769 results match your criteria Imaging in Twin-to-Twin Transfusion Syndrome


Bronchopulmonary Sequestration with Fetal Hydrops in a Monochorionic Twin Successfully Treated with Multiple Courses of Betamethasone.

AJP Rep 2018 Oct 3;8(4):e359-e361. Epub 2018 Dec 3.

Department of Gynaecology and Obstetrics, Third Faculty of Medicine, Charles University, Prague, Czech Republic.

 We present a case of severe bronchopulmonary sequestration (BPS) and fetal hydrops in one of the monochorionic twin successfully treated with multiple courses of betamethasone.  A 21-year-old gravida 2 para 1 was referred to our hospital for suspected twin-to-twin transfusion syndrome (TTTS) at 28 weeks of gestational age. However, prenatal ultrasound of the larger twin revealed a chest lesion that was associated with significant ascites, massive hydrothorax, scant hepatomegaly, subcutaneous edema, and severe polyhydramnios. Read More

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http://dx.doi.org/10.1055/s-0038-1676339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277237PMC
October 2018
1 Read

Deep-learned placental vessel segmentation for intraoperative video enhancement in fetoscopic surgery.

Int J Comput Assist Radiol Surg 2019 Feb 27;14(2):227-235. Epub 2018 Nov 27.

Yale University School of Medicine, New Haven, USA.

Introduction: Twin-to-twin transfusion syndrome (TTTS) is a potentially lethal condition that affects pregnancies in which twins share a single placenta. The definitive treatment for TTTS is fetoscopic laser photocoagulation, a procedure in which placental blood vessels are selectively cauterized. Challenges in this procedure include difficulty in quickly identifying placental blood vessels due to the many artifacts in the endoscopic video that the surgeon uses for navigation. Read More

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http://link.springer.com/10.1007/s11548-018-1886-4
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http://dx.doi.org/10.1007/s11548-018-1886-4DOI Listing
February 2019
3 Reads

Fetal stroke and cerebrovascular disease: Advances in understanding from lenticulostriate and venous imaging, alloimmune thrombocytopaenia and monochorionic twins.

Eur J Paediatr Neurol 2018 Nov 11;22(6):989-1005. Epub 2018 Sep 11.

Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom; Clinical and Experimental Sciences, University of Southampton, United Kingdom.

Fetal stroke is an important cause of cerebral palsy but is difficult to diagnose unless imaging is undertaken in pregnancies at risk because of known maternal or fetal disorders. Fetal ultrasound or magnetic resonance imaging may show haemorrhage or ischaemic lesions including multicystic encephalomalacia and focal porencephaly. Serial imaging has shown the development of malformations including schizencephaly and polymicrogyra after ischaemic and haemorrhagic stroke. Read More

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http://dx.doi.org/10.1016/j.ejpn.2018.08.008DOI Listing
November 2018
12 Reads

Prognosis of the co-twin following spontaneous single intrauterine fetal death in twin pregnancies: a systematic review and meta-analysis.

BJOG 2018 Nov 20. Epub 2018 Nov 20.

Centre for Women's and Children Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.

Background: Single intrauterine fetal death affects approximately 6% of twin pregnancies and can have serious sequelae for the surviving co-twin.

Objectives: Determine the prognosis of the surviving co-twin following spontaneous single intrauterine fetal death to aid counselling patients and highlight future research areas.

Search Strategy: Medline, Embase, Web of Science, and Cochrane Library, from 1980 to June 2017. Read More

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http://dx.doi.org/10.1111/1471-0528.15530DOI Listing
November 2018
5 Reads

Segmentation and classification in MRI and US fetal imaging: Recent trends and future prospects.

Med Image Anal 2019 Jan 19;51:61-88. Epub 2018 Oct 19.

BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain; ICREA, Barcelona, Spain.

Fetal imaging is a burgeoning topic. New advancements in both magnetic resonance imaging and (3D) ultrasound currently allow doctors to diagnose fetal structural abnormalities such as those involved in twin-to-twin transfusion syndrome, gestational diabetes mellitus, pulmonary sequestration and hypoplasia, congenital heart disease, diaphragmatic hernia, ventriculomegaly, etc. Considering the continued breakthroughs in utero image analysis and (3D) reconstruction models, it is now possible to gain more insight into the ongoing development of the fetus. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S13618415183084
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http://dx.doi.org/10.1016/j.media.2018.10.003DOI Listing
January 2019
10 Reads

Measurement of cardiac function by cardiac time intervals, applicability in normal pregnancy and twin-to-twin transfusion syndrome.

J Echocardiogr 2018 Oct 20. Epub 2018 Oct 20.

Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, B3-089, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.

