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Soussan S, Egloff C, Peyronnet V, Winer N, Weingertner AS, Rault E, Fuchs F, Quibel T, Bourgon N, Vivanti AJ, Rosenblatt J, Ponzio-Klijanienko A, Dap M, Mandelbrot L, Picone O. Perinatal outcomes between immediate vs deferred selective termination in dichorionic twin pregnancies with fetal congenital anomalies: a French multicenter study. Am J Obstet Gynecol MFM 2024:101363. [PMID: 38574858 DOI: 10.1016/j.ajogmf.2024.101363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Because selective termination (ST) for discordant dichorionic twin anomalies carries a risk of pregnancy loss, deferring the procedure until the third trimester can be considered in settings where it is legal. OBJECTIVE To determine whether perinatal outcomes were more favorable following deferred rather than immediate ST. STUDY DESIGN A French multicenter retrospective study from 2012 to 2023 on dichorionic twin pregnancies with ST for fetal conditions which were diagnosed before 24 WG. Pregnancies with additional risk factors for late miscarriage were excluded. We defined two groups according to the intention to perform ST within 2 weeks after the diagnosis of the severe fetal anomaly was established (immediate ST) or to wait until the third trimester (deferred ST). The primary outcome was perinatal survival at 28 days of life. Secondary outcomes were pregnancy losses before 24 WG and preterm delivery. RESULTS Of 390 pregnancies, 258 were in the immediate ST group and 132 in deferred ST group. Baseline characteristics were similar in both groups. Overall survival of the healthy co-twin was 93.8% (242/258) in the immediate ST group vs 100% (132/132) in the deferred ST group (p<0.01). Preterm birth < 37 weeks' gestation was lower in the immediate than in the deferred ST group (66.7% vs 20.2%, p<0.01); preterm birth < 28 WG and < 32 WG did not differ significantly (respectively 1.7% vs 0.8%, p=0.66 and 8.26% vs 11.4%, p=0.36). In the deferred ST group, an emergency procedure was performed in 11.3% (15/132) because of threatened preterm labor, of which 3.7% (5/132) for imminent delivery. CONCLUSION Overall survival after ST was high regardless of the gestational age at which the procedure was performed. Postponing ST until the third trimester seems to improve survival, while immediate ST reduces the risk of preterm delivery. Furthermore, deferred ST requires an expert center capable of performing the ST procedure on an emergency basis if required.
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Affiliation(s)
- Stanley Soussan
- Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France; Universié Paris Cité, Paris, France
| | - Charles Egloff
- Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France; Universié Paris Cité, Paris, France
| | - Violaine Peyronnet
- Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France
| | - Norbert Winer
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes, France
| | - Anne-Sophie Weingertner
- Service de gynécologie-obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Emmanuel Rault
- Service de gynécologie-obstétrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Florent Fuchs
- Service de Gynécologie-Obstétrique. CHU de Montpellier., Hôpital Arnaud de Villeneuve 371 Avenue du Doyen Gaston Giraud, Montpellier, France; Inserm CESP Centre de recherche en Épidémiologie et Santé des Populations, U1018, Équipe Épidémiologie Clinique, Villejuif; Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP), Univ Montpellier, INSERM, (CHU Montpellier), Montpellier, France
| | - Thibault Quibel
- Maternité, Centre hospitalier intercommunal de Poissy - Saint Germain en Laye, Poissy, France; Université Paris Saclay, UVSQ, Inserm, Équipe U1018, Épidémiologie clinique, CESP, Montigny-le-Bretonneux
| | - Nicolas Bourgon
- Service Obstétrique - Maternité, chirurgie médecine et imagerie fœtales, Hôpital Necker, AP-HP, Paris, France
| | - Alexandre J Vivanti
- Service de Gynécologie - Obstétrique, Hôpital Antoine Béclère, AP-HP, Clamart, France
| | - Jonathan Rosenblatt
- Service de Gynécologie-Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France
| | | | - Matthieu Dap
- Service de gynécologie-obstétrique, CHRU de Nancy, Université de Lorraine, Nancy, France
| | - Laurent Mandelbrot
- Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France; Universié Paris Cité, Paris, France; IAME, INSERM, Paris, France; FHU PREMA, Paris, France.
| | - Olivier Picone
- Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France; Universié Paris Cité, Paris, France; IAME, INSERM, Paris, France; FHU PREMA, Paris, France
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Minella C, Jeandidier E, Koch A, Antal MC, Favre R, Sananes N, Weingertner AS. Trisomy 22: First and Second Trimester Cytogenetic Analysis and Phenotypic Presentation in a Series of Seven Cases. Fetal Diagn Ther 2023; 51:112-124. [PMID: 37926071 DOI: 10.1159/000534619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Trisomy 22 is a chromosomal disorder rarely encountered prenatally. Even fewer live births are observed and generally correspond to confined placental mosaic trisomy 22, or even more uncommonly, to true fetal mosaic trisomy 22. CASE PRESENTATION We examine and describe a series of seven cases of trisomy 22 encountered prenatally in terms of their cytogenetic and phenotypic presentations and discuss their interrelationships along with case management and outcomes. We aimed to identify aspects of prenatal data suggestive of fetal trisomy 22 and to determine whether a prognosis can be established from these factors. CONCLUSION Our conclusion is that prenatal data elements can provide key elements of information to guide multidisciplinary care and support for the couple and the neonate.
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Affiliation(s)
- Chris Minella
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Eric Jeandidier
- Department of Genetics, Groupe Hospitalier de la Region de Mulhouse et Sud Alsace, Mulhouse, France
| | - Antoine Koch
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Maria Cristina Antal
- Department of Anatomopathology and Fetopathology, Strasbourg University Hospital, Strasbourg, France
| | - Romain Favre
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Nicolas Sananes
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, Strasbourg, France
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Pencole L, Sibiude J, Weingertner AS, Mandelbrot L, Vauloup-Fellous C, Picone O. Congenital lymphocytic choriomeningitis virus: A review. Prenat Diagn 2022; 42:1059-1069. [PMID: 35695127 DOI: 10.1002/pd.6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Lymphocytic choriomeningitis virus (LCMV) uses rodents such as mice and hamsters as its principal reservoir. When women acquire LCMV during pregnancy because of contact with rodents, it can lead to congenital LCMV infection, which is associated with high mortality and morbidity. Although the number of cases reported in the literature is increasing, LCMV is rarely mentioned because a history of exposure to rodents is uncommon and mostly unknown. OBJECTIVES The main objective of this article was to summarize all morphological, antenatal, and postnatal abnormalities that may suggest a congenital LCMV infection. METHODS We reviewed PubMed case reports and case series where an antenatal and/or a postnatal description of at least one case of congenital LCMV infection was documented. RESULTS We found 70 cases of congenital LCMV infection, 68 of which had antenatal or postnatal brain abnormalities, which were mainly chorioretinitis (59/70), hydrocephaly (37/70), microcephaly (22/70), ventriculomegaly (11/70) and periventricular calcifications (11/70). Antenatal and postnatal extracerebral abnormalities were mainly small for gestational age, ascites, cardiomegaly or anemia. Other organ damage was rare, but could include skin abnormalities, hydrops or hepatosplenomegaly. Seventy percent (49/70) of cases had major cerebral abnormalities that could have been detected by antenatal ultrasound examination. Congenital LCMV infection is associated with a significant mortality rate (30%) and survivors often have severe neurologic sequelae. CONCLUSION LCMV is a rare congenital infection, but awareness of the various prenatal ultrasound morphological abnormalities should be improved, and LCMV should be considered when first-line etiological explorations are negative, especially when the mother's medical history indicates exposure to rodents.
