[Comparison of foetal and neonatal mortality of monochorionic monoamniotic and monochorionic biamniotic twin pregnancies]

OBJECTIVES

To compare the mortality of monochorionic-monoamniotic (MCMA) and monochorionic-biamniotic (MCBA) twin pregnancies, from 14weeks of gestation to 28th day of life, before and after exclusion of major congenital malformations.

METHODS

We conducted a retrospective cohort study in two level 3 maternity units of the Hospices civils de Lyon (France) including all patients with a monochorionic twin pregnancy between January 2013 and December 2020. We excluded TRAP sequences and conjoined twins.

RESULTS

A total of 38 MCMA and 658 MCBA pregnancies were included. We showed an increase in overall mortality in the MCMA group compared to the MCBA group (31.6% versus 16.4%, P=0.03) even after exclusion of major congenital malformations (20.3% versus 9.5%, P=0.01). The main cause of mortality found in the MCMA group was the occurrence of unexpected IUGR.

CONCLUSIONS

MCMA pregnancies have a higher foetal and neonatal mortality rate than MCBA pregnancies even after exclusion of congenital malformations related to the occurrence of unexpected MFIU.

Neurodevelopmental outcome at 2 years of corrected age in fetuses with increased nuchal translucency thickness and normal karyotype compared with matched controls

OBJECTIVES

Increased nuchal translucency (NT) thickness is an antenatal marker of aneuploidy or malformation that can lead to termination of pregnancy. This study assessed the long-term neurodevelopmental prognosis of infants who had isolated increased NT in utero.

METHODS

This was a prospective cohort study of infants with a NT thickness > 95^th percentile in the first trimester, but with a normal karyotype and no major anomalies, and controls with normal NT matched for birth weight, Apgar score, place of birth, parity and gestational age at birth. At 2 years of corrected age, all infants underwent the psychometric Brunet-Lézine test to evaluate their developmental quotient (DQ), overall (global) and specifically for the areas of posture, language, coordination and sociability.

RESULTS

A total of 203 chromosomally normal infants were included in the increased-NT group and 208 in the control group. The mean global DQ was significantly lower in the increased-NT group than in the control group (108.6 ± 9.7 vs 112.8 ± 8.3; P < 0.0001), but it was within the normal range expected for that age in both groups. Similarly, the mean DQs for coordination, sociability and language, but not for posture, were significantly lower in infants with increased NT than in controls. Only one case with increased NT had a DQ < 70 (defined as severe neurodevelopmental impairment), compared with none in the control group. The difference between the two groups remained significant for a NT threshold ≥ 99^th percentile and when the data were adjusted for NT thickness, the infant's sex and the mother's educational level. In the increased-NT group, NT thickness was < 3.5 mm in over half (56%) of the infants, between 3.5 mm and 5 mm in 33% and > 5 mm in 11%, with a mean global DQ of 108.4, 110.1 and 109.7, respectively.

CONCLUSIONS

Infants who had isolated increased fetal NT in the first trimester had a significantly lower, but normal, DQ at a corrected age of 2 years, when compared with controls. The findings were independent of the infant's sex, fetal NT thickness and the mother's educational level. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Prenatal microarray comparative genomic hybridization: Experience from the two first years of activity at the Lyon university-hospital

OBJECTIVES

This study aims to describe how microarray comparative genomic hybridization (aCGH) has shifted to become a prenatal diagnosis tool at the Lyon university-hospital.

MATERIALS AND METHODS

This retrospective study included all patients who were referred in the 3 pluridisciplinary centers for prenatal diagnosis of the Lyon university-hospital and who received a prenatal aCGH between June 2013 and June 2015. aCGH was systematically performed in parallel with a karyotype, using the PréCytoNEM array design.

RESULTS

A total of 260 microarrays were performed for the following indications: 249 abnormal ultrasounds (95.8%), 7 characterizations of chromosomal rearrangements (2.7%), and 4 twins with no abnormal ultrasounds (1.5%). With a resolution of 1 mega base, we found 235 normal results (90.4%), 23 abnormal results (8.8%) and 2 non-returns (0.8%). For the chromosomal rearrangements visible on the karyotype, aCGH identified all of the 12 unbalanced rearrangements and did not identify the 2 balanced rearrangements. Among the fetuses with normal karyotypes, 11 showed abnormal microarray results, corresponding to unbalanced cryptic chromosomal rearrangements (4.2%).

