Objective: This study was undertaken to detect missed anastomoses on the chorionic surface as well as hidden connections in the depth of the cotyledons in placentas after laser coagulation for twin-to-twin transfusion...Objective: This study was undertaken to detect missed anastomoses on the chorionic surface as well as hidden connections in the depth of the cotyledons in placentas after laser coagulation for twin-to-twin transfusion syndrome (TTTS) and to correlate these findings to clinical outcome. Study design: All cord vessels were injected with dyed barium sulphate. A digital photograph of the chorionic surface angioarchitecture and single-shot digital X- ray (Rx) angiograms were made. The presence and diameter of any missed anastomoses on the chorionic surface and of any hidden angiographic connections were determined. Results: Fifty placentas were analyzed,7 of double intrauterine fetal death (IUFD) and 43 of double survivors. In 9 of 43 (21% ) cases with double survival and in all 7 cases of double IUFD, missed anastomoses were identified that should have been ablated by laser coagulation (P < .001). There appeared to be a correlation between the type and diameter of missed anastomoses on the chorionic surface and the clinical outcome. Placentas with missed large arteriovenous/venoarterial anastomoses (AV/VA) (N = 8) were from cases with recurrent TTTS or double IUFD (unless compensated by a large arterioarterial anastomosis [AA]). Next, missed small AV/VA (N = 4) without AA resulted in isolated (ie, without TTTS) discordant hemoglobin levels requiring intrauterine transfusion. Finally, when there were no missed anastomoses (N = 34), TTTS had resolved in all cases and outcome was good, although 1 case had discordant hemoglobin values treated with a single intrauterine transfusion and 4 others had discordant hemoglobin at birth. On Rx angiography, potential hidden connections were present, all but 1 case. Conclusion: Coagulation of all anastomoses visible on the chorionic surface seems adequate to treat TTTS. However, hidden connections in the depth of the cotyledon could not be excluded and may be involved in lesser degrees of intertwin transfusion.展开更多
OBJECTIVE: To identify the main prenatal risk factors for cerebral palsy in ve ry preterm singletons and twins. METHODS: The data were from the Epipage study, which included all very preterm children (< 33 weeks) b...OBJECTIVE: To identify the main prenatal risk factors for cerebral palsy in ve ry preterm singletons and twins. METHODS: The data were from the Epipage study, which included all very preterm children (< 33 weeks) born in 1997 in 9 regions of France. The analysis included 1,954 children for whom a medical questionnaire was completed at the age of 2 years (83%of the surviving children). The risk f actors studied were pregnancy complications and specific factors in twins (type of placenta and death of cotwin). Logistic regression analysis was carried out f or singletons and generalized estimating equation models used for twins. RESULTS : The proportion of cerebral palsy was 8%in singletons and 9%in twins. For sin gletons, spontaneous preterm labor (adjusted odds ratio [OR] 3.4, 95%confidence interval [CI] 1.7-6.7), preterm premature rupture of membranes (PPROM) with sh ort latency (adjusted OR 4.9, 95%CI 2.0-11.8), and prolonged PPROM (adjusted OR 2.7, 95%CI 1.4-5.3) were associated with a higher risk of cerebral palsy than was hypertension. No such link was found between these preg nancy complications and cerebral palsy in twins. For twins, a monochorionic plac enta (OR 1.9, 95%CI 1.0-3.6) increased the risk of cerebral palsy, but the OR became nonsignificant after adjustment (OR 1.7, 95%CI 0.8-3.4). CONCLUSION: In very preterm singletons, spontaneous preterm labor and PPROM increased the risk of cerebral palsy compared with hypertension.展开更多
文摘Objective: This study was undertaken to detect missed anastomoses on the chorionic surface as well as hidden connections in the depth of the cotyledons in placentas after laser coagulation for twin-to-twin transfusion syndrome (TTTS) and to correlate these findings to clinical outcome. Study design: All cord vessels were injected with dyed barium sulphate. A digital photograph of the chorionic surface angioarchitecture and single-shot digital X- ray (Rx) angiograms were made. The presence and diameter of any missed anastomoses on the chorionic surface and of any hidden angiographic connections were determined. Results: Fifty placentas were analyzed,7 of double intrauterine fetal death (IUFD) and 43 of double survivors. In 9 of 43 (21% ) cases with double survival and in all 7 cases of double IUFD, missed anastomoses were identified that should have been ablated by laser coagulation (P < .001). There appeared to be a correlation between the type and diameter of missed anastomoses on the chorionic surface and the clinical outcome. Placentas with missed large arteriovenous/venoarterial anastomoses (AV/VA) (N = 8) were from cases with recurrent TTTS or double IUFD (unless compensated by a large arterioarterial anastomosis [AA]). Next, missed small AV/VA (N = 4) without AA resulted in isolated (ie, without TTTS) discordant hemoglobin levels requiring intrauterine transfusion. Finally, when there were no missed anastomoses (N = 34), TTTS had resolved in all cases and outcome was good, although 1 case had discordant hemoglobin values treated with a single intrauterine transfusion and 4 others had discordant hemoglobin at birth. On Rx angiography, potential hidden connections were present, all but 1 case. Conclusion: Coagulation of all anastomoses visible on the chorionic surface seems adequate to treat TTTS. However, hidden connections in the depth of the cotyledon could not be excluded and may be involved in lesser degrees of intertwin transfusion.
文摘OBJECTIVE: To identify the main prenatal risk factors for cerebral palsy in ve ry preterm singletons and twins. METHODS: The data were from the Epipage study, which included all very preterm children (< 33 weeks) born in 1997 in 9 regions of France. The analysis included 1,954 children for whom a medical questionnaire was completed at the age of 2 years (83%of the surviving children). The risk f actors studied were pregnancy complications and specific factors in twins (type of placenta and death of cotwin). Logistic regression analysis was carried out f or singletons and generalized estimating equation models used for twins. RESULTS : The proportion of cerebral palsy was 8%in singletons and 9%in twins. For sin gletons, spontaneous preterm labor (adjusted odds ratio [OR] 3.4, 95%confidence interval [CI] 1.7-6.7), preterm premature rupture of membranes (PPROM) with sh ort latency (adjusted OR 4.9, 95%CI 2.0-11.8), and prolonged PPROM (adjusted OR 2.7, 95%CI 1.4-5.3) were associated with a higher risk of cerebral palsy than was hypertension. No such link was found between these preg nancy complications and cerebral palsy in twins. For twins, a monochorionic plac enta (OR 1.9, 95%CI 1.0-3.6) increased the risk of cerebral palsy, but the OR became nonsignificant after adjustment (OR 1.7, 95%CI 0.8-3.4). CONCLUSION: In very preterm singletons, spontaneous preterm labor and PPROM increased the risk of cerebral palsy compared with hypertension.