Objectives: Antenatal diagnosis of twin anemia-polycythemia sequence (TAPS) in monochorionic diamniotic (MCDA) twin pregnancies is based on elevated peak systolic velocity in the middle cerebral artery (MCA-PSV) in the donor twin and decreased MCA-PSV in the recipient twin. However, the association between these parameters and neonatal polycythemia has not been established. The aim of this study was to determine whether MCA-PSV can predict polycythemia in MCDA pregnancies. Methods: Prospective cohort study of 69 MCDA pregnancies, recruited at 14-16 weeks of gestation. Fetal MCA Doppler waveforms were recorded every 1-2 weeks from 14-16 weeks of gestation till delivery. Neonatal hematocrit level was determined in all twins. Polycythemia was defined as hematocrit ≥ 65%. Results: Thirteen (9.4%) neonates were diagnosed with polycythemia and 7 pregnancies (10.1%) met the criteria of TAPS. In pooled analysis, MCA-PSV was negatively correlated with neonatal hematocrit (p = 0.017; r = -.215) and was significantly higher among anemic fetuses compared to controls (1.14 MOM vs 1 MOM, p = 0.009). While MCA-PSV was similar among polycythemic and normal twins (0.95 MOM vs 1 MOM, p = 0.35), intertwin difference in MCA-PSV (Delta MCA-PSV) was positively correlated with intertwin hematocrit difference (p = 0.002; r = .394). Moreover, twin pregnancies with intertwin hematocrit discordance of more than 24% had significantly higher Delta MCA-PSV compared to twin pregnancies with intertwin hematocrit discordance of less than 24% (12 vs 5, p = 0.008). Conclusions: MCA-PSV is not significantly decreased among polycythemic monochorionic twins. However, Delta MCA-PSV is associated with large intertwin hemoglobin difference and may be superior to the conventional methods in the risk assessment of TAPS.
analgesia demand, first recognized bowel movement, nausea, length of hospital stay, fever, endometritis surgical site infection rate and total satisfaction. Sub-analysis was done in each group for the different techniques. RESULTS: 21(65.6%) and 48(76.2%) women matched the operation they were allocated in the first and recurrent cesarean section groups, respectively. Intraoperative nausea was found to be the only complication significantly higher in the recurrent cesarean section (n¼17 ,40.4%) compared to first cesarean section (n¼4 ,16.7%), in the uterine exteriorization group (p¼0.046) .This difference was not demonstrated comparing uterine exteriorization to intraperitoneal repair in the recurrent cesarean section group (p¼0.856). No other significant differences in either intraoperative or postoperative complications were demonstrated in and between the groups. CONCLUSION: Exteriorization of the uterus in recurrent cesarean section is associated with increased incidence of nausea. No other differences in operative and post operative complication rates were found between uterine exteriorization versus intraperitoneal repair comparing first to recurrent caesarean section.
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