Background: To detect early cardiac deterioration, a simple and stable tool is needed. Measurement of time intervals in a simple 4-chamber view using color-coded tissue Doppler imaging is a relatively new approach to assess fetal cardiac function. The aim of this study was to evaluate the applicability of this modality and to construct reference ranges for cardiac time intervals. Read More

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http://link.springer.com/10.1007/s12574-018-0401-9
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http://dx.doi.org/10.1007/s12574-018-0401-9DOI Listing
October 2018
6 Reads

Twin Reversed Arterial Perfusion Sequence: Assessing the Role of the Correct Imaging Modality in a Rare Clinical Entity.

Cureus 2018 Jul 2;10(7):e2910. Epub 2018 Jul 2.

Department of Pathology, Aga Khan University Hospital, Karachi, PAK.

Acardiac twin formation is a rare anomaly. It is one of the most extreme complications of monozygotic twin pregnancies. Such occurrences are brought about when a normal twin donates blood to an abnormal twin through its umbilical arteries via vascular anastomoses at the level of the placenta, which is termed as twin reversed arterial perfusion sequence (TRAPS). Read More

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http://dx.doi.org/10.7759/cureus.2910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122656PMC
July 2018
10 Reads

Monochorionic-diamniotic twin pregnancy complicated by twin reversed arterial perfusion sequence and retroplacental hematoma - a case report.

Med Ultrason 2018 Aug;20(3):396-398

2nd Obstetrics and Gynecology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.

Twin reversed arterial perfusion (TRAP) sequence is a rare and severe complication specific to monochorionic twin pregnancies, involving the presence of an acardiac twin and a structurally normal co-twin (pump twin). We report on the case of a33-year-old female with a biamniotic monochorionic twin pregnancy complicated with TRAP sequence and polyhydramnios. The patient underwent fetoscopic termination of the acardiac twin and at 34 gestational weeks (GW) was readmitted with aretroplacental hematoma. Read More

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http://dx.doi.org/10.11152/mu-1486DOI Listing
August 2018
2 Reads

A mixed-reality surgical trainer with comprehensive sensing for fetal laser minimally invasive surgery.

Int J Comput Assist Radiol Surg 2018 Dec 27;13(12):1949-1957. Epub 2018 Jul 27.

Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.

Purpose: Smaller incisions and reduced surgical trauma made minimally invasive surgery (MIS) grow in popularity even though long training is required to master the instrument manipulation constraints. While numerous training systems have been developed in the past, very few of them tackled fetal surgery and more specifically the treatment of twin-twin transfusion syndrome (TTTS). To address this lack of training resources, this paper presents a novel mixed-reality surgical trainer equipped with comprehensive sensing for TTTS procedures. Read More

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http://dx.doi.org/10.1007/s11548-018-1822-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223750PMC
December 2018
5 Reads
1.660 Impact Factor

Twin-twin transfusion syndrome screening and diagnosis in the United States: A triangulation design of patient experiences.

PLoS One 2018 5;13(7):e0200087. Epub 2018 Jul 5.

College of Public Health, Kent State University, Kent, Ohio, United States of America.

Objective: Using patient-reported experiences, this study: 1) quantitatively evaluated TTTS screening trends, 2) examined screening and diagnostic experiences using a mixed methods approach, and 3) determined gaps in clinical care experiences.

Design: This was a cross-sectional study. Data was collected using a self-report, retrospective survey. Read More

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200087PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033438PMC
January 2019
5 Reads

Towards computer-assisted TTTS: Laser ablation detection for workflow segmentation from fetoscopic video.

Int J Comput Assist Radiol Surg 2018 Oct 27;13(10):1661-1670. Epub 2018 Jun 27.

Wellcome / EPSRC Centre for Interventional and Surgical Sciences Centre For Medical Image Computing, University College London, London, UK.

Purpose: Intrauterine foetal surgery is the treatment option for several congenital malformations. For twin-to-twin transfusion syndrome (TTTS), interventions involve the use of laser fibre to ablate vessels in a shared placenta. The procedure presents a number of challenges for the surgeon, and computer-assisted technologies can potentially be a significant support. Read More

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http://dx.doi.org/10.1007/s11548-018-1813-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153674PMC
October 2018
11 Reads

Congenital limb deficiency requiring transfemoral amputation.

BMJ Case Rep 2018 May 30;2018. Epub 2018 May 30.

Orthopaedic Surgery, Children's Hospital of Los Angeles, Los Angeles, California, USA.

A healthy female infant was born from a twin pregnancy with an isolated congenital lower extremity malformation. Aside from prenatally diagnosed polyhydramnios, the infant had normal prenatal and postnatal diagnostic workup. She underwent transfemoral amputation and healed uneventfully. Read More

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http://dx.doi.org/10.1136/bcr-2017-223980DOI Listing
May 2018
5 Reads

Factors associated to early intrauterine fetal demise after laser for TTTS by preoperative fetal heart and Doppler ultrasound.