CONCLUSION

Transferring aCGH to a prenatal diagnosis at the Lyon university-hospital has increased the detection rate of chromosomal abnormalities by 4.2% compared to the single karyotype.

[Cesarean scar ectopic pregnancies: combined modality therapies with uterine artery embolization before surgical procedure]

OBJECTIVES

To offer a therapeutic management of cesarean scar pregnancies (GSC) in the first trimester of pregnancy with a first approach by uterine artery embolization (UAE) PATIENTS AND METHODS: This study describes seven cases of GSC diagnosed between 2009 and 2013 in the clinic of the University Hospital of the Hospital of Croix-Rousse. We present the symptoms and how imagery has led to the diagnosis and the therapeutic management conducted.

RESULTS

The mean gestational age at diagnosis was 9 weeks gestation. There were ongoing pregnancies with cardiac activity present for each patient. An additional MRI was performed in five patients. Five patients were treated with methotrexate injection, two patients received the Mifegyne. All patients then received a selective uterine artery embolization. Finally within 48hours, suction curettage was performed in 6 patients. A patient at 13 WA+1 required a subtotal hysterectomy for placenta accreta. Intra-operative complications were represented by a bladder injury, two bleeding of 1000mL in patients at 13 WA+1 and 12 WA. For the 6 cases of GSC with a gestational age less than 10 WA, average blood loss was less than 500mL. Three patients underwent resection of scar isthmocele confirmed by EVAC. An intrauterine pregnancy was carried to term after care.

DISCUSSION AND CONCLUSION

Cesarean scar pregnancies is a diagnostic and therapeutic challenge, which should be diagnosed as early as soon as possible with care in a medical facility with a uterine artery embolization technical platform. Our protocol combining Mifegyne and methotrexate for termination of pregnancy and uterine artery embolization (UAE) followed by curettage for evacuation of pregnancy allows conservative treatment while minimizing the risk of bleeding (for GSC diagnosed before 10 WA).

[Trisomy 21 by isochromosome: a case report of true false negative of chorionic villi sampling]

We report a rare case of true false negative of chorionic villi sampling for a child with Down syndrome. A chorionic villi sampling was performed for a nuchal translucency at the first trimester. The karyotype was 46,XX for the short and the long-term culture. Because of facial dysmorphy and cardiopathy to the child, a karytoype was proposed. This postnatal karyotype showed a trisomy 21, by isochromosome 46,XX,i(21)(q10). We expose the mechanism of true false negative of chorionic villi sampling, and particularly the role of isochromosome in this case.

[Ogilvie's syndrome after cesarean section: A case report]

Ogilvie's syndrome is a rare postsurgical complication. The high mortality rate (normally 15 to 31% and up to 45% after caecal perforation) explains the seriousness of this clinical situation. The early diagnosis is made by plain abdominal X-ray. Conservative treatment is usually effective and surgery should be reserved for complicated cases or refractory to conservative treatment. We report a case of Ogilvie's syndrome after cesarean section, which has been treated by conservative methods.

Lymphadénectomie lombo-aortique cœlioscopique par voie extrapéritonéale gauche: morbidité et apprentissage de la technique

OBJECTIVE

Description of the morbidity and the learning curve of the left extraperitoneal laparoscopic paraaortic lymphadenectomy in patients with gynecologic cancers.

PATIENTS AND METHODS

Retrospective study of patients treated with the left extraperitoneal laparoscopic paraaortic lymphadenectomy between August 1999 and January 2005. Duration of surgery, per and post-operative complications, duration of the hospital stay, number of retrieved nodes, and pathologic results were studied. A comparative analysis of the results was performed between trained and training surgeons.

RESULTS

Eighty-one patients were planned for the left extraperitoneal laparoscopic paraaortic lymphadenectomy. The major indication (90% of cases) was advanced cervical carcinomas (stage IB2 and more). The median number of retrieved nodes was 14, with a mean operative time of 109 minutes. The median hospital stay was 3 days. Two major complications related to the surgical technique were observed: a laceration of the inferior vena cava and an acute abdominal syndrome. Seven lymphocysts (8.6%) were observed (with associated symptoms in 2 cases). Trained surgeons to the technique displayed higher success rate of this surgical technique and higher number of retrieved lymph nodes.

DISCUSSION AND CONCLUSIONS

The left extraperitoneal laparoscopic paraaortic lymphadenectomy allows the accurate staging and management of patients with gynecologic cancers and mainly women affected by advanced cervical carcinoma. The surgical technique is safe and reproducible when performed by trained surgeons.