Selective termination: a life-saving procedure for complicated monochorionic gestations.

Monochorionic twin pregnancies are a subset of twin pregnancies that face potential complications related to a shared circulation between the fetuses. These complications are related to anastomotic placental vessels connecting the cardiovascular systems of the two fetuses, which can result in significant sequela if one twin experiences intrauterine death. The sudden cardiovascular collapse in this scenario leads to a massive blood shift away from the healthy co-twin, significantly jeopardizing its life and long-term neurodevelopmental outcome.

Fetoscopic laser photocoagulation: a medically reasonable treatment option in the management of types II and III vasa previa.

Vasa previa is a condition where unprotected fetal vessels cross the cervix within the membranes, posing a considerable risk of fetal death or severe morbidity if the membranes rupture before or during delivery. There has not been a definitive treatment for this condition. Patients are typically closely monitored and hospitalized in the early third trimester and scheduled for cesarean delivery before term.

Intrauterine Transfusion Complicated by Umbilical Artery Thrombosis.

Background: Fetal anemia results from several conditions; however intrauterine transfusion (IUT) remains the treatment for severe cases. The complications of this procedure are rare and yet can result in preterm delivery or fetal death.

Case: 31 y/o G3P2002 with Rh alloimmunization underwent IUT from 19 to 35 weeks.

Fetal cardiovascular hemodynamics in twin-twin transfusion syndrome.

Twin-twin transfusion syndrome (TTTS) complicates 10-15% of monochorionic-diamniotic (MCDA) pregnancies. It originates from unbalanced transfer of fluid and vasoactive mediators from one twin to its co-twin via placental anastomoses. This results in hypovolemia in the donor and hypervolemia and vasoconstriction in the recipient twin.

Cryopreserved human umbilical cord patch for in-utero spina bifida repair.

Objective: To identify a patch system to repair surgically created spina bifida in a sheep model for its efficacy in healing the skin defect, protecting the underlying spinal cord and reducing the Chiari II malformation.

Methods: Spina bifida was created surgically in 16 fetuses from eight timed-pregnant sheep at gestational age of 75 days. Two fetuses did not survive the procedure.

Does anemia-polycythemia complicating twin-twin transfusion syndrome affect outcome after fetoscopic laser surgery?

Objective: Twin anemia-polycythemia sequence (TAPS) can occur as a unique disease or as a complication of twin-twin transfusion syndrome (TTTS). Middle cerebral artery (MCA) Doppler studies are not currently part of the routine evaluation of monochorionic twins since they are not used in the Quintero staging system. As such, the true incidence of TAPS is unknown.

Monocyte and lymphocyte activation in bipolar disorder: a new piece in the puzzle of immune dysfunction in mood disorders.

Background: This study tested the hypothesis that the low-grade inflammation presented in patients with bipolar disorder (BD) is associated with expansion of activated T cells, and this activated state may be due to a lack of peripheral regulatory cells.

Methods: Specifically, we investigated the distribution of monocytes and lymphocyte subsets, and investigated Th1/Th2/Th17 cytokines in plasma by flow cytometry. Twenty-one BD type I patients and 21 age- and sex-matched controls were recruited for this study.

Surveillance of monochorionic twins.

Until recently, all twin pregnancies were treated in a similar fashion. Ultrasounds were undertaken every 3 to 4 weeks to assess serial fetal growth. Monochorionic (MC) twins comprise only 20% of all twin pregnancies yet unique complications such as twin-twin transfusion syndrome (TTTS), twin reversed arterial perfusion sequence, twin anemia-polycythemia sequence, and selective intrauterine growth restriction can occur.

The problem of preterm delivery after laser surgery.

Preterm birth after fetoscopic laser surgery for twin-twin transfusion continues to be a major challenge despite improved survival rates. The risk factors for the complications have been identified, which include preterm premature rupture of membranes, cervical length shortening, larger cannula diameter, amnioinfusion, complicated procedure, and severe disease. The interventions to prevent preterm birth such as cervical cerclage for short cervix and collagen plug placement have not been successful.

Tracheal occlusion for fetal diaphragmatic hernia.

Despite advances in neonatal care, diaphragmatic hernia still inflicts significant morbidity and mortality on affected neonates. Abnormal embryologic events disrupt the formation of the diaphragm allowing the abdominal viscera to occupy the intrathoracic space. This interrupts normal pulmonary development with resulting pulmonary hypoplasia and pulmonary hypertension in neonatal survivors.

Outcome of fetoscopic laser ablation for twin-to-twin transfusion syndrome in dichorionic-triamniotic triplets compared with monochorionic-diamniotic twins.

Objective: To compare outcome of dichorionic-triamniotic (DCTA) triplet gestations with that of a paired cohort of monochorionic-diamniotic (MCDA) twin gestations undergoing laser therapy for treatment of twin-to-twin transfusion syndrome (TTTS).

Methods: All DCTA triplets treated at four referral centers between specified dates were included. A matched cohort group of MCDA twin gestations affected by TTTS was used for comparison.

A preliminary report of increased plasma levels of IL-33 in bipolar disorder: further evidence of pro-inflammatory status.

Background: Recent findings suggest an important role for inflammation in the neurobiology of bipolar disorder (BD). Interleukin 33 (IL-33) is a cytokine with multiple functions and may act as a nuclear factor regulating transcription and as an "alarmin". IL-33 exerts part of its function through the receptor ST2 that also exists in a soluble form (sST2).

The history of fetal therapy.

The Fetal Treatment Center founded by Michael Harrison is credited as the birthplace of fetal surgery. His trainees in pediatric surgery subsequently founded fetal centers throughout the United States. In Europe, the advent of minimally invasive fetal surgical techniques led to the establishment of treatment centers led predominantly by perinatologists.

Toward consistent terminology: assessment and reporting of amniotic fluid volume.

Amniotic fluid is typically measured by ultrasound using the amniotic fluid index (AFI) or the maximum vertical pocket (MVP). Although both parameters correlate poorly with the actual amniotic fluid volume measured with dye-dilution methods, cross-sectional studies have been used to establish gestational norms. The current acceptable definition of polyhydramnios in the late second and the third trimester in both singleton and multiple gestations is a MVP > 8 cm, while the definition of oligohydramnios is a MVP < 2 cm.