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Objective To investigate whether gestational age at intervention (< or ≥ 16 weeks) and other factors affect the risk of loss of the cotwin after selective fetal reduction using radiofrequency ablation (RFA) in monochorionic (MC) pregnancy. Methods This was a single‐center retrospective analysis of 63 consecutive RFA procedures performed at our institution from January 2011 to October 2019 for selective fetal reduction in complicated MC pregnancies. Indications for RFA were twin reversed arterial perfusion sequence (13 cases), twin‐to‐twin transfusion syndrome (12 cases), twin anemia–polycythemia sequence (two cases), selective fetal growth restriction (10 cases), discordant anomalies (17 cases) and multifetal pregnancy reduction in triplets or quadruplets with a MC pair (nine cases). Twenty‐six (41.3%) of these procedures were performed before and 37 (58.7%) after 16 weeks. Potential factors that could affect the risk of loss of the cotwin, including gestational age at RFA, order of multiple pregnancy, amnionicity, indication for RFA and number of ablation cycles, were assessed first by univariate analysis and then by multivariate analysis. Results There were 17 (27.0%) cotwin losses. Ablation cycles numbering four or more was the only factor among those investigated to be associated with loss of the cotwin after RFA (P = 0.035; odds ratio, 5.21), while the indication for RFA, order of multiple pregnancy, amnionicity and gestational age at RFA had no effect. Comparing RFA performed at < 16 vs ≥ 16 weeks, there was no difference in the rate of cotwin loss (23.1% vs 29.7%; P = 0.558) or preterm prelabor rupture of the membranes before 34 weeks (7.7% vs 5.4%; P = 0.853), or in the median gestational age at delivery (36.2 vs 37.3 weeks; P = 0.706). Conclusions RFA is a promising tool for early selective fetal reduction in MC pregnancy before 16 weeks. Four or more ablation cycles is a major risk factor for cotwin loss. Careful assessment pre‐ and post‐RFA, together with proficient operative skills to minimize the number of ablation cycles, are the mainstay to ensure that this procedure is effective and safe. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

Background: Low-pass genome sequencing (GS) detects clinically significant copy number variants (CNVs) in prenatal diagnosis. However, detection at improved resolutions leads to an increase in the number of CNVs identified, increasing the difficulty of clinical interpretation and management.Methods: Trio-based low-pass GS was performed in 315 pregnancies undergoing invasive testing. Rare CNVs detected in the fetuses were investigated. The characteristics of rare CNVs were described and compared to curated CNVs in other studies.Results: A total of 603 rare CNVs, namely, 597 constitutional and 6 mosaic CNVs, were detected in 272 fetuses (272/315, 86.3%), providing 1.9 rare CNVs per fetus (603/315). Most CNVs were smaller than 1 Mb (562/603, 93.2%), while 1% (6/603) were mosaic. Forty-six de novo (7.6%, 46/603) CNVs were detected in 11.4% (36/315) of the cases. Eighty-four CNVs (74 fetuses, 23.5%) involved disease-causing genes of which the mode of inheritance was crucial for interpretation and assessment of recurrence risk. Overall, 31 pathogenic/likely pathogenic CNVs were detected, among which 25.8% (8/31) were small (&lt;100 kb; n = 3) or mosaic CNVs (n = 5).Conclusion: We examined the landscape of rare CNVs with parental inheritance assignment and demonstrated that they occur frequently in prenatal diagnosis. This information has clinical implications regarding genetic counseling and consideration for trio-based CNV analysis.

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The increase in luminosity, and consequent higher backgrounds, of the LHC upgrades require improved rejection of fake tracks in the forward region of the ATLAS Muon Spectrometer. The New Small Wheel upgrade of the Muon Spectrometer aims to reduce the large background of fake triggers from track segments that don't originate from the interaction point. The New Small Wheel employs two detector technologies, the resistive strip Micromegas detectors and the “small” Thin Gap Chambers, with a total of 2.45 million electrodes to be sensed. The two technologies require the design of a complex electronics system given that it consists of two different detector technologies and is required to provide both precision readout and a fast trigger. It will operate in a high background radiation region up to about 20 kHz/cm2 at the expected HL-LHC luminosity of ℒ = 7.5 × 1034 cm-2 s-1. The architecture of the system is strongly defined by the GBTx data aggregation ASIC, the newly-introduced FELIX data router and the software based data handler of the ATLAS detector. The electronics complex of this new detector was designed and developed in the last ten years and consists of multiple radiation tolerant Application Specific Integrated Circuits, multiple front-end boards, dense boards with FPGA's and purpose-built Trigger Processor boards within the ATCA standard. The New Small Wheel has been installed in 2021 and is undergoing integration within ATLAS for LHC Run 3. It should operate through the end of Run 4 (December 2032). In this manuscript, the overall design of the New Small Wheel electronics is presented.

much research needed to look at the whole antenatal and postnatal anemia management pathway but, in the meantime, reduce red cell transfusion because of the well-recognized risks and cost associated with this practice and consider increasing the use of postdelivery iron therapy.

Introduction Umbilical cord prolapse is a major obstetric emergency associated with significant perinatal complications. However, there is no consensus on the optimal decision‐to‐delivery interval, as many previous studies have shown poor correlation between the interval and umbilical cord arterial blood gas or perinatal outcomes. We aim to investigate whether bradycardia‐to‐delivery or decision‐to‐delivery interval was related to poor cord arterial pH or adverse perinatal outcome in umbilical cord prolapse. Material and methods This was a retrospective study conducted at a university tertiary obstetric unit in Hong Kong. All women with singleton pregnancy complicated by cord prolapse during labor between 1995 and 2018 were included. Women were categorized into three groups. Group 1: persistent bradycardia; Group 2: any type of decelerations without bradycardia; and Group 3: normal fetal heart rate. The main outcome was cord arterial blood gas results of the newborns in different groups. Maternal demographic data and perinatal outcomes were reviewed. Correlation analysis between cord arterial blood gas result and time intervals including bradycardia‐to‐delivery, deceleration‐to‐delivery, and decision‐to‐delivery were performed for the different groups with Spearman test. Results There were 34, 30, and 50 women in Groups 1, 2, and 3, respectively. Cord arterial pH and base excess did not correlate with decision‐to‐delivery interval in any of the groups, but they were inversely correlated with bradycardia‐to‐delivery interval in Group 1 (Spearman’s ρ = −.349; P = .043 and Spearman's ρ = −.558; P = .001, respectively). The cord arterial pH drops at 0.009 per minute with bradycardia‐to‐delivery interval in Group 1 (95% CI 0.0180‐0.0003). The risk of significant acidosis (pH < 7) was 80% when bradycardia‐to‐delivery interval was >20 minutes, and 17.2% when the interval was <20 minutes. Conclusions There is significant correlation between bradycardia‐to‐delivery interval and cord arterial pH in umbilical cord prolapse with fetal bradycardia but not in cases with decelerations or normal heart rate. The drop of cord arterial pH is rapid and urgent delivery is essential in such situations.