Peter C. C. Hsieh

Clinical outcome and placental territory ratio of monochorionic twin pregnancies and selective intrauterine growth restriction with different types of umbilical artery Doppler

To evaluate the clinical outcome and placental territory ratio in monochorionic diamniotic (MCDA) twin pregnancies and selective intrauterine growth restrictions (sIUGR) with different types of umbilical artery (UA) Doppler.

The individual fetal weight/estimated placental weight ratios in monochorionic twins with selective intrauterine growth restriction.

To evaluate the individual fetal weight/estimated placental weight ratios (F/P ratio) of the two fetuses in monochorionic (MC) twins with selective intrauterine growth restriction (IUGR).

Ultrasound Assessment of Cervical Length in Pregnancy

Cervical length in high-risk women for preterm birth has to be identified before early second trimester. Sequential evaluations lead to high predictive significance. The mean cervical length at 24 weeks is about 35 mm when measured by transvaginal ultrasound. A short cervix is defined as a cervix that is less than 25 mm and funneling, i.e. ballooning of the membranes into a dilated internal os, but with a closed external os. Factors such as short cervical length, uterine anomaly, previous cervical surgery, multiple gestation and positive fetal fibronectin results are associated with preterm delivery. Serial transvaginal ultrasound examinations during the early second trimester would provide longitudinal changes in the cervical length. The use of 17alpha-hydroxyprogesterone caproate and cerclage has shown to be beneficial in preventing preterm delivery. When combined with other predictors such as occiput position, parity, maternal age and body mass index, cervical length is a useful parameter for predicting the feasibility of labor induction and successful delivery.

Increased autophagy in the placental territory of selective intrauterine growth-restricted monochorionic twins

This study investigates the placental autophagic activity in growth‐restricted fetuses in the monochorionic (MC) twin model.

The neurological outcomes of surviving twins in severe twin–twin transfusion syndrome treated by fetoscopic laser photocoagulation at a newly established center

To evaluate the incidence and predictive factors of poor neurological outcome in survivors of twin‐to‐twin transfusion syndrome (TTTS) treated with fetoscopic laser photocoagulation (FLP).

Short-term outcomes of fetoscopic laser surgery for severe twin–twin transfusion syndrome from Taiwan single center experience: Demonstration of learning curve effect on the fetal outcomes

OBJECTIVE To evaluate the learning curve effect on fetal outcomes while using fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS) as managed by a newly established single center in Taiwan. MATERIALS AND METHODS Between October 2005 and October 2010, women diagnosed to have TTTS before 26 weeks of gestation were offered FLP surgery. Cases were divided into first-half and second-half groups to evaluate the learning effect on fetal outcomes including at least one survival rate, two survival rate, and gestational age of delivery. RESULTS A total of 44 cases with a median gestational age of 20.1 weeks (range 16-25) at operation were included in the study. Overall, both twins survived in 22 (50.0%) cases, whereas only one twin was born alive in 13 (29.5%), and neither was born alive in the remaining nine cases (20.5%). The total survival rate was 64.8%. When comparing the first-half 22 cases and the second-half 22 cases, there were significant improvements in total survival rate (54.7% vs. 75.0%, p = 0.045), a prolonged interval between operation and delivery (62.1 vs. 89.1 days, p = 0.042), and more advanced gestational age of delivery (28.3 vs. 33.0 weeks, p = 0.008) in the second-half 22 cases. CONCLUSIONS With increasing experience in using fetoscopic guide laser therapy for TTTS, the fetal survival rate could be improved with advanced gestational age at delivery.

Placenta Share Discordance and Umbilical Artery Doppler Change After Antenatal Betamethasone Administration in Monochorionic Twins With Selective Intrauterine Growth Restriction: Is There a Link?

This study was designed to evaluate the degree of placenta share discordance in relation to the betamethasone-induced return of positive end-diastolic flow in monochorionic twin pregnancies with selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler. Monochorionic twins with sIUGR was defined as one twin having an estimated fetal weight below the 10th percentile combined with an estimated fetal weight discordance >25%. The umbilical artery Doppler directly prior to (D0) and 24 hours (D1) and 48 hours (D2) after the first dose of betamethasone administration was recorded. The estimated individual placental weight in monochorionic twins was obtained by cutting the placenta along the vascular equator into two territories; the placenta share discordance was calculated as [(estimated individual placental weight of appropriated for gestational age twin- estimated individual placental weight of growth restricted twin)/estimated individual placental weight of appropriated for gestational age twin] × 100%. Six (23.1%) of the 26 included cases achieved betamethasone-induced return of positive umbilical artery end-diastolic flow. The difference of placenta share discordance and birth weight discordance were not significantly different between twins with and without betamethasone-induced return of positive umbilical artery end-diastolic flow. Thus, according to our study results, it was proposed that although the placenta share discordance correlated with the abnormal umbilical artery Doppler in the IUGR fetus in monochorionic twin, the betamethasone-induced return of positive umbilical artery end-diastolic flow, however, did not reveal the similar relationship with the severity of placenta share discordance.

Transient Chorioamniotic Membrane Separation after Fetoscope Guide Laser Therapy for Twin–Twin Transfusion Syndrome: A Case Report

Chorioamniotic membrane separation (CMS) means that the close attachment of amniotic and chorionic membranes is disrupted, usually following the traumatic entry into the amniotic cavity including fetal therapy. We report a case of twin–twin transfusion syndrome receiving fetoscopic guide laser therapy at gestational age of 19 weeks with partial CMS detected at the fifth week (gestational age of 24 weeks) after surgery and resealed 1 week later. There was no more CMS noted till delivery at gestational age of 34 weeks 6 days. CMS after fetoscope surgery may reseal spontaneously.

Fetal hemodynamic changes following maternal betamethasone administration in monochorionic twin pregnancies featuring one twin with selective growth restriction and abnormal umbilical artery Doppler

Aim:  To evaluate fetal hemodynamic changes following maternal betamethasone administration in monochorionic twin pregnancies featuring one twin with selective intrauterine growth restriction (sIUGR) and absence of end‐diastolic velocity in umbilical artery (UA) Doppler.

Spontaneous Cessation of Communicating Flow in a Twin Reversed-arterial Perfusion with Large Acardiac Twin

We report a case of twin reversed-arterial perfusion diagnosed at the gestational age of 17 weeks. Though the acardiac/pump twin abdominal circumference ratio was 1.5, there was no critical Doppler finding of reverse A wave of ductus venosus, polyhydramnios or hydrops of the pump twin at the time of diagnosis, so the patient was regularly followed-up at clinic at 1-week intervals. Two weeks after the diagnosis, the patient requested surgical intervention because she was worried about the risk of heart failure in the pump twin. Fetoscopic guide laser coagulation of the communicating vessels was arranged. On the morning of the operation, cessation of the communicating flow was found, so the operation was cancelled. On the afternoon of the same day, amniocentesis was performed and the pump twin was found to have scalp edema. The patient was followed-up at clinic at 2-week intervals. A healthy female baby was born by vaginal delivery at the gestational age of 36 weeks.