neonatal Med, 12 (6), pp. 450-457Habli, M., Bombrys, A., Lewis, D., Lim, F.Y., Polzin, W., Maxwell, R., Incidence of complications in twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation: A single-center experience (2009) Am J Obstet Gynecol, 201 (4), pp. e1-e7. , 417Quintero, R.A., Morales, W.J., Allen, M.H., Bornick, P.W., Johnson, P.K., Kruger, M., Staging of twin-twin transfusion syndrome (1999) J Perinatol, 19 (1), pp. 550-555Jani, J., Keller, R.L., Benachi, A., Nicolaides, K.H., Favre, R., Gratacos, E., Prenatal prediction of survival in isolated left-sided diaphragmatic hernia (2006) Ultrasound Obstet Gynecol, 27 (1), pp. 18-22Weisz, B., Peltz, R., Chayen, B., Oren, M., Zalel, Y., Achiron, R., Tailored management of twin reversed arterial perfusion (TRAP) sequence (2004) Ultrasound Obstet Gynecol, 23 (5), pp. 451-455Quintero, R.A., Chmait, R.H., Murakoshi, T., Pankrac, Z., Swiatkowska, M., Bornick, P.W., Surgical management of twin reversed arterial perfusion sequence (2006) Am J Obstet Gynecol, 194 (4), pp. 982-991Hecher, K., Lewi, L., Gratacos, E., Huber, A., Ville, Y., Deprest, J., Twin reversed arterial perfusion: Fetoscopic laser coagulation of placental anastomoses or the umbilical cord (2006) Ultrasound Obstet Gynecol, 28 (5), pp. 688-691Nakata, M., Sumie, M., Murata, S., Miwa, I., Matsubara, M., Sugino, N., Fetoscopic laser photocoagulation of placental communicating vessels for twin-reversed arterial perfusion sequence (2008) J Obstet Gynaecol Res, 34 (2), pp. 649-652To, M.S., Skentou, C., Chan, C., Zagaliki, A., Nicolaides, K.H., Cervical assessment at the routine 23-week scan: Standardizing techniques (2001) Ultrasound Obstet Gynecol, 17 (3), pp. 217-219Salomon, L.J., Nasr, B., Nizard, J., Bernard, J.P., Essaoui, M., Bussieres, L., Emergency cerclage in cases of twin-to-twin transfusion syndrome with a short cervix at the time of surgery and relationship to perinatal outcome (2008) Prenat Diagn, 28 (13), pp. 1256-1261Gul, A., Gungorduk, K., Yildirim, G., Gedikbasi, A., Yildirim, D., Ceylan, Y., Fetal therapy in twin reversed arterial perfusion sequence pregnancies with alcohol ablation or bipolar cord coagulation (2008) Arch Gynecol Obstet, 278 (6), pp. 541-545Livingston, J.C., Lim, F.Y., Polzin, W., Mason, J., Crombleholme, T.M., Intrafetal radiofrequency ablation for twin reversed arterial perfusion (TRAP): A single center experience (2007) Am J Obstet Gynecol, 197 (4), pp. e1-e3. , 399Kagan, K.O., Gazzoni, A., Sepulveda-Gonzales, G., Sotiriades, A., Nicolaides, K.H., Discordance in nuchal translucency thickness in the prediction of severe twin-to-twin transfusion syndrome (2007) Ultrasound Obstet Gynecol, 29 (5), pp. 527-532Gul, A., Aslan, H., Polat, I., Cebeci, A., Bulut, H., Sahin, O., Natural history of 11 cases of twin-twin transfusion syndrome without intervention (2003) Twin Res, 6 (4), pp. 263-266Peralta, C.F.A., Ishikawa, L.E., Passini, J.R., Bennini, J.R., Nomura, M.L., Rosa, I.R.M., História natural das gestações gemelares monocoriônicas diamnióticas com e sem transfusão feto-fetal (2009) Rev Bras Ginecol Obstet, 31 (6), pp. 273-27

Natural History Of Monochorionic Diamniotic Twin Pregnancies With And Without Twin-twin Transfusion Syndrome [história Natural Das Gestações Gemelares Monocoriônicas Diamnióticas Com E Sem Transfusão Feto-fetal]