Prenat Diagn 2018 06 6;38(7):523-530. Epub 2018 Jun 6.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, CHU Sainte-Justine, Montreal University, Montreal, Québec, Canada.

Objective: To determine the prognostic value of fetal Doppler and echocardiographic parameters for intrauterine fetal demise (IUFD) within 24 hours and within 1 week after laser coagulation in monochorionic pregnancies complicated by twin-twin transfusion syndrome.

Method: This retrospective study correlated the preoperative hemodynamic and echocardiography parameters to the outcome in fetuses with twin-twin transfusion syndrome undergoing laser therapy.

Results: One hundred and twelve laser coagulations were performed between February 2006 and June 2015. Read More

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http://dx.doi.org/10.1002/pd.5280DOI Listing
June 2018
24 Reads

Brain-injured Survivors of Monochorionic Twin Pregnancies Complicated by Single Intrauterine Death: MR Findings in a Multicenter Study.

Radiology 2018 08 24;288(2):582-590. Epub 2018 Apr 24.

From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.).

Purpose To describe and classify the range of brain injuries present at prenatal, in-utero magnetic resonance (MR) imaging in co-twin survivors of monochorionic (MC) twin pregnancies complicated by single intrauterine death (SIUD). Materials and Methods This retrospective, observational study from six tertiary fetal medicine centers that perform tertiary-level prenatal in-utero MR studies reviewed cases in which prenatal in-utero MR imaging had shown a brain injury in a surviving co-twin of a twin pregnancy with a MC component complicated by SIUD. Results Forty-two surviving MC twins were described. Read More

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http://dx.doi.org/10.1148/radiol.2018171267DOI Listing
August 2018
11 Reads

Model Surgical Training: Skills Acquisition in Fetoscopic Laser Photocoagulation of Monochorionic Diamniotic Twin Placenta Using Realistic Simulators.

J Vis Exp 2018 03 21(133). Epub 2018 Mar 21.

Department of Obstetrics and Gynaecology, National University Health Systems; Experimental Fetal Medicine Group, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore;

Fetoscopic laser coagulation of arterio-venous anastomoses (AVA) in a monochorionic placenta is the standard of care for twin-twin transfusion syndrome (TTTS), but is technically challenging and can lead to significant complications. Acquiring and maintaining the necessary surgical skills require consistent practice, a critical caseload, and time. Training on realistic surgical simulators can potentially shorten this steep learning curve and enables several proceduralists to acquire procedure-specific skills simultaneously. Read More

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http://dx.doi.org/10.3791/57328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933233PMC
March 2018
9 Reads

Harmony Behind the Trumped-Shaped Vessel: the Essential Role of the Ductus Venosus in Fetal Medicine.

Balkan Med J 2018 03;35(2):124-130

Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, USA.

The ductus venosus is a fetal vessel that functions importantly in the transfer of oxygen-and nutrient-rich blood from the umbilical vein to vital organs. Its control under active regulation and its anatomy result in a flow-velocity profile that is typically forward throughout the cardiac cycle. This forward cardiac function reflects afterload, cardiac contractility, compliance, and vascular volume changes. Read More

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http://dx.doi.org/10.4274/balkanmedj.2017.1389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863249PMC
March 2018
1 Read

Role of ultrasonography in the management of twin gestation.

Int J Gynaecol Obstet 2018 Jun 2;141(3):304-314. Epub 2018 Apr 2.

Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA.

Twins represent 1%-2% of all pregnancies, yet continue to account for a disproportionate share of neonatal adverse events including neonatal intensive care admission, morbidity, and mortality. Ultrasonography is central to the proper diagnosis of the type of twinning. Ideally, ultrasonography is performed before 14 weeks of gestation to determine chorionicity and amnionicity. Read More

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http://dx.doi.org/10.1002/ijgo.12483DOI Listing
June 2018
4 Reads

Stage I Twin-Twin Transfusion Syndrome: Outcomes of Expectant Management and Prognostic Features.

Am J Perinatol 2018 Dec 8;35(14):1352-1357. Epub 2018 Feb 8.

Fetal Treatment Center, University of California San Francisco, San Francisco, California.

Objective:  This article describes the natural history of stage I twin-twin transfusion syndrome (TTTS) including risk of progression to higher stage TTTS and pregnancy outcomes, and to identify risk factors for progression.

Study Design:  Retrospective cohort study of monochorionic diamniotic (MCDA) twin pregnancies from 2006 to 2016 with expectantly managed Quintero stage I TTTS.

Results:  A total of 30 MCDA twin pregnancies with expectantly managed stage I TTTS were identified. Read More

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http://dx.doi.org/10.1055/s-0038-1627095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082735PMC
December 2018
10 Reads

Probabilistic visual and electromagnetic data fusion for robust drift-free sequential mosaicking: application to fetoscopy.

J Med Imaging (Bellingham) 2018 Apr 22;5(2):021217. Epub 2018 Feb 22.

