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Outcome perinatali di gravidanze gemellari monocoriali complicate dalla sindrome feto fetale.
No full textBackground: La trasfusione feto-fetale (TTTS) è una delle più gravi complicanze delle gravidanze gemellari monocoriali (MCDA), con una incidenza stimata del 10-15%. La diagnosi precoce e il trattamento della TTTS sono cruciali per massimizzare gli outcome perinatali. Infatti, la TTTS è generalmente diagnosticata nel secondo trimestre con la sequenza “oligo/polidramnios”. Gli interventi disponibili in epoca prenatale includono il trattamento fetoscopico mediante laser delle anastomosi placentari. I miglioramenti nelle tecniche chirurgiche, nello strumentario disponibile e nella qualità dell’imaging hanno permesso una riduzione significativa della mortalità perinatale e della morbidità neurologica.
Questa complicanza può verificarsi non solo nelle gravidanze MCDA ma anche in gravidanze trigemine con una componente monocoriale. Inoltre, e ad epoche gestazionali “non convenzionali” e cioè prima delle 18 settimane nei casi di “early TTTS” o dopo le 26 settimane nei casi di “late TTTS”. Lo scopo di questo studio multicentrico retrospettivo è quello di riportare dati sugli outcomes perinatale di gravidanze multiple complicate da TTTS.
Metodi: questo è uno studio multicentrico retrospettivo di coorte che include gravidanze multiple con una componente monocoriale proveniente da 21 centri partecipanti in tutto il mondo dal 2007 in poi. Il progetto vuole analizzare dati sulle gravidanze trigemine monocoriali o gemellari monocoriali complicate da TTTS ad epoche non convenzionali. Dati su età materna, modalità di concepimento, diagnosi di anomali strutturali o aneuploidie, epoca gestazionale alla diagnosi delle anomalie, TTTS, sequenza anemia-policitemia (TAPS), sequenza twin reversed arterial perfusion (TRAP) e restrizione di crescita selettiva (sFGR) sono stati raccolti dalle cartelle cliniche, incluso dati sulla riduzione selettiva fetale (da tre a due o da tre a uno nelle trigemenine), dati sul laser o altri tipi di interventi fetali attivi incluso l’amniodrenaggio. Dati sugli outcome perinatali sono stati altresì raccolti, incluso numero di nati vivi, morti fetali neonatali, terminazioni volontarie di gravidanza, ammissione in terapia intensiva neonatale ecc. Questi outcomes sono stati analizzati in base al tipo di management scelto (expectant o interventistico).
Risultati e risultati attesi: nella nostra coorte di trigemine a componente monocoriale (N=153 esclusi aborti precooci, interruzioni e perdite al follow-up), la maggior parte sono stati gestiti con expectant. L’incidenza di anomalie o TRAP è stata 13.7% e 5.2%, rispettivamente. La TTTS ha complicato il 27.6% delle gravidanze seguita da sFGR (16.4%),mentre la TAPS (spontanea and post-laser) si è verificata in solo lo 3.3%; nessuna complicanza è stata registrata nel 49.3%. Lça sopravvivenza è dipesa dallo sviluppo di complicanze 85.1%, 100% e 47.6% delle gravidanze con un gemello che sopravvive nelle gravidanze senza complicanze, con sFGR o TTTS rispettivamente. Il tasso di parto pretermine prima di 28 settimane e prima di 32 sono 14.5% e 49.2%, rispettivamente.
Per le TTTS non convenzionali ci proponiamo di valutare tasso di complicanze fetali e perinatali, tasso di progression di TTTS in forme più severe, di complicnze aggiuntive quali sFGR, TAPS o rottura premature delle membrane dopo procedura laser. Infine, valuteremo morbidità neonatale quale distress respiratorio, ammissione in terapia intensive neonatale, presenza di emorragie intraventricolari o leukomalacia periventricolare all’imaging.
Conclusioni: Le complicanze legate alla monocorionicità impattano negativamente sulle gravidanze multiple e pertanto rappresentano una sfia per il clinic nel counseling, sorveglianze e gestione.Background: Twin-to-twin transfusion syndrome (TTTS) is one of the most severe complications of monochorionic diamniotic (MCDA) twin pregnancies, with an estimated incidence of 10%-15%. Timely diagnosis and treatment of TTTS are crucial to maximize perinatal outcome. In fact, TTTS is usually diagnosed in the second trimester with oligo/polyhydramnios sequence. Prenatal intervention includes fetoscopic laser therapy of placental anastomoses, which is more effective than serial amnioreduction before 26 weeks. Improved surgical experience and improvement in technical equipment and image quality has led to a significant reduction in perinatal mortality and neurological morbidity.
This complication can occur not only in MCDA pregnancies but also in higher order pregnancies such as triplets with a monochorionic component. Furthermore, this can occur also at “unconventional” gestational ages such as before 18 weeks, i.e. “early TTTS”, or after 26 weeks, i.e. In “late TTTS”.