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Affiliation(s)
- Lucile Pencole
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, APHP, Université de Paris, Colombes, France
| | - Jeanne Sibiude
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, APHP, Université de Paris, Colombes, France.,INSERM IAME-U1137, Paris, France.,Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Vélizy, France
| | - A S Weingertner
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Laurent Mandelbrot
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, APHP, Université de Paris, Colombes, France.,INSERM IAME-U1137, Paris, France.,Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Vélizy, France
| | - Christelle Vauloup-Fellous
- Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Vélizy, France.,Division of Virology, Department of Biology Genetics and PUI, Paris Saclay University Hospital, APHP, Villejuif, France.,INSERM U1193, Université Paris Saclay, Villejuif, France
| | - Olivier Picone
- Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, APHP, Université de Paris, Colombes, France.,INSERM IAME-U1137, Paris, France.,Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Vélizy, France
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Minella C, Costantino B, Ruano R, Koch A, Weingertner AS, Favre R, Sananes N. Fetoscopic Release of Amniotic Band Syndrome: An Update. J Ultrasound Med 2021; 40:1039-1048. [PMID: 32951245 DOI: 10.1002/jum.15480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/17/2020] [Accepted: 08/02/2020] [Indexed: 06/11/2023]
Abstract
Amniotic band syndrome is a rare condition. There have been few cases reported of fetoscopic band dissection. The aim of this case series is to report 3 cases of fetoscopic treatment for amniotic band syndrome, including indication for surgery, technical aspects, complications and outcomes. Fetoscopic treatment was performed respectively at 23 5/7 , 26 5/7 and 18 3/7 weeks' gestation. Two procedures were performed with a laser fiber through a single trocar whereas one surgery was performed with scissors. In conclusion, fetoscopic release of the amniotic bands in case of amniotic band syndrome is feasible with encouraging results in order to prevent amputation and dysfunction of the extremities.
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Affiliation(s)
- Chris Minella
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, France
| | | | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Antoine Koch
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, France
| | | | - Romain Favre
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, France
| | - Nicolas Sananes
- Department of Maternal Fetal Medicine, Strasbourg University Hospital, France
- INSERM, UMR-S 1121, "Biomatériaux et Bioingénierie", Strasbourg University, France
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5
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Koch A, Favre R, Weingertner AS, Zaloszyc A, Kohler M, Guerra F, Rosenblatt J, Muller F, Dreux S, Sananès N. Evaluation of Sequential Urine Analysis when Selecting Candidates for Vesicoamniotic Shunting in Lower Urinary Tract Obstruction. Fetal Diagn Ther 2021; 48:265-271. [PMID: 33756463 DOI: 10.1159/000514911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/31/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of our study was to assess the utility of sequential fetal urine analysis in severe lower urinary tract obstruction (LUTO) when selecting cases suitable for vesicoamniotic shunting. MATERIAL AND METHODS This was a retrospective cohort study of cases of severe LUTO treated in our fetal medicine center from 1994 to 2013. Two fetal bladder samples were taken 24-48 h apart to assess renal function. A vesicoamniotic shunt was inserted in case of improvement in urinary biochemistry between the 2 samples. We assessed perinatal morbidity and mortality and renal function at 5 years. RESULTS Among a total of 26 LUTO cases with sequential urine analysis, 5 showed normal urinary biochemistry, 13 were abnormal, and 8 improved between the 2 samples. These 8 cases underwent vesicoamniotic shunt placement, leading to the birth of 6/8 (75%) live infants, 5/6 (83%) of whom had normal renal function at 5 years. The 5 cases with normal biochemistry occasioned 2 neonatal deaths and 3 children with normal renal function at 5 years. Elective termination of pregnancy was requested by parents for the fetuses exhibiting abnormal biochemistry. CONCLUSION An improvement in urinary biochemistry between 2 sequential fetal bladder punctures in severe LUTO could be an effective criterion in the selection of candidates for vesicoamniotic shunting. However, the benefit of a shunt in fetuses with normal amniotic fluid remains to be evaluated in clinical trials.
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Affiliation(s)
- Antoine Koch
- Maternal Fetal Medicine Department, Strasbourg University Hospital, Strasbourg, France,
| | - Romain Favre
- Maternal Fetal Medicine Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Ariane Zaloszyc
- Pediatric Nephrology Department, Strasbourg University Hospital, Strasbourg, France
| | - Monique Kohler
- Maternal Fetal Medicine Department, Strasbourg University Hospital, Strasbourg, France
| | - Fernando Guerra
- Maternal Fetal Medicine Department, Strasbourg University Hospital, Strasbourg, France
| | - Jonathan Rosenblatt
- Maternal Fetal Medicine Department, Robert Debré Hospital, AP-HP, Paris, France
| | - Françoise Muller
- Biochemistry-Hormonology Department, Robert Debré Hospital, AP-HP, Paris, France
| | - Sophie Dreux
- Biochemistry-Hormonology Department, Robert Debré Hospital, AP-HP, Paris, France
| | - Nicolas Sananès
- Maternal Fetal Medicine Department, Strasbourg University Hospital, Strasbourg, France.,INSERM, UMR-S 1121, "Biomatériaux et Bioingénierie", Strasbourg, France
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6
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Klein J, Buffin-Meyer B, Boizard F, Moussaoui N, Lescat O, Breuil B, Fedou C, Feuillet G, Casemayou A, Neau E, Hindryckx A, Decatte L, Levtchenko E, Raaijmakers A, Vayssière C, Goua V, Lucas C, Perrotin F, Cloarec S, Benachi A, Manca-Pellissier MC, Delmas HL, Bessenay L, Le Vaillant C, Allain-Launay E, Gondry J, Boudailliez B, Simon E, Prieur F, Lavocat MP, Saliou AH, De Parscau L, Bidat L, Noel C, Floch C, Bourdat-Michel G, Favre R, Weingertner AS, Oury JF, Baudouin V, Bory JP, Pietrement C, Fiorenza M, Massardier J, Kessler S, Lounis N, Auriol FC, Marcorelles P, Collardeau-Frachon S, Zürbig P, Mischak H, Magalhães P, Batut J, Blader P, Saulnier Blache JS, Bascands JL, Schaefer F, Decramer S, Schanstra JP. Amniotic fluid peptides predict postnatal kidney survival in developmental kidney disease. Kidney Int 2020; 99:737-749. [PMID: 32750455 DOI: 10.1016/j.kint.2020.06.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 12/16/2022]
Abstract
Although a rare disease, bilateral congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of end stage kidney disease in children. Ultrasound-based prenatal prediction of postnatal kidney survival in CAKUT pregnancies is far from accurate. To improve prediction, we conducted a prospective multicenter peptidome analysis of amniotic fluid spanning 140 evaluable fetuses with CAKUT. We identified a signature of 98 endogenous amniotic fluid peptides, mainly composed of fragments from extracellular matrix proteins and from the actin binding protein thymosin-β4. The peptide signature predicted postnatal kidney outcome with an area under the curve of 0.96 in the holdout validation set of patients with CAKUT with definite endpoint data. Additionally, this peptide signature was validated in a geographically independent sub-cohort of 12 patients (area under the curve 1.00) and displayed high specificity in non-CAKUT pregnancies (82 and 94% in 22 healthy fetuses and in 47 fetuses with congenital cytomegalovirus infection respectively). Change in amniotic fluid thymosin-β4 abundance was confirmed with ELISA. Knockout of thymosin-β4 in zebrafish altered proximal and distal tubule pronephros growth suggesting a possible role of thymosin β4 in fetal kidney development. Thus, recognition of the 98-peptide signature in amniotic fluid during diagnostic workup of prenatally detected fetuses with CAKUT can provide a long-sought evidence base for accurate management of the CAKUT disorder that is currently unavailable.
