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Sacco A, Van der Veeken L, Bagshaw E, Ferguson C, Van Mieghem T, David AL, Deprest J. Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta-analysis. Prenat Diagn 2019; 39:251-268. [PMID: 30703262 PMCID: PMC6492015 DOI: 10.1002/pd.5421] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/16/2019] [Accepted: 01/20/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To establish maternal complication rates for fetoscopic or open fetal surgery. METHODS We conducted a systematic literature review for studies of fetoscopic or open fetal surgery performed since 1990, recording maternal complications during fetal surgery, the remainder of pregnancy, delivery, and after the index pregnancy. RESULTS One hundred sixty-six studies were included, reporting outcomes for open fetal (n = 1193 patients) and fetoscopic surgery (n = 9403 patients). No maternal deaths were reported. The risk of any maternal complication in the index pregnancy was 20.9% (95%CI, 15.22-27.13) for open fetal and 6.2% (95%CI, 4.93-7.49) for fetoscopic surgery. For severe maternal complications (grades III to V Clavien-Dindo classification of surgical complications), the risk was 4.5% (95% CI 3.24-5.98) for open fetal and 1.7% (95% CI, 1.19-2.20) for fetoscopic surgery. In subsequent pregnancies, open fetal surgery increased the risk of preterm birth but not uterine dehiscence or rupture. Nearly one quarter of reviewed studies (n = 175, 23.3%) was excluded for failing to report the presence or absence of maternal complications. CONCLUSIONS Maternal complications occur in 6.2% fetoscopic and 20.9% open fetal surgeries, with serious maternal complications in 1.7% fetoscopic and 4.5% open procedures. Reporting of maternal complications is variable. To properly quantify maternal risks, outcomes should be reported consistently across all fetal surgery studies.
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Affiliation(s)
- Adalina Sacco
- Department of Maternal and Fetal MedicineInstitute for Women's Health, University College LondonLondonUK
| | - Lennart Van der Veeken
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical SciencesKU LeuvenLeuvenBelgium
| | - Emma Bagshaw
- Department of Maternal and Fetal MedicineInstitute for Women's Health, University College LondonLondonUK
| | - Catherine Ferguson
- Department of Maternal and Fetal MedicineInstitute for Women's Health, University College LondonLondonUK
| | - Tim Van Mieghem
- Department of Obstetrics and GynaecologyMount Sinai Hospital and University of TorontoTorontoOntarioCanada
| | - Anna L. David
- Department of Maternal and Fetal MedicineInstitute for Women's Health, University College LondonLondonUK
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical SciencesKU LeuvenLeuvenBelgium
- National Institute for Health ResearchUniversity College London Hospitals Biomedical Research CentreLondonUK
| | - Jan Deprest
- Department of Maternal and Fetal MedicineInstitute for Women's Health, University College LondonLondonUK
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical SciencesKU LeuvenLeuvenBelgium
- Clinical Department Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
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Perry H, Duffy JMN, Umadia O, Khalil A. Outcome reporting across randomized trials and observational studies evaluating treatments for twin-twin transfusion syndrome: systematic review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:577-585. [PMID: 29607558 DOI: 10.1002/uog.19068] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Twin-twin transfusion syndrome (TTTS) is associated with significant mortality and morbidity. Potential treatments for the condition require robust evaluation. The aim of this study was to evaluate outcome reporting across observational studies and randomized controlled trials assessing treatments for TTTS. METHODS Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE were searched from inception to August 2016. Observational studies and randomized controlled trials reporting outcome following treatment for TTTS in monochorionic-diamniotic twin pregnancy and monochorionic-triamniotic or dichorionic-triamniotic triplet pregnancy were included. Outcome reporting was systematically extracted and categorized. RESULTS Six randomized trials and 94 observational studies were included, reporting data from 20 071 maternal participants and 3199 children. Six different treatments were evaluated. Included studies reported 62 different outcomes, including six fetal, seven offspring mortality, 25 neonatal, six early childhood and 18 maternal/operative outcomes. Outcomes were reported inconsistently across trials. For example, when considering offspring mortality, 31 (31%) studies reported live birth, 31 (31%) reported intrauterine death, 49 (49%) reported neonatal mortality and 17 (17%) reported perinatal mortality. Four (4%) studies reported respiratory distress syndrome. Only 19 (19%) studies were designed for long-term follow-up and 11 (11%) of these reported cerebral palsy. CONCLUSIONS Studies evaluating treatments for TTTS have often neglected to report clinically important outcomes, especially neonatal morbidity outcomes, and most are not designed for long-term follow-up. The development of a core outcome set could help standardize outcome collection and reporting in TTTS studies. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - J M N Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
