F. Y. Chan

Long term outcome of twin-twin transfusion syndrome

AIMS To compare the perinatal mortality and morbidity of infants with twin-twin transfusion syndrome (TTTS) with those of gestation matched twin controls and to assess the neurodevelopmental outcome of surviving twins with TTTS. METHODS A cohort of 17 consecutive pregnancies with TTTS was enrolled over three years together with gestation matched twin pregnancies unaffected by TTTS. Serial amnioreduction for the TTTS pregnancies was performed as appropriate. Perinatal death and neonatal morbidities were recorded for both the TTTS cohort and controls. The TTTS survivors had neurodevelopmental follow up to at least 2 years of age. RESULTS In 12 of the pregnancies, serial amniocenteses were performed, but, in five, the infants were born before intervention. The mean gestational age at delivery was 29.1 weeks (range 23–36). There were five intrauterine deaths in the TTTS cohort and six neonatal deaths (survival 68%). In the control group, there was one intrauterine death and five neonatal deaths (survival 82%). Infants in the TTTS group had a greater requirement for inotropes (p = 0.04) and a higher incidence of renal failure (p = 0.005). Periventricular leucomalacia and cerebral atrophy were seen in 17% of the TTTS group, but none of the controls (p = 0.03). The 23 surviving TTTS infants were all followed up, with 22% having significant neurological morbidity: cerebral palsy and global developmental delay. CONCLUSIONS Twins with TTTS have high perinatal mortality and neonatal morbidity, and long term neurodevelopmental morbidity in survivors is high. Further investigation into the pathogenesis and management of TTTS is required.

Factors influencing the prenatal detection of structural congenital heart diseases

To assess the factors influencing the prenatal detection rate of structural congenital heart diseases (CHDs).

Cardiac outcomes of hydrops as a result of twin–twin transfusion syndrome treated with laser surgery

Aim:  To determine cardiac outcomes of foetal hydrops as a result of twin–twin transfusion syndrome treated with laser surgery.

OC30.10: Learning curve for fetoscopic laser surgery for severe twin–twin transfusion syndrome can be shortened

Background: Critical pulmonary stenosis or atresia (PAIVS) diagnosed in the second trimester progresses resulting in right ventricular (RV) growth failure. Fetal pulmonary valvuloplasty may improve outcome. We explore the determinants of right-sided growth in the fetus with PAIVS. Methods: Serial fetal echocardiography in 10 of 14 consecutive fetuses diagnosed with PAIVS in a fetal medicine centre (1999–2003). Assessment of morphology, right and left sided valvular and ventricular growth, Doppler across valves and in arterial and venous ducts (DV). DV waveforms were classified as ‘‘abnormal’’ if absent or reversed end diastolic flow (AREDF), signifying high right atrial pressure (RAP). Postnatal echocardiography confirmed morphology, Doppler & oval foramen restriction. Fetal pulmonary valvuloplasty (× 3) was performed percutaneously under ultrasound guidance at 21–30 weeks. Results: Three pregnancies with PAIVS were terminated. Six of the remaining 11 survived infancy, four with biventricular circulation. Fetal pulmonary valvuloplasty was offered in selected cases. Morphology was unsuitable in three. Two further monochorionic diamniotic twin pregnancies with good anatomy were excluded leaving three suitable for valvuloplasty. Valvuloplasty was successful in 2 cases but placental bleeding and bradycardia precipitated emergency delivery before valvuloplasty in the third. Eleven had high RAP (tricuspid regurgitation) with AREDF and hydrops in 1 case. The three with low RAP had the worst TV and PV growth velocities. At birth, median (95% CI) TV annulus Z score was −4.29 (−6.57 to −1.71). TV growth was significantly better in those with high RAP (−4.29 vs −6.00, p = 0.02) and oval foramen restriction. Conclusions: Fetuses with high RAP show the best RV growth, but may develop hydrops. AREDF may paradoxically be associated with better outcome, as fetal valvuloplasty may be most effective in those with high RAP.

Long‐term neurological outcome of survivors of twin twin transfusion syndrome (TTTS)

Aim:  The aim of this study was to examine the long‐term neurological outcome of survivors of TTTS.

OP09.08: Rate of amniorrhexis is not affected by fetoscopic access cannula diameter

Doppler. The 24 patients in our series consisted of 17 MCDA twins (7 with TTTs, 5 with Fetal anomaly, 4 with TRAP sequence and 1 with severe IUGR) 1 set of MCTA Triplets, 4 sets of DCTA Triplets(2 with TTTS and 2 multi fetal reductions), 1 set of DCDA Triplets and 1 MCMA Twins. Gestational age at the time of the procedure ranged between 13 + 0 weeks and 27 + 4 weeks (median 18 + 1 weeks). Results: The procedure was technically successful in 100% of cases. MRI of the surviving fetuses was normal in all the cases. 1 case miscarried, 12 have delivered and 11 pregnancies are ongoing with no complications seen on follow up scans. There were no maternal complications due to the procedure. Conclusions: Radiofrequency ablation is a safe and effective procedure for fetal reduction in complicated monochorionic pregnancies.

P09.30: Perinatal outcomes with laser therapy for severe twin–twin transfusion syndrome

rupture of the membranes, the median gestational age at delivery was 36.1 weeks (range 34.1–39.1), with a median weight of 2215 gr (range 1750–2850). No single case of brain damage was detected among the survivors, as assessed by both clinical examination and imaging techniques. Conclusion: Although the number of cases is small, our initial results doing cord occlusion by bipolar forceps are comparable with those reported by others.

The use of umbilical artery Doppler velocimetry in the monitoring of pregestational diabetic pregnancy

Purpose:  To assess whether umbilical artery Doppler velocity waveform analysis can predict adverse perinatal outcomes for pregnancies complicated with pre‐existing diabetes mellitus (types 1 and 2 diabetes mellitus).

Factors influencing the prenatal detection of structural congenital heart diseases: 11th World Congress on Ultrasound in Obstetrics and Gynecology FC01: Cardiac 1

Background:  Congenital heart disease is the commonest congenital anomaly, but the reported antenatal detection rate varies widely from 4.5 to 36%.

Cardiac function in fetuses of poorly controlled pregestational (pre‐existing) diabetic pregnancies

Background:  Cardiac impairment is frequently found in fetuses of diabetic mothers. Poor diabetic control has been implicated as one of the cause for cardiac dysfunction, but it is still controversial.