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Affiliation(s)
- Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Franck Boizard
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Nabila Moussaoui
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Ophélie Lescat
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Benjamin Breuil
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Camille Fedou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Guylène Feuillet
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Audrey Casemayou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Eric Neau
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - An Hindryckx
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Luc Decatte
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Elena Levtchenko
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anke Raaijmakers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Christophe Vayssière
- Université Toulouse III Paul-Sabatier, Toulouse, France; Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France; INSERM, UMR1027, Toulouse, France
| | - Valérie Goua
- Prenatal Diagnosis Unit, Poitiers University Hospital, Poitiers, France
| | | | - Franck Perrotin
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, Tours, France; INSERM, U1253, "Imaging and Brain," François-Rabelais University of Tours, Tours, France
| | - Sylvie Cloarec
- Reference Center for Rare Kidney Diseases, Pediatric Nephrology Service, CHRU Clocheville, Tours, France
| | - Alexandra Benachi
- Gynecology-Obstetric Service, AP-HP, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France
| | - Marie-Christine Manca-Pellissier
- Center for Prenatal Diagnosis, Timone Children's Hospital, Assistance Publique Hopitaux de Marseille, Aix-Marseille Université, Marseille, France
| | | | - Lucie Bessenay
- Pediatric Service, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Emma Allain-Launay
- Pediatric Nephrology Service, Hôpital Mère-Enfants, CHU Nantes, Nantes, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, Amiens, France; INSERM, U1105, Picardie Jules Verne University, CHU Amiens, Amiens, France
| | | | - Elisabeth Simon
- Prenatal Diagnosis, Fondation Lenval, CHU de Nice, Nice, France
| | - Fabienne Prieur
- Clinical Genetics Service, CHU de Saint-Etienne, Saint-Etienne, France
| | - Marie-Pierre Lavocat
- Department of Pediatrics, Hôpital Nord, CHU de Saint Etienne, Saint Etienne, France
| | - Anne-Hélène Saliou
- Multidisciplinary Center for Prenatal Diagnosis, CHRU de Brest, Brest, France
| | - Loic De Parscau
- Department of Pediatrics and Medical Genetics, CHRU Morvan, Brest, France
| | - Laurent Bidat
- Gynecology-Obstetrics Service, Centre Hospitalier René Dubos, Pontoise, France
| | - Catherine Noel
- Gynecology-Obstetrics Service, Centre Hospitalier René Dubos, Pontoise, France
| | - Corinne Floch
- Pediatric Service, Hôpital Louis Mourier, Colombes, France
| | | | - Romain Favre
- Ultrasound and Foetal Medicine Service of the Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, CMCO, Schiltigheim, France
| | - Anne-Sophie Weingertner
- Ultrasound and Foetal Medicine Service of the Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, CMCO, Schiltigheim, France
| | - Jean-François Oury
- Gynecology-Obstetrics Service, Hôpital Universitaire Robert Debré, APHP, Paris, France
| | - Véronique Baudouin
- Pediatric Nephrology Service, Hôpital Universitaire Robert-Debré, APHP, Paris, France
| | - Jean-Paul Bory
- Service de Gynécologie-Obstétrique, Maternité Alix-de-Champagne, CHU de Reims, Reims, France
| | | | - Maryse Fiorenza
- Gynecology-Obstetrics Service, l'Hôpital Mère Enfant de Limoges, Limoges, France
| | - Jérôme Massardier
- Gynecology-Obstetrics Service, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | | | - Nadia Lounis
- Pediatric Clinical Research Unit, Clinical Research Center Toulouse, Hôpital des Enfants, Toulouse, France
| | - Françoise Conte Auriol
- Pediatric Clinical Research Unit, Clinical Research Center Toulouse, Hôpital des Enfants, Toulouse, France
| | - Pascale Marcorelles
- Department of Pathology, EA 4685, Neuronal Epithelium Interaction Laboratory, Université de Bretagne Occidentale Brest, France
| | - Sophie Collardeau-Frachon
- Department of Pathology, Children and Mother's Hospital, Groupement Hospitalier Est, CHU de Lyon-Bron, France
| | - Petra Zürbig
- Mosaiques Diagnostics and Therapeutics, Hannover, Germany
| | - Harald Mischak
- Mosaiques Diagnostics and Therapeutics, Hannover, Germany; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Pedro Magalhães
- Mosaiques Diagnostics and Therapeutics, Hannover, Germany; Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Julie Batut
- Center for Developmental Biology (UMR5547) and Center for Integrative Biology (FR 3743), Université de Toulouse, CNRS, UPS, 31062, Toulouse, France
| | - Patrick Blader
- Center for Developmental Biology (UMR5547) and Center for Integrative Biology (FR 3743), Université de Toulouse, CNRS, UPS, 31062, Toulouse, France
| | - Jean-Sebastien Saulnier Blache
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | | | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Stéphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France; Pediatric Nephrology Service, Hôpital des Enfants, CHU Toulouse, Toulouse, France; Reference Center for Rare Renal Diseases of the Southwest (SORARE), Toulouse, France.
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France.
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Codaccioni C, Picone O, Lambert V, Maurice P, Pomar L, Winer N, Guibaud L, Lavergne RA, Saliou AH, Quinio D, Benachi A, Noel C, Ville Y, Cuillier F, Pomares C, Ferret N, Filisetti D, Weingertner AS, Vequeau-Goua V, Cateau E, Benoist G, Wallon M, Dommergues M, Villena I, Mandelbrot L. Ultrasound features of fetal toxoplasmosis: A contemporary multicenter survey in 88 fetuses. Prenat Diagn 2020; 40:1741-1752. [PMID: 32506432 DOI: 10.1002/pd.5756] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/16/2020] [Accepted: 05/23/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe the lesions detected by prenatal ultrasound examination in congenital toxoplasmosis (CT). METHODS We retrospectively analyzed all cases of fetal infection with Toxoplasma gondii with ultrasound anomalies described by fetal medicine experts in 2009 to 2019 in 30 French centers. RESULTS Eighty-eight cases of CT were included. Forty-five (51.1%) had one or more cerebral signs only, 35 (39.8%) had cerebral plus extracerebral signs and 8 (9.1%) had extracerebral signs only. The main cerebral signs were intracranial hyperechogenic nodular foci (n = 60) of which 20 were isolated, ventriculomegalies (n = 44) which generally increased during follow-up, and periventricular abscesses (n = 12). The main extracerebral signs were hepatomegaly and/or splenomegaly (n = 14), small for gestational age (n = 14), ascites (n = 14, including 2 with hydrops), and hyperechogenic bowel (n = 11). Maternal infection occurred mostly in the first or second trimester (81 cases), periconceptionally in one and in the third trimester in six cases. The first ultrasound signs were detected after a median of 7 weeks (range: 1.4; 24.0) following maternal toxoplasmosis seroconversion. CONCLUSION While no sign was specific of CT, there were typical associations of cerebral signs with or without extracerebral signs. Detailed ultrasound examination could improve prognostic evaluation, as well as diagnosis of CT in settings lacking serological screening.
