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ABSTRACT Objective Methods Results Conclusions To assess the validity of the Fetal Medicine Foundation (FMF) chorionicity‐specific models for fetal growth in twin pregnancy.This was an external validation study of the FMF models using a nationwide Danish cohort of twin pregnancies. The cohort included all dichorionic (DC) and monochorionic diamniotic (MCDA) twin pregnancies with an estimated delivery date between 2008 and 2018, which satisfied the following inclusion criteria: two live fetuses at the first‐trimester ultrasound scan (11–14 weeks' gestation); biometric measurements available for the calculation of estimated fetal weight (EFW) using the Hadlock‐3 formula; and delivery of two liveborn infants. Validation involved assessing the distributional properties of the models and estimating the mean EFW Z‐score deviations. Additionally, the models were applied to pregnancies that delivered preterm and attended non‐scheduled visits (complicated pregnancies).Overall, 8542 DC and 1675 MCDA twin pregnancies met the inclusion criteria. In DC twins, 17 084 fetuses were evaluated at a total of 95 346 ultrasound scans, of which 44.5% were performed at scheduled visits in pregnancies carried to 37 + 0 weeks or later. The median number of growth scans per DC twin fetus from 20 + 0 weeks onwards was four. The model showed good agreement with the validation cohort for scheduled visits in DC twins delivered at 37 + 0 weeks or later (mean EFW Z‐score, –0.14 ± 1.05). In MCDA twins, 3350 fetuses underwent 31 632 eligible ultrasound scans, of which 59.5% were performed at scheduled visits in pregnancies carried to 36 + 0 weeks or later. The median number of growth scans per MCDA twin fetus from 16 + 0 weeks onwards was 10. The model showed favorable agreement with the validation cohort for scheduled visits in MCDA twins delivered at 36 + 0 weeks or later (mean EFW Z‐score, –0.09 ± 1.01). Non‐scheduled visits and preterm delivery before 37 + 0 weeks for DC twins and before 36 + 0 weeks for MCDA twins corresponded with smaller weight estimates, which was consistent with the study's definition of complicated pregnancy.The FMF models provide a good fit for EFW measurements in our Danish national cohort of uncomplicated twin pregnancies assessed at routine scans. Therefore, the FMF models establish robust criteria for subsequent investigations and potential clinical applications. Future research should focus on exploring the consequences of clinical implementation, particularly regarding the identification of twins that are small‐for‐gestational age, as they are especially susceptible to adverse perinatal outcome. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: Uterine fibroids are monoclonal tumors, which are often genetically abnormal and associated with false‐positive genome‐wide cell‐free DNA (cfDNA) screening results, particularly when large. It is plausible that fibroids may also increase the risk of cfDNA failure by affecting fetal fraction or due to their genetic anomalies confounding cfDNA algorithms. We aimed to investigate a possible association between fibroids and cfDNA non‐informative results. Methods: This was a retrospective cohort study of women undergoing cfDNA screening for fetal chromosomal abnormalities between 2013 and 2020, comparing pregnancies with vs without uterine fibroids recorded on any obstetric ultrasound before 24 weeks' gestation. Univariable and multivariable logistic regression models were used to investigate the association between fibroids and cfDNA failure, adjusting for gestational age, maternal age, weight and height at blood sampling, mode of conception, multiple gestation and test platform (chromosome‐selective or genome‐wide). Analyses were stratified according to the number of fibroids and total fibroid volume. The impact of fibroids on fetal fraction was assessed using linear regression, adjusting for the same covariates. Results: Among 19 818 pregnancies undergoing cfDNA screening, fibroids were reported in 2038 (10.28%) and cfDNA failure at the first screening attempt occurred in 228 (1.15%) pregnancies. Non‐informative results occurred in 1.96% of pregnancies with fibroids and 1.06% of pregnancies without fibroids (adjusted odds ratio (aOR), 2.40 (95% CI, 1.65–3.48)). The risk of failure in the first screening attempt increased progressively with the number of fibroids (aOR, 5.05 (95% CI, 2.29–11.13) in women with four or more fibroids) and total fibroid volume, with greater than a 5‐fold and 14‐fold increase in risk among women with fibroid volumes of 100.1–400 mL (aOR, 5.52 (95% CI, 2.30–13.25)) and > 400 mL (aOR, 14.80 (95% CI, 4.50–48.69)), respectively. Although test failure was more common with chromosome‐selective than genome‐wide screening, fibroids similarly increased the risk of failure of both screening platforms. Compared to pregnancies without fibroids, those with fibroids had a fetal fraction on average 0.61% lower (adjusted mean difference, −0.61% (95% CI, −0.77% to −0.45%)). Conclusion: Uterine fibroids are associated with lower fetal fraction and an increased risk of cfDNA screening failure. The strength of this association increases with increasing fibroid number and volume. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. Linked article: There is a comment on this article by Li. Click here to view the Correspondence. [ABSTRACT FROM AUTHOR]

Objectives: Twin pregnancies are at higher risk of stillbirth compared to singletons. Fetal growth restriction (FGR) is a major cause of perinatal mortality, but its impact on twins vs singletons remains unclear. The primary objective of this study was to investigate the association of FGR and small‐for‐gestational age (SGA) with stillbirth in twin compared with singleton pregnancies. A secondary objective was to assess these associations stratified by gestational age at delivery. Furthermore, we aimed to compare the associations of FGR and SGA with stillbirth in twin pregnancies using twin‐specific vs singleton birth‐weight charts, stratified by chorionicity. Methods: This was a retrospective cross‐sectional study of pregnancies receiving obstetric care and giving birth between 1999 and 2022 at St George's Hospital, London, UK. The exclusion criteria included triplet and higher‐order pregnancies, those resulting in miscarriage or live birth at ≤ 23 + 6 weeks, termination of pregnancy and missing data regarding birth weight or gestational age at birth. Birth‐weight data were collected and FGR and SGA were defined as birth weight <5th and <10th centiles, respectively. While standard logistic regression was used for singleton pregnancies, the association of FGR and SGA with stillbirth in twin pregnancies was investigated using mixed‐effects logistic regression models. For twin pregnancies, intercepts were allowed to vary for twin pairs to account for intertwin dependency. Analyses were stratified by gestational age at delivery and chorionicity. Statistical significance was set at P ≤ 0.001. Results: The study included 95 342 singleton and 3576 twin pregnancies. There were 494 (0.52%) stillbirths in singleton and 41 (1.15%) stillbirths in twin pregnancies (17 dichorionic and 24 monochorionic). SGA and FGR were associated significantly with stillbirth in singleton pregnancies across all gestational ages at delivery: the odds ratios (ORs) for SGA and FGR were 2.36 ((95% CI, 1.78–3.13), P < 0.001) and 2.67 ((95% CI, 2.02–3.55), P < 0.001), respectively, for delivery before 32 weeks; 2.70 ((95% CI, 1.71–4.31), P < 0.001) and 2.82 ((95% CI, 1.78–4.47), P < 0.001), respectively, for delivery between 32 and 36 weeks; and 3.85 ((95% CI, 2.83–5.21), P < 0.001) and 4.43 ((95% CI, 3.16–6.12), P < 0.001), respectively, for delivery after 36 weeks. In twin pregnancies, when stratified by gestational age at delivery, both SGA and FGR determined by twin‐specific birth‐weight charts were associated with increased odds of stillbirth for those delivered before 32 weeks (SGA: OR, 3.87 (95% CI, 1.56–9.50), P = 0.003 and FGR: OR, 5.26 (95% CI, 2.11–13.01), P = 0.001), those delivered between 32 and 36 weeks (SGA: OR, 6.67 (95% CI, 2.11–20.41), P = 0.001 and FGR: OR, 9.54 (95% CI, 3.01–29.40), P < 0.001) and those delivered beyond 36 weeks (SGA: OR, 12.68 (95% CI, 2.47–58.15), P = 0.001 and FGR: OR, 23.84 (95% CI, 4.62–110.25), P < 0.001). However, the association of stillbirth with SGA and FGR in twin pregnancies was non‐significant when diagnosis was based on singleton charts (before 32 weeks: SGA, P = 0.014 and FGR, P = 0.005; 32–36 weeks: SGA, P = 0.036 and FGR, P = 0.008; after 36 weeks: SGA, P = 0.080 and FGR, P = 0.063). Conclusion: Our study demonstrates that SGA and, especially, FGR are associated significantly with an increased risk of stillbirth across all gestational ages in singleton pregnancies, and in twin pregnancies when twin‐specific birth‐weight charts are used. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. Linked article: There is a comment on this article by Nicolaides et al. Click here to view the Correspondence. [ABSTRACT FROM AUTHOR]

This article discusses the use of ultrasound in diagnosing vasa previa (VP), a condition where fetal blood vessels cross the cervix. The article explains how three-dimensional (3D) ultrasound can provide more precise information about the location of the vessels. It also describes the different views and techniques used in ultrasound surveys to identify VP. The article emphasizes the importance of accurate diagnosis and the potential risks associated with false-positive and false-negative diagnoses. It concludes by discussing the need for screening and clear protocols for managing VP to improve patient care and outcomes. [Extracted from the article]

