Objective
To determine the rate of and risk factors for fetal and neonatal brain lesions following laser ablation for twin‐to‐twin transfusion syndrome (TTTS).
Methods
A retrospective cohort study of 83 women with monochorionic twin pregnancies who underwent ablation for TTTS at a single tertiary hospital. Post‐laser survivors were followed‐up with fetal neurosonogram every 2 weeks and fetal brain MRI at 28–32 weeks of gestation; post‐natal brain imaging included neurosonogram. Cases with pre‐ and post‐natal brain lesions were compared to those without.
Results
153 fetuses survived the immediate post‐laser period and underwent brain imaging. Of these, 17 (11.11%) exhibited brain lesions on prenatal imaging studies, and 36 (32.4%) on post‐natal ultrasound. Later gestational age (GA) at the time of ablation (23.0 vs. 21.4 weeks, p = 0.0244), post‐laser twin‐anemia‐polycythemia‐sequence (TAPS) (29.41% vs. 9.56%, p = 0.035) and birthweight discordancy (30% vs. 9%, p = 0.0025) were associated with prenatal brain lesions. Earlier GA at delivery (31.0 weeks vs. 32.2, p = 0.0002) and post‐laser TAPS (25% vs. 9.33%, p = 0.038) were associated with post‐natal brain lesions.
Conclusions
Survivors of ablation for TTTS are at risk for brain lesions, which can be detected prenatally. Incorporation of neurosonogram and fetal brain MRI into the routine surveillance of such pregnancies should be considered.
Objectives
To determine the rate of fetal and neonatal brain lesions and define risk factors for such lesions in pregnancies complicated by Twin Anemia Polycythemia Sequence (TAPS).
Methods
A retrospective cohort study of monochorionic twin pregnancies which were diagnosed with TAPS in a single tertiary medical center between 2013 and 2021. Pregnancies were followed with fetal brain neurosonogram every 2 weeks and fetal brain MRI (magnetic resonance imaging) was performed when indicated at 28–32 weeks of gestation; post‐natal brain imaging included neonatal brain ultrasound. Pregnancies with pre‐ and post‐natal brain lesions were compared to those without such findings.
Results
Overall, 23 monochorionic diamniotic pregnancies were diagnosed with TAPS over the study period resulting in perinatal survival of 91.3% (42/46). In 6/23 (26%) pregnancies and 7/46 (15.2%) fetuses pre‐ or post‐natal brain lesions were detected, of whom five were the polycythemic twins and two were the anemic twins. Brain findings included intra‐cerebral hemorrhage and ischemic lesions and were diagnosed prenatally in 6/7 (85.7%) cases. No risk factors for severe brain lesions were identified.
Conclusions
TAPS may place the fetuses and neonates at increased risk for cerebral injuries. Incorporation of fetal brain imaging protocols may enhance precise prenatal diagnosis and allow for accurate parental counseling and post‐natal care.
Purpose: Our aim was to explore potential risk factors for Preterm birth (PTB) that had been associated with the patient's obstetric history and which had not been previously examined in depth.Methods: Retrospective analysis of all women who had their first, term, singleton delivery and their second delivery, between 2013 and 2020. Obstetrical and neonatal outcomes, including the rate of preterm birth in the following delivery, were compared among three different groups, based on complications occurring the first pregnancy: emergency end second stage cesarean, large for gestational age neonate and delivery which required a uterine and/or cervical revision. Results: There were 233 women of whom 77 underwent emergency end second stage cesarean delivery and 156 who underwent elective CD in their first delivery at term, with no difference in the rate of PTB between the two groups in the subsequent delivery (3.9% vs. 3.21%, p<0.72). There were 396 women with infants weighing more than 3.8kg and 5,136 women with infants weighing less than 3.8kg, in their first term delivery. These two groups did not differ in the rate of PTB in their subsequent delivery (1.52% vs. 2.94%, p<0.1). Finally, there were 298 women who underwent uterine and/or cervical revision who were compared to 5,234 women without these procedures, in their first term delivery. Again, there was no difference between these groups in the rate of PTB in the subsequent delivery (2.35% vs. 2.87%, p<0.72). Conclusion: Risk factors examined in our analysis did not emerge as risk factors for PTB.
Objectives: To determine the rate of fetal and neonatal brain lesions and define risk factors for such injury following laser ablation for Twin-twin transfusion syndrome (TTTS). Methods: A retrospective cohort study of 83 women with monochorionic twin pregnancies who underwent laser ablation for TTTS at a single tertiary medical centre. Immediate post-laser survivors were followed-up with fetal brain neurosonogram every 2 weeks and fetal brain MRI at 28-32 weeks of gestation; post-natal brain imaging included brain ultrasound. Cases with pre-and post-natal brain lesions were compared to those without. Results: Overall, 153 fetuses survived the immediate post-laser period and were available for brain imaging. Of these, 17 (11.11%) exhibited brain lesions on prenatal imaging studies, and 36(23.53%) demonstrated brain lesions on post-natal ultrasound. Comparison of fetuses with and without prenatal brain lesions revealed that gestational age (GA) at the time of laser ablation (23.0 weeks vs. 21.4 weeks, respectively, p = 0.0244), post-laser development of TAPS (29.41% vs. 9.56%, p = 0.035) and weight discordancy at birth (30% vs 9%, p = 0.0025) were associated with prenatal brain injury. The rate of prenatal brain injury was significantly higher when ablation was performed between 20-23 weeks compared to 16-19 weeks (17.07% vs. 2.08%, p = 0.031). Factors found to be associated with post-natal brain lesions included GA at delivery (31.0 weeks in those with lesions vs. 32.2 in those without,p = 0.0002) and post-laser TAPS (25% vs. 9.33%,p = 0.038). Conclusions: Survivors of laser ablation for TTTS are at risk for brain injury, which can be detected prenatally by ultrasound and/or MRI. Later GA at laser ablation and post-laser TAPS are associated with increased risk for prenatal brain injury. These findings highlight the importance of incorporation of neurosonogram and fetal brain MRI into routine surveillance of monochorionic twin pregnancies following laser ablation for TTTS. OC02.07 Relevant obstetric factors associated with twin pregnancies for cerebral palsy in Japan
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