Selective fetoscopic laser ablation in 100 consecutive pregnancies with severe twin-twin transfusion syndrome.

Aims: To report the perinatal outcomes of a large series of twin pregnancies with severe twin-twin transfusion syndrome (TTTS) managed with laser ablation surgery in an Australian tertiary perinatal centre and to compare the outcome with other large cohorts.

Methods: The outcomes of 100 consecutive pregnancies with severe TTTS managed with selective fetoscopic laser ablation from March 2002 to June 2007 were examined. Survival and neonatal morbidity were analysed.

Cardiac outcomes of hydrops as a result of twin-twin transfusion syndrome treated with laser surgery.

Aim: To determine cardiac outcomes of foetal hydrops as a result of twin-twin transfusion syndrome treated with laser surgery.

Methods: Hydrops identified in 16 recipient foetuses with twin-twin transfusion syndrome was treated with laser ablation surgery to anastomotic vessels. Prior to laser surgery, the foetuses were assessed by echocardiography for cardiac abnormalities and ventricular and valvular dysfunction.

Fetal tele-ultrasound and tele-therapy.

Advanced fetal diagnosis with real-time, high resolution ultrasound and fetal therapy with fetoscopic surgery represent the state-of-the-art in the subspecialty of fetal medicine. They allow accurate diagnosis of the fetal condition, multidisciplinary support for management, and in utero treatment, thereby significantly reducing perinatal mortality and morbidity. Such expertise is only available in a small number of advanced fetal medicine centres.

Parenting stress and psychosocial health in mothers with twin-twin transfusion syndrome managed with laser surgery: a preliminary study.

Twin-twin transfusion syndrome (TTTS) is a severe complication of twin pregnancies with high risk for perinatal mortality and long-term morbidity. This cross-sectional cohort study aimed to determine parenting stress and psychosocial health in mothers with a pregnancy complicated by TTTS that had been managed with laser ablation of communicating placental vessels. Questionnaires were sent to the mothers for completion: Parenting Stress Index (PSI), Edinburgh Postnatal Depression Scale (EPDS) and a semi-structured questionnaire related to mental health problems and support received from health professionals.

Perinatal outcomes with laser surgery for twin-twin transfusion syndrome.

The aim of this tertiary hospital-based cohort study was to determine and compare perinatal outcome and neonatal morbidities of pregnancies with twin-twin transfusion syndrome (TTTS) before and after the introduction of a treatment program with laser ablation of placental communicating vessels. Twenty-seven pregnancies with Stage II-IV TTTS treated with amnioreduction were identified (amnioreduction group). The data were compared with that obtained from the first 31 pregnancies with Stage II-IV TTTS managed with laser ablation of placental communicating vessels (laser group).

Women's evaluations of their experience in a multicenter randomized controlled trial of intrapartum fetal pulse oximetry (The FOREMOST Trial).

Background: Fetal pulse oximetry improves the assessment of fetal well-being during labor. The objective of this study was to evaluate women's satisfaction with their experience with this additional technology.

Methods: We surveyed women participating in the FOREMOST trial, a randomized controlled trial comparing the addition of fetal pulse oximetry (FPO) to conventional cardiotocograph (CTG) monitoring (intervention group), versus CTG-only (control group), in the presence of nonreassuring fetal status during labor.

Clinicians' evaluations of fetal oximetry sensor placement in a multicentre randomised trial (the FOREMOST trial).

Background: Fetal pulse oximetry (FPO) may improve the assessment of the fetal well-being in labour. Reports of health-care provider's evaluations of new technology are important in the overall evaluation of that technology.

Aims: To determine doctors' and midwives' perceptions of their experience placing FPO sensors.

The effect of intrapartum fetal pulse oximetry, in the presence of a nonreassuring fetal heart rate pattern, on operative delivery rates: a multicenter, randomized, controlled trial (the FOREMOST trial).

Objective: The objective of the study was to compare operative delivery rates for nonreassuring fetal status between 2 groups of laboring women: those having conventional cardiotocograph monitoring and those having cardiotocograph monitoring plus fetal pulse oximetry.

Study Design: The intrapartum fetal oximetry prospective, multicenter, randomized, controlled trial (the FOREMOST trial) was conducted in 4 Australian maternity hospitals. The primary outcome was operative birth rates for nonreassuring fetal status.

Use of umbilical artery Doppler velocimetry in the monitoring of pregnancy in women with pre-existing diabetes.

Background: The usefulness of umbilical artery Doppler velocimetry for the monitoring of diabetic pregnancies is controversial. The aim of the present study was to assess whether umbilical artery Doppler velocity waveform analysis can predict adverse perinatal outcomes for pregnancies complicated by pre-existing diabetes mellitus.

Methods: All diabetic pregnancies (type 1 and 2) delivered at Mater Mothers' Hospital, Queensland, between 1 January 1995 and 31 December 1999 were included.

Stage-based treatment of twin-twin transfusion syndrome.

Objective: The purpose of this study was to compare the outcomes of patients with twin-twin transfusion syndrome who were treated with either serial amniocentesis or selective laser photocoagulation of communicating vessels according to disease severity (stage).

Study Design: Centers that were experienced in the treatment of twin-twin transfusion syndrome were invited to share stage-based perinatal outcome data. All patients met basic standard sonographic criteria for twin-twin transfusion syndrome (polyhydramnios maximum vertical pocket, > or =8 cm; oligohydramnios maximum vertical pocket, < or =2 cm).

Human parvovirus B19 infection in pregnancy: should screening be offered to the low-risk population?

Human parvovirus B19 infection during pregnancy can result in fetal hydrops and death. Intra-uterine transfusion in hydropic fetuses affected by the virus can reduce perinatal deaths. Up to 33% of women with this infection are asymptomatic.

Fetal growth spurt and pregestational diabetic pregnancy.

Objective: To assess the timing of fetal growth spurt among pre-existing diabetic pregnancies (types 1 and 2) and its relationship with diabetic control. To correlate fetal growth acceleration with factors that might influence fetal growth.

Research Design And Methods: This retrospective study involved all pregestational diabetic pregnancies delivered at a tertiary obstetric hospital in Australia between 1 January 1994 and 31 December 1999.

Limb constriction as a complication of intra-uterine vesico-amniotic shunt: fetoscopic release.

Complete fetal bladder outlet obstruction was first diagnosed in a fetus at 13.5 weeks. After sequential vesicocentesis had shown good renal function, a vesico-amniotic shunt was inserted at 17 weeks with a Rodeck catheter.

The fetal tele-ultrasound project in Queensland.

The need for access to tertiary centre experts for those living in rural and remote areas of Queensland is well recognised. With an estimated population of 3.3 million people of whom 55% live outside the capital city, Queensland is ideally suited to telemedicine, as it provides a potential opportunity to improve access to specialist care.