University College London, Wellcome/EPSRC Center for Interventional and Surgical Sciences, London, United Kingdom.

The most effective treatment for twin-to-twin transfusion syndrome is laser photocoagulation of the shared vascular anastomoses in the placenta. Vascular connections are extremely challenging to locate due to their caliber and the reduced field-of-view of the fetoscope. Therefore, mosaicking techniques are beneficial to expand the scene, facilitate navigation, and allow vessel photocoagulation decision-making. Read More

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http://dx.doi.org/10.1117/1.JMI.5.2.021217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5822039PMC
April 2018
8 Reads

Ultrasound screening for complications in twin pregnancy.

Semin Fetal Neonatal Med 2018 04 18;23(2):133-141. Epub 2018 Feb 18.

Fetal Medicine Unit, St George's University of London, London, UK. Electronic address:

In the decades since the introduction of ultrasound into routine obstetric practice, the advantages of ultrasound have moved beyond the simple ability to identify multiple pregnancies antenatally to the possibility of screening them for fetal anomalies, pre-eclampsia, preterm birth, and the complications specific to monochorionic pregnancies. Screening studies have often excluded twins because physiological differences impact on the validity and sensitivity of the screening tests in routine use in singletons, and therefore, the evidence of screening performance in multiple pregnancy lags behind the evidence from singleton pregnancies. In general, most pregnancy complications are more common in twin pregnancy, but screening tests are less accurate or well validated. Read More

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http://dx.doi.org/10.1016/j.siny.2017.11.008DOI Listing
April 2018
1 Read

Fetal Doppler changes 1 week after endoscopic equatorial laser for twin-to-twin transfusion syndrome: A longitudinal study.

Prenat Diagn 2018 04 26;38(5):344-348. Epub 2018 Feb 26.

Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.

Objective: To investigate sequential Doppler changes in donors and recipients before and 1 week after endoscopic laser for twin-to-twin transfusion syndrome (TTTS) and to examine factors that may be associated with such changes.

Methods: In TTTS pregnancies undergoing laser treatment, we examined fetal Doppler changes before and 1 week postintervention. Intrauterine death rates and preoperative factors were analyzed in relation to Doppler changes. Read More

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http://dx.doi.org/10.1002/pd.5234DOI Listing
April 2018
12 Reads

Unusual course of hyperreactio luteinalis in twin pregnancy complicated by twin-twin transfusion syndrome.

Ultrasound Obstet Gynecol 2018 Nov;52(5):677-678

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.

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http://dx.doi.org/10.1002/uog.19010DOI Listing
November 2018
7 Reads

The relationship between preoperative fetal head circumference and 2-year cognitive performance after laser surgery for twin-twin transfusion syndrome.

Prenat Diagn 2018 02 24;38(3):173-178. Epub 2018 Jan 24.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Objective: To determine the relationship between preoperative fetal head circumference (HC) and cognitive performance among children treated with laser surgery for twin-twin transfusion syndrome (TTTS).

Methods: Donor and recipient twin HCs were measured preoperatively (16-26 weeks' gestation) and at 2 years corrected age. Multilevel multivariate regression models were used to test pregnancy and child-level risk factors for lower Battelle Developmental Inventory Second Edition (BDI-2) scores. Read More

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http://dx.doi.org/10.1002/pd.5204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867238PMC
February 2018
7 Reads

Polyhydramnios Affecting a Recipient-like Twin: Risk of Progression to Twin-Twin Transfusion Syndrome and Outcomes.

Am J Perinatol 2018 03 29;35(4):317-323. Epub 2017 Dec 29.

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.

Objective: The significance of polyhydramnios of one twin in the absence of oligohydramnios of the cotwin in monochorionic diamniotic (MCDA) twin pregnancies (polyhydramnios affecting a recipient-like twin [PART]) is unknown. Our aim is to assess the risk of progression to twin-twin transfusion syndrome (TTTS) with PART, progression to ≥ stage II TTTS, and neonatal survival.

Study Design: This study was a retrospective cohort study of MCDA twin pregnancies with PART evaluated at a referral center from 2008 to 2015. Read More

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0037-1615795
Publisher Site
http://dx.doi.org/10.1055/s-0037-1615795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842126PMC
March 2018
10 Reads

Radiofrequency ablation for selective reduction in complex monochorionic multiple pregnancies: A case series.

Taiwan J Obstet Gynecol 2017 Dec;56(6):740-744

Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.

Objective: To determine the safety and efficacy of radiofrequency ablation (RFA) for selective fetal reduction in complex monochorionic multiple pregnancies.

Materials And Methods: From July 2011 to January 2015, data on all cases treated with RFA were collected prospectively in our hospital. Indications, procedure details, cause of fetal demise and pregnancy outcomes were analyzed. Read More

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http://dx.doi.org/10.1016/j.tjog.2017.10.006DOI Listing
December 2017
17 Reads

Prenatal sonographic diagnosis of acardiac twin embedded within placenta.