Objective: To evaluate twin survival stratified by Quintero stage in patients with twin‐to‐twin transfusion syndrome (TTTS) after Solomon laser treatment. Methods: This was a single‐center study at Johns Hopkins Center for Fetal Therapy, investigating a cohort of consecutive twin pregnancies treated with the Solomon laser technique for TTTS. Preoperative Quintero stage, perioperative characteristics and obstetric factors were investigated in relation to neonatal survival of the recipient and donor twins at discharge. Determinants of twin survival were evaluated using univariate logistic regression and cumulative survival probability analyses. Results: Of 402 pregnancies with TTTS that underwent Solomon laser treatment, 80 (19.9%) were diagnosed with Quintero Stage‐I TTTS, 126 (31.3%) with Stage II, 169 (42.0%) with Stage III and 27 (6.7%) with Stage IV. Post‐laser twin anemia polycythemia sequence or recurrent TTTS occurred in 19 (4.7%) patients and 11 (2.7%) required repeat laser surgery. Preterm prelabor rupture of membranes occurred in 150 (37.3%) patients and median gestational age at delivery was 32 + 1 weeks. In 303 (75.4%) patients, both twins were alive at discharge; 67/80 (83.8%) were Stage I, 101/126 (80.2%) were Stage II, 113/169 (66.9%) were Stage III and 22/27 (81.5%) were Stage IV (P = 0.062). Donor twin survival was lower than that of recipients in cases with Stage‐III TTTS (118/169 (69.8%) vs 145/169 (85.8%) (χ2 = 26.076, P < 0.0001)). Higher intertwin size discordance and absent or reversed umbilical artery (UA) end‐diastolic velocity (EDV) were associated with donor demise (Nagelkerke R2, 0.38; P < 0.001). Overall, spontaneous post‐laser donor demise occurred in 53 (39.6%) patients, accounting for the majority of all losses. Cumulative donor survival decreased from 92% to 65% when intertwin size discordance was >30% and to 48% when UA‐EDV was absent or reversed (P < 0.001). Conclusions: The Solomon laser technique achieves TTTS resolution and double twin survival in a high proportion of cases. Recipient and donor survival is comparable unless there is significant intertwin size discordance and placental dysfunction. This degree of unequal placental sharing, typically found in Stage‐III TTTS, is the primary factor preventing double survival due to a higher rate of donor demise. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To determine the association between elevated (> 1.5 multiples of the median (MoM)) middle cerebral artery (MCA) peak systolic velocity (PSV) and fetal demise of the donor twin in pregnancies complicated by twin–twin transfusion syndrome (TTTS) in the absence of twin anemia–polycythemia sequence (TAPS). Secondary objectives were to evaluate if donor or recipient MCA‐PSV is associated with a risk for their corresponding fetal death, and to compare the proportion of donor fetuses with low MCA pulsatility index (PI) among donor twins with high MCA‐PSV and those with normal MCA‐PSV to evaluate the contribution of blood‐flow redistribution to the fetal brain in donor twins with high MCA‐PSV. Methods: This prospective cohort study included TTTS cases that underwent laser surgery between 2011 and 2022 at a single center. TAPS cases were excluded from the study. Multivariable and Poisson regression analysis were performed to explore the association between isolated elevated donor MCA‐PSV and fetal demise, adjusted for TTTS stage, selective fetal growth restriction (sFGR) and other confounders. Results: Of 660 TTTS cases, donor MCA‐PSV was not recorded in 48 (7.3%) cases. Of the remaining 612 patients, nine (1.5%) were lost to follow‐up and 96 TAPS cases were excluded; thus, 507 cases were included in the study. High donor MCA‐PSV was seen in 6.5% (33/507) of cases and was an independent risk factor for donor fetal demise (adjusted relative risk (aRR), 4.52 (95% CI, 2.72–7.50)), after adjusting for confounders. Regression analysis restricted to each Quintero TTTS stage demonstrated that high donor MCA‐PSV was an independent risk factor for fetal demise of the donor in Quintero Stage II (aRR, 14.21 (95% CI, 1.09–186.2)) and Quintero Stage III (aRR, 3.41 (95% CI, 1.82–6.41)). Donor MCA‐PSV in MoM was associated with fetal demise of the donor (area under the receiver‐operating‐characteristics curve (AUC), 0.69; P < 0.001), but recipient MCA‐PSV in MoM was not associated with fetal demise of the recipient (AUC, 0.54; P = 0.44). A higher proportion of donor twins in the group with high MCA‐PSV had a low MCA‐PI compared to the group with normal MCA‐PSV (33.3% vs 15.5%; P = 0.016). Conclusions: Elevated donor MCA‐PSV without TAPS prior to laser surgery for TTTS is associated with a 4‐fold increased risk for donor fetal demise, adjusted for sFGR, TTTS stage and other confounders. Doppler evaluation of donor MCA‐PSV prior to laser surgery may help stratify TTTS staging to evaluate the risk of donor fetal demise. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To examine infant outcomes at 3 years of age in monochorionic twin pregnancies with Type‐II or ‐III selective fetal growth restriction (sFGR) and isolated oligohydramnios who underwent fetoscopic laser photocoagulation (FLP). Methods: This multicenter prospective cohort study included monochorionic diamniotic twins that underwent FLP for sFGR between 16 and 25 weeks' gestation. The indication for performing FLP was Type‐II or ‐III sFGR with oligohydramnios of the growth‐restricted (FGR) twin in which the maximum vertical pocket of amniotic fluid was ≤ 2 cm. This was done in the absence of a typical diagnosis of twin–twin transfusion syndrome. The primary outcome was intact survival rate of both infants at the corrected gestational age of 40 weeks and at 3 years of age. Intact survival at the corrected age of 40 weeks was defined as survival without Grade‐III or ‐IV intraventricular hemorrhage or cystic periventricular leukomalacia. Intact survival at 3 years of age was defined as survival without neurodevelopmental morbidity, which included cerebral palsy, neurodevelopmental impairment with a total developmental quotient of < 70, bilateral deafness or bilateral blindness. Results: Among 45 patients with sFGR, 30 (66.7%) were classified as having Type‐II and 15 (33.3%) as Type‐III sFGR. The prevalence of intact survival at the corrected age of 40 weeks was 51.1% (n = 23) in FGR twins and 95.5% (n = 42) in larger twins. The prevalence of intact survival at 3 years of age was 46.7% (n = 21) in FGR twins and 86.4% (n = 38) in larger twins. There was one case of miscarriage. Among the 24 FGR twins who were not classified as having intact survival at 3 years of age, 22 (91.7%) cases suffered fetal or infant demise (other than miscarriage), and there was one case of neurodevelopmental impairment. All larger twins who were not diagnosed with intact survival at 3 years of age (n = 6 (13.6%)) had neurological morbidity. Conclusions: FGR twins and their larger cotwins, when subjected to FLP owing to sFGR coupled with umbilical artery Doppler abnormalities and isolated oligohydramnios, exhibit low rates of neurological morbidity and low mortality, respectively. Therefore, FLP for Type‐II or ‐III sFGR with oligohydramnios may be a feasible management option and one that is preferable to expectant management. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To evaluate longitudinal changes in cervical length (CL) and mean cervical shear wave elastography (CSWE) score in women with a singleton or twin pregnancy who undergo spontaneous preterm birth (sPTB) compared with those who deliver at term. Methods: This was a prospective longitudinal study of unselected women with a singleton or twin pregnancy attending a dedicated research clinic for screening for sPTB at four timepoints during pregnancy: 11 + 0 to 15 + 6 weeks, 16 + 0 to 20 + 6 weeks, 21 + 0 to 24 + 6 weeks and 28 + 0 to 32 + 6 weeks. At each visit, a transvaginal ultrasound scan was conducted to measure the CL and the CSWE scores in six regions of interest (ROI) (inner, middle and external parts of anterior and posterior cervical lips). The mean CSWE score from the six ROIs was calculated for analysis. Log10 transformation was applied to data to produce a Gaussian distribution prior to statistical analysis. A multilevel mixed‐effects analysis was performed to compare longitudinally CL and CSWE between the sPTB and term‐delivery groups. Results: The final cohort consisted of 1264 women, including 1143 singleton pregnancies, of which 57 (5.0%) were complicated by sPTB, and 121 twin pregnancies, of which 33 (27.3%) were complicated by sPTB. Compared to those who delivered at term, women with sPTB had a lower CL across gestation when controlling for history of cervical surgery, number of fetuses, gestational age (GA) at cervical assessment and the interaction between GA at cervical assessment and sPTB (P < 0.001). Specifically, CL in the sPTB group was significantly lower at 21 + 0 to 24 + 6 weeks (P = 0.039) and 28 + 0 to 32 + 6 weeks (P < 0.001). Twin pregnancies had significantly greater CL throughout pregnancy compared with singleton pregnancies (regression coefficient, 0.01864; P < 0.001). After adjusting for maternal age, weight, height, body mass index and GA at cervical assessment, CSWE score in the sPTB group was significantly lower compared with that in the term‐delivery group across gestation (P = 0.013). However, on analysis of individual visits, CSWE score in the sPTB group was significantly lower than that in the term‐delivery group only at 11 + 0 to 15 + 6 weeks (P = 0.036). There was no difference in CSWE score between singleton and twin pregnancies throughout gestation (regression coefficient, –0.00128; P = 0.937). Conclusions: Women with sPTB have a shorter and softer cervix across gestation compared with those who deliver at term. A shorter cervix in the sPTB group is observed from the late second trimester onwards, while lower cervical stiffness in the sPTB group is observed primarily in the first trimester. CL is significantly lower in singleton pregnancies compared with twin pregnancies, while cervical stiffness does not differ between the two. Our findings indicate that the cervix tends to undergo a softening process prior to shortening in sPTB cases. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: The performance of non‐invasive prenatal screening using cell‐free DNA testing of maternal blood in twin pregnancy is underevaluated, while serum marker‐based strategies yield poor results. This study aimed to assess the performance of non‐invasive prenatal screening for trisomy 21 in twin pregnancy as a first‐tier test. Secondary objectives were to assess its failure rate and factors associated with failure. Methods: This retrospective cohort study included twin pregnancies in which non‐invasive prenatal screening using cell‐free DNA was performed as the primary screening strategy between May 2017 and October 2019. We used the NIPT VeriSeq® test for in‐vitro diagnosis and set a fetal fraction cut‐off of 4% for monochorionic pregnancies and 8% for dichorionic ones. Clinical data and pregnancy outcome were collected from physicians or midwives via a questionnaire or were retrieved directly on‐site. We calculated the performance of non‐invasive cell‐free DNA screening for trisomy 21, analyzed its failure rate and assessed potentially associated factors. Results: Among 1885 twin pregnancies with follow‐up, there were six (0.32%) confirmed cases of trisomy 21. The sensitivity of non‐invasive prenatal screening for trisomy 21 was 100% (95% CI, 54.1–100%) and the false‐positive rate was 0.23% (95% CI, 0.06–0.59%). The primary failure rate was 4.6%, with 4.0% being due to insufficient fetal fraction. A successful result was obtained for 65.4% of women who underwent a new blood draw, reducing the overall failure rate to 2.8%. Maternal body mass index, gestational age at screening as well as chorionicity were significantly associated with the risk of failure. Conclusion: This study provides further evidence of the high performance, at an extremely low false‐positive rate, of non‐invasive prenatal screening in twins as part of a primary screening strategy for trisomy 21. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article discusses a rare type of uterine ectopic pregnancy called intramural pregnancy (IMP). IMP occurs when a pregnancy is implanted within the uterine corpus, above the internal cervical os, separate from the interstitial section of the Fallopian tube. The article presents a case of twin IMP after embryo transfer (ET), which was successfully treated laparoscopically. The patient later conceived again and delivered a healthy baby. The article emphasizes the importance of early and precise diagnosis of IMP, as it can be managed if diagnosed in the first trimester. [Extracted from the article]

