Mariano Lanna

Is fetal magnetic resonance imaging indicated when ultrasound isolated mild ventriculomegaly is present in pregnancies with no risk factors?: Role of MR in fetuses with mild isolated ventriculomegaly on US

Ventriculomegaly (VM) is the most common brain anomaly in prenatal ultrasound (US) diagnosis. There is a general trend to perform fetal magnetic resonance imaging (MRI) when VM is severe (greater than 15 mm) and/or it is not isolated. The role of MRI is debated when VM is borderline (between 10 and 15 mm) and isolated. Some authors have subdivided borderline VM into mild (10 to 12 mm) and moderate (>12 to15 mm). The aim of the study was to evaluate the role of MR in the imaging protocol of fetal cases characterized by mild isolated VM and no risk factors.

A randomized study to assess two different techniques of aspiration while performing transabdominal chorionic villus sampling

The technique used to perform transabdominal chorionic villus sampling (CVS) is not standardized, but aspiration of villi is generally obtained by discontinuous vacuum created in a syringe, manually or by a hand‐grip device. We evaluated the feasibility of a new method of performing CVS which employs a 4‐mL Vacutainer® connected to the needle, producing a continuous negative pressure.

Early diagnosis, follow-up, and prenatal treatment of a case of TRAP sequence occurring in a dichorionic triamniotic triplet pregnancy

We are reporting a case of twin reversed arterial perfusion (TRAP) sequence occurring in a dichorionic triamniotic triplet pregnancy with successful percutaneous prenatal treatment and excellent neonatal outcome. TRAP sequence was diagnosed at 11 weeks in a spontaneous dichorionic‐triamniotic triplet. Sonographic assessment showed persistent arterial flow and development of hydrops in the acardiac twin. Percutaneous cord interstitial laser coagulation was performed, and the co‐twin subsequently developed growth restriction. The 9‐month‐old twins have a normal developmental course. This report confirms that fetal intervention is indicated in cases of TRAP sequence in which the acardiac twin presents a significant enlargement on follow‐up sonographic examinations.

Selective intrauterine growth restriction in monochorionic twins: changing patterns in umbilical artery Doppler flow and outcomes

To describe changes in umbilical artery (UA) Doppler flow in monochorionic diamniotic (MCDA) twins affected by selective intrauterine growth restriction (sIUGR), to correlate Doppler findings with pregnancy course and perinatal outcome, and to report postnatal follow‐up.

Development of customized fetal growth charts in twins

BACKGROUND: Twin gestations are at significantly higher risk of fetal growth restriction in comparison with singletons. Using fetal biometric charts customized for obstetrical and parental characteristics may facilitate an accurate assessment of fetal growth. OBJECTIVE: The objective of the study was to construct reference charts for the gestation of fetal biometric parameters stratified by chorionicity and customized for obstetrical and parental characteristics. STUDY DESIGN: Fetal biometric measurements obtained from serial ultrasound examinations in uncomplicated twin pregnancies delivering after 36 weeks of gestation were collected by 19 Italian fetal medicine units under the auspices of the Società Italiana di Ecografia Ostetrica e Ginecologica. The measurements acquired in each fetus at each examination included biparietal diameter, head circumference, abdominal circumference, and femur length. Multilevel linear regression models were used to adjust for the serial ultrasonographic measurements obtained and the clustering of each fetus in twin pregnancy. The impact of maternal and paternal characteristics (height, weight, ethnicity), parity, fetal sex, and mode of conception was also considered. Models for each parameter were stratified by fetal chorionicity and compared with our previously constructed growth curves for singletons. RESULTS: The data set included 1781 twin pregnancies (dichorionic, n = 1289; monochorionic diamniotic, n = 492) with 8923 ultrasonographic examinations with a median of 5 (range, 2–8) observations per pregnancy in dichorionic and 6 in (range, 2–11) monochorionic pregnancies. Growth curves of twin pregnancies differed from those of singletons, and differences were more marked in monochorionic twins and during the third trimester. A significant influence of parental characteristics was found. CONCLUSION: Curves of fetal biometric measurements in twins are influenced by parental characteristics. There is a reduction in the growth rate during the third trimester. The reference limits for gestation constructed in this study may provide a useful tool for a more accurate assessment of fetal growth in twin pregnancies.

Twin-to-twin transfusion syndrome presenting at early stages: is there still a possible role for amnioreduction?

To assess the rate of resolution or progression after first line treatment with amnioreduction and related outcome of pregnancies with twin‐to‐twin transfusion syndrome (TTTS) diagnosed at stages I‐II.