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Affiliation(s)
- Camille Codaccioni
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, APHP Nord Université de Paris, Colombes, France.,Inserm, IAME, Université de Paris, Paris, France
| | - Olivier Picone
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, APHP Nord Université de Paris, Colombes, France.,Inserm, IAME, Université de Paris, Paris, France
| | - Véronique Lambert
- Service de Gynécologie-Obstétrique, Centre Hospitalier de l'Ouest Guyanais, St Laurent du Maroni, France
| | - Paul Maurice
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Foetale, Hôpital Trousseau, APHP Sorbonne, Paris, France
| | - Léo Pomar
- Service de Gynécologie-Obstétrique, Centre Hospitalier de l'Ouest Guyanais, St Laurent du Maroni, France
| | - Norbert Winer
- Centre Hospitalier Universitaire de Nantes, Service de Gynécologie-Obstétrique, NUN, INRA, UMR 1280, Phan, Université de Nantes, Nantes, France
| | - Laurent Guibaud
- Centre Hospitalier Universitaire de Nantes, Laboratoire Parasitologie et Mycologie, and NUN, INRA, UMR 1280, Phan, Université de Nantes, Nantes, France
| | - Rose-Anne Lavergne
- Service de Radiologie, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Anne-Hélène Saliou
- Service de Gynécologie-Obstétrique, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | - Dorothée Quinio
- Laboratoire Parasitologie et Mycologie, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | - Alexandra Benachi
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Université Paris-Saclay, Clamart, France
| | - Catherine Noel
- Service de Gynécologie-Obstétrique, Centre Hospitalier René Dubos, Pontoise, France
| | - Yves Ville
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Necker Enfants Malades APHP Centre Université de Paris, Paris, France
| | - Fabrice Cuillier
- Service de Gynécologie-Obstétrique, Centre Hospitalier Régional Félix Guyon, Saint-Denis, Réunion, France
| | - Christelle Pomares
- Centre Hospitalier Universitaire de Nice, Service de Parasitologie-Mycologie, C3M INSERM 1065, Université Côte d'Azur, Nice, France
| | - Nicole Ferret
- Centre Hospitalier Universitaire de Nice, Service de Pédiatrie, Université Côte d'Azur, Nice, France
| | - Denis Filisetti
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Anne-Sophie Weingertner
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Valérie Vequeau-Goua
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Estelle Cateau
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Guillaume Benoist
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Martine Wallon
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Marc Dommergues
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital de la Pité-Salpêtrière, APHP Sorbonne, Paris, France
| | - Isabelle Villena
- Centre National de Référence de la Toxoplasmose, Centre de Ressources Biologiques Toxoplasma, Service de Parasitologie-Mycologie, EA 7510, UFR Médecine, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, APHP Nord Université de Paris, Colombes, France.,Inserm, IAME, Université de Paris, Paris, France
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Delaine M, Weingertner AS, Nougairede A, Lepiller Q, Fafi-Kremer S, Favre R, Charrel R. Microcephaly Caused by Lymphocytic Choriomeningitis Virus. Emerg Infect Dis 2018; 23:1548-1550. [PMID: 28820372 PMCID: PMC5572864 DOI: 10.3201/eid2309.170775] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We report congenital microencephaly caused by infection with lymphocytic choriomeningitis virus in the fetus of a 29-year-old pregnant women at 23 weeks’ gestation. The diagnosis was made by ultrasonography and negative results for other agents and confirmed by a positive PCR result for lymphocytic choriomeningitis virus in an amniotic fluid sample.
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9
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Delaine M, Weingertner AS, Nougairede A, Lepiller Q, Fafi-Kremer S, Favre R, Charrel R. Congenital Lymphocytic Choriomeningitis Virus: A Case of Prenatal Diagnosis. J Ultrasound Med 2018; 37:804-806. [PMID: 28858375 DOI: 10.1002/jum.14372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Maia Delaine
- Hôpitaux Universitaires de Strasbourg Service d'échographie, Schiltigheim, France
| | | | - Antoine Nougairede
- UMR "Emergence des Pathologies Virales", Marseille, France
- Fondation IHU Méditerranée Infection APHM Public Hospitals of Marseille, Marseille, France
| | | | | | - Romain Favre
- Hôpitaux Universitaires de Strasbourg Service d'échographie, Schiltigheim, France
| | - Rémi Charrel
- UMR "Emergence des Pathologies Virales", Marseille, France
- Fondation IHU Méditerranée Infection APHM Public Hospitals of Marseille, Marseille, France
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10
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Lecointre L, Sananès N, Weingertner AS, Gaudineau A, Akladios C, Cavillon V, Langer B, Favre R. [Fetoscopic laser coagulation in 200 consecutive monochorionic pregnancies with twin-twin transfusion syndrome]. J Gynecol Obstet Hum Reprod 2017; 46:175-181. [PMID: 28403975 DOI: 10.1016/j.jogoh.2016.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 10/09/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To report preoperative data, surgical characteristics, complications and perinatal outcome of twin-twin transfusion syndrome (TTTS) managed with laser ablation surgery, to analyze predictors of neonatal survival and to compare the 100 most recent cases with the older 100. MATERIALS AND METHODS Observational cohort moncentric study of 200 cases of TTTS consecutively treated with fetoscopic laser coagulation between January 2004 and December 2014. RESULTS There were 49 stage I, 88 stage II, 55 stage III and eight stage IV. Median gestation at time of laser was 20.1±3.0 weeks' gestation (WG) whereas median gestation at delivery was 31.6±5.4 WG. Overall perinatal survival rate was 68.0% and 84.0% have one or more surviving twins. Preterm premature rupture of membranes occurred in 39 cases with and the median gestational age for this complication was 28.8±4.6 SA. Predictive factors to have at least one living birth were Quintero stage and gestational age at delivery. In the most recent period, there were significantly more TTTS Quintero stage I treated with laser, more coagulation by the Solomon technique and a larger number of coagulated vessels. CONCLUSION The neonatal survival of TTTS is improved by fetoscopic laser coagulation, preferely by using Solomon tecnhique. The use of active management of stage I is currently on research.