Objective: Radiofrequency ablation (RFA) is the preferred approach for selective reduction in complex monochorionic (MC) multiple pregnancies owing to the ease of operation and minimal invasiveness. To optimize the RFA technique and reduce the risk of adverse pregnancy outcome resulting from the heat‐sink effect of RFA therapy, we used an innovative RFA method, in which an electrode needle was expanded incrementally and stepwise. This study aimed to assess the efficacy and safety profile of this novel multistep incremental expansion RFA method for selective fetal reduction in MC twin and triplet pregnancies. Methods: This was a single‐center retrospective cohort study of all MC multiple pregnancies undergoing RFA between March 2016 and October 2022 at our center. The multistep RFA technique involved the use of an expandable needle, which was gradually expanded during the RFA procedure until cessation of umbilical cord blood flow was achieved. The needle used for the single‐step RFA method was fully extended from the start of treatment. Results: In total, 132 MC multiple pregnancies underwent selective reduction using RFA, including 50 cases undergoing multistep RFA and 82 cases undergoing single‐step RFA. The overall survival rates were not significantly different between the multistep and single‐step RFA groups (81.1% vs 72.3%; P = 0.234). Similarly, the rates of preterm prelabor rupture of the membranes within 2 weeks after RFA, procedure‐related complications, spontaneous preterm delivery and pathological findings on cranial ultrasound, as well as gestational age at delivery and birth weight, did not differ between the two groups. However, there was a trend towards a prolonged procedure‐to‐delivery interval following multistep RFA compared with single‐step RFA (median, 109 vs 99 days; P = 0.377). Moreover, the fetal loss rate within 2 weeks after RFA in the multistep RFA group was significantly lower than that in the single‐step RFA group (10.0% vs 24.4%; P = 0.041). The median ablation time was shorter (5.3 vs 7.8 min; P < 0.001) and the median ablation energy was lower (10.2 vs 18.0 kJ; P < 0.001) in multistep compared with single‐step RFA. There were no significant differences in neonatal outcomes following multistep vs single‐step RFA. Conclusions: Overall survival rates were similar between the two RFA methods. However, the multistep RFA technique was associated with a lower risk of fetal loss within 2 weeks after RFA. The multistep RFA technique required significantly less ablation energy and a shorter ablation time compared with single‐step RFA in selective fetal reduction of MC twin and triplet pregnancies. Additionally, there was a trend towards a prolonged procedure‐to‐delivery interval with the multistep RFA technique. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To perform a nationwide study of quadrichorionic quadriamniotic (QCQA) quadruplet pregnancies and to compare the pregnancy outcome in those undergoing fetal reduction with non‐reduced quadruplets and dichorionic diamniotic (DCDA) twin pregnancies from the same time period. Methods: This was a retrospective Danish national register‐based study performed using data from the national Danish Fetal Medicine Database, which included all QCQA quadruplets and all non‐reduced DCDA twin pregnancies with an estimated due date between 2008 and 2018. The primary outcome measure was a composite of adverse pregnancy outcomes, including pregnancy loss or intrauterine death of one or more fetuses. Secondary outcomes included gestational age at delivery, the number of liveborn children, preterm delivery before 28, 32 and 37 gestational weeks and birth weight. Data on pregnancy complications and baseline characteristics were also recorded. Outcomes were compared between reduced and non‐reduced quadruplet pregnancies, and between DCDA pregnancies and quadruplet pregnancies reduced to twins. A systematic literature search was performed to describe and compare previous results with our findings. Results: Included in the study were 33 QCQA quadruplet pregnancies, including three (9.1%) non‐reduced pregnancies, 28 (84.8%) that were reduced to twin pregnancy and fewer than three (6.1%) that were reduced to singleton pregnancy, as well as 9563 DCDA twin pregnancies. Overall, the rate of adverse pregnancy outcome was highest in non‐reduced quadruplets (66.7%); it was 50% in quadruplets reduced to singletons and 10.7% in quadruplets reduced to twins. The proportion of liveborn infants overall was 91.1% of the total number expected to be liveborn in quadruplet pregnancies reduced to twins. This was statistically significantly different from 97.6% in non‐reduced dichorionic twins (P = 0.004), and considerably higher than 58.3% in non‐reduced quadruplets. The rates of preterm delivery < 28, < 32 and < 37 weeks were decreased in quadruplets reduced to twins compared with those in non‐reduced quadruplet pregnancies. Quadruplets reduced to twins did not achieve equivalent pregnancy outcomes to those of DCDA twins. Conclusion: This national study of QCQA quadruplets has shown that multifetal pregnancy reduction improves pregnancy outcome, including a decreased rate of preterm delivery and higher proportion of liveborn children. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To compare morbidity, as measured by length of stay in the neonatal intensive care unit (NICU), in twin and singleton gestations classified as small‐for‐gestational age (SGA) according to estimated fetal weight < 10th percentile on twin or singleton growth charts. Methods: NICU length of stay was compared in 1150 twins and 29 035 singletons that underwent ultrasound assessment between 35 + 0 and 36 + 6 weeks' gestation. Estimated fetal weight was obtained from measurements of head circumference, abdominal circumference and femur length using the Hadlock formula. Gestational age was derived from the first‐trimester crown–rump length measurement, using the larger of the two twins. Singletons and twins were compared in terms of NICU admission rate and length of stay according to classification as SGA by the Fetal Medicine Foundation singleton and twin reference distributions. Results: The overall proportions of twins and singletons admitted to NICU were similar (7.3% vs 7.4%), but twins tended to have longer lengths of stay in NICU (≥ 7 days: 2.4% vs 0.8%; relative risk (RR), 3.0 (95% CI, 1.6–4.4)). Using the singleton chart, a higher proportion of twins were classified as SGA compared with singletons (37.6% vs 7.0%). However, the proportion of SGA neonates entering NICU was similar (10.2% for twins and 10.1% for singletons) and the proportion of SGA neonates spending ≥ 7 days in NICU was substantially higher for twins compared with singletons (3.7% vs 1.4%; RR, 2.6 (95% CI, 1.4–4.7)). Conclusions: When singleton charts are used to define SGA in twins and in singletons, there is a greater degree of growth‐related neonatal morbidity amongst SGA twins compared with SGA singletons. Consequently, singleton charts do not inappropriately overdiagnose fetal growth restriction in twins and they should be used for monitoring fetal growth in both twins and singletons. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: Low‐dose aspirin (LDA) has been shown to reduce the risk of preterm pre‐eclampsia and it has been suggested that it should be recommended for all pregnancies. However, some studies have reported an association between LDA and an increased risk of bleeding complications in pregnancy. Our aim was to evaluate the risk of placental abruption and postpartum hemorrhage (PPH) in patients for whom their healthcare provider had recommended prophylactic aspirin. Methods: This multicenter cohort study included 72 598 singleton births at 19 hospitals in the USA, between January 2019 and December 2021. Pregnancies complicated by placenta previa/accreta, birth occurring at less than 24 weeks' gestation, multiple pregnancy or those with data missing for aspirin recommendation were excluded. Propensity scores were calculated using 20 features spanning sociodemographic factors, medical history, year and hospital providing care. The association between LDA recommendation and placental abruption or PPH was estimated by inverse‐probability treatment weighting using the propensity scores. Results: We included 71 627 pregnancies in the final analysis. Aspirin was recommended to 6677 (9.3%) and was more likely to be recommended for pregnant individuals who were 35 years or older (P < 0.001), had a body mass index of 30 kg/m2 or higher (P < 0.001), had prepregnancy hypertension (P < 0.001) and who had a Cesarean delivery (P < 0.001). Overall, 1.7% of the study cohort (1205 pregnancies) developed preterm pre‐eclampsia: 1.3% in the no‐aspirin and 5.8% in the aspirin group. After inverse‐probability weighting with propensity scores, aspirin was associated with increased risk of placental abruption (adjusted odds ratio (aOR), 1.44 (95% CI, 1.04–2.00)) and PPH (aOR, 1.21 (95% CI, 1.05–1.39)). The aOR translated to a number needed to harm with LDA of 79 (95% CI, 43–330) for PPH and 287 (95% CI, 127–3151) for placental abruption. Conclusions: LDA recommendation in pregnancy was associated with increased risk for placental abruption and for PPH. Our results support the need for more research into aspirin use and bleeding complications in pregnancy before recommending it beyond the highest‐risk pregnancies. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To characterize fetal growth in dichorionic twins using individualized growth assessment (IGA), a method based on individual growth potential estimates. Methods: This secondary analysis included 286 fetuses/neonates from 143 dichorionic twin pregnancies that were part of the ESPRiT (Evaluation of Sonographic Predictors of Restricted Growth in Twins) study. The sample was subcategorized according to birth weight into appropriate‐for‐gestational‐age (AGA) (n = 243) and small‐for‐gestational‐age (SGA) (n = 43) cohorts. Serial biometric scans evaluating biparietal diameter, head circumference (HC), abdominal circumference, femur diaphysis length and estimated weight at 2‐week intervals were used to evaluate fetal growth, while measurements of birth weight, crown–heel length and HC determined neonatal growth outcome. Six abnormalities (hypoxic ischemic encephalopathy, periventricular leukomalacia, necrotizing enterocolitis, respiratory distress, sepsis and death) constituted the evaluated adverse neonatal outcomes (ANO). IGA was used to: evaluate differences in second‐trimester growth velocities between singletons (from a published dataset) and dichorionic twins (138 AGA twins with normal third‐trimester growth); describe the degree to which actual third‐trimester growth in twins followed expected growth (111 AGA twins, normal fetal growth and neonatal growth outcomes); determine if the fetal growth pathology score 1 (–FGPS1) could detect, quantify and classify twin growth pathology (224 AGA, 42 SGA); and assess the relationship between –FGPS1 and ANO (24 SGA twins with progressive growth restriction confirmed by abnormal neonatal growth outcome). Results: The differences in second‐trimester growth velocity between singletons and twins (means and variances) were small and not statistically significant. Percent deviations from the expected third‐trimester size trajectories were within the 95% reference ranges derived from singletons at 95.7% (1677/1752) of timepoints studied. Abnormal growth was detected in 37.9% of AGA twins and 85.7% of SGA twins. Growth restriction was more heterogeneous in AGA twins, while in SGA twins progressive growth restriction was the principal type (66.7%). –FGPS1 patterns previously defined in singletons classified 97.5% of pathological twin cases. In our most severe form of growth restriction (progressive), there were only three (12.5%) ANOs related to growth abnormalities, all in cases with –FGPS1 values more negative than –2.0%. Using these criteria, the frequency of ANO was 33%. Conclusions: With respect to growth, dichorionic twins can be considered as two singletons in the same uterus. Normally growing dichorionic twins have the same growth potential as singletons with normal growth outcome. These twins also follow expected third‐trimester growth trajectories with the same precision as do singletons. Third‐trimester growth pathology can be detected, quantified and classified using –FGPS1 as in singletons. Limited evidence of a relationship between fetal growth abnormalities and adverse neonatal outcome was found. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To determine the accuracy of sonographic fetal weight estimation in predicting birth weight (BW) and BW discordance in twin gestations, and to evaluate maternal and fetal characteristics that may affect the accuracy of this assessment. Methods: This was a retrospective cohort study of all twins delivered at a single tertiary medical center between 2010 and 2021. Twin gestations for which sonographic estimation of fetal weight was performed within the week preceding delivery were included. Statistical analysis was performed to evaluate the strength of the correlation between sonographic estimated fetal weight (EFW) and BW, and to determine the impact of maternal and fetal factors on the accuracy of sonographic estimation. Results: The study included 2154 twin pregnancies. There was a strong correlation between sonographic EFW and corresponding BW for all twins (r = 0.922; P < 0.001). Strong correlations were observed for both the presenting and non‐presenting cotwin (r = 0.921 and r = 0.922, respectively; both P < 0.001), as well as the larger and smaller cotwin (r = 0.928 and r = 0.934, respectively; both P < 0.001). The overall mean ± SD absolute error of sonographic EFW was 7.41 ± 6.81%. This error was greater for the non‐presenting cotwin compared with the presenting cotwin (7.99 ± 6.12% vs 7.17 ± 5.64%; P < 0.001), and for the smaller cotwin compared with the larger cotwin (8.56 ± 7.50% vs 6.58 ± 5.47%; P < 0.001). Advanced gestational age at scanning was correlated inversely with the mean absolute error of sonographic EFW. Multivariate logistic regression indicated that an earlier gestational age at scanning, being the non‐presenting cotwin and being the smaller cotwin were independent risk factors for sonographic EFW inaccuracy. Pregnancies in which the presenting twin was estimated to be the smaller cotwin had twice the rate of false‐positive BW discordance compared with pregnancies in which the presenting twin was estimated to be the larger cotwin (36.0% vs 13.0% for BW discordance > 15%, 35.0% vs 17.0% for BW discordance > 20% and 37.7% vs 12.1% for BW discordance > 25%; all P < 0.001). The error in sonographic EFW discordance was not related to chorionicity, the position of the presenting fetus or gestational age at the time of fetal weight estimation. Conclusions: Sonographic estimation of fetal weight within 7 days before delivery accurately predicts BW in twin pregnancy. Sonographic EFW accuracy is reduced for the non‐presenting twin, the smaller cotwin and when delivery occurs at an earlier gestational age. Sonographic estimation of fetal weight discordance is less accurate when the presenting twin is the smaller cotwin. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This document summarizes a systematic review and meta-analysis on the effectiveness of cervical cerclage in preventing preterm birth (PTB) and improving perinatal outcomes in twin pregnancies. The review found that cervical cerclage, when combined with progesterone therapy, can reduce the risk of PTB in women with a short cervical length and a history of PTB. It also suggests that cervical cerclage may be beneficial in asymptomatic twin pregnancies with cervical dilatation or a short cervical length. The study emphasizes the need to consider the unique factors of PTB in twin pregnancies when developing preventive strategies. [Extracted from the article]

