No abstract

of this review was to summarise available evidences concerning prenatal diagnosis and neonatal outcomes of LBCV anomalies (LBCVA) with particular interest to the risk of congenital heart disease (CHD), extracardiac (ECA) or genetic abnormalities. Methods: The web-based databases were extensively searched and 13 studies were retrieved from literature, with a total of 308 cases of LBCVA. Six cases from our series of pregnancies were added to cases from literature. Pooled proportions were calculated for risk of associated CHD, ECA or genetic abnormalities and obstetric outcomes. Results: 308 cases of LBCVA were collected, of which: 107 abnormal courses; 177 absent LBCV with a left superior vena cava (5 with absent right SVC); 20 LBCV dilation; 2 double LBVC. Of 308 cases of LBCVA 234 (75,9%) had an associated CHD (70,6% in retroesophageal, 65,5% in subaortic and 4,3% in intrathymic LBCV). Absent and double LBCV were always associated with CHD. ECAs were reported in 10 cases (3.2%). Genetic data were available in 19 fetuses; in 6 there was a genetic anomaly, with 3 cases of RASopathy. Neonatal outcomes were available for 64 fetuses of which 51 (79,7%) were normal. Conclusions: LBCVA are generally isolated defects with uncertain prevalence and rare prenatal detection. Unlike intrathymic forms, absent, double, subaortic, retroesophageal and dilated LBCV are frequently associated with CHD. Data on genetic abnormalities are scarce with higher risk for retroesophageal and subaortic courses. Neonatal outcomes were available for a minority of cases and it was favourable in most fetuses with intrathymic course, absent or dilated LBCV.

Objectives: To review our experience with selective termination in multiple pregnancies, especially in complicated monochorionic (MC) twin pregnancies, using ultrasound-guided radiofrequency ablation (RFA). Methods: Consecutive cases of complicated MC pregnancies and some multiple pregnancies with an indication for selective termination by ultrasound guided coagulation of the umbilical cord with RFA under local anesthesia between July 2013 and January 2020 were reviewed. We analysed the indications, gestational age at the procedure, cycles of RFA, the duration of RFA, and perinatal outcome. Results: 313 cases were treated during this period, and 7 cases' data were missed. The total left cases three hundred and six, including 266 pairs of MCDA (86.93%), two pairs of monoamniotic twins (0.65%), 30 DCTA triplets (1%), and 3 MCTA triplets (0.98%). Indications included Twin-twin transfusion syndrome (TTTS) (n=91), selective fetal growth restriction (sFGR) (n= 83), severe discordant structural malformation in one twin (n=78), multifetal pregnancy reduction (MFPR) (n=78), twin reverse arterial perfusion sequence (TRAPS) (n=19), and twin anemia polycythemia sequence (TAPS) (n=3). Comparing RFA done before and after 20 weeks, the co-twin loss rate was 20.9% vs. 21.5%; (p = 0.22), PPROM within 24 hours (1.5% vs. 1.2%; p = 0.145), and the median gestational age at delivery (36.02 ± 3.62 weeks vs. 36.07 ± 3.14 weeks; p < 0.001) were similar. Conclusions: RFA technique is a reasonable option when the normal fetal development is severely affected in multiple pregnancies. In our experience, the overall survival rate is 78.76% with RFA in selective feticide. The fetal loss rate is similar before 20 weeks and afterwards. OC17.04Twin-twin transfusion syndrome and COVID-19: impact on diagnosis, referral and eligibility for fetoscopic laser therapy and outcomes

Objectives: Radiofrequency ablation (RFA) is one of the best methods of fetal reduction to improve monochorionic pregnancy outcome; however, twins treated by RFA are still at increased risk of neurodevelopmental impairment. The aim of this study was to investigate the accuracy of fetal ultrasound, conventional magnetic resonance imaging (MRI), and diffusion-weighted imaging (DWI), in diagnosis of intracranial lesions especially hypoxic ischemic brain injury in the survivors. Methods: 43 monochorionic twins with mean gestational age of 20.2 weeks underwent RFA and were assessed between 2018-2020 by ultrasound and MRI (conventional and DWI sequences). Fetal brain imaging was performed in the surviving fetuses, at early (within 10 days after RFA) and late phase (after 3-6 weeks), to determine both acute and chronic ischemic lesions. Presence of anemia after RFA was also evaluated by Doppler ultrasound. Results: Overall, 13 of total 43 (30.2%) fetuses demonstrated MRI abnormalities with normal brain ultrasound results and no anemia including ten germinal matrix hemorrhage (GMH), two extensive cerebral ischemia in DWI and one mild ventriculomegaly. Also, totally 13 (30.2%) fetuses died in utero including 6 fetuses because of PROM, and two cases with extensive cerebral infarct and 5 cases with unknown etiology. Seven fetuses with GMH were eventually born alive with normal outcome. Besides, anemia was noted in 3 (6.9%) fetuses without abnormal findings on MRI. The postnatal investigations of the survivors showed no abnormalities. Conclusions: Fetal brain DWI can detect early intracranial ischemic changes in monochorionic pregnancies after RFA of one fetus, better than ultrasound. GMH seems to be a frequent finding and can be considered with little clinical significance. Normal brain ultrasound and no evidence of anemia in Doppler exam do not necessarily rule out fetal brain ischemia, and performing DWI in early phase is helpful in multiple pregnancies undergoing RFA for better management of pregnancy.