The aim of this multicenter retrospective study was to report on perinatal outcomes of multiple pregnancies complicated by TTTS.
Methods: This was a multicenter retrospective cohort study including multiple pregnancies with a monochorionic component managed in 21 participating centers around the world from 2007 onwards. The project analyzed data on monochorionic triplet pregnancies and twin complicated by “unconventional” TTTS. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anoma-lies, twin-to-twin transfusion syndrome (TTTS), twin anemia – polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one for triplets), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of livebirth, intrauterine demise, neonatal death, perinatal deathand termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention.
Results and expected results: In our cohort of MCTA triplet pregnancies (n=153 after excluding early miscarriages, TOP and loss to follow-up), the majority (90%) were managed expectantly. The incidence of fetal abnormalities and TRAP was 13.7% and 5.2%, respectively. The most common antenatal complication related to chorionicity was TTTS, which complicated just over a quarter (27.6%) of the pregnancies, followed by sFGR (16.4%), while TAPS (both spontaneous and post-laser) occurred in only 3.3%; no antenatal complication was recorded in 49.3% of pregnancies. Survival was largely associated with the development of these complications: 85.1%, 100% and 47.6% of pregnancies had at least one surviving newborn in those without antenatal complications, complicated by sFGR, or complicated by TTTS, respectively. The overall rates of preterm birth < 28 weeks and <32 weeks’ gestation were 14.5% and 49.2%, respectively.
For “unconventional” TTTS, we aim to assess the fetal and perinatal outcomes of twin pregnancies complicated by TTTS and neonatal morbidity.
Conclusion: Monochorionicity-related complications can impact adversely perinatal outcome in multiple pregnancies creating a challenge with regard to counseling, surveillance and management
Levonorgestrel-releasing intra-uterine systems as female contraceptives
No full textThe availability and use of long-acting reversible contraceptives (LARCs), such as levonorgestrel intrauterine systems (LNG-IUSs), have increased in recent times. Areas covered: The authors provide a narrative review of the LNG-IUSs currently available worldwide as female contraceptives (LNG-IUS 13.5, 19.5 and 52 mg). Specific features of the devices and their parameters of efficacy and tolerability were considered as outcomes. Expert opinion: The one-handed 3.8-mm-diameter inserter of LNG-IUS 13.5 mg and 19.5 mg may be particularly suitable in nulliparous women. While LNG-IUSs 13.5, 19.5 mg and LNG 52 mg should be used by women simply looking for an effective contraceptive method for up to 3, 4 or 5 years, LNG-IUS 52 mg has also been approved for the treatment of heavy menstrual bleeding and endometrial protection during hormone replacement therapy. LNG-IUS 52 mg is ideal for women who are experiencing a certain hyperestrogenic hormonal environment, with heavy menstrual bleeding due to hormonal imbalances, adenomyosis or fibroids, in the case of symptomatic endometriosis or for endometrial protection during hormone estrogenic replacement therapy in non-hysterectomized women
Outcome of fetal congenital pulmonary malformations: a systematic review and meta-analysis
Get PDFObjectives: To report the outcome of fetuses with a prenatal diagnosis of congenital lung malformation (CLM) diagnosed on ultrasound by performing a comprehensive assessment of these outcomes through a systematic review and meta-analysis. Content: CLMs are a heterogeneous group of anomalies that involve the lung parenchyma and its bronchovascular structures. Their presentation and evolution are variable, from entirely asymptomatic lesions with sonographic regression in utero to hydropic fetuses requiring fetal therapy, intrauterine death or neonatal morbidity. A systematic review was conducted in Medline, Embase and Cochrane databases including studies on fetuses with CLM diagnosed prenatally in order to report the in-utero natural history of these lesions. Thirty-nine studies (2,638 fetuses) were included in the final review. Summary: Regression/reduction in size of the lung lesion during pregnancy was reported in 31 % of cases, while its increase in 8.5 % of cases. Intra-uterine death complicated 1.5 % of pregnancies with fetal CLM, while neonatal and perinatal death were 2.2 and 3 %, respectively. Neonatal morbidity occurred in 20.6 % of newborns with CLM; 46 % had surgery, mainly elective. In fetuses with CLM and hydrops, fetal/perinatal loss occurred in 42 %. Assessment of the role of fetal therapy in improving the outcomes of pregnancies complicated by CLM was hampered by the small number of included cases and heterogeneity of type of interventions. Outlook: Fetuses with CLM prenatally diagnosed have a generally favorable outcome. Conversely, there is a low quality of evidence on the actual role of fetal therapy in improving the outcome of fetuses presenting with these anomalies
Screening for Low-Tract Genital Infections in Women with Threatened Preterm Labor: Which Role?
No full textThe aim of this study was to evaluate the possible relationship between cultural specimens and preterm birth in women admitted for threatened preterm labor. Preterm birth is the leading cause of neonatal mortality and antenatal hospitalization; several risk factors including intrauterine infections have been identified, but its real causes remain poorly understood
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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