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Danilo Buca, Giorgio Pagani, Giuseppe Rizzo, Alessandra Familiari, Maria Elena Flacco, Lamberto Manzoli, Marco Liberati, Francesco Fanfani, Giovanni Scambia, Francesco D'Antonio
OBJECTIVE: To explore the outcome of monochorionic (MC) twin pregnancies affected by selective intra-uterine growth restriction (sIUGR) according to the umbilical artery Doppler pattern of the smaller twin. METHODS: Medline, Embase, Cinhal and databases (2000-2016) were searched. sIUGR was defined as the presence of one twin with estimated fetal weight and/or abdominal circumference less than 10(th) or 5(th) percentile and classified according to the umbilical artery Doppler flow pattern of the smaller twin (type I: persistently positive, type II: persistently absent/reversed, type III: intermittently absent/reversed)...
November 18, 2016: Ultrasound in Obstetrics & Gynecology
Y Wang, Y Wei, P B Yuan, X J Wang, Y Y Zhao
Objective: To analyze the prognosis of surviving monochorionic co-twin after single intrauterine fetal demise (sIUFD). Methods: Retrospectively analyzed the twin pregnancy cases admitted in Peking University Third Hospital between Jan 2008 and Feb 2015. We recorded perinatal characteristics, neuroimage in co-twin, and followed up the neonatal outcome. Results: 47 cases were found, including 45 cases of monochorionic diamniotic (MCDA) and 2 cases of monochorionic monoamniotic (MCMA). Median gestational age at sIUFD was 27 weeks...
October 11, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Rosemary Townsend, Asma Khalil
PURPOSE OF REVIEW: Selective intrauterine growth restriction (sIUGR) in twin pregnancies presents a complex management problem for the fetal medicine specialist. This review summarizes what is currently known about sIUGR pathophysiology, particularly in monochorionic pregnancies and looks at the results of early trials of fetal intervention in high-risk sIUGR pregnancies. RECENT FINDINGS: sIUGR in monochorionic pregnancies is due to unequal placental sharing, but the clinical outcome is determined by the characteristics of the placental vascular anastomoses...
December 2016: Current Opinion in Obstetrics & Gynecology
Liran Hiersch, Mayan Eitan, Eran Ashwal, Boaz Weisz, Benny Chayen, Shlomo Lipitz, Yoav Yinon
OBJECTIVE: To estimate the risk for twin anemia-polycythemia sequence (TAPS) and adverse perinatal outcome in monochorionic diamniotic (MCDA) twin pregnancies with amniotic fluid discordance (AFD). METHODS: Retrospective cohort study of 34 MCDA pregnancies with AFD (intertwin difference of ≥3 cm in maximal vertical pocket measurement) without meeting the criteria for twin to twin transfusion syndrome or selective intrauterine growth restriction. Perinatal outcome measures and the risk for TAPS were compared with a control group consisted of 101 MCDA twin pregnancies without AFD, twin to twin transfusion syndrome, or selective intrauterine growth restriction...
December 2016: Prenatal Diagnosis
K Haino, K Ishii, H Muto, A Mabuchi, R Yamamoto, H Kawaguchi, S Hayashi, N Mitsuda
No abstract text is available yet for this article.
September 2016: Ultrasound in Obstetrics & Gynecology
S J Eschbach, L S T M Boons, E van Zwet, J M Middeldorp, F J C M Klumper, E Lopriore, A K K Teunissen, M E Rijlaarsdam, D Oepkes, A D J Ten Harkel, M C Haak
OBJECTIVE: Severe right Ventricular Outflow Tract Obstruction (RVOTO) is a complication in recipient twins in Twin-to-Twin-Transfusion Syndrome (TTTS), which requires post-partum follow-up or treatment. The objective of our study was to evaluate pregnancy characteristics of neonates with RVOTO in complicated monochorionic twin pregnancies. In the TTTS cases we aimed to determine the incidence and to construct a prediction model for the development of RVOTO. METHODS: An observational cohort study of all complicated monochorionic twin pregnancies with a post-partum neonatal diagnosis of RVOTO was performed...
July 1, 2016: Ultrasound in Obstetrics & Gynecology
Yao-Lung Chang, An-Shine Chao, Hsiu-Huei Peng, Shuenn-Dyh Chang, Sheng-Yuan Su, Kuan-Ju Chen, Po-Jen Cheng, Tzu-Hao Wang
Hypoxia is the primary stimulus for the production of erythropoietin (EPO) in both fetal and adult life. Here, we investigated fetal plasma EPO concentrations in monochorionic (MC) twin pregnancies with selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery (UA) Doppler. We diagnosed sIUGR in presence of (1) birth-weight discordance >20% and (2) either twin with a birth weight <10th percentile. An abnormal UA Doppler was defined as a persistent absent-reverse end diastolic flow (AREDF)...