Ultrasound Obstet Gynecol 2018 07 3;52(1):120-121. Epub 2018 Jun 3.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, 450 Clarkson Avenue, Box 24, Brooklyn, New York, NY, USA.

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http://dx.doi.org/10.1002/uog.18964DOI Listing
July 2018
2 Reads

ACR Appropriateness Criteria Multiple Gestations.

J Am Coll Radiol 2017 Nov;14(11S):S476-S489

Valley Hospital, Ridgewood, New Jersey and NYU School of Medicine, New York, New York; American College of Obstetrics and Gynecology.

Women with twin or higher-order pregnancies will typically have more ultrasound examinations than women with a singleton pregnancy. Most women will have at minimum a first trimester scan, a nuchal translucency evaluation scan, fetal anatomy scan at 18 to 22 weeks, and one or more scans in the third trimester to evaluate growth. Multiple gestations are at higher risk for preterm delivery, congenital anomalies, fetal growth restriction, placenta previa, vasa previa, and velamentous cord insertion. Read More

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http://dx.doi.org/10.1016/j.jacr.2017.08.051DOI Listing
November 2017
17 Reads

Does site of cord insertion increase risk of adverse outcome, twin-to-twin transfusion syndrome and discordant growth in monochorionic twin pregnancy?

Ultrasound Obstet Gynecol 2018 Sep 5;52(3):385-389. Epub 2018 Aug 5.

Department of Obstetrics and Gynaecology, University Hospitals Leuven; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.

Objectives: It is not currently well known to what extent the sites of cord insertion influence the risk of complicated outcome in monochorionic twin pregnancy. The objectives of this study were to examine whether the sites of cord insertion, as determined on prenatal ultrasound examination, affect the risks of adverse outcome, twin-to-twin transfusion syndrome (TTTS) and discordant growth, and whether discordance in insertion sites or velamentous insertion in one or both twins best predicts risk.

Methods: This was a retrospective cohort study of monochorionic diamniotic twin pregnancies followed from the first trimester. Read More

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http://dx.doi.org/10.1002/uog.18926DOI Listing
September 2018
23 Reads

Severe gyration and migration disorder in fetofetal transfusion syndrome: two case reports and a review of the literature on the neurological outcome of children with lesions on neuroimaging.

Childs Nerv Syst 2018 01 2;34(1):155-163. Epub 2017 Oct 2.

Division of Neuropediatrics, Hospital for Children and Adolescents, University of Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany.

Introduction: Fetofetal transfusion syndrome is a dreaded cause of morbidity and mortality in monochorionic pregnancies.

Case Reports: We present two pairs of twins one of which we have followed for more than 6 years. The donors suffer from cerebral palsy, orofacial, and motor problems, and both are significantly smaller than their recipient twins. Read More

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http://dx.doi.org/10.1007/s00381-017-3595-7DOI Listing
January 2018
12 Reads

Time Interval Measurements of the Ductus Venosus During the Early Second Trimester of Pregnancy: Reference Ranges and Clinical Application.

J Ultrasound Med 2018 Mar 26;37(3):745-753. Epub 2017 Sep 26.

Epidemiology Unit , Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

Objectives: The aims of this study were to construct reference ranges for the time interval parameters of the ductus venosus during the early second trimester of pregnancy and to demonstrate the clinical utility in various fetal disorders.

Methods: The ductus venosus Doppler measurements of 331 healthy fetuses between 15 and 22 weeks' gestation were analyzed. The systolic time and diastolic time were subdivided into the systolic acceleration time, systolic deceleration time, diastolic acceleration time, and diastolic deceleration time. Read More

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http://doi.wiley.com/10.1002/jum.14409
Publisher Site
http://dx.doi.org/10.1002/jum.14409DOI Listing
March 2018
5 Reads

No. 260-Ultrasound in Twin Pregnancies.

J Obstet Gynaecol Can 2017 Oct;39(10):e398-e411

Vancouver, BC.

Objective: To review the literature with respect to the use of diagnostic ultrasound in the management of twin pregnancies. To make recommendations for the best use of ultrasound in twin pregnancies.

Outcomes: Reduction in perinatal mortality and morbidity and short- and long-term neonatal morbidity in twin pregnancies. Read More

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http://dx.doi.org/10.1016/j.jogc.2017.08.014DOI Listing
October 2017
5 Reads

Aortic Isthmus Flow Recording Predicts the Outcome of the Recipient Twin after Laser Coagulation in Twin-Twin Transfusion Syndrome.

Fetal Diagn Ther 2018 16;44(2):135-141. Epub 2017 Sep 16.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.

Introduction: The objective was to assess the prognostic value of the systolic flow through the aortic isthmus in monochorionic pregnancies complicated by twin-twin transfusion syndrome (TTTS) treated by placental laser ablation.

