Developmental outcomes for survivors of placental laser photocoagulation for the management of twin-to-twin transfusion syndrome.

Background: Fetoscopic laser coagulation of placental anastomoses reverses the pathological process in twin-to-twin transfusion syndrome, thereby increasing survival, but there are a paucity of studies addressing long-term neurodevelopmental outcome of survivors. This study aimed to ascertain the presence of neurodevelopmental disabilities in child survivors of monochorionic pregnancies managed by placental laser photocoagulation in the Australian state of Victoria.

Methods: All pregnancies undergoing placental laser photocoagulation with the Victorian Fetal Therapy Service between 2006-2017 were included.

Influence of foetal position on the degree of isolated antenatal hydronephrosis.

Backgrounds: The effect of foetal position on the degree of antenatal hydronephrosis (ANH) is unknown. We hypothesized that foetal position is an important contextual factor in ANH, with consequences on prenatal counselling and postnatal management. The current study aimed to investigate the effect of foetal position on the degree of ANH.

Subjective and Objective Sonographic Assessment for the Prenatal Detection of Neonatal Coarctation of the Aorta.

Introduction: The objective of this study was to assess the performance of antenatal ultrasound markers in detecting neonatal coarctation of the aorta (CoA).

Methods: We performed a retrospective study including fetuses with suspected CoA and no other cardiac abnormalities. Data obtained from antenatal ultrasounds included subjective assessment of ventricular and arterial asymmetry, appearance of aortic arch, presence of a persistent left superior vena cava, and objective Z-score measurements of the mitral, tricuspid, aortic (AV), and pulmonary (PV) valves.

Induction of left ventricular hypoplasia by occluding the foramen ovale in the fetal lamb.

Disturbed fetal haemodynamics often affects cardiac development and leads to congenital cardiac defects. Reduced left ventricular (LV) preload in the fetus may result in hypoplastic LV, mitral and aortic valve, mimicking a moderate form of hypoplastic left heart complex. We aimed to induce LV hypoplasia by occluding the foramen ovale (FO) to reduce LV preload in the fetal sheep heart, using percutaneous trans-hepatic catheterisation.

Mirroring preeclampsia: the molecular basis of Ballantyne syndrome.

The purpose of this article was to further elucidate the pathophysiology of Mirror (Ballantyne) syndrome within the context of known biomarkers for preeclampsia. This novel insight from clinical practice involved a case of post-twin-to-twin transfusion syndrome-laser hydrops in an ex-donor twin, corroborated by histopathologic placental territory edema and maternal sequelae of Mirror syndrome. We serially measured the levels of activin A, follistatin, endothelin-1 (ET-1), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), soluble fms-like tyrosine kinase 1 (sFlt), and von Willebrand factor (vWF) in the maternal serum from disease evolution through to recovery.

How to perform a sonographic morphological assessment of the fetus at 11-14 weeks of gestation.

Introduction: First-trimester ultrasound is widely accepted as part of standard care in many countries. With improvements in equipment, expertise and increasing number of technical studies describing imaging techniques, the detection rate for major fetal anomalies in the first trimester continues to rise and can be as high as 60% in high-risk populations.

Methods: We set out to create a systematic pictorial guide for trained ultrasound providers to describe the common anatomical structures that are identifiable in the first trimester with provided images.

Twin-to-twin transfusion syndrome neurodevelopmental follow-up study (neurodevelopmental outcomes for children whose twin-to-twin transfusion syndrome was treated with placental laser photocoagulation).

Background: Twin-to-twin transfusion syndrome (TTTS) is a serious complication of 10-15% of twin or triplet pregnancies in which multiple fetuses share a single placenta. Communicating placental vessels allow one fetus (the donor) to pump blood to the other (the recipient). Mortality rates without intervention are high, approaching 100% in some series, with fetal deaths usually due to cardiac failure.

Biparietal diameter measurements using the outer-to-outer versus outer-to-inner measurement: A question of pedantry?

Objectives: To compare two methods of measuring fetal biparietal diameter (BPD) - outer-to-inner (BPDoi) vs. outer-to-outer (BPDoo) calliper placement - and to compare the differences in EFW calculated using the Hadlock 4 formula and other common EFW formulae.

Methods: A total of 543 fetuses underwent a single ultrasound prospectively performed by 40 sonographers between 14 and 40 weeks of gestation, taking into account the intra- and inter-observer variability.

Fetal brain injury in complicated monochorionic pregnancies: diagnostic yield of prenatal MRI following surveillance ultrasound and influence on prognostic counselling.

Objective: This study aimed to determine the additional diagnostic information provided by prenatal (fetal) magnetic resonance imaging (pMRI) following tertiary ultrasound (US) for fetal cranial abnormalities in complicated monochorionic gestations.

Methods: Women with complicated monochorionic gestations complicated by twin-twin transfusion syndrome, co-twin demise (CD), selective intrauterine growth restriction, and/or twin anaemia-polycythaemia sequence who were referred for pMRI after tertiary US were included. Additional diagnostic information by pMRI that changed prognostic counselling was the primary outcome.

Optimal Interval between Ultrasound Scans for the Detection of Complications in Monochorionic Twins.