August 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Maria Angela Rustico, Dario Consonni, Mariano Lanna, Stefano Faiola, Vito Schena, Barbara Scelsa, Paola Introvini, Andrea Righini, Cecilia Parazzini, Gianluca Lista, Francesco Barretta, Enrico Ferrazzi
OBJECTIVE: To describe changes in the umbilical artery (UA) Doppler flow of monochorionic diamniotic (MC DA) twins with selective intrauterine growth restriction (sIUGR), to correlate Doppler findings with pregnancy course and perinatal outcome, to report postnatal follow up. METHODS: Retrospective study of 140 MC DA twins with sIUGR. UA end-diastolic flow, defined as pattern Type I (persistently positive), Type II (persistently absent or persistently reversed), and Type III (intermittent) was recorded at first examination and monitored weekly until double or single fetal death, bipolar cord coagulation, or delivery...
April 7, 2016: Ultrasound in Obstetrics & Gynecology
Zhiming He, Hanlin Lu, Huijuan Luo, Fei Gao, Tong Wang, Yu Gao, Qun Fang, Junwen Wang
Intrauterine growth restriction (IUGR) affects the foetus and has a number of pathological consequences throughout life. Recent work has indicated that variations in DNA methylation might cause placental dysfunction, which may be associated with adverse pregnancy complications. Here, we investigated the promoter methylomes of placental shares from seven monochorionic (MC) twins with selective intrauterine growth restriction (sIUGR) using the healthy twin as an ideal control. Our work demonstrated that the IUGR placental shares harboured a distinct DNA hypomethylation pattern and that the methylation variations preferentially occurred in CpG island shores or non-CpG island promoters...
February 2, 2016: Scientific Reports
Kristi R Van Winden, Rubén A Quintero, Eftichia V Kontopoulos, Lisa M Korst, Arlyn Llanes, Ramen H Chmait
INTRODUCTION: We examined placental weight characteristics associated with donor selective intrauterine growth restriction (SIUGR) among patients with twin-twin transfusion syndrome (TTTS) who underwent laser surgery. MATERIALS AND METHODS: Fresh placental specimens were studied. Pregnancies with higher-order multiples, fetal demise, or disrupted or nonsubmitted placental specimens were excluded. Placental characteristics prospectively collected included total placental weight, individual placental weight, and placental share...
2016: Fetal Diagnosis and Therapy
Satoshi Hayashi, Ai Anami, Keisuke Ishii, Mari S Oba, Yuichiro Takahashi, Masahiko Nakata, Jun Murotsuki, Takeshi Murakoshi, Haruhiko Sago
OBJECTIVES: This study aimed to assess the perinatal outcome in monochorionic diamniotic (MD) twin pregnancies complicated by amniotic fluid discordance (AFD) adjoining twin-twin transfusion syndrome (TTTS). METHODS: An observational study of 84 consecutive MD twin pregnancies complicated by AFD that resembled TTTS was conducted. AFD adjoining TTTS was defined by a maximal vertical pocket of amniotic fluid ≤3 cm in one twin and ≥7 cm in the other excluding TTTS...
February 2016: Prenatal Diagnosis
Yao-Lung Chang, Tzu-Hao Wang, Shuenn-Dyh Chang, An-Shine Chao, Peter C C Hsieh
OBJECTIVES: To investigate placental autophagic activity in cases of twin-twin transfusion syndrome (TTTS) after successful laser therapy and to evaluate the effect of intertwin anastomoses on discordant placenta autophagic activity in monochorionic twins with one twin exhibiting selective intrauterine growth restriction. MATERIALS AND METHODS: Placenta samples were prospectively obtained from 11 cases of successful TTTS post-laser therapy with two living babies...
October 2015: Taiwanese Journal of Obstetrics & Gynecology
Keisuke Ishii, Masahiko Nakata, Seiji Wada, Takeshi Murakoshi, Haruhiko Sago
AIM: This study aimed to clarify the feasibility and perinatal outcomes of fetoscopic laser photocoagulation (FLP) for monochorionic twin gestation with selective intrauterine growth restriction (sIUGR) accompanied by both abnormal umbilical artery Doppler waveforms and isolated severe oligohydramnios of the sIUGR twin. METHODS: In this prospective clinical trial, which included 10 cases with absent or reversed end-diastolic flow in the umbilical artery and severe oligohydramnios of the sIUGR twin, the main outcomes investigated were the feasibility of FLP and the rate of severe FLP-related maternal complications...
