Susumu Murata

Experience of fetoscopic laser photocoagulation and cord transection for twin‐reversed arterial perfusion sequence

The purpose of this study was to evaluate the usefulness of fetoscopic laser photocoagulation of placental communicating vessels or umbilical cord for twin‐reversed arterial perfusion (TRAP) sequence.

Ratio of fetal anteroposterior to transverse cerebellar diameter for detection of the cerebellar hypoplasia in the second trimester and comparison with trisomy 18.

Cerebellar hypoplasia, particularly, trisomy 18, represents a chromosomal abnormality. However, morphological assessment of the fetal cerebellum is yet to be established. The purpose of this study was to produce reference values for the fetal transverse cerebellar diameter (TCD), anteroposterior cerebellar diameter (APCD) and the ratio of APCD to TCD (APCD/TCD ratio) in normal fetuses, compared with cases of trisomy 18.

Reproducibility of automated fetal heart rate measurement using a novel technique with two-dimensional tracking

PurposeTo assess the accuracy of automated fetal heart rate measurement using two-dimensional tracking (AutoFHR) by comparison with the conventional free-angle M-mode (M-mode) and pulsed-waved Doppler (PWD) methods.MethodsA multicenter prospective comparative study was conducted. AutoFHR is a novel technique for the automatic calculation of fetal heart rate using a two-dimensional speckle-tracking method. The fetal heart rate (FHR) obtained by AutoFHR was compared with that obtained by the conventional M-mode and PWD. Statistical analysis was performed on the correlation between the FHR measured by AutoFHR and that determined by M-mode and PWD.ResultsData from 326 singleton pregnancies were analyzed, and all the data and the data from 178 cases were compared with M-mode and PWD, respectively. The intraobserver ICC was 0.96 (95% CI: 0.93–0.98), whereas the interobserver ICC was 0.97 (95% CI: 0.95–0.99). Systematic bias was not observed between M-mode and PWD, based on the Bland–Altman plots. Analyses of the relationships among the FHRs yielded by each method revealed that AutoFHR was strongly associated with M-mode (rs = 0.99, p < 0.001) and PWD (rs = 0.86, p < 0.001).ConclusionEvaluation of FHR by AutoFHR was proved to be equivalent to evaluation by the conventional M-mode and PWD. AutoFHR can be employed with only B-mode data, making FHR measurement easier and safer.

Distribution of PAPP-A and total hCG between 11 and 13 weeks of gestation in Japanese pregnant women

Abstract Objectives: To establish the reference values for PAPP-A and total hCG between 11 and 13 weeks of gestation for the use of risk assessment of fetal aneuploidy in Japanese pregnant women. Methods: A multicenter prospective study was conducted. The subjects included only Japanese pregnant women with viable singleton who requested the first trimester combined (nuchal translucency and maternal serum marker) screening for fetal aneuploidy. Reference values of PAPP-A and total hCG in Japanese population were made and compared with them in Caucasian. Results: Overall 1,751 Japanese pregnant women were analyzed. Median vales of maternal serum concentration in Japanese pregnant women from 11 + 0–13 + 6 weeks’ gestation were ranged from 3.01 to 9.51 mIU/mL for PAPP-A and from 70.2 to 58.3 IU/mL for total-hCG, respectively. Regression curve of median maternal serum PAPP-A and total-hCG concentration against gestational days are significantly higher in Japanese comparing with Caucasian. At most distant values, Japanese serum concentration indicated 1.45 MoM for total-hCG and 1.70 MoM for PAPP-A based on Caucasian regression curves. Conclusion: A modification of the equations by specific reference values is necessary for Japanese pregnant women at the risk assessment of chromosomal abnormalities using the first trimester maternal serum marker.

The experience of modified sequential selective laser photocoagulation of communicating vessels technique for twin-twin transfusion syndrome

Abstract Objective: Fetoscopic laser photocoagulation of vascular anastomoses (FLP) is the essential choice in twin-twin transfusion syndrome (TTTS). We proposed that the modified sequential selective laser photocoagulation of communicating vessels (modified SQLPCV) to clarify the perinatal outcomes in TTTS. Methods: The modified SQLPCV was designed with the following order: 1, artery-to-artery anastomoses; 2, venous-to-venous anastomoses; 3, artery-to-venous anastomoses from donor to recipient; and 4, artery-to-venous anastomoses from recipient to donor. The perinatal outcomes were present in TTTS patients who underwent the modified SQLPCV. Results: A total of 203 women underwent modified SQLPCV. The mean pregnancy prolongation period was 83 days, and the mean gestational age at delivery was 33 weeks (range 23–40 weeks). There was a significantly lower rate of recipient fetal demise than donor fetal demise (4% vs. 13%; p < .01). The survival rate of zero and one were respectively 6% (13/203) and 19% (39/203). Two survivors were seen in 74% (151/203), and at least one survivor in 94% (190/203). Univariate and multivariate analysis showed that abnormal fetal Doppler measurements in donor were correlated with donor demise after surgery. Conclusions: The modified SQLPCV represents satisfactory outcomes for fetuses complicating with TTTS.