Material And Methods: Fetal echocardiography and outcome data of 105 cases of TTTS treated by laser photocoagulation of placental anastomoses were reviewed. Hemodynamic parameters were collected before and after treatment. Read More

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http://dx.doi.org/10.1159/000479736DOI Listing
December 2018
28 Reads

Neonatal cerebral lesions predict 2-year neurodevelopmental impairment in children treated with laser surgery for twin-twin transfusion syndrome.

J Matern Fetal Neonatal Med 2019 Jan 6;32(1):80-84. Epub 2017 Sep 6.

d Division of General Pediatrics, Department of Pediatrics , Keck School of Medicine, University of Southern California , Los Angeles , CA , USA.

Objective: The objective of this study is to assess whether postnatally detected cerebral abnormalities are predictive of neurodevelopmental impairment (NDI) in survivors of twin-twin transfusion syndrome (TTTS) that underwent laser surgery.

Materials And Methods: Ninety-nine children treated for TTTS had neurodevelopmental assessment at age 2-years (±6 weeks). 'High-risk survivors' had cerebral imaging in the neonatal period. Read More

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http://dx.doi.org/10.1080/14767058.2017.1371694DOI Listing
January 2019
26 Reads

The role of ultrasound in the prediction of birth weight discordance in twin pregnancies: are we there yet?

J Perinat Med 2018 Feb;46(2):163-168

Department of Obstetrics B, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Objective: To analyze the accuracy of ultrasound prediction of birth weight discordance (BWD) and the influence of chorionicity and fetal growth restriction (FGR) on ultrasound performance.

Methods: Retrospective analysis of 176 twin pregnancies at a Portuguese tertiary center, between 2008 and 2014. Last ultrasound biometry was recorded. Read More

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http://dx.doi.org/10.1515/jpm-2016-0371DOI Listing
February 2018
4 Reads

Pseudoamniotic Band Syndrome After Fetoscopic Laser Ablation of Placental Anastomoses for Twin-Twin Transfusion Syndrome: Two Case Reports and Systematic Review.

J Ultrasound Med 2017 Nov 24;36(11):2373-2377. Epub 2017 Jul 24.

Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, Caen, France.

Pseudoamniotic band syndrome is a rare complication that occurs after invasive procedures for complicated monochorionic twins. We report 2 cases of intrauterine recipient fetal death after laser therapy for twin-twin transfusion syndrome due to umbilical cord constriction by the amniotic band. Read More

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http://dx.doi.org/10.1002/jum.14295DOI Listing
November 2017
4 Reads

A Continuum Robot and Control Interface for Surgical Assist in Fetoscopic Interventions.

IEEE Robot Autom Lett 2017 Mar;2(3):1656-1663

Surgical Robot Vision Group, Centre for Medical Image Computing, University College London, London WC1E 6BT, U.K.

Twin-twin transfusion syndrome requires interventional treatment using a fetoscopically introduced laser to sever the shared blood supply between the fetuses. This is a delicate procedure relying on small instrumentation with limited articulation to guide the laser tip and a narrow field of view to visualize all relevant vascular connections. In this letter, we report on a mechatronic design for a comanipulated instrument that combines concentric tube actuation to a larger manipulator constrained by a remote centre of motion. Read More

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http://dx.doi.org/10.1109/LRA.2017.2679902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5495161PMC
March 2017
18 Reads

Perimortem Demonstration and Treatment of Recipient-to-Donor Transfusion in Monochorionic-Diamniotic Twin Gestation.

Fetal Diagn Ther 2017 2;42(3):232-235. Epub 2017 Jun 2.

KU Center for Advanced Fetal Care, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Kansas City, KS, USA.

Twin-twin transfusion syndrome is a complication of monochorionic-diamniotic placentation. Should one twin die, ≈30% of co-twins will also die, and if they survive, ≈30% experience severe morbidity rates, each believed secondary to hemorrhage of the co-twin into the deceased twin. We report apparently the first ultrasound-documented case of perimortem hemorrhage in twin-twin transfusion syndrome and its treatment by emergent ultrasound-guided percutaneous cord occlusion followed by percutaneous fetal intravascular transfusion. Read More

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http://dx.doi.org/10.1159/000476033DOI Listing
June 2018
22 Reads

Quantified discordant placental echogenicity in twin anemia-polycythemia sequence (TAPS) and middle cerebral artery peak systolic velocity.

Ultrasound Obstet Gynecol 2018 Sep 23;52(3):373-377. Epub 2018 Jul 23.

Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Objective: To quantify sonographic placental echogenicity in twin anemia-polycythemia sequence (TAPS) and to correlate it with middle cerebral artery peak systolic velocity (MCA-PSV) measurements.