Purpose: to evaluate the evolution of monochorionic-diamniotic twin pregnancies with and without the twin-twin transfusion syndrome (TTTS), followed up in an expectant way. Methods: retrospective study in which the pregnancies with and without TTTS and with mild (Quintero's stage I) and severe (Quintero's stages II, III, IV and V) disease manifestations were compared according to extreme preterm delivery, neurological impairment and the twins' nursery discharge. The extreme preterm twins who had had TTTS, or not, were compared whether they had or not neurological impairment. The X 2 or Fisher's exact test were used. Results: among 149 monochorionic-diamniotic twin pregnancies, 15 presented TTTS, 11 (11/15 - 73.3%) in the severe form and 4 (4/15 - 26.7%) at stage I. The extreme preterm delivery was more frequent (p<0.001) in the cases with the disease (11/15 - 73.3%) than in the cases without it (25/134 - 18.7%), and more common (p=0.033) in severe (10/11 - 91.1%) than in mild cases (1/4 - 25.0%). Neurological impairment in at least one twin was more frequent in cases with (5/8 - 62.5%) than in cases without (9/134 - 6.7%) the disease (p<0.001). Nursery discharge of at least one twin was more common (p<0.001) in cases without (132/134 - 98.5%) than in cases with the disease (8/15 - 53.0%). Neurological impairment in at least one of the twins was more frequent (p=0.04) in the severe (5/5 - 100%) than in the mild (1/4 - 25%) form of the disease. Nursery discharge of both twins was more common (p=0.004) at stage I (4/4 - 100%), than in the severe form of the disease (1/11 - 9.0%). Among the 47 extreme preterm twins, the neurological impairment was more frequent (p=0.001) among the ones who had (6/6 - 100%), than among those who did not have TTTS (11/41 - 26.8%). Conclusions: cases with twin-twin transfusion syndrome, followed up in an expectant way have bad perinatal prognosis, with high neonatal mortality and high rates of neurological arrest among the survivors.316273278Bermúdez, C., Becerra, C.H., Bornick, P.W., Allen, M.H., Arroyo, J., Quintero, R.A., Placental types and twin-twin transfusion syndrome (2002) Am J Obstet Gynecol, 187 (2), pp. 489-94de Paepe, M.E., Dekoninck, P., Friedman, R.M., Vascular distribution patterns in monochorionic twin placentas (2005) Placenta, 26 (6), pp. 471-5Lewi, L., Jani, J., Cannie, M., Robyr, R., Ville, Y., Hecher, K., Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome: Is there more than meets the eye? (2006) Am J Obstet Gynecol, 194 (3), pp. 790-5Umur, A., van Gemert, M.J., Nikkels, P.G., Ross, M.G., Monochorionic twins and twin-twin transfusion syndrome: The protective role of arterio-arterial anastomoses (2002) Placenta, 23 (2-3), pp. 201-9Berghella, V., Kaufmann, M., Natural history of twin-twin transfusion syndrome (2001) J Reprod Med, 46 (5), pp. 480-4Gul, A., Aslan, H., Polat, I., Cebeci, A., Bulut, H., Sahin, O., Natural history of 11 cases of twin-twin transfusion syndrome without intervention (2003) Twin Res, 6 (4), pp. 263-6Sebire, N.J., Souka, A., Skentou, H., Geerts, L., Nicolaides, K.H., Early prediction of severe twin-to-twin transfusion syndrome (2000) Hum Reprod, 15 (9), pp. 2008-10Quintero, R.A., Morales, W.J., Allen, M.H., Bornick, P.W., Johnson, P.K., Kruger, M., Staging of twin-twin transfusion syndrome (1999) J Perinatol, 19 (8 PART 1), pp. 550-5Quintero, R.A., Dickinson, J.E., Morales, W.J., Bornick, P.W., Bermúdez, C., Cincotta, R., Stage-based treatment of twin-twin transfusion syndrome (2003) Am J Obstet Gynecol, 188 (5), pp. 1333-40Denbow, M.L., Battin, M.R., Cowan, F., Azzopardi, D., Edwards, A.D., Fisk, N.M., Neonatal cranial ultrasonographic findings in preterm twins complicated by severe fetofetal transfusion syndrome (1998) Am J Obstet Gynecol, 178 (3), pp. 479-83Adegbite, A.L., Castille, S., Ward, S., Bajoria, R., Prevalence of cranial scan abnormalities in preterm twins in relation to chorionicity and discordant birth weight (2005) Eur J Obstet Gynecol Reprod Biol, 119 (1), pp. 47-55Lopriore, E., Middeldorp, J.M., Sueters, M., Vandenbussche, F.P., Walther, F.J., Twin-to-twin transfusion syndrome: From placental anastomoses to long-term neurodevelopmental outcome (2005) Curr Pediatr Rev, 1 (3), pp. 191-203ACOG Practice Bulletin: Assessment of risk factors for preterm birth. Clinical management guidelines for obstetrician-gynecologists. Number 31, October 2001. (Replaces Technical Bulletin number 206, June 1995Committee Opinion number 172, May 1996Committee Opinion number 187, September 1997Committee Opinion number 198, February 1998and Committee Opinion number 251, January 2001) (2001) Obstet Gynecol., 98 (4), pp. 709-16. , American College of Obstetricians and GynecologistsACOG practice bulletin. Management of preterm labor. Number 43, May 2003 (2003) Int J Gynaecol Obstet., 82 (1), pp. 127-35. , Committee on Practice Bulletins-ObstetricsHack, M., Wright, L.L., Shankaran, S., Tyson, J.E., Horbar, J.D., Bauer, C.R., Very-low-birth-weight outcomes of the National Institute of Child Health and Human Development Neonatal Network, November 1989 to October 1990 (1995) Am J Obstet Gynecol., 172 (2 PART 1), pp. 457-64Fanaroff, A.A., Wright, L.L., Stevenson, D.K., Shankaran, S., Donovan, E.F., Ehrenkranz, R.A., Very-low-birth-weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, May 1991 through December 1992 (1995) Am J Obstet Gynecol., 173 (5), pp. 1423-31Gibbs, R.S., Romero, R., Hillier, S.L., Eschenbach, D.A., Sweet, R.L., A review of premature birth and subclinical infection (1992) Am J Obstet Gynecol, 166 (5), pp. 1515-28Cincotta, R.B., Gray, P.H., Phythian, G., Rogers, Y.M., Chan, F.Y., Long term outcome of twin-twin transfusion syndrome (2000) Arch Dis Child Fetal Neonatal Ed., 83 (3), pp. F171-6Haverkamp, F., Lex, C., Hanisch, C., Fahnenstich, H., Zerres, K., Neurodevelopmental risks in twin-to-twin transfusion syndrome: Preliminary findings (2001) Eur J Paediatr Neurol, 5 (1), pp. 21-7Lopriore, E., Nagel, H.T., Vandenbussche, F.P., Walther, F.J., Long-term neurodevelopmental outcome in twin-to-twin transfusion syndrome (2003) Am J Obstet Gynecol, 189 (5), pp. 1314-9de Lia, J.E., Surgery of the placenta and umbilical cord (1996) Clin Obstet Gynecol, 39 (3), pp. 607-25Hecher, K., Plath, H., Bregenzer, T., Hansmann, M., Hackelöer, B.J., Endoscopic laser surgery versus serial amniocenteses in the treatment of severe twin-twin transfusion syndrome (1999) Am J Obstet Gynecol, 180 (3 PART 1), pp. 717-24Hecher, K., Diehl, W., Zikulnig, L., Vetter, M., Hackelöer, B.J., Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid-trimester twin-to-twin transfusion syndrome (2000) Eur J Obstet Gynecol Reprod Biol, 92 (1), pp. 135-9Quintero, R.A., Comas, C., Bornick, P.W., Alen, M.H., Kruger, M., Selective versus non-selective laser photocoagulation of placental vessels in twin-to-twin transfusion syndrome (2000) Ultrasound Obstet Gynecol, 16 (3), pp. 