Saul Snowise

Preterm prelabor rupture of membranes after fetoscopic laser surgery for twin–twin transfusion syndrome

To assess the incidence, clinical course, risk factors and outcomes of preterm prelabor rupture of membranes (PPROM) after fetoscopic laser surgery (FLS) for twin–twin transfusion syndrome (TTTS).

Donor Death After Selective Fetoscopic Laser Surgery for Twin-Twin Transfusion Syndrome.

OBJECTIVE: To assess the incidence, timing, and risk factors for death of the donor fetus after fetoscopic laser surgery, we evaluated our cohort of patients who underwent the procedure for twin–twin transfusion syndrome. METHODS: This was a prospective cohort study of 166 consecutive patients with twin–twin transfusion syndrome at a single center. Fetal death was diagnosed by ultrasonography after surgery and before onset of labor. Risk factors for death of the donor twin were identified on univariate analysis and then subjected to multivariate, stepwise, logistic regression analysis. RESULTS: Donor demise occurred in 20 (13%) cases and recipient twin death occurred in four (2.6%). The median procedure to death interval was 4 days (range 1–89 days). Risk factors for donor death were fetal growth discordance greater than 30% (odds ratio [OR] 6.7, 95% confidence interval [CI] 2–23), reverse end-diastolic velocity in the donor umbilical artery (OR 25.0, 95% CI 2–290), a marginal and velamentous cord insertion (OR 4.4, 95% CI 1–19), and an increased number of anastomoses (OR 1.2, 95% CI 1.1–1.5). All four donors with both fetal growth discordance greater than 30% and reverse end-diastolic velocity in the donor umbilical artery resulted in a demise. CONCLUSION: Four risk factors significantly affecting acute and delayed donor demise after fetoscopic laser surgery were identified. The presence of both fetal growth discordance greater than 30% and reverse end-diastolic velocity in the donor umbilical artery was highly predictive of donor demise in our cohort. Knowledge of these risk factors can aid in counseling and assist patients in choosing the most appropriate intervention in the management of twin–twin transfusion syndrome. LEVEL OF EVIDENCE: III

Preterm delivery after fetoscopic laser surgery for twin–twin transfusion syndrome: etiology and risk factors

Preterm delivery after fetoscopic laser surgery (FLS) for twin–twin transfusion syndrome (TTTS) is a major complication. The causative factors leading to preterm delivery continue to be elusive and a better understanding of the risk factors could reduce complications. The objective of this study was to determine the etiology of preterm delivery after FLS for TTTS and its associated risk factors.

Tracheal occlusion for fetal diaphragmatic hernia.

Despite advances in neonatal care, diaphragmatic hernia still inflicts significant morbidity and mortality on affected neonates. Abnormal embryologic events disrupt the formation of the diaphragm allowing the abdominal viscera to occupy the intrathoracic space. This interrupts normal pulmonary development with resulting pulmonary hypoplasia and pulmonary hypertension in neonatal survivors. This review will outline the relevant embryology, etiologies, and pertinent historical aspects of diaphragmatic hernia treatments to better understand the current antenatal approach to therapy for this disease process.

Does anemia-polycythemia complicating twin-twin transfusion syndrome affect outcome after fetoscopic laser surgery?

Twin anemia–polycythemia sequence (TAPS) can occur as a unique disease or as a complication of twin–twin transfusion syndrome (TTTS). Middle cerebral artery (MCA) Doppler studies are not currently part of the routine evaluation of monochorionic twins since they are not used in the Quintero staging system. As such, the true incidence of TAPS is unknown. We aimed to compare the characteristics and outcomes of twin pregnancies with TTTS complicated by spontaneous anemia–polycythemia vs those with TTTS alone.

122 – Nonimmune Hydrops Fetalis

Abstract Nonimmune hydrops fetalis (NIHF) encompasses all causes of fetal hydrops that are not caused by the passage of maternal antibodies into the fetal compartment. Secondary to the decreasing prevalence of immune hydrops, NIHF now comprises 90% of all hydrops cases. The dilemma for the treating physician is the wide range of possible etiologies resulting in NIHF, and differentiating when a prenatal treatment is possible. This chapter outlines the definition, epidemiology, pathophysiology, most common etiologies, laboratory and ultrasound evaluation, and the clinical management of fetuses affected by this disorder.

123 – Immune Hydrops Fetalis

Abstract Immune hydrops is fetal hydrops resulting from the passage of maternal antibodies into the fetal compartment causing fetal anemia and subsequent hydrops. This disease process can affect both the fetus and neonate and is better labeled as hemolytic disease of the fetus and newborn (HDFN). Although the incidence of rhesus (Rh) D alloimmunization has decreased with the advent of rhesus immunoglobulin to the D antigen, HDFN resulting from Rh(D) and non-Rh(D) antibodies still poses a significant risk to the fetus and neonate. This chapter will outline the definition, epidemiology, pathophysiology, laboratory and ultrasound evaluation, and clinical management of women affected by alloimmunization.

Cryopreserved human umbilical cord versus biocellulose film for prenatal spina bifida repair in a physiologic rat model

Prenatal spina bifida (SB) repair with a regenerative patch may improve neurological outcomes by decreasing inflammatory scarring.