Objective: To investigate the national prevalence and prenatal detection rate (DR) of major congenital heart disease (mCHD) in twin pregnancies without twin‐to‐twin transfusion syndrome (TTTS)‐associated CHD in a Danish population following a standardized prenatal screening program. Methods: This was a national registry‐based study of data collected prospectively over a 10‐year period. In Denmark, all women with a twin pregnancy are offered standardized screening and surveillance programs in addition to first‐ and second‐trimester screening for aneuploidies and malformation, respectively: monochorionic (MC) twins every 2 weeks from gestational week 15 and dichorionic (DC) twins every 4 weeks from week 18. The data were retrieved from the Danish Fetal Medicine Database and included all twin pregnancies from 2009–2018, in which at least one fetus had a pre‐ and/or postnatal mCHD diagnosis. mCHD was defined as CHD requiring surgery within the first year of life, excluding ventricular septal defects. All pregnancy data were pre‐ and postnatally validated in the local patient files at the four tertiary centers covering the entire country. Results: A total of 60 cases from 59 twin pregnancies were included. The prevalence of mCHD was 4.6 (95% CI, 3.5–6.0) per 1000 twin pregnancies (1.9 (95% CI, 1.3–2.5) per 1000 live births). The prevalences for DC and MC were 3.6 (95% CI, 2.6–5.0) and 9.2 (95% CI, 5.8–13.7) per 1000 twin pregnancies, respectively. The national prenatal DR of mCHD in twin pregnancies for the entire period was 68.3%. The highest DRs were in cases with univentricular hearts (100%) and the lowest with aortopulmonary window, total anomalous pulmonary venous return, Ebstein's anomaly, aortic valve stenosis and coarctation of the aorta (0–25%). Mothers of children with prenatally undetected mCHD had a significantly higher body mass index (BMI) compared to mothers of children with a prenatally detected mCHD (median, 27 kg/m2 and 23 kg/m2, respectively; P = 0.02). Conclusions: The prevalence of mCHD in twins was 4.6 per 1000 pregnancies and was higher in MC than DC pregnancies. The prenatal DR of mCHD in twin pregnancies was 68.3%. Maternal BMI was higher in cases of prenatally undetected mCHD. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: Twin pregnancy is currently an exclusion criterion for prenatal repair of open spina bifida (OSB). The main objective of this study was to report on our experience of treating twin pregnancies with OSB using the skin‐over‐biocellulose for antenatal fetoscopic repair (SAFER) technique. We also discuss reconsideration of the current exclusion criteria for fetal OSB repair. Methods: Eight fetuses with OSB from seven twin pregnancies underwent successful prenatal repair. Six pregnancies were dichorionic diamniotic with only one twin affected, and one was monochorionic diamniotic with both twins affected. Percutaneous fetoscopy was performed under CO2 insufflation of the sac of the affected twin. Neurosurgical repair was performed using a biocellulose patch to protect the placode, with the skin sutured to hold the patch in place, with or without a myofascial flap. Neurodevelopment was assessed using the pediatric evaluation of disability inventory scale in babies older than 6 months of adjusted age, whereas the Alberta scale was used for babies younger than 6 months of adjusted age. Results: All 14 fetuses were liveborn and none required additional repair. Gestational age at surgery ranged from 27.3 to 31.1 weeks, and gestational age at birth ranged from 31.6 to 36.0 weeks. Four out of eight affected twins developed sepsis, but had a good recovery. No sequela of prematurity was found in any of the unaffected twins. Short‐term neurodevelopment was normal in all evaluated unaffected twins (5/5) and in all but one affected twins (7/8). In the affected group, only one baby required ventriculoperitoneal shunt placement. Conclusions: Prematurity is frequent after fetal surgery, and the risk is increased in twin pregnancy. Nevertheless, prenatal surgery using the SAFER technique is feasible, with low risk to both twins and their mother when performed by a highly experienced team. Long‐term cognitive assessment of the unaffected twin is needed. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of women's reproductive history on live‐birth rate and perinatal outcome after first frozen–thawed embryo transfer (FET) without preimplantation genetic testing for aneuploidy. Methods: This was a retrospective cohort study of women who had undergone their first FET cycle between January 2014 and December 2020 at a university‐affiliated fertility center. No transferred embryo underwent preimplantation genetic testing for aneuploidy. The women were categorized into five groups based on their reproductive history: no previous pregnancy; previous termination of pregnancy (TOP); previous pregnancy loss; previous ectopic pregnancy (EP); and previous live birth. The women with no previous pregnancy were considered as the reference group. The primary outcome was the live‐birth rate and secondary endpoints included rates of positive pregnancy test, clinical pregnancy, pregnancy loss and EP as well as perinatal outcomes such as birth weight and preterm birth. Multivariable logistic regression analyses were used to control for a number of potential confounders, including age, body mass index, education level, duration and cause of infertility, insemination method, type of endometrial preparation, number of embryos transferred, embryo developmental stage, quality of the embryos transferred, year of treatment and endometrial thickness. Additionally, propensity score matching (PSM) was used to check the robustness of the main findings. Results: In total, 25 329 women were included in the final analysis. On univariate analysis, each reproductive‐history type except for previous EP was significantly associated with worse pregnancy outcome following in‐vitro fertilization (IVF), including rates of positive pregnancy test, clinical pregnancy, pregnancy loss and live birth, when compared with the group of women with no previous pregnancy. However, after correcting for several potential confounders, the differences in rates of live birth, pregnancy loss, positive pregnancy test and clinical pregnancy were no longer significant between the study and control groups on multivariable regression models, while the risk of EP after embryo transfer was elevated among women with a previous TOP or EP. There was no increased risk of adverse perinatal outcome associated with reproductive history compared with the control group. Notably, similar results were obtained from the PSM models, confirming the robustness of the main findings. Conclusion: Relative to women without a previous pregnancy, those with a prior TOP, pregnancy loss, EP or live birth did not have compromised live‐birth rate or perinatal outcomes following FET without preimplantation genetic testing for aneuploidy, with the exception of an increased risk of EP in those with prior TOP or EP. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: The published literature reports mostly on the outcome of twin pregnancies complicated by twin–twin transfusion syndrome (TTTS) without considering whether the pregnancy is also complicated by another pathology, such as selective fetal growth restriction (sFGR). The aim of this systematic review was to report on the outcome of monochorionic diamniotic (MCDA) twin pregnancies undergoing laser surgery for TTTS that were complicated by sFGR and those not complicated by sFGR. Methods: MEDLINE, EMBASE and Cochrane databases were searched. The inclusion criteria were studies reporting on MCDA twin pregnancies with TTTS undergoing laser therapy that were complicated by sFGR and those not complicated by sFGR. The primary outcome was the overall fetal loss following laser surgery, defined as miscarriage and intrauterine death. The secondary outcomes included fetal loss within 24 h after laser surgery, survival at birth, preterm birth (PTB) prior to 32 weeks of gestation, PTB prior to 28 weeks, composite neonatal morbidity, neurological and respiratory morbidity, and survival free from neurological impairment. All outcomes were explored in the overall population of twin pregnancies complicated by sFGR vs those not complicated by sFGR in the setting of TTTS and in the donor and recipient twins separately. Random‐effects meta‐analysis was used to combine data and the results are reported as pooled odds ratios (OR) with 95% CI. Results: Five studies (1710 MCDA twin pregnancies) were included in the qualitative synthesis and four in the meta‐analysis. The overall risk of fetal loss after laser surgery was significantly higher in MCDA twin pregnancies with TTTS complicated by sFGR (20.90% vs 14.42%), with a pooled OR of 1.6 (95% CI, 1.3–1.9) (P < 0.001). The risk of fetal loss was significantly higher in MCDA twin pregnancies with TTTS and sFGR for the donor but not for the recipient twin. The rate of live twins was 79.1% (95% CI, 72.6–84.9%) in TTTS pregnancies with sFGR and 85.6% (95% CI, 81.0–89.6%) in those without sFGR (pooled OR, 0.6 (95% CI, 0.5–0.8)) (P < 0.001). There was no significant difference in the risk of PTB prior to 32 weeks of gestation (P = 0.308) or prior to 28 weeks (P = 0.310). Assessment of short‐ and long‐term morbidity was affected by the small number of cases. There was no significant difference in the risk of composite (P = 0.506) or respiratory (P = 0.531) morbidity between twins complicated by TTTS with vs those without sFGR, while the risk of neurological morbidity was significantly higher in those with TTTS and sFGR (pooled OR, 1.8 (95% CI, 1.1–2.9)) (P = 0.034). The risk of neurological morbidity was significantly higher for the donor twin (pooled OR, 2.4 (95% CI, 1.1–5.2)) (P = 0.029) but not for the recipient twin (P = 0.361). Survival free from neurological impairment was observed in 70.8% (95% CI, 45.0–91.0%) of twin pregnancies with TTTS complicated by sFGR and in 75.8% (95% CI, 51.9–93.3%) of those not complicated by sFGR, with no difference between the two groups. Conclusions: sFGR in MCDA pregnancies with TTTS represents an additional risk factor for fetal loss following laser surgery. The findings of this meta‐analysis may be useful for individualized risk assessment of twin pregnancy complicated by TTTS and tailored counseling of the parents prior to laser surgery. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the outcome of monochorionic diamniotic (MCDA) twins complicated by Type‐II selective fetal growth restriction (sFGR) who underwent fetoscopic laser photocoagulation and to validate a previously proposed subclassification system for Type‐II sFGR in a large multicenter cohort. Methods: This retrospective multicenter cohort study included all MCDA twins complicated by Type‐II sFGR who underwent laser photocoagulation of placental anastomoses at four large tertiary fetal‐care centers between 2006 and 2020. Cases were subclassified according to a recently proposed system based on Doppler evaluation of the ductus venosus (DV) and middle cerebral artery (MCA) into Type‐IIA (normal DV flow and MCA peak systolic velocity (PSV) of the growth‐restricted fetus) or Type‐IIB (absent or reversed flow in the DV during atrial contraction and/or MCA‐PSV ≥ 1.5 multiples of the median of the growth‐restricted fetus). Demographic characteristics and pregnancy outcomes were compared between the groups. Data are presented as mean ± SD or n (%) as appropriate. P‐values < 0.05 were considered statistically significant. Results: A total of 98 patients with MCDA twins met our inclusion criteria, with 56 subclassified as Type IIA and 42 as Type IIB. Demographic characteristics were similar between the groups; however, Type‐IIB cases had a significantly earlier gestational age at diagnosis and at laser surgery, as well as larger intertwin estimated fetal weight discordance, which may be a reflection of disease severity. Postnatal survival of the growth‐restricted fetus to 30 days of age was significantly lower in Type‐IIB compared to Type‐IIA cases (23.8% vs 46.4%; P = 0.034). Conclusions: In MCDA twins complicated by Type‐II sFGR and treated with laser photocoagulation of placental anastomoses, preoperative Doppler assessment of the DV and MCA helped identify a subset of patients at increased risk of demise of the growth‐restricted fetus following intervention. This study provides valuable information for guiding surgical management and patient counseling. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of a monochorionic monoamniotic (MCMA) triplet pregnancy with conjoined twins. The patient, a 27-year-old individual with previous pregnancies, opted for selective reduction of the conjoined twins, which was successfully performed using fetoscopy and cord transection. The patient later experienced preterm labor and delivered a live female baby, who was transferred to the neonatal intensive care unit. This case represents the first reported live birth resulting from the management of a MCMA triplet pregnancy with conjoined twins using selective fetal reduction with percutaneous umbilical cord ligation and cord transection. [Extracted from the article]