230-6Senat, M.V., Deprest, J., Boulvain, M., Paupe, A., Winer, N., Ville, Y., Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome (2004) N Engl J Med, 351 (2), pp. 136-44Moise Jr., K.J., Dorman, K., Lamvu, G., Saade, G.R., Fisk, N.M., Dickinson, J.E., A randomized trial of amnioreduction versus septostomy in the treatment of twin-twin transfusion syndrome (2005) Am J Obstet Gynecol, 193 (3 PART 1), pp. 701-7Ruano, R., Brizot Mde, L., Liao, A.W., Zugaib, M., Selective fetoscopic laser photocoagulation of sperficial placental anastomoses for the treatment of severe twin-twin transfusion syndrome (2009) Clinics (Sao Paulo), 64 (2), pp. 91-6Kagan, K.O., Gazzoni, A., Sepulveda-Gonzalez, G., Sotiriades, A., Nicolaides, K.H., Discordance in nuchal translucency thickness in the prediction of severe twin-to-twin transfusion syndrome (2007) Ultrasound Obstet Gynecol, 29 (5), pp. 527-3

Fetal Bilateral Obstructive Uropathies: Ultrasound Findings During Pregnancy And Postnatal Outcomes [uropatias Obstrutivas Bilaterais Fetais: Sinais Ultrassonográficos Durante Agravidez E Evolução Pós-natal]

Purpose: To verify the association between ultrasonographic signs during gestation and post-delivery evolution in fetuses with bilateral obstructive uropathies, followed up in an expectant way. Methods: Fetuses with bilateral obstructive uropathies presenting severe oligoamnios and narrow thorax have been compared with fetuses with bilateral obstructive uropathies without those alterations, concerning the presence or absence of cysts in both kidneys, and the presence or absence of parenchymal hyperechogenicity in both kidneys. Cases of neonatal death were compared with cases of neonatal discharge from the nursery, regarding the same renal echographic aspects mentioned above, the presence of severe oligoamnios and narrow thorax. The sensitivity, specificity, positive and negative predictive value of the presence of bilateral renal cysts, bilateral renal hyperechogenicity, severe oligoamnios and narrow fetal thorax for the neonatal death were calculated. RESULTS: severe oligoamnios and narrow thorax were more frequent (p=0.03; p<0.001) in fetuses with bilateral renal cysts, as compared to those with echographically normal renal parenchyma. Neonatal death was more frequent among cases with severe oligoamnios (p<0.001), narrow thorax (p<0.001) and bilateral renal cysts (p<0.002), when respectively compared with cases without those alterations. The best values of sensitivity, specificity, positive and negative predictive value for the death of neonatal/breastfeeding infants were obtained using the echographic aspect of narrow thorax, and were 81.8, 100, 100 and 79.3%, respectively. Conclusions: In cases of fetuses with bilateral obstructive uropathies followed up in an expectant way, the ultrasonographic signs more associated to bad prognosis are severe oligoamnios, narrow fetal thorax and presence of bilateral renal cysts.3111540546Helin, I., Persson, P.H., Prenatal diagnosis of urinary tract abnormalities by ultrasound (1986) Pediatrics, 78 (5), pp. 879-883Rosendahl, H., Ultrasound screening for fetal urinary tract malformations a prospective study in general population (1990) Eur J Obstet Gynecol Reprod Biol, 36 (1-2), pp. 27-33James, C.A., Watson, A.R., Twining, P., Rance, C.H., Antenatally detected urinary tract abnormalities: Changing incidence and management (1998) Eur J Pediatr, 157 (6), pp. 508-511Thomas, D.F., Prenatally detected uropathy: Epidemiological considerations (1998) Br J Urol, 81 (SUPPL. 