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First-trimester screening for trisomies 21 and 18 on the basis of maternal age, maternal levels of free beta human chorionic gonadotropin and pregnancy-associated plasma protein A, and measurement of fetal nuchal translucency has good sensitivity at an acceptable false positive rate.

The quality of evidence in the document was rated using the criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1). Summary Statement In Canada multivitamin tablets with folic acid are usually available in 3 formats: regular over-the-counter multivitamins with 0.4 to 0.6 mg folic acid, prenatal over-the-counter multivitamins with 1.0 mg folic acid, and prescription multivitamins with 5.0 mg folic acid. (III) Recommendations 1. Women should be advised to maintain a healthy folate-rich diet; however, folic acid/multivitamin supplementation is needed to achieve the red blood cell folate levels associated with maximal protection against neural tube defect. (III-A) 2. All women in the reproductive age group (12-45 years of age) who have preserved fertility (a pregnancy is possible) should be advised about the benefits of folic acid in a multivitamin supplementation during medical wellness visits (birth control renewal, Pap testing, yearly gynaecological examination) whether or not a pregnancy is contemplated. Because so many pregnancies are unplanned, this applies to all women who may become pregnant. (III-A) 3. Folic acid supplementation is unlikely to mask vitamin B12 deficiency (pernicious anemia). Investigations (examination or laboratory) are not required prior to initiating folic acid supplementation for women with a risk for primary or recurrent neural tube or other folic acid-sensitive congenital anomalies who are considering a pregnancy. It is recommended that folic acid be taken in a multivitamin including 2.6 ug/day of vitamin B12 to mitigate even theoretical concerns. (II-2A) 4. Women at HIGH RISK, for whom a folic acid dose greater than 1 mg is indicated, taking a multivitamin tablet containing folic acid, should be advised to follow the product label and not to take more than 1 daily dose of the multivitamin supplement. Additional tablets containing only folic acid should be taken to achieve the desired dose. (II-2A) 5. Women with a LOW RISK for a neural tube defect or other folic acid-sensitive congenital anomaly and a male partner with low risk require a diet of folate-rich foods and a daily oral multivitamin supplement containing 0.4 mg folic acid for at least 2 to 3 months before conception, throughout the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues. (II-2A) 6. Women with a MODERATE RISK for a neural tube defect or other folic acid-sensitive congenital anomaly or a male partner with moderate risk require a diet of folate-rich foods and daily oral supplementation with a multivitamin containing 1.0 mg folic acid, beginning at least 3 months before conception. Women should continue this regime until 12 weeks' gestational age. (1-A) From 12 weeks' gestational age, continuing through the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues, continued daily supplementation should consist of a multivitamin with 0.4 to 1.0 mg folic acid. (II-2A) 7. Women with an increased or HIGH RISK for a neural tu...

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Objective To assess the clinical effectiveness of endoscopic laser coagulation of placental vessels in the Design Prospective study.Setting Three referral centres for the management of twin-to-twin transfusion syndrome.Population One hundred and thirty-two pregnancies complicated by severe twin-to-twin transfusion syndrome, reflected by polyhydramnios and enlarged bladder of one twin and oligoanhydramnios and collapsed bladder of the other twin, presenting before 28 weeks of gestation.Methods Prospective collection of data on pre-procedure assessment, the procedure and the follow up were collected prospectively. Laser coagulation of placental vessels crossing the intertwin membrane on the chorionic surface under sono-endoscopic guidance, followed by amniodrainage. Main outcome measuresMaternal and pregnancy complications, perinatal death and morbidity were assessed over the last five years with follow up of survivors.Results Endoscopic laser was carried out at a median gestation of 21 weeks. The total number of surviving infants was 144 (55%) and there was at least one survivor in 97 cases (73%). At a minimum age of one year neurological handicap was suspected in six survivors (4.2%). ConclusionsThe results of this multicentre study are similar to those in our original report on the first 45 cases. In comparison with serial amniodrainage, the survival rate may be similar, but the handicap rate in survivors appears much lower. This study stresses the need for a prospective study comparing treatment of severe transfusion syndrome.threse two techniques. INTRODUCTIONMonochorionic twin pregnancies presenting during the second trimester with severe twin-to-twin transfusion syndrome is associated with a high risk of miscarriage, perinatal death and subsequent handicap in Although survival can be improved by serial amniodrainage, there remains a risk of serious handicap in 15% to 50% of survivors"8. A more recent development in the management of this condition is fetoscopy and laser coagulation to interrupt the placental vascular communications between the twins which may constitute the underlying mechanism of the syndrome9J O. Preliminary data have suggested that survival of at least one twin can be achieved in about 70% of pregnancies, and this improved survival may be associated with a substantially reduced risk of handicap (about 5%)". We report the results of a multicentre study on endoscopic laser coagulation reports in the management of 132 pregnancies with severe twin-to-twin transfusion syndrome including at least one year follow up. METHODSSono-endoscopic laser coagulation was carried out in 132 pregnancies complicated by severe twin-to-twin transfusion syndrome with severe polyhydramnios during the second trimester of pregnancy, between 1992 and 1996. The women were managed in one of three centres by members of the original team who developed this technique". The subsequent obstetric care was undertaken in the referring hospital. In all cases, ultrasound examination demonstrated the characteristic features of...

Objective To assess the clinical effectiveness of endoscopic laser coagulation of placental vessels in the Design Prospective study. Setting Three referral centres for the management of twin-to-twin transfusion syndrome. Population One hundred and thirty-two pregnancies complicated by severe twin-to-twin transfusion syndrome, reflected by polyhydramnios and enlarged bladder of one twin and oligoanhydramnios and collapsed bladder of the other twin, presenting before 28 weeks of gestation. Methods Prospective collection of data on pre-procedure assessment, the procedure and the follow up were collected prospectively. Laser coagulation of placental vessels crossing the intertwin membrane on the chorionic surface under sono-endoscopic guidance, followed by amniodrainage. Main outcome measures Maternal and pregnancy complications, perinatal death and morbidity were assessed over the last five years with follow up of survivors. Results Endoscopic laser was carried out at a median gestation of 21 weeks. The total number of surviving infants was 144 (55%) and there was at least one survivor in 97 cases (73%). At a minimum age of one year neurological handicap was suspected in six survivors (4.2%). Conclusions The results of this multicentre study are similar to those in our original report on the first 45 cases. In comparison with serial amniodrainage, the survival rate may be similar, but the handicap rate in survivors appears much lower. This study stresses the need for a prospective study comparing treatment of severe transfusion syndrome. threse two techniques. Ultrasound probe Fig. 1. Diagram of the spatial organisation for endoscopic laser coagulation. 0 RCOG 1998 Br J Obstet Gynaecol 105, 446-453