Lisa Örtqvist

A definition of selectivity in laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome and its relationship to perinatal outcome

OBJECTIVE This study was undertaken to correlate selectivity of surgery and perinatal outcome in twin-to-twin transfusion syndrome treated by endoscopic laser coagulation, using a quantitative definition of selectivity. STUDY DESIGN 287 consecutive cases of severe twin-to-twin transfusion syndrome were reviewed. A selectivity index was built as the ratio of selective over nonselective coagulations per procedure. Outcome measures were survival at 28 days and failure of surgery as defined by recurrence of twin-to-twin transfusion syndrome or fetofetal hemorrhage. RESULTS Two populations were identified: a high selectivity group (63.8%) and a low selectivity group (36.2%). Survival of at least one twin and survival of both twins were higher in the high-selectivity group (p = .007 and p = .04 respectively). Failure of surgery rates were similar in both groups. CONCLUSION A quantitative definition of selectivity appears justified by the large variations found in the practice of a single center and by significant differences in outcome. Survival is significantly improved in highly selective procedures.

Intertwin discordance in umbilical venous volume flow: a reflection of blood volume imbalance in twin-to-twin transfusion syndrome

To compare umbilical venous volume flow (UVVF) between donor and recipient twins in twin‐to‐twin transfusion syndrome (TTTS) using an index that is independent of gestational age and to correlate changes in this index with outcome following endoscopic laser surgery.

OC184: Emergency cerclage in cases with short cervix at the time of fetoscopic surgery in twin‐to‐twin transfusion syndrome and its relationship to perinatal outcome

Methods: Since 2002, pulmonary valvuloplasty was attempted in nine fetuses with PA/IVS and evolving right heart hypoplasia. Median gestational age was 24 weeks (range 21–28 weeks). Fetal echocardiographic data were collected prior to the procedure and at regular intervals after the procedure and at birth. Postnatal outcomes were recorded. Results: The first three valvuloplasty procedures were technically unsuccessful. In the fourth the valve was perforated but not dilated. In the subsequent five cases, the PV was successfully perforated and dilated. After successful intervention, prenatal growth of the RV, PV, and TV was improved compared to fetuses following unsuccessful procedures. After birth, the four cases where dilation was unsuccessful resulted in two (67%) infants with single ventricle circulation and one with biventricular circulation after several surgeries. The fourth pregnancy after unsuccessful intervention was terminated. The five cases where valvuloplasty was successful resulted in four (80%) infants with biventricular circulation and one with a single ventricle. Conclusions: In utero PV perforation and dilation in the midgestation fetus with PA/IVS is technically feasible, and appears to be associated with improved right heart growth and postnatal outcome. In our series, 80% of infants following successful in utero intervention had biventricular circulation. There is an important learning curve with this procedure, and much remains to be learned about selection of appropriate fetuses for prenatal intervention.

P05.26: Early correction of polyuria in recipients following laser treatment in twin–twin transfusion syndrome assessed by 3D ultrasound

our centre, at between 26 to 33 weeks of gestation in order to screen for subtle fetal cerebral lesions. Gestational age was established according to crown-rump length. Fetal cerebral maturation was characterized according to gyration for gestational age in both twins. One donor presented a delay in fetal cerebral maturation at 28 weeks of gestation. This fetus had growth retardation < 3th percentile. Delayed gyration consisted of a 2 week-delay as compared to that of its co-twin. Neurological development was normal in both twins at 3, 6 and 12 months of age. In conclusion, delay in fetal brain maturation may occur in TTTS even in cases with two survivors and a normal outcome. This should be accounted for in the follow-up of these cases.

OC79: Twin–twin transfusion syndrome before 18 weeks of gestation

or scanty vascularized endometriomas (55.72 + 29.37) (p = 0.001). No differences in AFSr score and stage as well as the presence of adhesions were found between groups. Conclusions: We conclude that vascularization of ovarian endometriomas evaluated by transvaginal power Doppler and MVD is higher in patients presenting with pelvic pain than in asymptomatic patients. This could be an indicator for endometriosis activity.

P05.24: Discordance in fetal brain maturation in cases of twin–twin transfusion syndrome with a good outcome

Conjoined twins are the rarest type of monozygotic, monochorionic, monoamniotic twins, and have the incidence of 1:50000–1:100000 newborns. The prenatal diagnosis of conjoined twins allows better management of the multidisciplinary team associated with good parents counseling. The association of three-dimensional (3D) ultrasound and magnetic resonance imaging (MRI) to twodimensional (2D) ultrasound imaging can improve the diagnostic and classification of the twins malformations. We report two cases of thoraco-omphalopagus twins analyzed by 2D, 3D ultrasound and MRI, diagnosed during October 2005 and March 2006. First case: 28-years old woman G2P1 with 20 weeks spontaneous pregnancy, submitted to ultrasound with the diagnosis of conjoined twins. There was thoracoabdominal fusion with one umbilical cord formed by 2 arteries and one vein. There were two normal heads, with normal members and pelvics. The fetal heart was fused, with single atrium, two ventricles, valve anomaly, complex venous and arterial connection. It has been detected hepatic and diaphragmatic fusions and normal kidneys by ultrasound, confirmed by MR. Second case: 16-year old woman G1P0 with 22 weeks spontaneous pregnancy. She was submitted to ultrasound with the diagnosis of conjoined twins. The 3D and MR were performed to complement the diagnosis of organs fusion extension. There was thoracoabdominal fusion with one umbilical cord formed by 2 arteries and one vein. A complex fusion fetal heart, associated to hepatic and diaphragmatic fusion was detected. The superior and inferior members and heads were normal. The association of ultrasound 3D and MR improved the diagnostic and management of conjoined twins establishing the extension of organ sharing, by images not accessible by 2D ultrasound. It could also help the parents to understand better the kind of fetal fusion. The accurate diagnosis of conjoined twins is very important to determinate the fetal prognosis.