Y. Torii

Ultrasound predictors of mortality in monochorionic twins with selective intrauterine growth restriction

The aim of this study was to evaluate the use of ultrasound assessment to predict risk of mortality in expectantly managed monochorionic twin fetuses with selective intrauterine growth restriction (sIUGR).

Validation of Quintero stage III sub‐classification for twin–twin transfusion syndrome based on visibility of donor bladder: characteristic differences in pathophysiology and prognosis

To validate the Quintero stage III subclassification for twin–twin transfusion syndrome (TTTS) based on visibility of the bladder of the donor twin.

Monochorionic monoamniotic twin pregnancies with two yolk sacs may not be a rare finding: a report of two cases

The exact determination of amnionicity is a major issue for the clinical management of monochorionic twin pregnancies, due to the high risk of perinatal mortality and morbidity in monochorionic monoamniotic (MCMA) twins. Counting the number of yolk sacs is believed to be a good indicator of amnionicity in the early first trimester, and it has previously been suggested that the number of yolk sacs is equal to amnionicity in both MCMA and monochorionic diamniotic twin pregnancies. However, the accuracy of the relationship between number of yolk sacs and amnionicity has recently been called into question. To the best of our knowledge, no previous reports have shown two yolk sacs in MCMA twin pregnancies. We report two cases of MCMA twins with two yolk sacs on first‐trimester ultrasonography, and confirmed monoamnionicity in the second trimester showing umbilical cord entanglement. Postnatal examination showed an MCMA placenta in both cases, and entangled umbilical cords confirmed monoamnionicity. The possibility of monoamnionicity must still be suspected when two yolk sacs are detected early in the first trimester on ultrasound examination in monochorionic twin pregnancies. Copyright

P09.12: Fetoscopic laser photocoagulation of communicating vessels for twin–twin transfusion syndrome: Japanese 2 years' experience and considering Stage 3 sub‐classification

tissue. The laser ablation was followed by an amnioreduction to a maximum vertical pocket of 5 cms in the recipient sac. Results: All patients for whom laser was chosen as therapy are included in the analysis. To date we have 37 completed cases, 29 of whom have delivered. One patient required two laser procedures and in one patient laser was not performed, as amniotic fluid was too turbid secondary to a prior amniocentesis. Mean gestational age (GA) at therapy was 21.9 weeks and mean GA at delivery was 33.2 weeks. Survival data is as follows:

OP05.07: The outcome of twin reversed arterial perfusion sequence in monochorionic monoamniotic twin pregnancies

Methods: Between July 2009 and February 2011, 54 pairs of MCDA twins and 2 triplets were delivered in 3 tertiary care centers. All pregnancies were followed with a weekly fetal surveillance for fetal weight discordance and twin-to-twin transfusion syndrome (TTTS). After birth, placentas were observed and stained to search type and number of vascular anastomoses, type and distance between cord insertions and placental distribution. Birth weights as fetal and neonatal mortality and early morbidity were recorded from clinic charts. Placental characteristics were analized in relation to perinatal outcome. Triplets were analized separately. Results: Anastomoses were detected in all placentas with fetal growth alterations in 44% of the studied pregnancies. Between fetuses with growth disturbances 12 pairs were diagnosed as TTTS, 9 pairs as selective intrauterine growth restriction (IUGR) and 3 pairs as growth discordances without IUGR. Eight fetal deaths were recorded, in 2 pregnancies a single fetal death occurred and in other 3 pregnancies both fetuses died in spite of fetal therapy. Relation between abnormal cord insertions and smaller placental territories were seen in all abnormal growth pregnancies and in 50% of pregnancies without growth disturbances. Between discordant growth pregnancies, only all TTTS cases had unequal shared territories and neonatal weight discordance more than 20%. There were 3 cases of severe early morbidity and 6 babies died during the early neonatal period, most in relation to mayor malformations. Conclusions: Placental characteristics are closely related to perinatal outcome, mainly with the presence of TTTS and fetal growth disturbances. Prenatal identification of these characteristics in this group of pregnancies may change parent counselling as surveillance and intrauterine therapy program.

OP19.04: Twin pregnancies with ‘lambda’ sign on ultrasound examination may not rule out monochorionic diamniotic twins

hypertension and preeclampsia. Between two neonatal groups, there were no significant differences in distribution between the sexes, gestational age at delivery, birth weight and Apgar at 5’. MB pregnancies showed a number of small for gestational age fetuses (27.1% vs. 11.8% P = 0.002) compared to the BB group. In 97.4% of cases was performed a Caesarean section, in most cases for programming assistance (66.5%), selective growth restriction (10%), maternal disease (10.5%) and other reasons (13%). There were also 5 vaginal deliveries (2.6%), 3 spontaneous, one operative and the last one previous the Caesarean section of the second twin. RDS was higher in BM pregnancies (37.8% vs. 19.4% P = 0.06). Conclusions: MB pregnancies do not differ in perinatal outcome respect to BB pregnancies in terms of maternal and neonatal morbidity.

