S. Faiola

Bipolar cord coagulation for selective feticide in complicated monochorionic twin pregnancies: 118 consecutive cases at a single center

To review the experience of performing selective feticide with bipolar cord coagulation (BCC) in complicated monochorionic (MC) twin pregnancies at a single center.

Neonatal suppression-burst without epileptic seizures: expanding the electroclinical phenotype of STXBP1-related, early-onset encephalopathy

Early-onset epileptic encephalopathies (EOEEs) are characterised by epileptic seizures beginning in the first months of life, abnormal background EEG activity, and are associated with severe developmental delay and poor prognosis. Mutations and deletions in the STXBP1 gene are associated with Ohtahara syndrome, also known as “early infantile epilepticencephalopathy”. We report an infant affected by EOEE with a 9q34.11 deletion that encompassed the genes STXBP1 and SPTAN1. The infant presented with neonatal encephalopathy without epileptic seizures and an EEG pattern varying from highly discontinuous to suppression-burst. This was followed by West syndrome at 2 months with atypical hypsarrhythmia and spasms, easily controlled by therapy. Our findings suggest that molecular analysis of STXBP1 should be considered for newborns affected by neonatal encephalopathy associated with a peculiar EEG pattern, even in the absence of neonatal epileptic seizures.

Color-dye injection of monochorionic placentas and correlation with pregnancy complications

INTRODUCTION Vascular anastomoses in monochorionic (MC) twin placenta can be easily identified with color-dye injection. The aim of this study is to analyze the relationship between different type of anastomoses and twin pregnancy complications. METHODS From January 2011 to October 2014, MC placentas were analyzed with color-dye injection and five group of pregnancies were identified: those that were not complicated (NC), those complicated with selective intrauterine growth restriction (sIUGR), twin-twin transfusion syndrome (TTTS), or twin anemia-polycitemia sequence (TAPS) and those with amniotic fluid discordance (AFD) between twins. Cases of TTTS treated with endoscopic laser coagulation of placenta anastomoses or cases with in utero death of one twin were excluded. RESULTS A total of 118 MC placentas were observed, 58 (49%) NC, 35 (30%) sIUGR, 10 (8%) TTTS, 13 (11%) AFD and 2 (2%) TAPS. The median number of anastomoses was 7 (range 1-15), 8 (2-18), 4 (2-11), 7 (2-13) and 1 (1-1), respectively. At least one artero-venous anastomoses was found in the placenta observed, while the prevalence of artero-arterial anastomoses was 95% for NC, 91% for sIUGR, 60% for TTTS, and 77% for AFD; no TAPS placenta had this type of anastomoses. The diameter of arteroarterial anastomoses was greater in the AFD group (3.3 mm), compared to the NC, sIUGR and TTTS groups (2.3, 2.5 and 1.4 respectively, p 0.04). DISCUSSION In this large serie of MC placenta analyzed with color-dye injection, a specific distribution of anastomoses emerged for twins with amniotic fluid discordance, which points to a need for intensive surveillance.

Cervical length measurement at mid gestation to predict spontaneous preterm birth in asymptomatic triplet pregnancies

To assess the predictive value of sonographic cervical‐length (CL) measurement in mid‐gestation for spontaneous preterm birth (PTB) in asymptomatic triplet pregnancy.

Prenatal diagnosis of extrahepatic umbilicosystemic shunt: a new variant?

Extrahepatic umbilicosystemic shunts are a rare occurence, caused when critical anastomoses fail to form between the three major pairs of veins in the fetal venous system: umbilical, cardinal and vitelline veins1,2. Various anastomoses of the umbilical vein with extrahepatic veins have been reported, e.g. with the iliac vein, the inferior vena cava, the right or left atrium or the coronary sinus2–4. We report a case of extrahepatic umbilicosystemic shunt formed by an aberrant vessel, which, bypassing the portal veins, branches into two vessels and simultaneously connects the umbilical system with the superior vena cava (SVC) and the inferior vena cava (IVC). To our knowledge, this is the first report of such a variant.

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.