Masami Yamamoto

Maternal administration of valaciclovir in symptomatic intrauterine cytomegalovirus infection

Objectivesu2002 To report early experience with treatment of intrauterine cytomegalovirus (CMV) infection using maternal oral administration of valaciclovir (VACV).

Selective feticide in complicated monochorionic twin pregnancies using ultrasound-guided bipolar cord coagulation

Objectiveu2003 To review our experience with selective feticide in complicated monochorionic (MC) twin pregnancies, using ultrasound‐guided cord coagulation with a bipolar forceps.

Specific detection of 16 micro-organisms in amniotic fluid by polymerase chain reaction and its correlation with preterm delivery occurrence☆☆☆★★★

OBJECTIVEnOur purpose was to develop a specific polymerase chain reaction detection method for 16 micro-organisms in amniotic fluid and to correlate its performance with bacterial cultures and preterm delivery occurrence.nnnSTUDY DESIGNnThe study group was made up of 50 patients with preterm labor and intact membranes. The control group consisted of 23 patients not in labor and undergoing amniocentesis for either karyotype or lung maturity studies. Polymerase chain reaction and bacterial cultures were assayed in amniotic fluid of all patients. Results were correlated with pregnancy outcome.nnnRESULTSnPolymerase chain reaction identified micro-organisms in 23 cases in the study group (46%), whereas cultures identified only 6 (12%). All control samples were negative for polymerase chain reaction and cultures. The sensitivity of polymerase chain reaction and cultures for the identification of patients delivering before 34 weeks gestation was 64% and 18%, respectively.nnnCONCLUSIONnA polymerase chain reaction gene amplification method was developed to identify 16 micro-organisms in amniotic fluid. Compared with bacterial cultures, polymerase chain reaction amplification in amniotic fluid appears to be more sensitive in identifying patients delivering prematurely.

Fetal medicine: Intrauterine fetal demise following laser treatment in twin‐to‐twin transfusion syndrome

Objectiveu2002 To evaluate the incidence, risk factors and consequences of intrauterine fetal demise (IUFD) of at least one twin in twin‐to‐twin transfusion syndrome (TTTS) treated by laser.

Twin-to-twin transfusion syndrome : Management options and outcomes

Introduction Twin-to-twin transfusion syndrome (TTTS) has a high perinatal mortality rate and may affect 15% of all monochorionic twin pregnancies. Recent data on the benefit of primary treatment with laser over amnioreduction has focused attention on optimization of the results with laser treatment as well as the management of the related complications. Two important steps in the understanding of TTTS must be outlined. First, ultrasound diagnosis of the polyhydramnios/oligohydramnios sequence has become the gold standard for diagnosis of TTTS irrespective of the discordance in estimated fetal weight or hemoglobin levels. Second, laser has been demonstrated to be better than amnioreduction in treating TTTS in the only randomized study and also in a systematic review of the literature. Therefore, there is a consensus on diagnosis and on the most appropriate first-line treatment when the condition develops before 26 weeks of gestation. Efforts should now focus on improving survival rates and developing new strategies for different complications arising in treated cases. Miscarriage, preterm premature rupture of membranes, and preterm delivery have to be addressed because they account for more than 20% of the mortality after treatment. Recurrence of TTTS, fetal demise, or fetofetal hemorrhage with the development of isolated marked anemia/polycythemia are complications that have to be managed with different Correspondence: Yves Ville, PhD, Service deGynécologie Obstétrique, CHI Poissy Saint Germain en Laye, Université de Paris-Ouest Versailles-St. Quentin en Yvelines, 10 Rue de Champ Gaillard Poissy 78300, France. E-mail: yville@wanadoo.fr

Recent findings on laser treatment of twin-to-twin transfusion syndrome.

Purpose of review Despite the recent demonstration of the benefit of the primary laser over amnioreduction, overall survival is far from optimal (70–80%), and therefore diagnosis and management of early and late complications following placental surgery became of great importance. Recent findings Laser therapy has proven to be better than amnioreduction in treating twin-to-twin transfusion syndrome. Miscarriage, preterm premature rupture of the membranes and preterm delivery account for more than 20% of perinatal mortality after treatment. In those who die despite treatment, recurrence of twin-to-twin transfusion syndrome, placental insufficiency or feto-fetal hemorrhage with anemia/polycythemia are complications that have to be managed with different secondary therapeutic options, such as amnioreduction, cord coagulation, intrauterine transfusion or repeat fetoscopy-guided laser. Ex-vivo placental angiography has confirmed that these complications occur when anastomoses are missed. Early predictors of laser efficacy in twin-to-twin transfusion syndrome treatment, such as improvement in the umbilical vein flow imbalance and urine production, are being evaluated, because they are earlier predictors of outcome than amniotic fluid discordance. Summary Optimization of laser treatment of twin-to-twin transfusion syndrome and new insight into the follow-up are likely to become the key to a better prognosis, and they are therefore important issues that have to be addressed in forthcoming studies.

Three‐dimensional sonographic assessment of fetal urine production before and after laser surgery in twin‐to‐twin transfusion syndrome

Fetal urine production in twin‐to‐twin transfusion syndrome (TTTS) reflects the hemodynamic imbalance between the donor and recipient twins but it has not been measured in this particular condition. The aim of this study was to measure fetal urine production using three‐dimensional (3D) ultrasound in donor and recipient twins before and after laser treatment for TTTS and to correlate this with umbilical venous volume flow (UVVF).

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.

Analysis of Fetal Growth After Laser Therapy in Twin-to-Twin Transfusion Syndrome

The purpose of this study was to evaluate fetal growth patterns after laser therapy in twin‐to‐twin transfusion syndrome (TTTS).

Maternal pseudo primary hyperaldosteronism in twin-to-twin transfusion syndrome

Objectiveu2002 To monitor changes in the maternal renin–angiotensin–aldosterone system following laser therapy and amnioreduction in severe twin‐to‐twin transfusion syndrome (TTTS).