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Affiliation(s)
- L Lecointre
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France; Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - N Sananès
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France; Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Inserm, UMR-S 1121, « Biomatériaux et Bioingénierie », 11, rue Humann, 67085 Strasbourg cedex, France
| | - A S Weingertner
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France
| | - A Gaudineau
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France; Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - C Akladios
- Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - V Cavillon
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France
| | - B Langer
- Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - R Favre
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France
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11
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Miguet M, Thevenon J, Laugel V, Lefebvre M, Bourchany A, Rivière JB, Duffourd Y, Schaefer E, Antal MC, Abida R, Weingertner AS, Kremer V, Vabres P, Morice-Picard F, Gonzales M, Lipsker D, Fraitag S, Mandel JL, Chelly J, Dollfus H, Faivre L, Thauvin-Robinet C, Calmels N, El Chehadeh S. Mutations in theERCC2(XPD) gene associated with severe fetal ichthyosis and dysmorphic features. Prenat Diagn 2016; 36:1276-1279. [DOI: 10.1002/pd.4965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/19/2016] [Accepted: 11/04/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Marguerite Miguet
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace (IGMA), Centre de Référence Maladies Rares Anomalies du Développement et Syndromes Malformatifs de l'Est, Hôpitaux Universitaires de Strasbourg; Hôpital de Hautepierre; Strasbourg France
| | - Julien Thevenon
- FHU TRANSLAD, Centre de Référence Maladies Rares, Anomalies du Développement et Syndromes Malformatifs de l'Est, Centre de Génétique; CHU de Dijon; Dijon France
- GAD: EA 4271, Génétique et Anomalies du Développement (GAD); Université de Bourgogne; Dijon France
| | - Vincent Laugel
- Service de Neuropédiatrie, Hôpitaux Universitaires de Strasbourg; Hôpital de Hautepierre; Strasbourg France
- U1112 Laboratoire de Génétique Médicale, Faculté de Médecine; Université de Strasbourg; Strasbourg France
| | - Mathilde Lefebvre
- FHU TRANSLAD, Centre de Référence Maladies Rares, Anomalies du Développement et Syndromes Malformatifs de l'Est, Centre de Génétique; CHU de Dijon; Dijon France
| | - Aurélie Bourchany
- FHU TRANSLAD, Centre de Référence Maladies Rares, Anomalies du Développement et Syndromes Malformatifs de l'Est, Centre de Génétique; CHU de Dijon; Dijon France
| | - Jean-Baptiste Rivière
- GAD: EA 4271, Génétique et Anomalies du Développement (GAD); Université de Bourgogne; Dijon France
- Laboratoire de Biologie Moléculaire, Plateau Technique de Biologie; CHU de Dijon; Dijon France
| | - Yannis Duffourd
- GAD: EA 4271, Génétique et Anomalies du Développement (GAD); Université de Bourgogne; Dijon France
- Laboratoire de Biologie Moléculaire, Plateau Technique de Biologie; CHU de Dijon; Dijon France
| | - Elise Schaefer
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace (IGMA), Centre de Référence Maladies Rares Anomalies du Développement et Syndromes Malformatifs de l'Est, Hôpitaux Universitaires de Strasbourg; Hôpital de Hautepierre; Strasbourg France
| | | | - Rosalie Abida
- Centre de Ressources Biologiques; Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Anne-Sophie Weingertner
- Service de Gynécologie-Obstétrique; Centre Médico-Chirurgical et Obstétrical; Schiltigheim France
| | - Valérie Kremer
- Service de Cytogénétique, Hôpitaux Universitaires de Strasbourg; Hôpital de Hautepierre; Strasbourg France
| | - Pierre Vabres
- Service de Dermatologie; CHU de Dijon; Dijon France
- GAD: EA 4271, Génétique et Anomalies du Développement (GAD); Université de Bourgogne; Dijon France
| | - Fanny Morice-Picard
- Unité de Dermatologie Pédiatrique, CHU de Bordeaux; Hôpital Pellegrin; Bordeaux France
| | - Marie Gonzales
- Département de Génétique Médicale, CHU Paris Est, Hôpital Armand Trousseau; APHP et UPMC; Paris France
| | - Dan Lipsker
- Service de Dermatologie, Hôpitaux Universitaires de Strasbourg; Hôpital civil; Strasbourg France
| | - Sylvie Fraitag
- Département de Pathologie, Hôpital Necker-Enfants Malades; APHP; Paris France
| | - Jean-Louis Mandel
- Laboratoire de Diagnostic Génétique, Hôpitaux Universitaires de Strasbourg; Nouvel Hôpital Civil; Strasbourg France
| | - Jamel Chelly
- Laboratoire de Diagnostic Génétique, Hôpitaux Universitaires de Strasbourg; Nouvel Hôpital Civil; Strasbourg France
| | - Hélène Dollfus
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace (IGMA), Centre de Référence Maladies Rares Anomalies du Développement et Syndromes Malformatifs de l'Est, Hôpitaux Universitaires de Strasbourg; Hôpital de Hautepierre; Strasbourg France
- U1112 Laboratoire de Génétique Médicale, Faculté de Médecine; Université de Strasbourg; Strasbourg France
| | - Laurence Faivre
- FHU TRANSLAD, Centre de Référence Maladies Rares, Anomalies du Développement et Syndromes Malformatifs de l'Est, Centre de Génétique; CHU de Dijon; Dijon France
- GAD: EA 4271, Génétique et Anomalies du Développement (GAD); Université de Bourgogne; Dijon France
| | - Christel Thauvin-Robinet
- FHU TRANSLAD, Centre de Référence Maladies Rares, Anomalies du Développement et Syndromes Malformatifs de l'Est, Centre de Génétique; CHU de Dijon; Dijon France
- GAD: EA 4271, Génétique et Anomalies du Développement (GAD); Université de Bourgogne; Dijon France
| | - Nadège Calmels
- Laboratoire de Diagnostic Génétique, Hôpitaux Universitaires de Strasbourg; Nouvel Hôpital Civil; Strasbourg France
| | - Salima El Chehadeh
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace (IGMA), Centre de Référence Maladies Rares Anomalies du Développement et Syndromes Malformatifs de l'Est, Hôpitaux Universitaires de Strasbourg; Hôpital de Hautepierre; Strasbourg France
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12
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Sananès N, Veujoz M, Severac F, Barthoulot M, Meyer N, Weingertner AS, Kohler M, Guerra F, Gaudineau A, Nisand I, Favre R. Evaluation of the Utility of in utero Treatment of Twin Anemia-Polycythemia Sequence. Fetal Diagn Ther 2015; 38:170-8. [PMID: 25790745 DOI: 10.1159/000380822] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/09/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the interest in the in utero treatment of twin anemia-polycythemia sequence (TAPS). METHODS The obstetrical and neonatal data on all cases of TAPS followed up in our institution between 2006 and 2013 were reviewed. Statistical analyses were conducted using Bayesian methods. RESULTS Twenty cases of TAPS were included. Laser therapy or intrauterine transfusion (IUT) was performed on the donor twin in 9 cases. Eleven cases were included in the 'nontreated' group (managed expectantly or diagnosed at birth). The gestational age at diagnosis was lower in the group with treated TAPS [difference (diff) = -22.20 days (-57.13, 14.28), probability (Pr) (diff >0) = 10.6%]. The rate of preterm premature rupture of membranes was higher in the group with treated TAPS [diff = 22.5% (-14, 57), Pr (diff >0) = 89%], but overall mortality was similar. The interval between diagnosis and delivery was longer [diff = 44.37 days (9.41, 77.90), Pr (diff >0) = 99.2%], the TAPS resolution rate was higher [diff = 49.9% (12, 81), Pr (diff >0) = 99.4%], and the neonatal transfusion rate was lower [diff = -30.5% (-60, 0), Pr (diff >0) = 2.6%] in the treated group. CONCLUSION In utero treatment for TAPS is associated with a higher resolution rate of TAPS and a longer time between diagnosis and birth, but overall mortality is the same as with expectant management.