2), pp. 8-12Dicke, J.M., Blanco, V.M., Yan, Y., Coplen, D.E., The type and frequency of fetal renal disorders and management of renal pelvis dilatation (2006) J Ultrasound Med, 25 (8), pp. 973-977Loirat, C., Ehrich, J.H., Geerlings, W., Jones, E.H., Landais, P., Mallick, N.P., Report on management of renal failure in children in Europe, XXIII, 1992 (1994) Nephrol Dial Transplant, 9 (SUPPL. 1), pp. 26-40Gauderer, M.W., Jassani, M.N., Izant Jr, R.J., Ultrasonographic antenatal diagnosis: Will it change the spectrum of neonatal surgery? (1984) J Pediatr Surg, 19 (4), pp. 404-407Mahony, B.S., Filly, R.A., Callen, P.W., Hricak, H., Golbus, M.S., Harrison, M.R., Fetal renal dysplasia: Sonographic evaluation (1984) Radiology, 152 (1), pp. 143-146Grignon, A., Filion, R., Filiatrault, D., Robitaille, P., Homsy, Y., Boutin, H., Urinary tract dilatation in utero: Classification and clinical applications (1986) Radiology, 160 (3), pp. 645-647Corteville, J.E., Gray, D.L., Crane, J.P., Congenital hydronephrosis: Correlation of fetal ultrasonographic findings with infant outcome (1992) Am J Obstet Gynecol, 167 (2), pp. 384-388McHugo, J., Whittle, M., Enlarged fetal bladders: Aetiology, management and outcome (2001) Prenat Diagn, 21 (11), pp. 958-963Muller, F., Dommergues, M., Mandelbrot, L., Aubry, M.C., Nihoul-Fekete, C., Dumez, Y., Fetal urinary biochemistry predicts postnatal renal function in children with bilateral obstructive uropathies (1993) Obstet Gynecol, 82 (5), pp. 813-820Miguelez, J., Bunduki, V., Yoshizaki, C.T., Sadek, L.S., Koch, V., Peralta, C.F., Fetal obstructive uropathy: Is urine sampling useful for prenatal counselling? (2006) Prenat Diagn, 26 (1), pp. 81-84Lee, R.S., Cendron, M., Kinnamon, D.D., Nguyen, H.T., Antenatal hydronephrosis as a predictor of postnatal outcome: A meta-analysis (2006) Pediatrics, 118 (2), pp. 586-593Keays, M.A., Guerra, L.A., Mihill, J., Raju, G., Al-Asheeri, N., Geier, P., Reliability assessment of Society for Fetal Urology ultrasound grading system for hydronephrosis (2008) J Urol, 180 (4 SUPPL.), pp. 1680-1682Moore, T.R., Cayle, J.E., The amniotic fluid index in normal human pregnancy (1990) Am J Obstet Gynecol, 162 (5), pp. 1168-1173Moore, T.R., Superiority of the four-quadrant sum over the single-deepest-pocket technique in ultrasonographic identification of abnormal amniotic fluid volumes (1990) Am J Obstet Gynecol, 163 (3), pp. 762-767Moore, T.R., Sonographic screening for oligohydramnios: Does it decrease or increase morbidity? (2004) Obstet Gynecol, 104 (1), pp. 3-4Johnson, J.M., Chauhan, S.P., Ennen, C.S., Niederhauser, A., Magann, E.F., A comparison of 3 criteria of oligohydramnios in identifying peripartum complications: A secondary analysis (2007) Am J Obstet Gynecol, 197 (2). , 207.e1-7discussion 207.e7-8Rudd, P.T., Hughes, E.A., Placzek, M.M., Hodes, D.T., Reference ranges for plasma creatinine during the first month of life (1983) Arch Dis Child, 58 (3), pp. 212-215Andreoli, S.P., Acute renal failure in the newborn (2004) Semin Perinatol, 28 (2), pp. 112-123Blyth, B., Snyder, H.M., Duckett, J.W., Antenatal diagnosis and subsequent management of hydronephrosis (1993) J Urol, 149 (4), pp. 693-698Gunn, T.R., Mora, J.D., Pease, P., Antenatal diagnosis of urinary tract abnormalities by ultrasonography after 