This article, titled "Analysis of determinants of fetal fraction in cell-free fetal DNA testing," explores the factors that contribute to low fetal fraction (FF) in cell-free fetal DNA (cffDNA) testing. The study conducted a retrospective cohort analysis of antenatal women who underwent cffDNA testing for fetal aneuploidies. The results showed that FF was positively correlated with gestational age and negatively correlated with maternal age and BMI. Low FF was associated with advanced maternal age, high BMI, IVF pregnancies, maternal overt diabetes/autoimmune diseases, and low serum biochemical markers. Low FF was also linked to higher rates of fetal aneuploidies, pre-eclampsia, small for gestational age babies, fetal growth restriction, and NICU stay. The findings of this study can aid in the interpretation of cffDNA testing results and provide counseling for women with inconclusive results. [Extracted from the article]

This article discusses the sonographic features, prenatal course, and pregnancy outcomes of pregnancies in which a placental cyst or an atypical placental sonolucency (PCAPS) was detected in the first trimester. The study found that PCAPS is a rare finding during the 11-13 week scan, with a prevalence of 0.14%. Most cases were incidental and had no clinical significance, resolving by the second trimester. However, when PCAPS was detected in fetuses with congenital anomalies, the prognosis depended on the severity of the associated malformations. [Extracted from the article]

This article presents a retrospective analysis of 1576 twin pregnancies delivered at the Institute for the Care of Mother and Child in Prague from 2012 to 2020. The study found that 59.1% of the pregnancies were dichorionic diamniotic (DC) twins, 28% were monochorionic diamniotic (MC) twins, and 12.9% were MC twins who underwent intrauterine surgery (MCS). The median gestational week was 37 for DC twins, 35 for MC twins, and 33 for MCS twins. The study also found that MC pregnancies had a higher incidence of perinatal complications, including higher prematurity and lower birthweight. [Extracted from the article]

This article, titled "EP14.23: Ultrasound screening for preterm birth in twin pregnancies: a prospective longitudinal pilot study," explores the efficacy of different cervical parameters measured through transvaginal 2D ultrasound and elastography in predicting preterm birth in twin pregnancies. The study collected data from 36 twin pregnant women and compared various parameters between those who delivered at term and those who delivered prematurely. The results showed that the uterocervical angle (UCA) and the ratio of internal os strain (IOS) to external os strain (EOS) were significantly different between the two groups, indicating that a wider angle and higher strain ratio were associated with a higher risk of preterm birth. The study suggests that alternative ultrasound parameters, particularly UCA, may be useful in screening and managing twin pregnancies at risk of premature labor or rupture of membranes. [Extracted from the article]

This article, published in the journal Ultrasound in Obstetrics & Gynecology, examines the impact of Twin-twin transfusion syndrome (TTTS) on maternal circulation in twin pregnancies. The study analyzed data from three groups: singleton pregnancies, uncomplicated mono-chorionic diaphragmatic twin pregnancies, and TTTS cases. The results showed that TTTS cases had smaller left ventricular end-diastolic volume and end-systolic volume compared to the uncomplicated twin pregnancies, but no significant difference compared to singleton pregnancies. Additionally, TTTS cases had a higher left ventricular ejection fraction and heart rate. The study suggests that TTTS may decrease circulating blood volume and that maternal cardiac function may adapt to compensate for cardiac output in these cases. [Extracted from the article]

This article discusses a retrospective observational study conducted at a maternity and children hospital in Jakarta, Indonesia, to evaluate the natural evolution of monochorionic twins with selective Fetal Growth Restriction (sFGR) under expectant management. The study found that different types of sFGR could convert to other subtypes, which could affect the outcomes. The article provides data on the clinical characteristics and neonatal outcomes of 11 patients with the natural conversion subtype of sFGR. The findings highlight the importance of clinicians being aware of this phenomenon. [Extracted from the article]

This article presents the findings of a retrospective cohort study conducted in Victoria, Australia, which aimed to evaluate the rates of adverse maternal and perinatal outcomes in pregnant women with chronic hypertension (CH) compared to normotensive controls. The study analyzed 390,282 births and found that CH, pre-eclampsia (PE), and eclampsia occurred in 1.24%, 2.56%, and 0.08% of pregnant women, respectively. Superimposed PE occurred in 0.25% of the overall population and 20.5% of CH patients. Pregnant women with CH had higher rates of complications such as acute pulmonary edema, PE, eclampsia, disseminated intravascular coagulation, and placental abruption compared to controls. The study also identified multiple pregnancies and being attended on the public health sector as risk factors for superimposed PE. The authors conclude that CH increases the risk of maternal and perinatal complications, and understanding the risk factors for superimposed PE is important for patient counseling. [Extracted from the article]

Ovarian masses are a common complication during pregnancy, with most being functional or benign. However, around 5% of ovarian masses in pregnancy are malignant. Ultrasound and MRI are effective in diagnosing these masses, but histology confirmation may be necessary in uncertain cases. Complications can include torsion, rupture, bleeding, and premature labor. In a case study, a 40-year-old woman with a twin pregnancy underwent laparotomy and bilateral ovarian cystectomy due to an inconclusive diagnosis and high risk of complications. The histopathological finding revealed bilateral hemorrhagic corpus luteum cysts, and the pregnancy was successfully carried to term. Early detection and characterization of ovarian masses in pregnancy are crucial for proper management and to minimize morbidity and mortality for both the mother and child. [Extracted from the article]

This article analyzes the rate of Caesarean sections (CS) at the University of Benin Teaching Hospital in Nigeria using the Robson 10-group classification system. The study found that the CS rate during the one-year period was 45.8%. The highest contributing groups to the CS rate were Group 5 (multiparous with at least 1 previous CS), Group 2 (nulliparous with induced or prelabour CS), and Group 10 (women with a single cephalic pregnancy before 37 weeks, including those with previous CS). The study suggests that efforts should be made to reduce the primary CS rate and discourage the increasing use of CS for non-obstetric reasons. [Extracted from the article]

This article, published in the journal "Ultrasound in Obstetrics & Gynecology," examines the pregnancy outcomes of patients with intrauterine twin pregnancy complicated by ectopic pregnancy after assisted reproductive technology. The study analyzed the medical records of 42 patients and found that the live birth rate was 81.0%, with a preterm birth rate of 31.0% and a full-term birth rate of 50%. The study suggests that assisted reproductive technology may increase the incidence of this complication, but the incidence has decreased with the reduction of multiple embryo transfers. The findings are important for improving the safety of pregnancy for patients undergoing assisted reproductive technology. [Extracted from the article]

This article discusses the acceptance and feasibility of selective feticide in monochorionic twins in Lebanon, where medical termination of pregnancy is generally not authorized except in rare cases. The article presents two cases of monochorionic diamniotic twin pregnancies that were referred to a center for management. After extensive counseling, the patients expressed their wish to undergo a selective termination of the affected fetus, which was approved by the Ethical Committee. The article highlights the successful performance of umbilical cord occlusion in these cases, emphasizing the need for a multidisciplinary approach and specialized counseling. [Extracted from the article]

This article discusses a case report of a prenatal diagnosis of a left ventricular aneurysm (LVA) in one fetus of a dichorionic diamniotic (DCDA) twin gestation. The diagnosis was made during a targeted anomaly scan at 19 weeks, where a thin-walled outpouching with fetal arrhythmia was observed in one fetus. The family opted for selective reduction of the affected fetus, and the pregnancy continued with close monitoring. The article also mentions that isolated congenital LVAs are more common and can lead to complications such as spontaneous rupture, arrhythmia, and congestive heart failure. Treatment options for symptomatic LVAs include surgical correction and thromboembolism prevention. [Extracted from the article]

This article discusses the indications for fetal echocardiography (FE), a procedure used to detect congenital heart disease in fetuses. The authors conducted a systematic literature search to identify guidelines and expert consensuses published between 2014 and 2023. They found that there is a lack of consensus among these sources regarding the risk factors that warrant FE. While there was complete agreement on three risk factors, there were disagreements and inconsistencies for others. The authors suggest that an international agreement would be beneficial for physicians and guideline developers, and further evidence is needed to justify FE for many risk factors. [Extracted from the article]

This article discusses the perinatal outcomes of monochorionic diamniotic (MCDA) twin pregnancies complicated by selective fetal growth restriction (sFGR) in a tertiary fetal care center. The study, conducted from 2010 to 2023, retrospectively analyzed data from 416 MCDA twin pregnancies with sFGR. The primary outcomes examined were double survivors, single survivors, and double loss. The results showed that type 1 sFGR had the highest incidence of double live births, followed by type 3 sFGR, while type 2 had the highest double fetal loss rate. The study emphasizes the importance of umbilical artery Doppler assessment in predicting outcomes and guiding clinicians in making informed decisions. [Extracted from the article]

This article, titled "Perinatal outcomes of selective fetal growth restriction in monochorionic pregnancies diagnosed with different criteria: ISUOG versus Delphi criteria," examines the outcomes of fetuses diagnosed with selective fetal growth restriction (sFGR) using different diagnostic criteria. The study includes 220 monochorionic twin pregnancies, with 45 of them complicated by sFGR. The results show that both the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) criteria and the Delphi criteria identified fetuses at higher risk of perinatal morbidity and mortality compared to uncomplicated twins. However, the Delphi criteria increased the diagnostic rate of sFGR and included cases at lower risk of adverse outcomes. [Extracted from the article]

This article presents the findings of a register-based cohort study conducted in Denmark from 2008 to 2018, which aimed to assess and compare the incidence and risk of pre-eclampsia (PE) in twin pregnancies based on various factors. The study included 9,398 dichorionic (DC) and 1,947 monochorionic diamniotic (MCDA) twin pregnancies, as well as 19,341 singletons. The results showed that MCDA twins had a significantly higher cumulative risk of PE at lower gestational ages (GA) compared to DC twins, particularly before 34+0, 36+0, and 38+0 weeks. Additionally, monozygotic (MZ) twins had a higher risk of PE compared to dizygotic (DZ) twins before GA 34+0, and there was a marginal significance in PE risk between male and female MZ twin pregnancies before GA 34+0. However, there were no significant differences in the overall incidence of PE or the risk before GA 28+0 or 32+0 weeks. [Extracted from the article]