Introduction: Monochorionic-diamniotic (MCDA) twin pregnancies are high risk, due to twin-to-twin transfusion syndrome (TTTS), twin anaemia polycythaemia sequence (TAPS) and intrauterine growth restriction (IUGR). There is limited evidence to guide ultrasound surveillance protocols. Using a retrospective cohort, we aimed to provide insight into the optimal interval of ultrasound surveillance.

Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?

The benefits of fetoscopic laser photocoagulation (FLP) for treatment of twin-to-twin transfusion syndrome (TTTS) have been recognized for over a decade, yet access to FLP remains limited in many settings. This means at a population level, the potential benefits of FLP for TTTS are far from being fully realized. In part, this is because there are many centers where the case volume is relatively low.

Early clinical experience of cell-free DNA-based aneuploidy screening: A survey of obstetric sonologists in Australia and New Zealand.

Background: Cell-free DNA-based non-invasive prenatal testing for aneuploidy (NIPT) is now established as the most accurate screening test for trisomy 21. This test became clinically available on a patient-funded basis in Australia and New Zealand in 2013.

Aim: To investigate the clinical implementation of NIPT use by members of the Australian Association of Obstetrical and Gynaecological Ultrasonologists (AAOGU) during its first year of local availability.

Isolated ventriculomegaly on prenatal ultrasound: what does fetal MRI add?

Introduction: Cerebral ventriculomegaly is one of the most commonly detected fetal anomalies at the midtrimester ultrasound. Current evidence suggests that magnetic resonance imaging (MRI) is indicated when the isolated ventriculomegaly (IVM) on ultrasound is severe (>15 mm), but there is less agreement when IVM is mild or moderate (10-15 mm). The current study aimed to determine the frequency and nature of additional findings on MRI in IVM and their relationship to the severity of VM and gestational age.

Percutaneous fetal cardiac catheterization technique for stenting the foramen ovale in a midgestation lamb model.

Background: Intact or highly restricted intra-atrial septum can be reliably diagnosed in the human fetus as early as 22 to 24 weeks of gestation. Fetal interventions targeting the atrial septum have used a direct approach through the atrial wall. Here, we report stenting of the foramen ovale with a large, open-cell stent via percutaneous access through the fetal hepatic vein in a sheep model.

A percutaneous fetal cardiac catheterization technique for pulmonary valvuloplasty and valvulotomy in a mid-gestation lamb model.

Objective: We aimed to assess the feasibility of using a percutaneous transhepatic cardiac catheterization technique to perform fetal pulmonary valvuloplasty and valvulotomy under ultrasound guidance at mid-gestation.

Method: In 13 mid-gestation fetal lambs without cardiac pathology, percutaneous transhepatic cardiac catheterization was used to position a coronary angioplasty catheter within the pulmonary valve. The balloon was inflated/deflated several times, simulating pulmonary valvuloplasty.

'A problem shared is a problem halved': success of a statewide collaborative approach to fetal therapy. Outcomes of fetoscopic laser photocoagulation for twin-twin transfusion syndrome in Victoria.

Aims: To evaluate the performance of a collaborative fetal therapy service for treatment for twin-twin transfusion syndrome (TTTS).

Methods: The Victorian Fetal Therapy Service (VFTS) was developed in 2006. It is a state-based three-centre collaborative service comprising a surgical team and clinical leadership group, designed to optimise access to, and performance of, fetoscopic procedures in Victoria.

Ovarian status in healthy postmenopausal women: follow-up 12 months after transvaginal ultrasound.

Objective: We have previously reported on the point prevalence of ovarian lesions detected by transvaginal ultrasound (TVU) in 515 asymptomatic women at least 5 years postmenopause. The aims of this study were to report, in the same women, on the repeatability of visualization of the ovaries (TVU) and the natural history of ovarian lesions seen at baseline but not treated surgically and to assess whether any women developed new ovarian abnormalities 12 months later.

Methods: The study involved a cohort of 515 postmenopausal women recruited from the community, at least 5 years past their last period.

Ovarian status in healthy postmenopausal women.

Objective: There are currently no programs to assess ovarian health in postmenopausal women. The aim of this study was to describe the ovaries in healthy women at least 5 years after menopause by questionnaire, transvaginal ultrasonography, and blood ovarian cancer markers.

Design: A total of 515 women who were asymptomatic and at the Stages of Reproductive Aging Workshop +2 stage of menopause (>5 y postmenopause) were recruited by advertisement.

Corpus luteum across the first trimester: size and laterality as observed by ultrasound.

Objective: To study the site and size of the corpus luteum (CL) across the first trimester of pregnancy.

Design: Retrospective observational study of 1,806 ultrasound scans performed at 5 to 9 (+6 d) weeks' gestation, as well as a prospective study (n = 313) performed at 10 to 13 (+6 d) weeks' gestation.

Setting: Four ultrasound practices across Victoria, Australia.

Ultrasound detection of the Essure permanent birth control device: a case series.

Background: The current recommendation to check the position of the Essure permanent birth control (PBC) micro-insert device after its insertion is by abdominal X-ray 3 months after insertion. We propose that ultrasound imaging is more suited for this purpose and gives reassurance much earlier. The sonographic appearance of the micro-inserts and the reliability of this modality in localising the devices is described in the present study.