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Affiliation(s)
- Nicolas Sananès
- Department of Obstetrics and Gynecology, Strasbourg University Teaching Hospitals, Strasbourg, France
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13
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Veujoz M, Sananès N, Severac F, Meyer N, Weingertner AS, Kohler M, Guerra F, Gaudineau A, Nisand I, Favre R. Evaluation of prenatal and postnatal diagnostic criteria for twin anemia-polycythemia sequence. Prenat Diagn 2015; 35:281-8. [DOI: 10.1002/pd.4545] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/30/2014] [Accepted: 12/01/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Marine Veujoz
- Department of Obstetrics and Gynecology; Strasbourg University Teaching Hospital; Strasbourg France
- Federation of Translational Medicine; Strasbourg University Teaching Hospital; Strasbourg France
| | - Nicolas Sananès
- Department of Obstetrics and Gynecology; Strasbourg University Teaching Hospital; Strasbourg France
- Federation of Translational Medicine; Strasbourg University Teaching Hospital; Strasbourg France
- INSERM, UMR-S 1121, ‘Biomatériaux et Bioingénierie’; Strasbourg France
| | - François Severac
- Federation of Translational Medicine; Strasbourg University Teaching Hospital; Strasbourg France
- Department of Public Health; Strasbourg University Teaching Hospital; Strasbourg France
| | - Nicolas Meyer
- Federation of Translational Medicine; Strasbourg University Teaching Hospital; Strasbourg France
- Department of Public Health; Strasbourg University Teaching Hospital; Strasbourg France
| | - Anne-Sophie Weingertner
- Department of Obstetrics and Gynecology; Strasbourg University Teaching Hospital; Strasbourg France
- Federation of Translational Medicine; Strasbourg University Teaching Hospital; Strasbourg France
| | - Monique Kohler
- Department of Obstetrics and Gynecology; Strasbourg University Teaching Hospital; Strasbourg France
- Federation of Translational Medicine; Strasbourg University Teaching Hospital; Strasbourg France
| | - Fernando Guerra
- Department of Obstetrics and Gynecology; Strasbourg University Teaching Hospital; Strasbourg France
- Federation of Translational Medicine; Strasbourg University Teaching Hospital; Strasbourg France
| | - Adrien Gaudineau
- Department of Obstetrics and Gynecology; Strasbourg University Teaching Hospital; Strasbourg France
- Federation of Translational Medicine; Strasbourg University Teaching Hospital; Strasbourg France
| | - Israël Nisand
- Department of Obstetrics and Gynecology; Strasbourg University Teaching Hospital; Strasbourg France
- Federation of Translational Medicine; Strasbourg University Teaching Hospital; Strasbourg France
| | - Romain Favre
- Department of Obstetrics and Gynecology; Strasbourg University Teaching Hospital; Strasbourg France
- Federation of Translational Medicine; Strasbourg University Teaching Hospital; Strasbourg France
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14
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Sananès N, Ruano R, Weingertner AS, Regnard P, Salmon Y, Kohler A, Miry C, Mager C, Guerra F, Schneider A, Becmeur F, Leroy J, Dimarcq JL, Debry C, Favre R. Experimental fetal endoscopic tracheal occlusion in rhesus and cynomolgus monkeys: nonhuman primate models. J Matern Fetal Neonatal Med 2014; 28:1822-7. [DOI: 10.3109/14767058.2014.969234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Gapp-Born E, Sananes N, Weingertner AS, Guerra F, Kohler M, Fritz G, Viville B, Gaudineau A, Langer B, Sauleau E, Nisand I, Favre R. Predictive value of cardiovascular parameters in twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol 2014; 44:427-433. [PMID: 24585420 DOI: 10.1002/uog.13351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 02/01/2014] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the prognostic value of the Children's Hospital Of Philadelphia (CHOP) cardiovascular score and the modified myocardial performance index (MPI), in determining the risk of recipient fetal loss in twin-to-twin transfusion syndrome (TTTS). METHODS This cohort study was based on data collected prospectively from 105 pregnancies complicated by TTTS (Quintero stages I-IV) and treated with laser photocoagulation between May 2008 and February 2013. Fetuses underwent detailed anatomical and Doppler ultrasonography with cardiac assessment as part of routine care. CHOP score and right MPI were calculated and cut-offs selected using receiver-operating characteristics curve analysis. These were compared according to loss of recipient fetus, using univariate and multivariate logistic regression. The correlation between CHOP score, MPI and Quintero stage was determined and we investigated differences in MPI before and after laser coagulation in a cohort of 90 recipient fetuses. RESULTS Rates of recipient fetal loss were significantly higher when the CHOP score was ≥ 3 (39.5% vs 12.9%, P = 0.002) and when MPI z-score was > 1.645 (34.5% vs 10.6%, P = 0.004). After adjustment for Quintero stage, the risk of recipient fetal loss remained significantly higher when the CHOP score was ≥ 3 (odds ratio, 3.09; 95% CI, 1.035-9.21). There was a positive correlation between CHOP score, MPI and Quintero stage. MPI was significantly lower after compared with before laser coagulation. CONCLUSION CHOP score and MPI are predictors of recipient fetal loss in TTTS and may be used to supplement Quintero's classification.
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Affiliation(s)
- E Gapp-Born
- Department of Obstetrics and Gynaecology, Strasbourg University Teaching Hospital, Strasbourg, France
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16
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Lecointre L, Sananes N, Weingertner AS, Kohler M, Guerra F, Fritz G, Viville B, Langer B, Nisand I, Favre R. Fetoscopic laser coagulation for twin-twin transfusion syndrome before 17 weeks' gestation: laser data, complications and neonatal outcome. Ultrasound Obstet Gynecol 2014; 44:299-303. [PMID: 24677292 DOI: 10.1002/uog.13375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/22/2014] [Accepted: 03/14/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare laser data, complications and neonatal outcome in pregnancies that undergo 'early' (≤ 17 weeks' gestation) fetoscopic laser ablation of placental vascular anastomoses for twin-twin transfusion syndrome (TTTS) with those from 'conventional' cases treated after 17 weeks. METHODS This was a cohort study of data collected prospectively between January 2004 and December 2012. We included monochorionic diamniotic twin pregnancies complicated by TTTS and treated by fetoscopic laser coagulation. Pregnancies were grouped according to laser treatment ≤ 17 gestational weeks or > 17 weeks and obstetric and neonatal outcomes were compared between groups. RESULTS A total of 178 pregnancies with TTTS underwent laser therapy: 40 at or before 17 weeks and 138 after 17 weeks. There was no statistically significant difference between these two groups with respect to the rate of preterm prelabor rupture of membranes (PPROM), gestational age at PPROM and rate of PPROM occurring in the 7 days following fetoscopic laser coagulation. In the early group, the interval between performing fetoscopic laser coagulation and the time of delivery was significantly longer (104 days vs 74 days, P=0.0002) and the delivery rate within 7 days of laser treatment was significantly lower (2.5% vs 15.9%, P=0.026). There was no significant difference between the two groups with regard to the rates of pregnancy without live birth (15.4% vs 15.4%, P=0.993), with one live birth (84.6% vs 84.6%, P=0.993) and with two live births (64.1% vs 58.1%, P=0.500). CONCLUSION In the event of early TTTS, fetoscopic laser coagulation is technically feasible before 17 gestational weeks and obstetric and neonatal outcomes are comparable with those in cases of laser treatment performed after 17 weeks.