This article, titled "Perinatal outcomes of early Twin–twin transfusion syndrome treated with laser: an international multicentre study," presents the results of a study on the perinatal outcomes of monochorionic diamniotic (MCDA) twin pregnancies with early Twin–twin transfusion syndrome (TTTS) that were treated with laser surgery. The study included 542 pregnancies diagnosed with early TTTS, with 12.2% of the women diagnosed at or before 16 weeks. The majority of cases (85.4%) were at stage II or III at diagnosis, and 81.5% of the cases were treated with laser before 18 weeks. The study found that laser surgery, even when performed before 18 weeks, was associated with a good outcome, with at least one surviving fetus in 67.4% of pregnancies and two surviving fetuses in 43.6% of pregnancies. [Extracted from the article]

This article discusses a potential alternative treatment for Twin-twin transfusion syndrome (TTTS), a condition that affects twin pregnancies and can lead to death or disability for both twins. The current standard treatment involves laser fetoscopy, which has a survival rate of less than 60% and carries risks of infection and premature delivery. The authors propose using High-Intensity Focused Ultrasound (HIFU) technology as a non-invasive alternative to laser treatment. They conducted experiments on pregnant monkeys with TTTS and found that HIFU treatment using a toroidal transducer was able to safely and effectively occlude placental vessels. This research suggests that HIFU treatment could be a promising option for the treatment of TTTS in the future. [Extracted from the article]

This article presents the findings of a randomized controlled trial comparing the safety and efficacy of microwave ablation (MWA) and radiofrequency ablation (RFA) in selective reduction of complex monochorionic twin pregnancies. The study, conducted in China, involved 144 women who were randomly allocated to either MWA or RFA. The overall survival rates, neonatal outcomes, and developmental state of the surviving children were found to be similar between the two groups. These results suggest that MWA may be a viable option for intrauterine surgeries in complex monochorionic pregnancies. [Extracted from the article]

This article discusses the correlation between SNP-based prenatal cell free DNA (cfDNA) screening and the clinical findings of complete hydatidiform mole with a coexisting fetus (CHMCF). CHMCF is associated with various pregnancy complications, and the study aimed to identify SNP patterns that are compatible with CHMCF. Out of 4,901,007 prenatal cfDNA samples received, 75 had an SNP profile consistent with CHMCF. Most of these cases had prenatal findings compatible with molar change, and a small percentage had fetal abnormalities detected by ultrasound. The article concludes that these rare results should prompt referral for high-risk pregnancy management and further evaluation. [Extracted from the article]

Objective: Data are lacking on the impact on pregnancy outcome of the position of the abnormal fetus in a discordant twin pregnancy undergoing selective termination (ST). Tissue maceration post ST of the presenting twin may lead to early rupture of membranes, amnionitis and preterm labor. The aim of this study was to evaluate pregnancy complications and outcome following ST of the presenting vs non‐presenting twin. Methods: This was a multicenter retrospective cohort study of dichorionic diamniotic twin pregnancies that underwent ST due to a discordant fetal anomaly (structural or genetic) between 2007 and 2021. The study population was divided into two groups according to the position of the reduced twin (presenting or non‐presenting) and outcomes were studied accordingly. The primary outcome was a composite of early complications following ST, including infection, preterm prelabor rupture of membranes and pregnancy loss. Results: A total of 190 dichorionic twin pregnancies were included, of which 73 underwent ST of the presenting twin and 117 of the non‐presenting twin. The groups did not differ in either baseline demographic characteristics or mean gestational age at the time of the procedure. ST of the presenting twin resulted in a significantly higher rate of early complications compared with the non‐presenting twin (19.2% vs 7.7%; P = 0.018). Moreover, the rates of preterm delivery (75.3% vs 37.6%; P < 0.001) and neonatal intensive care unit admission (45.3% vs 17.1%; P < 0.001) were higher, and birth weight was lower (P < 0.001), in those pregnancies in which the presenting twin was reduced. Conclusions: ST of the presenting twin resulted in a higher rate of adverse pregnancy outcome compared with that of the non‐presenting twin. These findings should be acknowledged during patient counseling and, if legislation permits, taken into consideration when planning ST. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. A video abstract of this article is available online here. [ABSTRACT FROM AUTHOR]