Methods: We performed a retrospective search for consecutive TAPS cases between 16 and 36 weeks of gestation (MCA-PSV > 1.5 multiples of the median (MoM) in the anemic donor and < 1. Read More

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http://dx.doi.org/10.1002/uog.17535DOI Listing
September 2018
20 Reads

Ultrasonic identification of pump twin by dual-gate Doppler in a monochorionic-triamniotic triplet twin reversed arterial perfusion sequence before preventative radiofrequency ablation: a case report.

J Med Ultrason (2001) 2018 Jan 9;45(1):185-187. Epub 2017 May 9.

Department of Fetal-Maternal Medicine, Nagara Medical Center, 1300-7, Nagara, Gifu, 502-87558, Japan.

We performed a dual-gate Doppler examination for a twin reversed arterial perfusion (TRAP) sequence in a monochorionic-triamniotic triplet pregnancy at 16 weeks of gestation and were able to identify the pump twin by arterial pulse rate synchronicity. We performed radiofrequency ablation to coagulate blood flow in the acardius at 16 weeks of gestation without any postoperative complication. At 29 weeks of gestation, we performed a cesarean section due to preterm rupture of the membranes and the patient delivered 1167/1237-g female neonates and a macerated acardius. Read More

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http://dx.doi.org/10.1007/s10396-017-0792-7DOI Listing
January 2018
7 Reads

Recipient umbilical artery elongation (redundancy) in twin-twin transfusion syndrome.

Am J Obstet Gynecol 2017 08 25;217(2):206.e1-206.e11. Epub 2017 Apr 25.

Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, UTHealth, University of Texas Health Science Center at Houston, Houston, TX. Electronic address:

Background: Chronic hypertension in adults causes arterial lengthening in major arteries, but the effects of early fetal hypertension on the twin-twin transfusion syndrome recipient's vascular architecture remains unknown.

Objective: We hypothesize that arterial cord redundancy is related to recipient hypertension and subsequent heart failure. Our objectives were to: (1) establish a 3-dimensional color Doppler ultrasound method of measuring umbilical arterial length relative to its corresponding venous segment in the umbilical cord using artery vein angle; (2) compare recipient artery vein angle to gestational age-matched controls; and (3) test the association of artery vein angle with recipient heart failure. Read More

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http://dx.doi.org/10.1016/j.ajog.2017.04.024DOI Listing
August 2017
8 Reads

Fetal brain injury in complicated monochorionic pregnancies: diagnostic yield of prenatal MRI following surveillance ultrasound and influence on prognostic counselling.

Prenat Diagn 2017 Jun 23;37(6):611-627. Epub 2017 May 23.

Department of Medical Imaging, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.

Objective: This study aimed to determine the additional diagnostic information provided by prenatal (fetal) magnetic resonance imaging (pMRI) following tertiary ultrasound (US) for fetal cranial abnormalities in complicated monochorionic gestations.

Methods: Women with complicated monochorionic gestations complicated by twin-twin transfusion syndrome, co-twin demise (CD), selective intrauterine growth restriction, and/or twin anaemia-polycythaemia sequence who were referred for pMRI after tertiary US were included. Additional diagnostic information by pMRI that changed prognostic counselling was the primary outcome. Read More

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http://dx.doi.org/10.1002/pd.5059DOI Listing
June 2017
10 Reads

Chorioamniotic Membrane Separation after Fetoscopic Laser Photocoagulation.

Fetal Diagn Ther 2018 22;43(1):40-44. Epub 2017 Apr 22.

Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.

Introduction: This study aimed to investigate the risk factors, incidence, and influence on the perinatal outcome of chorioamniotic membrane separation (CMS) after fetoscopic laser photocoagulation (FLP).

Material And Methods: This retrospective study included 312 women who underwent FLP for twin-to-twin transfusion syndrome (TTTS). Clinical records were used to review obstetrical examinations, complications, operative data, ultrasonographic findings, and perinatal and neonatal follow-up data in all patients. Read More

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http://dx.doi.org/10.1159/000472713DOI Listing
August 2018
8 Reads

Cardiac pathophysiology in twin-twin transfusion syndrome: new insights into its evolution.

Ultrasound Obstet Gynecol 2018 Mar 8;51(3):341-348. Epub 2018 Feb 8.

The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics, Gynecology and Reproductive Science, UTHealth McGovern Medical School, Houston, TX, USA.

Objectives: In twin-twin transfusion syndrome (TTTS), unbalanced transfer of vasoactive mediators and fluid from the donor to the recipient cotwin alters their cardiovascular function. The aims of this study were to describe the impact of TTTS on fetal cardiac function in a large cohort of monochorionic-diamniotic (MCDA) pregnancies, and determine the early hemodynamic response to selective fetoscopic laser photocoagulation (SFLP).

