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Erin E Washburn, Teresa N Sparks, Kristen A Gosnell, Larry Rand, Juan M Gonzalez, Vickie A Feldstein
OBJECTIVE:  This article describes the natural history of stage I twin-twin transfusion syndrome (TTTS) including risk of progression to higher stage TTTS and pregnancy outcomes, and to identify risk factors for progression. STUDY DESIGN:  Retrospective cohort study of monochorionic diamniotic (MCDA) twin pregnancies from 2006 to 2016 with expectantly managed Quintero stage I TTTS. RESULTS:  A total of 30 MCDA twin pregnancies with expectantly managed stage I TTTS were identified...
February 8, 2018: American Journal of Perinatology
Nicola Persico, Francesco D'Ambrosi, Isabella Fabietti, Simona Boito, Elisa Aiello, Alessandro Bulfoni, Fabrizio Ciralli, Alessandra Kustermann, Fabio Mosca, Luigi Fedele
OBJECTIVE: To investigate sequential Doppler changes in donors and recipients before and one week after endoscopic laser for twin-to-twin transfusion syndrome (TTTS) and to examine factors that may be associated with such changes. METHODS: In TTTS pregnancies undergoing laser treatment, we examined fetal Doppler changes before and one week post-intervention. Intrauterine death rates and preoperative factors were analysed in relation to Doppler changes. RESULTS: Among 129 (85...
February 13, 2018: Prenatal Diagnosis
Haruhiko Sago, Keisuke Ishii, Rika Sugibayashi, Katsusuke Ozawa, Masahiro Sumie, Seiji Wada
The aim of this study was to review fetoscopic laser photocoagulation (FLP), which ablates placental vascular anastomoses to treat twin-twin transfusion syndrome (TTTS). A review of studies reporting on the procedures, outcomes, complications and nonconventional applications of FLP for TTTS was conducted. FLP has been established as the primary treatment for monochorionic twin pregnancy associated with TTTS at 16-26 weeks. FLP is the only therapy that directly addresses the underlying pathophysiology. The recent technique modification of FLP, referred to as the 'Solomon technique', induces selective coagulation to connect the anastomoses ablation sites and has been introduced to reduce residual anastomoses...
February 13, 2018: Journal of Obstetrics and Gynaecology Research
Maela Le Lous, Imen Mediouni, Gihad Chalouhi, Laurent Salomon, Laurence Bussières, Aude Carrier, Jean-Pierre Bernard, Yves Ville
OBJECTIVES: The objective of our study was to determine the impact of laser therapy for twin-to-twin transfusion syndrome (TTTs) on subsequent pregnancies. METHODS: This was a monocentric retrospective observational study. Women treated by laser fetoscopy for TTTs were asked to answer a postal questionnaire about subsequent pregnancies. The primary outcome was fecundity (number of pregnancies and time to pregnancy). We also assessed pregnancy complications, birth weight, and gestational age at delivery...
February 8, 2018: Prenatal Diagnosis
Chin Yee Ho, Zong-Rong He, San-Nan Yang, Yung-Ning Yang
RATIONALE: Late-onset transient adrenal insufficiency with circulatory collapse is a rare condition that occurs in preterm infants. Although the incidence of late-onset transient adrenal insufficiency in preterm infants has been reported in Japan, reports from Western countries are lacking. In addition, no study has investigated the effect of twin-to-twin transfusion syndrome (TTTS) in monozygotic twins. PATIENT CONCERNS: A pair of extremely low birth weight twins presented with TTTS...
November 2017: Medicine (Baltimore)
J Stirnemann, F Djaafri, A Kim, I Mediouni, L Bussieres, E Spaggiari, C Veluppillai, A Lapillonne, E Kermorvant, J-F Magny, C Colmant, Y Ville
OBJECTIVE: Preterm premature rupture of membranes (PPROM) is a leading complication following fetoscopic laser coagulation (FLC) for twin-twin transfusion syndrome (TTTS). Our primary objective was to describe the impact of improvements in surgical technique on survival and rate of PPROM over time. The secondary objective was to assess potential risk factors for PPROM. DESIGN AND SETTING: Single center retrospective observational study. POPULATION: 1092 consecutive cases of TTTS operated by FLC, between 2000 and 2016, with a 6...
January 30, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
Myrna S Aboudiab, Andrew H Chon, Lisa M Korst, Arlyn Llanes, Joseph G Ouzounian, Ramen H Chmait
The objective of this study was to describe the management and perinatal outcomes of patients with twin-twin transfusion syndrome (TTTS) and an extremely short cervical length (CL). This retrospective study examined 17 patients with TTTS and a preoperative CL ≤1.0 cm who had undergone laser surgery and perioperative cervical cerclage placement successfully. In this subset of patients, the median interval between surgery and delivery was 9.6 (range 2.1-13.9) weeks and only one patient had PPROM within 3 weeks of surgery...