November 2015: Journal of Obstetrics and Gynaecology Research
Claudia D E de Bruin, N Margreth van der Lugt, Remco Visser, Wilma Oostdijk, Erik W van Zwet, Arjan B Te Pas, Enrico Lopriore
OBJECTIVE: Small-for-gestational-age (SGA) neonates (birth weight <10th centile) are at higher risk of altered glucose homeostasis compared to appropriate for gestational age (AGA) neonates. The aim of this matched case-control study was to estimate the incidence of hypoglycaemia and/or hyperglycaemia in monochorionic (MC) twins with selective intrauterine growth restriction (sIUGR). METHODS: We included all MC twins with sIUGR (2002-2013). Neonates in the SGA group were matched with their AGA co-twin...
2016: Journal of Maternal-fetal & Neonatal Medicine
Mauro Parra-Cordero, Mar Bennasar, José María Martínez, Elisenda Eixarch, Ximena Torres, Eduard Gratacós
OBJECTIVE: To describe perinatal outcomes achieved with cord occlusion (CO) in monochorionic twins with severe selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler in the IUGR twin (types II and III). METHODS: We studied a consecutive series of 90 cases of sIUGR with abnormal Doppler treated with CO of the IUGR fetus. Abnormal Doppler was defined as continuous (type II, n = 41) or intermittent (type III, n = 49) absent/reversed end-diastolic flow...
2016: Fetal Diagnosis and Therapy
Mariano Matteo Lanna, Dario Consonni, Stefano Faiola, Vito Schena, Martina Ratti, Enrico Ferrazzi, Maria Angela Rustico
INTRODUCTION: Vascular anastomoses in monochorionic (MC) twin placenta can be easily identified with color-dye injection. The aim of this study is to analyze the relationship between different type of anastomoses and twin pregnancy complications. METHODS: From January 2011 to October 2014, MC placentas were analyzed with color-dye injection and five group of pregnancies were identified: those that were not complicated (NC), those complicated with selective intrauterine growth restriction (sIUGR), twin-twin transfusion syndrome (TTTS), or twin anemia-polycitemia sequence (TAPS) and those with amniotic fluid discordance (AFD) between twins...
October 2015: Placenta
V Stagnati, G Pagani, A Fichera, F Prefumo
OBJECTIVES: To assess the role of intertwin discrepancy in middle cerebral artery peak systolic velocity (MCA-PSV) for the prediction of late selective intrauterine growth restriction (sIUGR) at birth and birth weight discrepancy of > 25% (BW-25) in otherwise uncomplicated monochorionic-diamniotic (MCDA) twin pregnancies. METHODS: This was a cohort study including all MCDA pregnancies followed in a tertiary fetal medicine unit between 2008 and 2013. Exclusion criteria were referral after first trimester, abnormal karyotype, structural anomalies, twin-to-twin transfusion syndrome, twin anemia-polycythemia sequence and sIUGR detected before 28 weeks...
July 2016: Ultrasound in Obstetrics & Gynecology
Dongcai Wu, Linhuan Huang, Zhiming He, Xuan Huang, Qun Fang, Yanmin Luo
OBJECTIVE: To identify the association between preeclampsia (PE) and selective intrauterine growth restriction (sIUGR) in twin pregnancies. METHODS: This was a retrospective cohort study of 1004 twin pregnancies from 2008 to 2014. We specifically compared the incidence, clinical characteristics and outcomes of PE between sIUGR and normal-growth twin pregnancies. RESULTS: PE occurred more frequently in sIUGR pregnancies [29.0% (51/176)] than in normal-growth twin pregnancies [13...
2016: Journal of Maternal-fetal & Neonatal Medicine
J U Ortiz, E Eixarch, A Peguero, S M Lobmaier, M Bennasar, J M Martinez, E Gratacós
OBJECTIVE: To evaluate the incidence of chorioamniotic membrane separation (CMS) after fetoscopy in monochorionic diamniotic (MCDA) twins and its impact on pregnancy outcome. METHODS: The study group comprised a consecutive series of 338 women with an MCDA pregnancy complicated by twin-twin transfusion syndrome (TTTS) or selective intrauterine growth restriction (sIUGR) treated with selective laser photocoagulation of communicating vessels (SLPCV) or cord occlusion (CO)...
March 2016: Ultrasound in Obstetrics & Gynecology
I Vlašínová, L Hruban, P Janků, R Gerychová, P Ventruba, V Ťápalová, Z Hodická
OBJECTIVE: Purpose of this study was to determine the frequency of occurence of specific complications of monochorionic diamniotic twins born after 24 weeks of pregnancies and the effect of these complications on perinatal morbidity and mortality. TYPE OF STUDY: Restrospective analysis. SETTING: Dpt. of Obstetrics and Gynecology Masaryk University and University Hospital Brno. METHODOLOGY: A retrospective analysis of 175 monochorionic diamniotic pregnancies (mo-bi), which were terminated after the 24th week of pregnancy at the Department of Obstetrics and Gynecology Masaryk University and University Hospital Brno between the years 2008-2013...
June 2015: Ceská Gynekologie
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