P03.18: Prenatal diagnosis of heterotaxy syndrome: an 11-year experience

S. Forys1, K. Janiak2, A. Zarkowska2, M. Slodki1, M. Respondek-Liberska1,2, A. Sysa3 1Department of Diagnosis and Prophylaxis of Congenital Malformations, Institute of Polish Mother Memorial Hospital, Lodz, Poland; 2Department of Diagnosis and Prophylaxis of Congenital Malformations, Institute of Polish Mother Memorial Hospital & Medical University, Lodz, Poland; 3Department of Pediatric Cardiology, Institute of Polish Mother Memorial Hospital, Lodz, Poland

P18.14: Perioperative complication with the double bascket catheter in fetal thoracoamniotic shunt

Objective: Fetuses with megavesica are typically diagnosed between 14 and 18 weeks of pregnancy. Oligohydarmnion is often paralling and complicates detailed sonographic evaluation. In early pregnancy it is difficult to estimate fetal kidney function beside normal amniotic fluid production. Patients: We report on a series of 9 cases with fetal megavesica. First diagnosis was established between 13 + 5 and 19 + 6 weeks of pregnancy. All parents were offered interdisciplinary management (neonatalogy, nephrology), invasive diagnostic testing (amniocentesis, urine analysis) and treatment (shunting, puncture). Results: 8 pregnancies underwent vesicocentesis (14 + 5 to 20 + 0 weeks) for urine analysis (sodium, chloride, mikroalbumines, osmolality) before intrauterine shunting was performed. 5 mothers decided to have fetal karyotyping. 2 pregnancies were terminated after vesicocentesis and parental counselling. In 6 fetuses showing at least partial normal kidney morphology a double pig-tail stent (Harrison drain; Cook; Spencer; Indiana; USA) was inserted into the megavesica. Dislocation of the shunt occurred in all fetuses. In one case the parents decided to terminate the pregnancy at 16 + 2 weeks after dislocation. Replacement of further shunts was performed in 4 fetuses up to 3times. Delivery took place between 26 + 0 and 39 + 6 weeks of pregnancy. Preterm delivery was necessary due to chorioamnionitis (26 + 0, neonatal death after 10 days), fetal hemorrhage (31 + 2) and PROM at 34 + 3 weeks. In one case with 4 insertion of a cook-stent and 2 vescocentesis delivery took place at 39 + 3 weeks. Conclusions: Despite unfavourable prenatal findings and having undergone numerous fetal interventions neonatal outcome may be favourable. Counselling parents therefore is difficult and merits interdisciplinary early approach.

P51.12: Preoperative ultrasound view of placental surface vessels in twin–twin transfusion syndrome

Objectives: To evaluate the placental vessels angio-architecture by preoperative ultrasonography with the view of placental surface rendering. Methods: Six cases affected with TTTS were examined by power Doppler with 3D surface rendering (Accuvix XQ, Medison, Seoul Korea) preoperatively, and compared the images to fetoscopic placental surface view. Gestational ages at examination were average of 20 weeks’ gestation (18 to 23). Three cases were anterior placenta, and the other three were posterior placenta. Results: One case of anterior placenta obtained a sufficient image of vasculature running through the placental surface compared to fetoscopical view. All three posterior placentae were not able to get adequate images because of its technical limitation; motion noise of amniotic fluid or fetus, far distance of placenta location, and far distance between both umbilical cord insertion. Conclusions: 3D power Doppler surface rendering, which still has technical limitations, may have the potential of preoperative ultrasound guide to simulate the angio-architecture of communicating vessels especially for anterior placenta cases, if the sufficient view is obtained.

P36.02: Transitory changes in middle cerebral artery peak systolic velocity of the recipient twins after fetoscopic laser photocoagulation for twin–twin transfusion syndrome

Material and Methods: 109 ovaries were studied in follicular phase (days 3–5), 54 of them were PCO and 55 NO. The ultrasound was performed with Voluson TM 730 Expert (GE TM ) and VOCAL TM in manual mode with a 15◦ rotation. The follicular count was done with inverted mode. Vascular indexes (VI, FI and VFI) were also calculated. Results: There was a high correlation between the volume on 2D and 3D (r = 0.876, P < 0.01). The number of follicles in PCO group was higher than in NO group (13.12 ± 4.335 vs. 6.49 ± 1.516, P < 0.001). No significant differences were found when vascular indexes were compared between both groups. Concludion: The removal of ovarian parenchyma allows the individualization of each liquid containing cavity in the ovary improving the follicular counting. Even some studies found an increase in the VI, FI and VFI values in PCO though our data do not support these features.