28 weeks' gestation: Incidence and outcome (1995) Am J Obstet Gynecol, 172 (2 Pt 1), pp. 479-486Livera, L.N., Brookfield, D.S., Egginton, J.A., Hawnaur, J.M., Antenatal ultrasonography to detect fetal renal abnormalities: A prospective screening programme (1989) Bmj, 298 (6685), pp. 1421-1423Sairam, S., Al-Habib, A., Sasson, S., Thilaganathan, B., Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound (2001) Ultrasound Obstet Gynecol, 17 (3), pp. 191-196Madarikan, B.A., Hayward, C., Roberts, G.M., Lari, J., Clinical outcome of fetal uropathy (1988) Arch Dis Child, 63 (8), pp. 961-963Hobbins, J.C., Romero, R., Grannum, P., Berkowitz, R.L., Cullen, M., Mahoney, M., Antenatal diagnosis of renal anomalies with ultrasound. I. Obstructive uropathy (1984) Am J Obstet Gynecol, 148 (7), pp. 868-877Reznik, V.M., Murphy, J.L., Mendoza, S.A., Griswold, W.R., Packer, M.G., Kaplan, G.W., Follow-up of infants with obstructive uropathy detected in utero and treated surgically postnatally (1989) J Pediatr Surg, 24 (12), pp. 1289-1292Wigglesworth, J.S., Desai, R., Is fetal respiratory function a major determinant of perinatal survival? (1982) Lancet, 1 (8266), pp. 264-267Barss, V.A., Benacerraf, B.R., Frigoletto Jr, F.D., Second trimester oligohydramnios, a predictor of poor fetal outcome (1984) Obstet Gynecol, 64 (5), pp. 608-610Bastide, A., Manning, F., Harman, C., Lange, I., Morrison, I., Ultrasound evaluation of amniotic fluid: Outcome of pregnancies with severe oligohydramnios (1986) Am J Obstet Gynecol, 154 (4), pp. 895-900Mandell, J., Peters, C.A., Estroff, J.A., Benacerraf, B.R., Late onset severe oligohydramnios associated with genitourinary abnormalities (1992) J Urol, 148 (2 Pt 2), pp. 515-518Prudente, A., Reis, L.O., França, R.P., Miranda, M., D'ancona, C.A., Vesicostomy as a protector of upper urinary tract in long-term follow-up (2009) Urol J, 6 (2), pp. 96-100Soliman, S.M., Primary ablation of posterior urethral valve in low birth weight neonates by visually guided fogarty embolectomy catheter (2009) J Urol, 181 (5), pp. 2284-2289Song, S.H., Lee, S.B., Park, Y.S., Kim, K.S., Is antibiotic prophylaxis necessary in infants with obstructive hydronephrosis? (2007) J Urol, 177 (3), pp. 1098-1101Yohannes, P., Hanna, M., Current trends in the management of posterior urethral valves in the pediatric population (2002) Urology, 60 (6), pp. 947-953Carvalho, M.H., Brizot, M.L., Lopes, L.M., Chiba, C.H., Miyadahira, S., Zugaib, M., Detection of fetal structural abnormalities at the 11-14 week ultrasound scan (2002) Prenat Diagn, 22 (1), pp. 1-4Souka, A.P., Pilalis, A., Kavalakis, I., Antsaklis, P., Papantoniou, N., Mesogitis, S., Screening for major structural abnormalities at the 11- to 14-week ultrasound scan (2006) Am J Obstet Gynecol, 194 (2), pp. 393-396Dane, B., Dane, C., Sivri, D., Kiray, M., Cetin, A., Yayla, M., Ultrasound screening for fetal major abnormalities at 11-14 weeks (2007) Acta Obstet Gynecol Scand, 86 (6), pp. 666-670Liao, A.W., Sebire, N.J., Geerts, L., Cicero, S., Nicolaides, K.H., Megacystis at 10-14 weeks of gestation: Chromosomal defects and outcome according to bladder length (2003) Ultrasound Obstet Gynecol, 21 (4), pp. 338-341Bunduki, V., Saldanha, L.B., Sadek, L., Miguelez, J., Miyadahira, S., Zugaib, M., Fetal renal biopsies in obstructive uropathy: Feasibility and clinical correlations - preliminary results (1998) Prenat Diagn, 18 (2), pp. 101-10