- Balliol College, University of Oxford, Oxford, UK
| | - O Umadia
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
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Squire SA, Yang R, Robertson I, Ayi I, Squire DS, Ryan U. Gastrointestinal helminths in farmers and their ruminant livestock from the Coastal Savannah zone of Ghana. Parasitol Res 2018; 117:3183-3194. [PMID: 30030626 DOI: 10.1007/s00436-018-6017-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/12/2018] [Indexed: 01/08/2023]
Abstract
To identify the gastrointestinal helminths of veterinary, zoonotic and public health importance in farmers and their ruminant livestock in Ghana, faecal samples were collected from 95 farmers and their livestock (cattle = 328, sheep = 285 and goats = 217) and examined by microscopy and/or molecular techniques. Overall, 21 farmers tested positive for at least one gastrointestinal helminth, 80.9% of which were single infections and 19.0% co-infections. The parasites identified in the farmers consisted of hookworms (n = 13) (9 were Necator americanus and the other 4 could not be amplified by PCR), Trichostrongylus spp. (n = 9), Schistosoma mansoni (n = 1), Schistosoma haematobium (n = 1) and Diphyllobothrium latum (n = 1). In livestock, strongylid nematodes were dominant (56.6%), followed by Paramphistomum spp. (16.9%), Dicrocoelium spp. (7.1%), Thysaniezia spp. (5.8%), Trichuris spp. (3.3%), Moniezia spp. (3.1%), Fasciola spp. (2.8%), Toxocara spp. (1.1%) and Schistosoma spp. (0.2%). Genotyping of Trichostrongylus spp. in the farmer's stools identified six T. colubriformis similar to T. colubriformis detected in cattle, sheep and goats in the study, two Trichostrongylus spp. with 98.3% and 99.2% genetic similarity to T. probolurus respectively and one Trichostrongylus spp. which showed 96.6% similarity to both T. probolurus and T. rugatus. Trichostrongylus axei was also identified in cattle, sheep and goats. This is the first molecular characterisation of Trichostrongylus spp. in Ghana and the species identified in the present study suggests zoonotic transmission from cattle, sheep and goats. Further studies involving larger numbers of farmers and their household members are essential to understand the transmission dynamics and impact of these parasites on farming communities in Ghana.
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Affiliation(s)
- Sylvia Afriyie Squire
- School of Veterinary and Life Sciences, Murdoch University, 90 South Street, Murdoch, Western Australia, Australia. .,Council for Scientific and Industrial Research, Animal Research Institute, P. O. Box AH 20, Achimota, Accra, Ghana.
| | - Rongchang Yang
- School of Veterinary and Life Sciences, Murdoch University, 90 South Street, Murdoch, Western Australia, Australia
| | - Ian Robertson
- School of Veterinary and Life Sciences, Murdoch University, 90 South Street, Murdoch, Western Australia, Australia.,China-Australia Joint Research and Training Center for Veterinary Epidemiology, Huazhong Agricultural University, Wuhan, China
| | - Irene Ayi
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG 581, Legon, Accra, Ghana
| | - Daniel Sai Squire
- School of Veterinary and Life Sciences, Murdoch University, 90 South Street, Murdoch, Western Australia, Australia.,Usher Polyclinic, Ghana Health Service, P. O. Box GP 2105, Accra, Ghana
| | - Una Ryan
- School of Veterinary and Life Sciences, Murdoch University, 90 South Street, Murdoch, Western Australia, Australia
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Miller JL, Ahn ES, Garcia JR, Miller GT, Satin AJ, Baschat AA. Ultrasound-based three-dimensional printed medical model for multispecialty team surgical rehearsal prior to fetoscopic myelomeningocele repair. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:836-837. [PMID: 28850758 DOI: 10.1002/uog.18891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/11/2017] [Accepted: 08/18/2017] [Indexed: 06/07/2023]
Affiliation(s)
- J L Miller
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, 600 North Wolfe Street, Nelson 228, Baltimore, MD, 21287, USA
| | - E S Ahn
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J R Garcia
- Department of Art as Applied to Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - G T Miller
