Recent Updates in the Management of Monochorionic Twin Pregnancy

Monochorionic pregnancies are at high risk of developing severe complications leading to high perinatal morbidity and mortality. About 15% of these twins have unidirectional anastomosis of the placenta, which is responsible for the major complications specific to monochorionic pregnancies. An important first step in the management is the identification of the chorionicity. Once it is identified, a close follow-up every 2 weeks is vital to allow early detection of complications and their management. Approximately 1 in 10 monochorionic pregnancies develops twin-to-twin transfusion syndrome, congenital anomalies, anaemia polycythaemia sequence, selective intrauterine growth restriction and intrauterine death of a co-twin. Rare complications that can occur are twin reversed arterial perfusion syndrome. Timely screening and detection of all such complications can lead to appropriate intervention such as in utero foetoscopic laser treatment. These interventions can increase the survival rate of at least one or both twins with reduced neonatal morbidity. Besides, early detection can facilitate parents to have an informed choice to decide if the prognosis of the pregnancy is otherwise not good

Advancements of non-invasive prenatal testing: the role of obstetricians

Since its debut in 2011, Non-Invasive Prenatal Testing (NIPT) has continually demonstrated its effectiveness in detecting an expanding number of diseases. NIPT offers a less invasive approach to prenatal chromosomal disease screening, providing prospective parents with vital information to better prepare for their potential pregnancy outcomes. NIPT was primarily designed for screening trisomy 13, 18, and 21. However, its scope has since broadened to encompass microdeletions and autosomal dominant monogenic diseases. Conversely, the normalization of NIPT can have unintended consequences. Some patients opt for NIPT without any medical indications, driven by a desire to remain cautious. This over-screening for chromosomal abnormalities can exacerbate pregnancy-related anxiety, as individuals might feel pressured into taking the test unnecessarily. While NIPT can be highly successful when conducted correctly, it is not infallible, and obstetricians play a crucial role in managing patient expectations. This includes providing genetic counseling to individuals with relevant genetic information regarding their personal and family histories. In the context of NIPT, a bioinformatics analysis is performed on a cell-free DNA (cfDNA) sample extracted from the mother’s placenta to determine the fetal fraction (FF). This FF measurement is vital for quality control and ensuring statistical confidence in the test results. Raising awareness among clinicians about the significance of FF enhances patient care and alleviate concerns about the possibility of failed NIPT. This paper aims to explore the ongoing debates and more specifically the significance and pitfalls of NIPT on a psychosocial and ethical scale, all while highlighting the importance of genetic counseling

Analysis of endometrial biopsy reports from adult women with abnormal uterine bleeding, a cross-sectional descriptive study

Background: Abnormal uterine bleeding is a common complaint in most women of different ages that prompts seeking gynecologic care. This study aimed to analyze and age-classify the prevalence of endometrial pathologies in women with abnormal uterine bleeding.Methods: This is a cross-sectional and a descriptive study, conducted at the obstetrics and gynecology department of the American Mission Hospital in the Kingdom of Bahrain on 88 patients who presented with abnormal uterine bleeding between January 2019 and January 2020.Results: Eighty-eight women with abnormal uterine bleeding demonstrated a fluctuating pattern of twenty endometrial pathologies distributed among five age groups in the range of 30-71. The mean age of the study cohort was 44.9±7.65 years; 55% of which were reported in the 41-50 age group. Benign endometrial polyp was reported as the most common pathology, accounting for 47.8% of the cohort. Although benign endometrial polyp was significantly the highest overall finding in all three age groups younger than 60, disordered proliferative endometrium was the highest reported single pathology in the age group 41-50, (N=10, p≤0.0001).Conclusions: This study demonstrated that benign endometrial polyp was the most common finding in women with abnormal uterine bleeding. This information could be essential for patient guidance and awareness of the benefits of endometrial biopsy. Eventually, the prediction of the potential endometrial pathology in women with abnormal uterine bleeding is vital for early disease management

A study illustrating the risk factors, clinical presentation and management of ectopic pregnancy in a secondary hospital in Bahrain

Background: Assess the risk factors, clinical presentation and type of intervention indicated in ectopic pregnancies at American mission hospital in Bahrain. Methods: This is a retrospective cohort study conducted from August 2021 to April 2022 at American mission hospital in Bahrain. All patients (n=205) who attended the hospital from January 2017 to June 2021 with a presentation suggestive of ectopic pregnancy were extracted from the electronic medical record database and reviewed. Data was recorded on Microsoft Excel version 16.61.1 and numerical data was extrapolated into graphs and tables via IBM SPSS Statistics version 28.0.0.0 (190). Data was subjected to descriptive and stratification analysis. Results: The leading risk factor for ectopic pregnancy was previous pelvic surgery (40.4%). The most reported symptom was amenorrhea (65.9%). Risk of rupture was tripled when serum B-hCG level was elevated, rendering it the strongest predictor of rupture according to our data (95% CI=1.25, 7.19; p-value 0.0139). Majority of patients (56.4%) were treated with methotrexate with a success rate of 88.7% and 8.5% of cases were managed expectantly. Those who failed medical management or presented with rupture were treated surgically.Conclusions: Our study found B-hCG levels to be the most sensitive predictor of rupture and need for surgical intervention. Therefore, management was largely, but not exclusively, based on B-hCG levels. Majority of cases were treated medically and patients undergoing expectant management experienced no complications.