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Affiliation(s)
- L Lecointre
- Fetal Medicine, CMCO-HUS, Schiltigheim/Strasbourg, France
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17
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Slaghekke F, Favre R, Peeters SHP, Middeldorp JM, Weingertner AS, van Zwet EW, Klumper FJ, Oepkes D, Lopriore E. Laser surgery as a management option for twin anemia-polycythemia sequence. Ultrasound Obstet Gynecol 2014; 44:304-310. [PMID: 24706478 DOI: 10.1002/uog.13382] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/27/2014] [Accepted: 03/27/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of laser treatment for antenatally detected twin anemia-polycythemia sequence (TAPS) compared with intrauterine transfusion or expectant management. METHODS All monochorionic twin pregnancies with TAPS managed between 2005 and 2013 in two European fetal therapy centers were evaluated. The outcomes of TAPS cases treated primarily with laser surgery were compared with the outcomes of cases managed expectantly or treated with intrauterine transfusion. RESULTS In this retrospective study 52 cases of TAPS were detected antenatally and were managed with either laser surgery (n=8; 15%) or intrauterine blood transfusion (n=17; 33%) or expectantly (n=27; 52%). Perinatal survival in the laser group was 94% (15/16) vs 85% (29/34) in the intrauterine-transfusion group and 83% (45/54) in the expectant-management group (P=0.30). The rates of severe neonatal morbidity in liveborn neonates in the laser, intrauterine-transfusion and expectant-management groups were 7% (1/15), 38% (12/32) and 24% (12/50), respectively (P=0.17). There was a significant reduction in respiratory distress syndrome in cases treated by laser. No severe postnatal hematological complications were detected in the laser group compared with 72% (23/32) in the intrauterine-transfusion group and 52% (26/50) in the expectant-management group (P<0.01). Median time between diagnosis and birth was 11 weeks in the laser group compared to 5 weeks after intrauterine transfusion and 8 weeks after expectant management (P<0.01). After injection of colored dye no residual anastomoses were found in the laser group. CONCLUSIONS Laser surgery for TAPS appears to improve perinatal outcome by prolonging pregnancy and reducing respiratory distress syndrome. Larger, adequately controlled studies are needed to reach firm conclusions on the optimal management of TAPS.
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Affiliation(s)
- F Slaghekke
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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18
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Slaghekke F, Lopriore E, Lewi L, Middeldorp JM, van Zwet EW, Weingertner AS, Klumper FJ, DeKoninck P, Devlieger R, Kilby MD, Rustico MA, Deprest J, Favre R, Oepkes D. Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: an open-label randomised controlled trial. Lancet 2014; 383:2144-51. [PMID: 24613024 DOI: 10.1016/s0140-6736(13)62419-8] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Monochorionic twin pregnancies complicated by twin-to-twin transfusion syndrome are typically treated with fetoscopic laser coagulation. Postoperative complications can occur due to residual vascular anastomoses on the placenta. We aimed to assess the efficacy and safety of a novel surgery technique that uses laser coagulation of the entire vascular equator (Solomon technique). METHODS We undertook an open-label, international, multicentre, randomised controlled trial at five European tertiary referral centres. Women with twin-to-twin transfusion syndrome were randomly assigned by online randomisation (1:1) with permuted blocks to the Solomon technique or standard laser coagulation. The primary outcome was a composite of incidence of twin anaemia polycythaemia sequence, recurrence of twin-to-twin transfusion syndrome, perinatal mortality, or severe neonatal morbidity. Analyses were by intention to treat, with results expressed as odds ratios (ORs) and 95% CIs. This trial is registered with the Dutch Trial Registry, number NTR1245. FINDINGS Between March 11, 2008, and July 12, 2012, 274 women were randomly assigned to either the Solomon group (n=139) or the standard treatment group (n=135). The primary outcome occurred in 94 (34%) of 274 fetuses in the Solomon group versus 133 (49%) of 270 in the standard treatment group (OR 0·54; 95% CI 0·35-0·82). The Solomon technique was associated with a reduction in twin anaemia polycythaemia sequence (3% vs 16% for the standard treatment; OR 0·16, 95% CI 0·05-0·49) and recurrence of twin-to-twin transfusion syndrome (1% vs 7%; 0·21, 0·04-0·98). Perinatal mortality and severe neonatal morbidity did not differ significantly between the two groups. Outside of the common and well-known complications of twin-to-twin transfusion syndrome and its treatment, no serious adverse events occurred. INTERPRETATION Fetoscopic laser coagulation of the entire vascular equator reduces postoperative fetal morbidity in severe twin-to-twin transfusion syndrome. We recommend that fetoscopic surgeons consider adopting this strategy for treatment of women with twin-to-twin transfusion syndrome. FUNDING Netherlands Organization for the Health Research and Development (ZonMw 92003545).
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Affiliation(s)
- Femke Slaghekke
- Department of Obstetrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Liesbeth Lewi
- Department of Obstetrics, University Hospitals KU Leuven, Leuven, Belgium
| | | | - Erik W van Zwet
- Department of Medical Statistics, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Frans J Klumper
- Department of Obstetrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Philip DeKoninck
- Department of Obstetrics, University Hospitals KU Leuven, Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics, University Hospitals KU Leuven, Leuven, Belgium
| | - Mark D Kilby
- Fetal Medical Centre, Birmingham Women's Foundation Trust and University of Birmingham, Edgbaston, Birmingham, UK
| | - Maria Angela Rustico
- Department of Obstetrics, Fetal Therapy Unit, Children's Hospital Vittore Buzzi, Milan, Italy
| | - Jan Deprest
- Department of Obstetrics, University Hospitals KU Leuven, Leuven, Belgium
| | - Romain Favre
- Department of Obstetrics, University Hospital of Strasbourg, Strasbourg, France
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Centre, Leiden, Netherlands.
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19
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Slaghekke F, Lewi L, Middeldorp J, Weingertner AS, Klumper F, DeKoninck P, Devlieger R, Kilby M, Rustico M, Deprest J, Favre R, Oepkes D, Lopriore E. 173: Residual anastomoses after fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Sananès N, Schuller E, Gaudineau A, Kohler M, Guerra F, Weingertner AS, Fritz G, Viville B, Langer B, Nisand I, Favre R. What is predictive of preterm delivery in the first trimester: isthmus or cervical length? Prenat Diagn 2013; 33:894-8. [PMID: 23733613 DOI: 10.1002/pd.4158] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aims to evaluate the utility of first trimester cervical ultrasonography in predicting preterm delivery by separate analysis of measurements of cervical and isthmus length. METHODS This is a cohort study based on data collected prospectively on singletons between 1 July 2011 and 1 February 2013. Mean cervical, isthmus and cervico-isthmic complex length were measured for deliveries before and after 37 weeks. RESULTS A total of 1494 pregnancies were analysed, including 51 cases of spontaneous preterm delivery (3.4%). The cervico-isthmic complex in the first trimester was significantly shorter in patients who delivered before term (43.8 mm vs 47.5 mm, p = 0.04). This difference is related to differences in length at the isthmus (10.7 mm vs 14.1 mm, p = 0.005) rather than at the cervix proper (34.5 mm vs 35.0 mm, p = 0.56). CONCLUSIONS Measurement of the cervico-isthmic complex enables detection of a number of patients who will go on to deliver before term. Further studies are necessary to confirm that isthmic length and not cervical length is predictive of preterm delivery.
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Affiliation(s)
- Nicolas Sananès
- Department of Obstetrics and Gynecology, Strasbourg University Teaching Hospital, Strasbourg, France.