Methods: Echocardiography was performed in 145 MCDA pregnancies, including 26 uncomplicated MCDA, 61 TTTS Stages I+II and 58 TTTS Stages III+IV pregnancies, prior to SFLP for TTTS. Read More

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http://doi.wiley.com/10.1002/uog.17480
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http://dx.doi.org/10.1002/uog.17480DOI Listing
March 2018
1 Read

Bi-parametric magnetic resonance imaging applied to obstetrics.

J Obstet Gynaecol 2017 Jul 17;37(5):670-672. Epub 2017 Mar 17.

d Santa Maria del Carmine Hospital , Provincial Health Care Services, Institute of Pathology , Rovereto , Italy.

Foetal magnetic resonance imaging (MRI) plays an increasingly important role in the diagnosis of foetal abnormalities. Over the years, we have successfully applied bi-parametric MRI (bp-MRI) to the following obstetric conditions: (1) neurologic vascular diseases; (2) assessment of lung parenchyma maturation; (3) renal pathologies, such as polycystic kidney, suspected renal infarction, unilateral or bilateral renal agenesis; (4) placental pathologies, as twin-twin transfusion syndrome or placenta accreta; (5) benignant and malignant congenital tumours or cysts of the liver, such as haemangioendothelioma, hepatoblastoma or metastatic neuroblastoma, of the kidney (e.g. Read More

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http://dx.doi.org/10.1080/01443615.2017.1281237DOI Listing
July 2017
12 Reads

Medical-grade Sterilizable Target for Fluid-immersed Fetoscope Optical Distortion Calibration.

J Vis Exp 2017 02 23(120). Epub 2017 Feb 23.

Translational Imaging Group, CMIC, University College London.

We have developed a calibration target for use with fluid-immersed endoscopes within the context of the GIFT-Surg (Guided Instrumentation for Fetal Therapy and Surgery) project. One of the aims of this project is to engineer novel, real-time image processing methods for intra-operative use in the treatment of congenital birth defects, such as spina bifida and the twin-to-twin transfusion syndrome. The developed target allows for the sterility-preserving optical distortion calibration of endoscopes within a few minutes. Read More

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http://dx.doi.org/10.3791/55298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409324PMC
February 2017
10 Reads

Doppler assessment of patients with twin-to-twin transfusion syndrome and survival following fetoscopic laser surgery.

Int J Gynaecol Obstet 2017 Jun 27;137(3):241-245. Epub 2017 Mar 27.

Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital of Granada (CHUG), Granada, Spain.

Objective: To investigate fetal-survival rates following laser surgery for twin-to-twin transfusion syndrome (TTTS) and the impact of Doppler analysis.

Methods: The present retrospective single-center study included data from patients with pregnancies exhibiting TTTS treated with fetoscopic laser surgery between January 1, 2007, and December 31, 2016. Perinatal outcomes were examined and variables were compared between the donor and recipient fetuses that survived and died, respectively. Read More

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http://dx.doi.org/10.1002/ijgo.12143DOI Listing
June 2017
8 Reads

Different patterns of left ventricular "rigid body rotation" in 8-year-old twins with anamnestic twin-to-twin transfusion syndrome (from the MAGYAR-Twin Study).

Quant Imaging Med Surg 2017 Feb;7(1):140-141

The Second Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary.

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http://dx.doi.org/10.21037/qims.2016.11.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337181PMC
February 2017
9 Reads

[A Case Report of Mirror Syndrome after Fetoscopic Laser Photocoagulation for Twin to Twin Transfusion Syndrome].

Masui 2017 03;66(3):313-315

Mirror syndrome is a rare obstetric condition where a mother "mirrors" the edema of her hydropic fetus and placenta. We present the successful resolution of mirror syndrome following fetoscopic laser photocoag- ulation for twin to twin transfusion syndrome (TTTS). A 36-year-old woman was pregnant with monocho- rionic twins. Read More

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March 2017
7 Reads

Successful Closure of Small Iatrogenic Chorioamniotic Membranes Defect After Fetoscopy with Laser: A Case Report.

J Reprod Med 2017 Mar-Apr;62(3-4):194-99

Background: Fetoscopic laser coagulation of the placental anastomoses is the standard treatment for twin-to-twin transfusion syndrome (TTTS). Despite certain improvements in fetoscopic technique, every fourth fetoscopic procedure is still complicated by preterm premature rupture of membranes, leading to ascending infection, fetal demise, and/or preterm delivery. re-TTTS occurs after fetoscopy in 2–14% of cases, impairing the outcome. Read More

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October 2018
9 Reads

Modified diagnostic criteria for twin-to-twin transfusion syndrome prior to 18 weeks' gestation: time to change?

Authors:
A Khalil

Ultrasound Obstet Gynecol 2017 06 2;49(6):804-805. Epub 2017 May 2.

Fetal Medicine Unit, St George's University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, SW17 0RE, UK.

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http://dx.doi.org/10.1002/uog.17443DOI Listing
June 2017
1 Read