- Medical Modeling & Simulation Innovation Center, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Materiel Command, Fort Detrick, MD, USA
| | - A J Satin
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, 600 North Wolfe Street, Nelson 228, Baltimore, MD, 21287, USA
| | - A A Baschat
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, 600 North Wolfe Street, Nelson 228, Baltimore, MD, 21287, USA
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Henry A, Gopikrishna S, Mahajan A, Alphonse J, Meriki N, Welsh AW. Use of the Foetal Myocardial Performance Index in monochorionic, diamniotic twin pregnancy: a prospective cohort and nested case-control study. J Matern Fetal Neonatal Med 2018; 32:2017-2029. [DOI: 10.1080/14767058.2018.1424817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Amanda Henry
- School of Women’s and Children’s Health, UNSW Medicine, UNSW, Sydney, Australia
- Department of Women’s and Children’s Health, St. George Hospital, Sydney, Australia
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, Australia
| | - Saranya Gopikrishna
- School of Women’s and Children’s Health, UNSW Medicine, UNSW, Sydney, Australia
| | - Aditi Mahajan
- School of Women’s and Children’s Health, UNSW Medicine, UNSW, Sydney, Australia
- Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Jennifer Alphonse
- School of Women’s and Children’s Health, UNSW Medicine, UNSW, Sydney, Australia
| | - Neama Meriki
- Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Maternal Fetal Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Alec W. Welsh
- School of Women’s and Children’s Health, UNSW Medicine, UNSW, Sydney, Australia
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, Australia
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Fisher KE, Welsh AW, Wilson I, Henry A. Uncommon complications of monochorionic twin pregnancies: Twin anaemia-polycythaemia sequence. Australas J Ultrasound Med 2016; 19:56-63. [PMID: 34760444 DOI: 10.1002/ajum.12013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction Twin anaemia-polycythaemia sequence (TAPS) occurs when significant haemoglobin discordance exists between monochorionic fetuses. Most reported cases occur iatrogenically after twin-to-twin transfusion syndrome (TTTS) laser therapy; spontaneous TAPS is also reported. The purpose of this study was to investigate pregnancy management and immediate neonatal outcomes for monochorionic multiple pregnancies complicated by TAPS referred to the NSW Fetal Therapy Centre (FTC). Methods Retrospective cohort study of multiple pregnancies referred to NSW FTC between April 2006 and April 2014. Fourteen TAPS cases [discordant middle cerebral artery peak systolic volume (MCA-PSV) or clinician diagnosis antenatally, or Hb >20 g/dL vs. <12 g/dL post-natally] were compared to an existing TTTS database (n = 142) and uncomplicated monochorionic diamniotic (MCDA) twin pregnancies (n = 45). Outcomes measured were maternal demographics; ultrasound findings at referral; management, including whether in utero fetal therapy was performed; and pregnancy outcome, including gestation at birth, mode of birth, birthweight, fetal/neonatal complications and neonatal survival to discharge. Results The majority of TAPS cases were spontaneous (9/14) and occurred later in pregnancy than TTTS (median gestation at diagnosis 26.0 ± 4.9 vs. 20.4 ± 2.6 weeks, P < 0.001). However, TAPS perinatal outcome was similar to TTTS (survival of both twins 62% vs. 53%, survival of at least one twin 85% vs. 87%, overall survival 73% vs. 70%) and overall survival significantly lower than for uncomplicated MCDA pregnancies (73% vs. 98%, P < 0.001). Conclusion Overall mortality for TAPS was similar to that of TTTS but significantly higher compared to uncomplicated MCDA pregnancies, underscoring the potential severity of TAPS despite its later gestational onset.
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Affiliation(s)
- Katie E Fisher
- School of Women's and Children's Health University of New South Wales Kensington New South Wales Australia
| | - Alec W Welsh
- School of Women's and Children's Health University of New South Wales Kensington New South Wales Australia.,Department of Maternal-Fetal Medicine Royal Hospital for Women Sydney New South Wales Australia.,Australian Centre for Perinatal Science UNSW Medicine Sydney New South Wales Australia
| | - Isabella Wilson
- School of Women's and Children's Health University of New South Wales Kensington New South Wales Australia
| | - Amanda Henry
- School of Women's and Children's Health University of New South Wales Kensington New South Wales Australia.,Department of Maternal-Fetal Medicine Royal Hospital for Women Sydney New South Wales Australia.,Australian Centre for Perinatal Science UNSW Medicine Sydney New South Wales Australia
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