G. E. Chalouhi

Specific complications of monochorionic twin pregnancies: twin–twin transfusion syndrome and twin reversed arterial perfusion sequence

Monochorionic twins are subjected to specific complications which originate in either imbalance or abnormality of the single placenta serving two twins. This unequal placental sharing can cause complications including twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), selective intrauterine growth restriction or twin reversed arterial perfusion sequence (TRAP). Monochorionicity also makes the management of these specific complications as well as that of a severe malformation in one twin hazardous since the spontaneous death of one twin exposes the co-twin to a risk of exsanguination into the dead twin and its placenta. The latter is responsible for the death of the co-twin in up to 20% of the cases and in ischemic sequelae in about the same proportions in the survivors. Although the symptoms of all these complications are very different, the keystone of their management comes down to either surgical destruction of the inter-twin anastomoses on the chorionic plate when aiming at dual survival or selective and permanent occlusion of the cord of a severely affected twin aiming at protecting the normal co-twin. This can be best achieved by fetoscopic selective laser coagulation and bipolar forceps cord coagulation respectively.

First-trimester uterine scar assessment by transvaginal ultrasound.

OBJECTIVE The objective of the study was to describe the assessment of lower segment uterine scar (LSCS) by transvaginal ultrasound (TVUS) during a first-trimester scan. STUDY DESIGN Patients with a history of LSCS were prospectively enrolled over a 6 month period. Four groups were defined: type 1A, thin scar within cervicoisthmic canal (CIC); type 1B, thin above the internal os (IO); type 2A, dehiscent within the CIC; type 2B, dehiscent above the IO. Accuracy of first-trimester TVUS was investigated by blind testing a panel of 14 operators over a web-based dataset. RESULTS The scar was visualized in 122 of 123 patients enrolled. Types 1A, 1B, 2A, and 2B occurred in 49.2%, 3.3%, 38.3%, and 9.2%, respectively. When blind tested, fetal medicine specialists achieved a median sensitivity of 82% and specificity of 100% for the detection of a scar. These were 83% and 87% for nonspecialists. CONCLUSION First-trimester uterine scar assessment may become a valuable tool in early recognition of patients at risk of subsequent perinatal complications.

Hidden mortality of prenatally diagnosed vein of Galen aneurysmal malformation: retrospective study and review of the literature

To evaluate the prognosis of prenatally diagnosed vein of Galen aneurysmal malformation (VGAM) in a large cohort with this condition and to review the literature on prenatally diagnosed VGAM.

A comparison of first trimester measurements for prediction of delivery date

Objective. We evaluated the biometric values of first trimester measurements for prediction of delivery date by computing new dating formulas and evaluating them within the same settings in a large population. Methods. We studied unselected pregnancies undergoing first trimester ultrasound examination by a single experimented sonographer. We used 331 pregnancies conceived by assisted reproductive treatment to build a new dating formula and another 3667 normal pregnancies with spontaneous delivery to test the accuracy of these measurements and formulas. The reproducibility of the two measurements which performed best was done. Results. Crown-rump length (CRL) had the lowest random and systematic errors. The mean (SD) of errors in predicting day of delivery were 0.023 (7.873), 0.092 (7.928), 0.088 (8.208) and 0.269 (8.310) for CRL, biparietal diameter (BPD), head circumference (HC) and abdominal circumference (AC) respectively. CRL and BPD proved to be highly reproducible. The percentages of deliveries within ±10 and ±14 days of the predicted term were comparable for CRL and BPD but were significantly smaller when using HC, AC. Conclusions. Both CRL and BPD proved to be highly reproducible and able to predict with good precision the date of delivery. However, CRL has significantly lower random and systematic errors than all other biometric parameters.

Secondary bladder herniation in isolated gastroschisis justifies increased surveillance.

To assess the perinatal outcome of fetuses with gastroschisis complicated by secondary bladder herniation.

Vein of Galen aneurysmal malformation (VGAM) in the fetus: retrospective analysis of perinatal prognostic indicators in a two-center series of 49 cases

Vein of Galen aneurysmal malformation (VGAM) is a rare fetal anomaly, the neurological outcome of which can be good with appropriate perinatal management. However, most fetal series are too small to allow reliable statistical assessment of potential prognostic indicators. Our aim was to assess, in a two‐center series of 49 cases, the prognostic value of several prenatal variables, in order to identify possible prenatal indicators of poor outcome, in terms of mortality and cerebral disability.

P33.17: Gastroschisis and bladder herniation

Introduction: Gastroschisis is a defect in the abdominal wall, typically situated on the right side of a normally inserted umbilical cord, through which bowel and other abdominal contents herniate. Its prevalence is still increasing worldwide for unknown reason. Usually, gastroschisis occurs in isolation, but other organ defects, especially intestinal malrotation, should always be ruled out. Material and methods: We report an interesting case of gastroschisis complicated with bladder herniation, with a well documented iconography, and a meticulous follow-up since its diagnosis in the first trimester and throughout the pregnancy. Results: Secondary bladder exteriorization is rarely reported in gastroschisis. The occurrence of secondary complications due to bladder herniation may alter the management strategy and influence the mode and date of extraction. Typically, bladder herniation occurs in the third trimester, mostly in female fetuses. Conclusion: There is no consensus, up till now, on the ideal time and mode of delivery, close follow up should be installed in fetuses with gastroschisis and bladder herniation as this may be another contributing factor to fetal distress and secondary complications.