January 27, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Federico Alonso Zumaya-Estrada, Jesús Martínez-Barnetche, Andrés Lavore, Rolando Rivera-Pomar, Mario Henry Rodríguez
BACKGROUND: Insects operate complex humoral and cellular immune strategies to fend against invading microorganisms. The majority of these have been characterized in Drosophila and other dipterans. Information on hemipterans, including Triatominae vectors of Chagas disease remains incomplete and fractionated. RESULTS: We identified putative immune-related homologs of three Triatominae vectors of Chagas disease, Triatoma pallidipennis, T. dimidiata and T. infestans (TTTs), using comparative transcriptomics based on established immune response gene references, in conjunction with the predicted proteomes of Rhodnius prolixus, Cimex lecticularis and Acyrthosiphon pisum hemimetabolous...
January 22, 2018: Parasites & Vectors
Javier U Ortiz, Ximena Torres, Elisenda Eixarch, Mar Bennasar, Monica Cruz-Lemini, Olga Gómez, Silvia M Lobmaier, Josep M Martínez, Eduard Gratacós, Fatima Crispi
OBJECTIVE: To evaluate left myocardial performance index (MPI) and time intervals in fetuses with twin-to-twin transfusion syndrome (TTTS) before and after laser surgery. METHODS: Fifty-one fetal pairs with TTTS and 47 uncomplicated monochorionic twin pairs were included. Left ventricular isovolumetric contraction time (ICT), ejection time (ET), and isovolumetric relaxation time (IRT) were measured using conventional Doppler. RESULTS: Recipients showed prolonged ICT (46 ± 12 vs...
January 19, 2018: Fetal Diagnosis and Therapy
Simen Vergote, Liesbeth Lewi, Willem Gheysen, Luc de Catte, Roland Devlieger, Jan Deprest
BACKGROUND: An improved survival and quality of life for neonatal survivors after fetoscopic laser therapy (FLC) for twin-twin transfusion syndrome (TTTS) has been reported. However, little is known about the medium-term maternal effects after FLC with respect to reproductive and gynecologic outcomes. OBJECTIVE: To document reproductive, obstetric, gynecologic and psychological outcomes in women who underwent FLC for TTTS. STUDY DESIGN: Monocentric controlled study on consecutive women who underwent FLC for TTTS between 2007 and 2013 at the University Hospitals Leuven (cases; n=198)...
January 12, 2018: American Journal of Obstetrics and Gynecology
Hiroko Konno, Takeshi Murakoshi, Akiko Yamashita, Mitsuru Matsushita
AIM: We evaluated risk factors for birthweight discordance in monochorionic diamniotic (MCDA) twin pregnancies without twin-twin transfusion syndrome (TTTS). METHODS: We investigated all MCDA twin placentas injected with colored dye at our institution between 2007 and 2015. We excluded pairs of twins with TTTS, fetal demise, or severe fetal malformation. All pairs of twins were assigned to the discordant group (birthweight discordance ≥ 25%) or the concordant group (birthweight discordance < 25%)...
January 5, 2018: Journal of Obstetrics and Gynaecology Research
Andrew H Chon, Mary Rose Mamey, Sheree M Schrager, Douglas L Vanderbilt, Ramen H Chmait
OBJECTIVE: To determine the relationship between preoperative fetal head circumference (HC) and cognitive performance among children treated with laser surgery for twin-twin transfusion syndrome (TTTS). METHODS: Donor and recipient twin HCs were measured preoperatively (16-26 weeks' gestation) and at 2 years corrected age. Multilevel multivariate regression models were used to test pregnancy and child-level risk factors for lower Battelle Developmental Inventory Second Edition (BDI-2) scores...
January 4, 2018: Prenatal Diagnosis
Amanda Henry, Saranya Gopikrishna, Aditi Mahajan, Jennifer Alphonse, Neama Meriki, Alec W Welsh
AIMS: Assess clinical utility of the foetal Myocardial Performance Index (MPI) in evaluation and management of monochorionic, diamniotic twin (MCDA) pregnancies. METHODS: Prospective cohort of (a) initially uncomplicated MCDA (b) Complicated MCDA, including twin-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), and liquor and/or growth discordance (L/GD) not meeting TTTS or sIUGR criteria. TTTS and sIUGR were case-control matched...