Objective: To evaluate outcomes of dichorionic twin pregnancies undergoing early vs late selective termination of pregnancy (ST). Methods: MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to March 2022. The primary outcome of this study was pregnancy loss prior to 24 weeks' gestation. The secondary outcomes included preterm birth (PTB) before 37, 34, and 32 weeks, preterm prelabor rupture of membranes (PPROM), gestational age (GA) at delivery, Cesarean delivery, mean birth weight, 5‐min Apgar score < 7, overall neonatal morbidity and neonatal survival. Only prospective or retrospective studies reporting data on the outcome of early (before 18 weeks) vs late (at or after 18 weeks) ST in dichorionic twin pregnancies were considered suitable for inclusion. Quality assessment of the included studies was performed using the Newcastle–Ottawa scale for cohort studies. Random‐effects head‐to‐head meta‐analysis was used to analyze the data. Results: Seven studies reporting on 649 dichorionic twin pregnancies were included in this systematic review. The risk of pregnancy loss prior to 24 weeks was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST (1% vs 8%; odds ratio (OR), 0.25 (95% CI, 0.10–0.65); P = 0.004). The risk of PTB was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST when considering PTB before 37 weeks (19% vs 45%; OR, 0.36 (95% CI, 0.23–0.57); P < 0.00001), before 34 weeks (4% vs 19%; OR, 0.24 (95% CI, 0.11–0.54); P = 0.0005) and before 32 weeks (4% vs 20%; OR, 0.21 (95% CI, 0.05–0.85); P = 0.03). The mean birth weight was significantly greater in the early‐ST group (mean difference (MD), 392.2 g (95% CI, 59.1–726.7 g); P = 0.02), as was the mean GA at delivery (MD, 2.47 weeks (95% CI, 0.04–4.91 weeks); P = 0.049). There was no significant difference between dichorionic twin pregnancies undergoing early compared with late ST in terms of PPROM (P = 0.27), Cesarean delivery (P = 0.38), 5‐min Apgar score < 7 (P = 0.35) and neonatal survival of the non‐reduced twin (P = 0.54). Conclusions: The risk of pregnancy loss prior to 24 weeks and the rate of PTB before 37, 34 and 32 weeks were significantly higher in dichorionic twin pregnancies undergoing late vs early ST, thus highlighting the importance of early diagnosis of fetal anomalies in twin pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To describe neurosonographic findings diagnostic or highly suggestive of the presence of malformations of cortical development involving the cortex that may be identified before 24 weeks of gestation. Methods: This was a retrospective single‐center study of fetuses referred for neurosonography, during 2012–2019, with an abnormal cortical or sulcation pattern diagnosed early in the mid trimester. Stored files were analyzed for demographic data, abnormal brain findings, non‐central nervous system abnormalities, final diagnosis and postnatal outcome. Results: The study cohort included 20 fetuses, with a mean gestational age at diagnosis of 18.7 (range, 14.4–23.6) weeks, in 11 of which the diagnosis was made before 20 weeks of gestation. Reasons for referral were: midline anomaly (n = 7), ventriculomegaly (n = 4), infratentorial findings (n = 3), suspected malformation of cortical development (n = 3), 'abnormal brain' (n = 2) and skeletal dysplasia (n = 1). On neurosonography, both the sulcation pattern and the cortical layer were abnormal in four cases, only the sulcation pattern was considered abnormal in seven and only the cortical layer was abnormal in nine. Nineteen fetuses presented with associated central nervous system anomalies and six also had non‐central nervous system malformations. One case was recurrent. Eighteen parents opted for termination of pregnancy, including one selective termination in a twin pregnancy, and two fetuses were liveborn. Conclusions: Familiarity with fetal brain anatomy and its early sonographic landmarks allowed early diagnosis of malformations involving cortical development. These patients are likely to represent the most severe cases and all had associated malformations. The presence of an abnormal cortical layer and/or abnormal overdeveloped sulci appear to be early signs of malformation of cortical development. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To compare the prevalence of preterm birth (PTB) (delivery before 37 weeks) in Israel before and after publication of national guidelines recommending second‐trimester sonographic cervical‐length (CL) measurement. Methods: The Israeli Society of Obstetrics and Gynecology (ISOG) guidelines, issued on 1 January 2012, specified that CL should be measured transabdominally or, if this is not possible, transvaginally, at the 19–25‐week ultrasound anomaly scan and that CL < 25 mm should indicate further work‐up and treatment, although the type of treatment was unspecified. In 2000, the Israel Ministry of Health issued a legal requirement for the submission of delivery records to a national registry. These data were used to compare PTB prevalence in the period before (2000–2011) and that after (2012–2020) publication of the guidelines, as well as trends within each time period. Information was available on singleton and multiple pregnancy and maternal age and parity, as well as low birth weight (< 2500 g). Results: During the period 2000–2020, there were 3 403 976 infants liveborn in Israel: 1 797 657 before and 1 606 319 after publication of the ISOG guidelines. There were 247 187 PTBs overall, with a prevalence of 7.64% (95% CI, 7.52–7.77%) before publication of the guidelines and 6.84% (95% CI, 6.43–7.24%) afterwards (P < 0.0002, two‐tailed). The annual PTB prevalence was static in the first time period but declined by 0.18% per annum during the second period, after publication of the guidelines. The proportionate reduction in PTB prevalence after compared with before publication of the guidelines was 10% overall, 9% for PTB at 33–36 weeks, 18% for PTB at 28–32 weeks and 24% for PTB at < 28 weeks. After publication of the guidelines, reduced prevalence of PTB was observed among singletons (5.49% before vs 4.83% after, P < 0.0001), but not among infants in twin or higher‐order multiple pregnancy. There was a statistically significant reduction in the rate of PTB following publication of the guidelines in both nulliparous and parous women and in the 19–39‐year‐old maternal‐age group. Although reductions in PTB prevalence were also noted in high‐risk age groups (maternal age < 19 years and ≥ 40 years), these did not reach statistical significance. Following publication of the guidelines, there was a statistically significant reduction in the prevalence of birth weight under 2500 g, of a magnitude similar to that for PTB prevalence. Conclusions: The publication of national guidelines recommending routine CL measurement at the time of the second‐trimester anomaly scan was associated with a fall in PTB prevalence in singleton pregnancies. Whilst direct evidence linking screening with this fall in prevalence is lacking, it is likely that implementation of routine CL screening played an important role in the reduction of PTB rate. Our experience indicates that screening can be incorporated into the second‐trimester anomaly scan. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To report on the early detection of congenital heart disease (CHD) in low‐ and high‐risk populations managed at our hospital; and perform a detailed analysis of false‐negative diagnoses, in order to derive possible recommendations on how to reduce their incidence. Methods: This was a retrospective observational study analyzing cases which underwent an ultrasound examination at the end of the first trimester at the Fetal Medicine and Surgery Unit of Gaslini Children's Hospital, Genoa, Italy, in the period January 2015 to December 2021. The study population included both low‐risk pregnancies that underwent standard first‐trimester combined screening and high‐risk ones referred to our unit because of a positive combined test or suspicion of fetal anomalies raised in a regional community hospital. For each case, the following variables were retrieved and analyzed: number of fetuses, maternal body mass index, gestational age at first‐trimester screening, whether the pregnancy was low or high risk, nuchal translucency thickness (normal or > 99th centile), type of CHD, associated extracardiac anomalies, karyotype and pregnancy outcome. For low‐risk pregnancies, suspicion of CHD was also recorded. In low‐risk cases, sonographic cardiac screening comprised evaluation of the four‐chamber view (grayscale and color/power Doppler) and three‐vessel‐and‐trachea view (color/power Doppler). High‐risk cases underwent early fetal echocardiography. False‐negative cases were categorized according to likely cause of the missed diagnosis, as follows: human factor; technical factor; acoustic‐window factor. Results: Gestational age at ultrasound ranged from 12 + 0 to 13 + 6 weeks (crown–rump length (CRL), 50.1–84.0 mm) in the low‐risk group and from 11 + 5 to 13 + 6 weeks (CRL, 45.1–84.0 mm) in the high‐risk group. Over the 7‐year study period, 7080 pregnancies were evaluated in the first trimester. Of these, 6879 (7167 fetuses) were low‐risk and 201 were high‐risk cases. In the low‐risk group, there were 30 fetuses with CHD (including 15 major and 15 minor CHD), yielding a prevalence of 4.2/1000 (2.1/1000 for major CHD). Nine of the 30 CHD cases were suspected at screening ultrasound (7/15 major CHD). Excluding cases in which the CHD would not be expected to be associated with a modification of the screening views and would therefore not be detectable on screening ultrasound, 7/12 cases of major CHD were detected, corresponding to a sensitivity of 58.3%. Among the 201 high‐risk cases, there were 46 fetuses with CHD (including 44 major and two minor CHD), of which 43 were detected, corresponding to a sensitivity for early fetal echocardiography of 93.5%, or 97.7% if the two cases that were unlikely to be detectable on first‐trimester screening were excluded. Analysis of the 11 (of 24) false‐negative cases that would be expected to be picked up on screening views revealed that human error (image interpretation and/or scanning approach) was involved in all 11 cases and technical factors (excessive color priority (color‐balance function) and/or incorrect plane alignment) were present in two. There was impairment of the acoustic window (associated with maternal obesity and/or twin gestation) as a cofactor in five of the 11 cases. Conclusions: The sensitivity for detection of major CHD of early cardiac screening in low‐risk pregnancy is under 60%, partly due to the natural history of CHD and, it seems, partly relating to human error and technical issues with image quality. Factors associated with false‐negative diagnoses may be categorized into three types: human error, technical factors and acoustic‐window impairment. We recommend: appropriate assessment with fetal posterior spine; that sufficient time is spent on assessment of the fetal situs; and that color/power Doppler settings are adapted to the individual case. A lower threshold for referring doubtful cases for early fetal echocardiography should be adopted in cases of maternal obesity and in twin gestation. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To develop a model based on factors available at the time of diagnosis of twin–twin transfusion syndrome (TTTS) for predicting the probability of dual twin survival following fetoscopic laser photocoagulation (FLP) using a machine‐learning algorithm. Methods: This was a retrospective study of data collected at two university‐affiliated tertiary fetal centers between 2012 and 2021. The cohort included monochorionic diamniotic twin pregnancies complicated by TTTS that underwent FLP. Data were stratified based on survival 30 days after delivery, and cases with dual survival were compared to those without dual survival. A random forest machine‐learning algorithm was used to construct a prediction model, and the relative importance value was calculated for each parameter that presented a statistically significant difference between the two study groups and was included in the model. The holdout method was applied to check overfitting of the random forest algorithm. A prediction model for dual twin survival 30 days after delivery was presented based on the test set. Results: The study included 537 women with monochorionic diamniotic twin pregnancy, of whom 346 (64.4%) had dual twin survival at 30 days after delivery and were compared with 191 (35.6%) cases that had one or no survivors. Univariate analysis demonstrated no differences in demographic parameters between the groups. At the time of diagnosis, the dual‐survival group had lower rates of estimated fetal weight (EFW) < 10th centile for gestational age in the donor twin (56.4% vs 69.4%; P = 0.004), intertwin EFW discordance > 25% (40.8% vs 56.5%; P = 0.001) and anterior placenta (40.5% vs 50.0%; P = 0.034). Comparison of Doppler findings between the two groups demonstrated significant differences in the donor twin, with a lower rate of pulsatility index (PI) > 95th centile in the umbilical artery and ductus venosus and a lower rate of PI < 5th centile in the fetal middle cerebral artery in the dual‐survival group. Relative importance values for each of these six parameters were calculated, allowing the construction of a prediction model with an area under the receiver‐operating‐characteristics curve of 0.916 (95% CI, 0.887–0.946). Conclusions: We developed a predictive model for dual survival in monochorionic twin pregnancies following FLP for TTTS, which incorporates six variables obtained at the time of diagnosis of TTTS, including donor EFW < 10th centile, intertwin EFW discordance > 25%, anterior placenta and abnormal PI in the umbilical artery, ductus venosus and middle cerebral artery of the donor twin. This clinically applicable tool may improve treatment planning and patient counseling. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the prevalence, subtypes and postnatal outcomes of congenital heart defects (CHD) in a cohort of monochorionic diamniotic (MCDA) twin pregnancies complicated by selective fetal growth restriction (sFGR), and to compare this population with a cohort of uncomplicated MCDA pregnancies evaluated during the same period. Methods: This was a retrospective analysis of all consecutive MCDA pregnancies referred between 2009 and 2018, including those complicated by sFGR (Group A) and those without complications (Group B). All neonates delivered in our center were screened for CHD before discharge. Discharge letters for all those delivered elsewhere were retrieved. Pregnancies with complications other than sFGR and those without perinatal follow‐up were excluded. Pregnancies in Group A were divided into three types according to the Gratacós system of sFGR classification. Results: A total of 870 MCDA twin pregnancies were included: 296 in Group A and 574 in Group B. In Group A, the prevalence of CHD was 3.7% (22/592 twins), with no significant difference in CHD frequency between the three types of sFGR (Type I, 3.7%; Type II, 3.2%; Type III, 4.2%; P = 0.55). Of four Type‐III sFGR pregnancies with CHD, one had pulmonary stenosis (PS) in the larger twin and isolated coarctation of the aorta in the smaller cotwin, and three had PS in the larger twin only. No Type‐III sFGR pregnancies in which only the smaller twin was affected by CHD were observed. Of 11 CHD cases in the larger twin, 10 (91%) were right ventricular outflow tract abnormalities (RVOTA), and one (9%) was a ventricular septal defect. In the smaller twins, 11 cases of CHD were observed, covering a broad spectrum of cardiac abnormalities. In Group B, the CHD prevalence was 1.1% (13/1148 twins), which was similar to that in the general population, according to the EUROCAT registry for the same period and geographical area of the study (0.96%; P = 0.579). The CHD prevalence was significantly higher in Group A compared with Group B (3.7% vs 1.1%; P = 0.0002; odds ratio, 3.57 (95% CI, 1.78–7.22)). In all pregnancies with CHD in the study population, the anomaly was discordant. Conclusions: In MCDA twin pregnancy, sFGR was associated with a three‐fold higher prevalence of CHD. Women with such pregnancies should be referred to a tertiary care hospital for pre‐ and postnatal cardiac evaluation, treatment and long‐term follow‐up. In larger twins, the only major CHD observed was RVOTA, while a broad spectrum of CHD was noted in smaller twins. The higher risk of CHD in MCDA pregnancies appears to be due to the typical complications of the monochorionic pregnancy, rather than to the monochorionic nature of the pregnancy itself. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]