Isabella Fabietti

Stomach position in prediction of survival in left‐sided congenital diaphragmatic hernia with or without fetoscopic endoluminal tracheal occlusion

To investigate the value of fetal stomach position in predicting postnatal outcome in left‐sided congenital diaphragmatic hernia (CDH) with and without fetoscopic endoluminal tracheal occlusion (FETO).

Prenatal ultrasound predictors of postnatal major cerebral abnormalities in fetuses with apparently isolated mild ventriculomegaly.

We aim to examine the incidence of major cerebral abnormalities on postnatal imaging in cases with isolated mild ventriculomegaly on fetal sonography and to evaluate the relationship between the presence or absence of such defects and prenatal ultrasound factors.

Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome

BACKGROUND Endoscopic laser coagulation of placental anastomoses is the first-line treatment for severe twin-to-twin transfusion syndrome. A recent randomized controlled trial reported that laser coagulation along the entire vascular equator was associated with a similar dual survival and survival of at least 1 twin compared with the group that was treated with the selective technique. In addition, there was a significantly lower incidence of postoperative recurrence of twin-to-twin transfusion syndrome and the development of twin anemia-polycythemia sequence in the equatorial group. OBJECTIVE The purpose of this study was to report on neonatal survival in twin-to-twin transfusion syndrome pregnancies that were treated with endoscopic laser therapy with the use of the equatorial technique and to examine the relationship between preoperative factors and twin loss. STUDY DESIGN Endoscopic equatorial laser therapy was carried out as the primary treatment for twin-to-twin transfusion syndrome in all consecutive monochorionic diamniotic twin pregnancies that were referred at a single fetal surgery Center over a 4-year period. All visible placental anastomoses were coagulated; additional laser ablation of the placental tissue between the coagulated vessels was carried out. Pre-laser ultrasound data, periprocedural complications, pregnancy outcome, and postnatal survival at hospital discharge were recorded and analyzed. RESULTS A total of 106 pregnancies were treated during the study period. Median gestational age at laser therapy was 19.7 weeks (range, 15.1-27.6 weeks). There was postoperative recurrence of twin-to-twin transfusion syndrome or the development of twin anemia-polycythemia sequence in 2 (1.9%) and 2 (1.9%) cases, respectively. The survival rates of both and at least 1 twin were 56.6% and 83.0%, respectively. Donor survival was significantly lower compared with the recipient co-twin (64.2% vs 75.5%, respectively; P < .05). The rate of fetal death, which was the most common cause of twin loss, was significantly higher in donors compared with recipient fetuses (23.6% vs 10.4%, respectively; P < .05). In cases with absent or reversed end-diastolic velocity in the donor umbilical artery, dual and donor survival rates were significantly lower compared with the remaining twin-to-twin transfusion syndrome pregnancies (40.0% vs 64.8% and 40.0% vs 76.1%, respectively; P < .05). There were no significant differences between the 2 groups in the survival of at least 1 twin and in the recipient survival. CONCLUSIONS Endoscopic equatorial laser therapy was associated with a survival of both and at least 1 twin of approximately 55% and 83%, respectively, with a low rate of recurrent twin-to-twin transfusion syndrome and twin anemia-polycythemia sequence. In addition, the preoperative finding of abnormal donor umbilical artery Doppler on ultrasound identified a subgroup of twin-to-twin transfusion syndrome pregnancies with a lower dual survival rate caused by increased intrauterine deaths of donor twins.

Prenatal ultrasound factors and genetic disorders in pregnancies complicated by polyhydramnios

The objective of the study is to examine the incidence of chromosomal or genetic abnormalities in pregnancies complicated by polyhydramnios and to assess the value of prenatal ultrasound findings in the prediction of cases associated with such disorders.

Fetal Behavioral States

Main points: historical survey, sleep in children and premature infants, fetal micro-awakenings are not wakefulness, fetal ocular motions building blocks of the visual system, development of behavioral states, and differences and similarities with neonatal states

Prenatal and postnatal findings in five cases of Fryns syndrome

It is characterized by a variety of congenitalanomalies, such as diaphragmatic hernia, facial dysmorphisms(coarse face, hypertelorism, broad and flat nasal bridge withthick nasal tip, long philtrum, tented upper lip, wide mouth,micrognathia, low-set and poorly formed ears), distal digitalhypoplasia, and others (cerebral, ocular, cardiovascular,genitourinary).

Congenital diaphragmatic hernia as prenatal presentation of Apert syndrome

may be very helpful in doubtfulcases.Early prenatal diagnoses of AS have been reported inseveral families with previous known risk for this con-dition (Narayan and Scott, 1991). In such cases, sono-graphic abnormalities of the fetal head or extremitieshave not been difficult to interpret as a recurrence of thedisease. In contrast, most of sporadic cases remain undi-agnosed until delivery, or are diagnosed in late gestationwhen the characteristic sonographic features of cran-iosynostosis are usually detected (Filkinks

Cell‐free DNA testing in the maternal blood in high‐risk pregnancies after first trimester combined screening

The objective of this study was to investigate a strategy for clinical implementation of cell‐free DNA (cfDNA) testing in high‐risk pregnancies after first‐trimester combined screening.

Prophylactic use of the Arabin cervical pessary in fetuses with severe congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO): Preliminary experience

The aim of this study was to describe whether the prophylactic use of a cervical pessary decreases the rate of premature birth in congenital diaphragmatic hernia (CDH) fetuses treated with fetoscopic tracheal occlusion (FETO).

New minimally invasive technique for cystoscopic laser treatment of fetal ureterocele

Prenatal ultrasound detection of fetal ureterocele with bilateral hydroureteronephrosis, obstruction of the bladder outlet and progressive amniotic fluid reduction have been associated with a significant risk of end‐stage chronic renal disease after birth. Fetal cystoscopic laser incision of the ureterocele, using standard 3.5‐mm fetoscopic access to the amniotic cavity and the fetal bladder with the aim of relieving the bladder outflow obstruction to preserve renal function, has been reported previously in a case with a favorable outcome. We report on two additional cases of fetal ureterocele treated by cystoscopic laser decompression. In the first case, a standard 3.3‐mm uterine entry was used. In the second case, a new approach was adopted using an ‘all‐seeing needle’ 1.6‐mm endoscope. Copyright