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Obstetrics: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Complications unique to twins or higher-order births include the in utero death of one twin (1), discordant growth of a twin (1), congenital anomalies specific to twin pregnancies, such as conjoined twins or twin reversed arterial perfusion (acardiac twin), and abnormalities related to the in utero environment, e.g. talipes and congenital dislocation of the hip (1).
Fetal surgery
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Which of the options listed above is the most appropriate treatment for the following scenarios? Each option may be used once, more than once, or not at all. A fetus with a large cervical teratoma causing tracheal deviation.Twin–twin transfusion syndrome.Twin reversed arterial perfusion syndrome.
Fetal surgery
Published in Prem Puri, Newborn Surgery, 2017
Identical twins may have separate placentas (dichorionic) or share a single placenta (monochorionic). Monochorionic twins may have unequal shares of placenta or blood flow and are at risk of discordant growth. More severe anomalies such as twin–twin transfusion syndrome (TTTS) or twin reversed arterial perfusion sequence (TRAP) can arise from monochorionic pregnancies. Complications arising from monochorionic twin gestations are the most common cause for referral to fetal diagnosis and treatment centers.42
Antenatal management and neonatal outcomes of monochorionic twin pregnancies in a tertiary teaching hospital: a 10-year review
Published in Journal of Obstetrics and Gynaecology, 2021
Dominique A. Badr, Elisa Bevilacqua, Andrew Carlin, Kalina Gajewska, Elisa Done, Teresa Cos Sanchez, Camille Olivier, Jacques C. Jani
Selective laser photocoagulation (LPC) of the AV anastomoses is the established treatment of choice for more advanced stages of TTTS (Senat et al. 2004) although it remains uncertain if all Quintero stage I cases should also undergo LPC. TAPS is a relatively new phenomenon with the first case being described in 2007 (Lopriore et al. 2007) and the optimal treatment is yet to be determined. Twin reversed arterial perfusion (TRAP) sequence also poses significant management dilemmas but hopefully the ongoing TRAP Intervention STudy (https://clinicaltrials.gov/ct2/show/NCT02621645) will be able to give some guidance in the future. The optimal management of selective foetal growth restriction (FGR) is also challenging with a complete lack of prospective interventional studies to inform best practice (Badr et al. 2020). In these cases, as with TTTS, TAPS and TRAP, parental choice must also be considered before deciding on the best course of action.
Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond
Published in Expert Review of Hematology, 2020
Marjolijn S. Spruijt, Enrico Lopriore, Sylke J. Steggerda, Femke Slaghekke, Jeanine M.M. Van Klink
There is still a lot of ground to cover before these goals can be achieved. High-intensity focused ultrasound (HIFU) is a noninvasive technique which can be used to ablate blood flow in placental vessels, and therefore holds promise for the future treatment of TTTS. Although some preliminary experience with HIFU has been reported in animals as well as human cases of twin reversed arterial perfusion sequence (TRAP), safety and efficacy in humans with TTTS remain to be established [92,93]. In the meantime, technological innovations may be able to further improve visibility and accessibility of the vascular equator during laser procedures. The further development of instrumentation aimed at minimizing the risk of PPROM after laser surgery is another important focus of research in future years, hopefully helping to prolong pregnancies further beyond 32 weeks’ gestation and thereby minimizing the risks associated with preterm birth. Also, as the severity of placental damage after laser surgery is associated with PPROM and earlier delivery, the further fine-tuning of laser technique using minimal energy but obtaining maximum effect can certainly contribute to even better perinatal outcome.
Screening of fetal chromosomal aneuploidy diseases using noninvasive prenatal testing in twin pregnancies
Published in Expert Review of Molecular Diagnostics, 2019
Wenqian Yu, Yuan Lv, Shaowei Yin, Hao Liu, Xue Li, Bo Liang, Lingyin Kong, Caixia Liu
Evaluation of amniotic fluid, umbilical cord blood, and follow-up visits were performed for pregnant women participating in this study. The pregnant women with high-risk NIPT results were further examined by amniocentesis, a 20-ml sample of amniotic fluid or 1-ml sample of umbilical cord blood from each case was extracted for cell culture and chromosome karyotype analysis. For the pregnant women with low-risk NIPT results, the chromosome karyotype analysis and follow-up visit were performed for verification. Some cases were verified by chromosome karyotype analysis of amniotic fluid at 19–26 weeks or umbilical cord blood after 26 weeks，while the inclusion criteria of this condition were as follows: (1) ultrasound results showed that one of the twins had structural abnormalities; (2) ultrasound testing showed abnormal nuchal translucency in early pregnancy; (3) twin reversed-arterial-perfusion sequence (TRAP) and twin-to-twin transfusion syndrome (TTTS) occurred after NIPT; (4) history of abortion or abnormal gestation; (5) pregnant women aged 35 years or over. The cases that met the above conditions were performed invasive prenatal procedure. In case where amniocentesis was not performed, umbilical cord blood was taken at delivery for karyotyping. Other low-risk NIPT cases were validated telephone follow-ups.