Brain-injured Survivors of Monochorionic Twin Pregnancies Complicated by Single Intrauterine Death: MR Findings in a Multicenter Study

Purpose To describe and classify the range of brain injuries present at prenatal, in-utero magnetic resonance (MR) imaging in co-twin survivors of monochorionic (MC) twin pregnancies complicated by single intrauterine death (SIUD). Materials and Methods This retrospective, observational study from six tertiary fetal medicine centers that perform tertiary-level prenatal in-utero MR studies reviewed cases in which prenatal in-utero MR imaging had shown a brain injury in a surviving co-twin of a twin pregnancy with a MC component complicated by SIUD. Results Forty-two surviving MC twins were described. The primary distinction of brain abnormalities was into nonfocal and focal lesions. The nonfocal lesions included periventricular leukomalacia (group 1; two fetuses), generalized encephalomalacia (group 2; nine fetuses), posterior encephalomalacia (group 3; seven fetuses), and bilateral parasagittal and perisylvian injury (group 4; three fetuses). The focal lesions included nonhemorrhagic lesions (group 5; 14 fetuses) and hemorrhagic lesions (group 6; seven fetuses). Focal brain lesions were more likely to be found in the surviving MC pregnancies complicated by twin-twin transfusion syndrome (TTTS) (odds ratio, 2.4; 95% confidence interval: 1.3, 18.5; P = .01) and in fetuses that underwent an obstetric intervention (odds ratio, 2.8; 95% confidence interval: 1.8, 23.6; P = .006). Conclusion Brain injury of the surviving co-twin after SIUD in MC pregnancies is usually of ischemic origin and spares the brainstem and cerebellum. Focal brain lesions are more frequent in pregnancies complicated by TTTS or in those where an intervention has been performed.

I315 ECHOCARDIOGRAPHY IN MULTIPLES

for and diagnosis of GDM. IADPSG reached a consensus setting cut-off points for GDM where main outcomes (birthweight, cord C-peptide level, percent body fat above the 90th percent) were 1.75 fold greater than patients with mean glucose levels for the population. The dramatic result of this approach is the frequency of GDM potentially increased to 16%-20%, leading to medicalisation of currently healthy pregnancies. This high rate places an unusual burden on the healthcare community increasing the financial costs of obstetrical care. The concernment of care givers about the appropriate allocation of resources have risen the question whether the recently approved IADPSG diagnostic criteria are arbitrary and not evidence-based. The highest level of scientific evidence should accomplish preventive medical programs. It is obvious that prescribing interventions to a large number of individuals with a lesser degree of hyperglycemia can decrease credibility of any recommendation, even for those patients with indisputably diabetic conditions.

OP19.11: Management of twin reversed arterial perfusion (TRAP) sequence: a single center experience

the presentation is the same vertex at mid-3rd trimester (98.9% vs. 87%, P = 0.01)). The different chances of being vertex presentation at birth was statistically significant when comparing group [2] with group [4] (38.5% vs. 14.3%, P = 0.045). Conclusions: Almost all twins with vertex presentation at 3rd trimester is unlikely to be non-vertex at birth. We concluded that twins with vertex presentation at mid-3rd trimester had different chances of becoming a vertex-presenting twin at delivery according to presentation at early-3rd trimester. Inversely we can explain a mother with non-vertex presenting twin at mid-3rd trimester that the baby’s position is more unstable when it had vertex presentation at early-3rd trimester.

OP02.05: Thoraco‐amniotic shunting as treatment for fetal pleural effusion

Objectives: The natural history of echogenic lung lesions such as congenital cystic adenomatoid malformation (CCAM) and pulmonary sequestration (PS) has been altered by the advent of antenatal ultrasonography. Initial reports were characterized by a high incidence of adverse features (hydrops) and a poor outcome and did not accord with recent experience. Our purpose was to review the evolution and outcome of these lesions in our series. Methods: A retrospective review was conducted on fetuses diagnosed antenatally in the Fetal Medicine Unit of Hospital Vall d Hebron in Barcelona, Spain, between 2001 and 2007. A computer search identified all referred cases, and the records of these patients were examined to determine the pregnancy outcome. Results: In a 6-year period, 34 fetuses with echogenic lung lesions were referred for further management. The median age at diagnosis was 23 (range, 20–41) weeks. The lesion was on the right side in 19 (55%) and 15 (45%). All cases were unilateral. One case was diagnosed as CCAM type I (3%), 14 CCAM type II (41%) 11 CCAM type III (32%), 3 PS (8.8%) and five were mixed PS/CCAM (15%). All the fetuses had no associated anomalies and normal karyotype except one (47 XX+18). Termination of pregnancy was performed in seven cases of CCAM. In all cases histologic examination showed definitive diagnostic features of CCAM. In two cases diagnostic type of CCAM was changed from CCAM type II to type I and from CCAM type III to type II. Mediastinal shift was present in 16 fetuses (47%). Severe signs of fetal distress (hydrops) were present in three (8.8%). Because of hydrops, antenatal intervention was performed in two fetuses (thoracoamniotic shunting) and it was resolved. During the course of the pregnancy 70.5% (24/34) cases reduced in size or resolved spontaneously. All cases had good perinatal outcome. Conclusions: Most cases of prenatally diagnosed echogenic lung lesions had a good outcome. This review has positively influenced the counseling of women with this diagnosis.