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21
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Kuhn-Beck F, Moutel G, Weingertner AS, Kohler M, Hornecker F, Hunsinger MC, Kohler A, Mager C, Neumann M, Nisand I, Favre R. Fetal reduction of triplet pregnancy: one or two? Prenat Diagn 2012; 32:122-6. [PMID: 22418954 DOI: 10.1002/pd.2906] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To review outcomes following reductions in trichorionic triplet pregnancies at our institution. METHOD Retrospective analysis of the outcome of trichorionic triamniotic triplets reduced to singletons (group I, n = 44) or twins (group II, n = 136) at 10 and 12 weeks of gestation. RESULTS Reduction to one or two was based on parent's preference, hence unrelated to any specific obstetrical or maternal issue. Early fetal loss rate (e.g. <24 weeks) was 9.1% in group I versus 5.1% in group II (p = 0.83). In group I, the take-home baby rate was 86.4% versus 91.9% in group II (p = 0.8). In group I, 17.5% of the women gave birth between 33 and 36(+6) weeks of gestation versus 40.6% in group II (p = 0.026). Delivery beyond 37 weeks was 72.5% in group I and 46.9% in group II (p = 0.01). Intrauterine growth restriction rate was 27.0% in group I versus 45.0% in group II (p = 0.049). CONCLUSION Reduction to one rather than two fetuses led to significantly higher term delivery rate without significant differences in fetal loss rate or take-home baby rate.
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Affiliation(s)
- F Kuhn-Beck
- Département d'Echographie et de Médecine Fœtale, Hôpitaux Universitaire de Strasbourg-Centre Médico-Chirurgical et Obstétrical (HUS-CMCO), Schiltigheim, France.
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22
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Weingertner AS, Kohler A, Kohler M, Bouffet N, Hunsinger MC, Mager C, Hornecker F, Neumann M, Schmerber E, Tanghe M, Viville B, Favre R. Clinical and placental characteristics in four new cases of twin anemia-polycythemia sequence. Ultrasound Obstet Gynecol 2010; 35:490-494. [PMID: 20069657 DOI: 10.1002/uog.7508] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report and analyze four new cases of spontaneous twin anemia-polycythemia sequence (TAPS) and discuss antenatal management by fetoscopic laser coagulation for this uncommon form of chronic intertwin transfusion. The clinical course and placental characteristics of four pairs of monochorionic-diamniotic (MCDA) twins with spontaneous TAPS, of which one was treated with fetoscopic laser surgery, are described. For the three cases that did not undergo intrauterine intervention, serial Doppler measurement revealed a gradual increase in the middle cerebral artery peak systolic velocity (MCA-PSV) in the donor and a concomitant decrease in the recipient. These twins were born at between 32 and 34 weeks' gestation by Cesarean section. At birth, the donor twins were severely anemic and the recipient twins were polycythemic. Placental injection studies revealed a few small arteriovenous (AV) and venoarterial anastomoses. In the fourth case, because of the high suspicion of TAPS on MCA-PSV data at 24 weeks' gestation, fetoscopic laser coagulation of three small AV anastomoses was successfully performed. No hematological abnormalities were detected at birth. TAPS is a newly described form of chronic twin-to-twin transfusion associated with chronic anemia in the donor and polycythemia in the recipient, without twin oligo-polyhydramnios sequence (TOPS). The monitoring of MCDA pregnancies should include measurement of MCA-PSV in both fetuses even in the absence of intertwin discordance in amniotic fluid volume. Early detection of TAPS could indicate fetoscopic laser coagulation of AV anastomoses.
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Affiliation(s)
- A S Weingertner
- Department of Fetal Medicine, CMCO-SIHCUS, Schiltigheim, France.
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23
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Weingertner AS, Rodriguez B, Ziane A, Gibon E, Thoma V, Osario F, Haddad C, Wattiez A. The use of JJ stent in the management of deep endometriosis lesion, affecting or potentially affecting the ureter: a review of our practice. BJOG 2008; 115:1159-64. [DOI: 10.1111/j.1471-0528.2008.01795.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Weingertner AS, Kohler M, Firtion C, Vayssière C, Favre R. Interest of foetal nasal bone measurement at first trimester trisomy 21 screening. Fetal Diagn Ther 2006; 21:433-8. [PMID: 16912493 DOI: 10.1159/000093886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Accepted: 10/17/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The purpose of this study is to assess the feasibility of foetal nasal bone (NB) measurement during the first trimester of pregnancy, and to examine the contribution of this measurement to the prenatal screening for Down syndrome following the definition of NB threshold using ROC curves in an unselected population. METHODS This prospective study was carried out at our centre SIHCUS-CMCO (reference centre) from January 2002 to December 2004 on a total of 2,044 pregnant outpatients at gestational weeks 11-14. Only 1260 singleton foetuses were used for statistical analysis. In the 784 other patients, we were unable to obtain a correct image allowing a reproducible measurement. NB was measured during the same session as nuchal translucency (NT) measurement. Ten trained sonographers took part in the study. Correlation index was evaluated to shed light on a link between interest variables and NB. Screening values of NB measurement in T 21 were also calculated with NB measurement according to crown-rump length, and expressed as the best threshold of multiple of the median determined by ROC curve. Screening values of genetic ultrasound were then evaluated by adding NB measurement to maternal age and NT measurement. RESULTS Two thousand and forty-four patients were included. We indexed 30 cases of T 21, 14 cases of Trisomy 18, 10 cases of Trisomy 13 and 25 cases of other karyotype abnormalities. Feasibility of measurement was 62% of all cases. We observed a significant relation between NB and NT (p = 0.001 ), as well as between NB and crown-rump-length (p < 0.0001 ). However, size of NB was not correlated to maternal ethnic group (p = 0.314). At 0.6 multiple of the median thresholds, screening values of NB measurement in T 21 were: sensibility 32%, false positive rate 10%, positive predictive value 13.6%, and negative predictive value 96.9%. The likelihood ratio for T 21 in case of NB < or = 0.6 multiple of the median was 4.4 (2.0-9.4). Screening values for maternal age and NT measurement were: sensitivity 88%, false positive rate 23%,positive predictive value 9.7%, and negative predictive value 99.6%. Inclusion of NB measurement increased sensitivity to 100%, positive predictive value to 13.6%, and negative predictive value to 100%, and decreased false positive rate to 5%. CONCLUSION NB measurement seemed to be a great sonographic marker for T 21. However, its low feasibility made it inadequate for routine settings in first trimester T 21 screening in an unselected population. Statistical independence with NT thickness needed to be further evaluated.
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Affiliation(s)
- A S Weingertner
- Department of Obstetric & Gynaecology, Syndicat Inter-Hospitalier de la Communauté Urbaine de Strasbourg, Centre Médico, Chirurgical et Obstétrical, Schiltigheim, France
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Abstract
BACKGROUND The initial manifestation of a lymphoma as an ovarian mass is unusual, with a reportedly poor prognosis. An exploratory laparotomy is often performed as the ovarian tumor can mimic an advanced epithelial carcinoma. The criteria of lymphoma used in the selection of a nonsurgical approach, that is, chemotherapy possibly associated with radiation, are rarely defined. CASE We report the case of a 36-year-old woman who presented with an ovarian tumor suggestive of advanced carcinoma. After an initial approach including optimal surgery, the diagnosis of large B-cell CD30+ non-Hodgkin malignant lymphoma was established. Complete remission was obtained after a chemotherapy regimen, appropriate to the specific histologic type of the lymphoma. CONCLUSION The choice treatment of ovarian non-Hodgkin lymphoma (NHL) is chemotherapy. In the presence of an ovarian tumor, the possibility of ovarian NHL must be considered, and its clinical, biological, and/or radiological signs must be actively sought. Controlled biopsies must also be included to avoid mutilating surgery.
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Affiliation(s)
- A S Weingertner
- Department of Obstetrics and Gynaecology, University Hospital of Strasbourg, 1 Avenue Moliere, 67098 Strasbourg Cedex, France
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