January 18, 2018: Journal of Maternal-fetal & Neonatal Medicine
Erin E Washburn, Teresa N Sparks, Kristen A Gosnell, Larry Rand, Juan M Gonzalez, Vickie A Feldstein
OBJECTIVE:  The significance of polyhydramnios of one twin in the absence of oligohydramnios of the cotwin in monochorionic diamniotic (MCDA) twin pregnancies (polyhydramnios affecting a recipient-like twin [PART]) is unknown. Our aim is to assess the risk of progression to twin-twin transfusion syndrome (TTTS) with PART, progression to ≥ stage II TTTS, and neonatal survival. STUDY DESIGN:  This study was a retrospective cohort study of MCDA twin pregnancies with PART evaluated at a referral center from 2008 to 2015...
December 29, 2017: American Journal of Perinatology
Monique E De Paepe, Füsun Gündoğan, Quanfu Mao, Sharon Chu, Svetlana Shapiro
INTRODUCTION/OBJECTIVES: Recent studies suggest redness (color) discordance of the placental basal plate may be a marker for twin anemia-polycythemia sequence (TAPS), a recently described complication of diamniotic-monochorionic twinning characterized by marked intertwin hemoglobin (Hb) discordance in the absence of oligohydramnios-polyhydramnios. In this study, we determined the clinicoplacental and choriovascular correlates of basal plate color discordance in monochorionic twin placentas, and assessed its value as postnatal indicator of TAPS...
December 2017: Placenta
Brian J Gordon, Andrew H Chon, Lisa M Korst, Arlyn Llanes, David A Miller, Ramen H Chmait
INTRODUCTION: Incidental septostomy, or inadvertent perforation of the twins' dividing membranes, can create a functional monoamniotic twin pregnancy. Our aim was to describe the perinatal outcomes and antenatal management of patients with incidental septostomy after laser surgery for twin-twin transfusion syndrome (TTTS). MATERIALS AND METHODS: Monochorionic diamniotic multiple gestations with a gestational age (GA) between 16 and 26 weeks that underwent laser surgery from March 2006 to December 2015 were studied retrospectively...
December 5, 2017: Fetal Diagnosis and Therapy
Matthew M Finneran, Megan A Templin, Courtney D Stephenson
OBJECTIVE: To investigate the natural course of abnormal umbilical artery Doppler (UAD) findings in donor fetuses after laser surgery and the prognostic significance of resolution, persistence, or new onset UAD abnormalities with and without the presence of preoperative growth discordance. STUDY DESIGN: Retrospective cohort study of all monochorionic-diamniotic multi-fetal gestations diagnosed with twin-twin transfusion syndrome (TTTS) undergoing laser surgery at a single large metropolitan referral center from 2010-2016...
November 27, 2017: Journal of Maternal-fetal & Neonatal Medicine
Fatiha Djaafri, Julien Stirnemann, Imen Mediouni, Claire Colmant, Yves Ville
Monochorionic twin pregnancies are at increased risk for adverse outcome compared to dichorionic twin pregnancies and singletons. Monochorionic-specific complications include twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence, single intrauterine fetal demise and its consequences on the co-twin, and selective intrauterine growth restriction. Whereas the natural history of monochorionic-specific complications carries a high risk of fetal death or severe neurologic disability, a framework now exists, based on well-designed clinical trials, for optimal treatment of these entities...
December 2017: Seminars in Fetal & Neonatal Medicine
Thorsten Rieth, Nico Röder, Matthias Lehmann, Heiner Detert
Star-shaped discotic liquid crystals with columnar superstructures constitute a highly interesting class of organic materials. Phenyl-substituted tris[1,2,4]triazolo-[1,3,5]triazine, prepared by a Huisgen reaction of phenyltetrazole and cyanuric chloride, represents an excellent core for discotic liquid crystals (DLCs). The thermal stability is not perfect, at temperatures above the clearing point, a successive threefold isomerization leads to a highly planar, C3 -symmetrical isomer, which mainly differs in the orientation of the aryl substituents to the centre of the molecule...
January 2, 2018: Chemistry: a European Journal
Andrew H Chon, Lisa M Korst, Brendan H Grubbs, Eftichia V Kontopoulos, Rubén A Quintero, Ramen H Chmait
OBJECTIVE: To quantify and assess potential risk factors for transplacental passage of fetal red blood cells (RBCs) into the maternal circulation (fetomaternal bleeding, FMB) after laser surgery for twin-twin transfusion syndrome (TTTS). STUDY DESIGN: A retrospective study of Rhesus-D negative patients that underwent laser surgery for TTTS. Patients with and without postoperative detectable fetal RBCs on Kleihauer-Betke (KB) testing were compared to determine risk factors for FMB...
December 2017: Prenatal Diagnosis
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