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Longitudinal Twin Growth Discordance Patterns and Adverse Perinatal Outcomes.
Am J Obstet Gynecol
January 2025
Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Twin and Multiple Pregnancy Centre for Research and Clinical Excellence, St George's University Hospital, St George's University of London, London, UK; Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, United Kingdom. Electronic address:
Objective: The objective of this study was to conduct a longitudinal assessment of inter-twin growth and Doppler discordance, to identify possible distinct patterns, and to investigate the predictive value of longitudinal discordance patterns for adverse perinatal outcomes in twin pregnancies.
Methods: This retrospective cohort study included twin pregnancies followed and delivered at a tertiary University Hospital in London (UK), between 2010 and 2023. We included pregnancies with at least three ultrasound assessments after 18 weeks and delivery after 34 weeks' gestation.
Proximate cord insertion in monochorionic twins with selective fetal growth restriction.
Am J Obstet Gynecol MFM
January 2025
Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands (Spekman, Ros, van Klink, Groene, and Lopriore).
Background: Monochorionic (MC) twins share a single placenta which can be unequally shared, leading to selective fetal growth restriction (sFGR). Limited data is available on the prevalence and clinical consequences of proximate cord insertion (PCI) in sFGR pregnancies.
Objective: We aimed to investigate the prevalence of PCI in MC placentas with and without sFGR and per type of sFGR, and study the placental characteristics and perinatal outcome of PCI in sFGR pregnancies.
Resolution of selective fetal growth restriction after laser surgery for twin-to-twin transfusion syndrome can be predicted by predisease growth discordance.
Ultrasound Obstet Gynecol
January 2025
Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Objective: To determine if the resolution of fetal growth discordance after laser surgery in pregnancies with twin-to-twin transfusion syndrome (TTTS) and coexisting selective fetal growth restriction (sFGR) can be predicted by estimated fetal weight (EFW) discordance recorded prior to the development of TTTS (pre-TTTS).
Methods: This was a single-center, retrospective analysis of prospectively collected data on monochorionic twins with concurrent TTTS and sFGR that underwent laser surgery and had available growth ultrasound records from a pre-TTTS ultrasound evaluation. Maternal demographics, pregnancy characteristics and birth outcomes were compared between three outcome groups: double twin survival with resolved sFGR determined by birth weight discordance (BWD) < 20%; double twin survival with ongoing sFGR determined by BWD ≥ 20%; and single or double fetal demise after laser surgery.
Cord Occlusion in Twin Reversed Arterial Perfusion Sequence: A Retrospective Study of Laser Photocoagulation versus Radiofrequency Ablation.
Fetal Diagn Ther
November 2024
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.
Article Synopsis
- Twin reversed arterial perfusion (TRAP) sequence affects identical twins and can be managed with umbilical cord occlusion (UCO) to improve the survival of the healthier twin, known as the "pump twin."
- A study compared the effectiveness of two techniques used in UCO—laser photocoagulation and radiofrequency ablation (RFA)—on the outcomes of high-risk TRAP sequence cases.
- Results showed no significant difference in 30-day neonatal survival rates between the two treatment methods, with survival rates of approximately 91.9% for laser and 89.2% for RFA.
Twisting the theory on the origin of human umbilical cord coiling featuring monozygotic twins.
Life Sci Alliance
August 2024
Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
The human umbilical cord (hUC) is the lifeline that connects the fetus to the mother. Hypercoiling of the hUC is associated with pre- and perinatal morbidity and mortality. We investigated the origin of hUC hypercoiling using state-of-the-art imaging and omics approaches.
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