We report two cases of transient single umbilical artery (UA) blood flow in growth-discordant monochorionic twins. The interval of single UA was for one week in case 1 and for a few days in case 2. We speculate a cord factor such as length, twisting, and insertion site can be the etiology of this condition.
Oral communication abstractswere compared to those not identified (group B). In group A antenatal surveillance included feto-maternal Doppler, amniotic fluid evaluation and computerized cardiotocography. Results: 772 SGA infants were included in the study: 133 in group A and 639 in group B. Mean gestational age at delivery was 38+6 weeks' gestation in group A and 39+3 in group B (P < 0.001). Induction of labour and Caesarean section were more frequent in group A than in group B (33% vs. 18% (P > 0.001) and 42% vs. 26% (P > 0.001) respectively. There were no intrauterine deaths in group A, and 2 in group B (P = 1). Mean birth weight and birth weight percentile were significantly lower in group A (2400 ± 349 g; 4 th percentile) than in group B (2639 ± 210 g; 7 th percentile; P < 0.001). Mean umbilical artery pH was not significantly different between the groups (7.25 ± 0.9 vs. 7.23 ± 0.1; P = 0.061). Admissions to NICU were 14% in group A and 3% in group B (P < 0.001). Respiratory distress, intraventricular hemorrhage, periventricular leukomalacia, necrotizing eneterocolitis and retinopathy of prematurity did not differ significantly between the two groups. On multivariate regression analysis, birth weight z-score and antenatal diagnosis of SGA, but not delivery mode, were significantly associated with pH at birth. Conclusions: Group A newborns were significantly smaller than those in group B. Nevertheless, the perinatal outcome was not significantly different. Moreover, a higher birth weight z-score and antenatal recognition were positively associated with higher umbilical artery pH. OC03.06Amnioinfusion and tocolysis before 26 weeks gestation for extremely severe fetal-growth restriction with oligohydramnios and long-term follow up Fetal-maternal Medicine, Fetal Therapy, Nagara-Medical Center, Gifu, JapanObjectives: Prognosis of severe FGR with severe oligohydramnios before 26 weeks gestation is still poor. But in some cases, amnioinfusion and tocolysis may effective to improve fetal environment. We report the new strategy with data of the long-term follow-up. Methods: When we diagnosed FGR (below − 1.5SD; Japanese standard) and oligohydramnios (Deepest vertical pool < 2 cm) with deceleration by USG and/or Doppler's abnormalities (UA, DV, IVC-PLI, UV pulsation) before 26 weeks gestation, we performed tocolysis and amnioinfusion. Cases with multiple anomalies were excluded. Criteria for delivery are used usual obstetrical indications. Experts of pediatrics performed long-term follow up of survival infant. Results: Twelve cases were indicated. Diagnosis and started intervention were performed at 22.6 ± 2.3 weeks gestation (WG). Median birth weight was 625 g (156-1600 g), mean Z score was − 4.0SD at birth, and mean WG at delivery was 28.7 ± 3.5. Median extended pregnant period was 5.0 (0-12) weeks. Overall effective rate (extended period over for 4 weeks) was 9/12 (75%), survival rate was 50% (6/12) included 5 fetal deaths. In 3 cases, progression of oligohydramnios improved. Growth were detected in 4/10 (40%). 3/3...
Fetal lung maturity assessment in twin pregnancy has been discussed, but is still controversial. The purpose of this study is to predict the occurrence of respiratory distress syndrome (RDS) using lamellar body count (LBC) and analyze the validity of LBC for fetal lung maturity assessment in twin pregnancy. Three-hundred two amniotic fluid samples were obtained at cesarean section from 29 to 38 weeks of gestation. Samples were analyzed immediately with no centrifugation and the number of lamellar bodies was counted using a platelet channel on the Sysmex SF-3000. There were 18 neonates (6.0%) suffering from RDS. An LBC cut-off value of 2.95 × 10 4 /μL resulted in 91.5% sensitivity and 83.3% specificity for predicting RDS. This cut-off value for predicting RDS was the same as that in singleton pregnancy. Moreover, the median LBC value in RDS cases was significantly lower than in non-RDS cases (1.50 ± 1.1 × 10 4 /μL vs. 10.6 ± 7.5 × 10 4 /μL; p < .001). This is the first report on the validity of LBC in twin pregnancy and also the largest study on fetal lung maturity assessment in twin pregnancy. An LBC value of >2.95 × 10 4 /μL means reassuring findings for RDS even in twin pregnancy. We believe the data in this study provide valuable, new information for the management of twin pregnancies.
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