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Objective: the use of twin-specific versus singleton charts in the assessment of twin pregnancies has been controversial. The aim of the study was to assess whether a diagnosis of small for gestational age (SGA) made using twin specific estimated fetal weight (EFW) and birthweight (BW) charts is more strongly associated with adverse neonatal outcomes compared to singleton charts in twin pregnancies. Methods: this was a cohort study of twin pregnancies delivered at St George's Hospital in London between January 2007 and May 2020. Twin pregnancies complicated by intrauterine demise of one or both twins; aneuploidy or major fetal abnormality, twin-to-twin transfusion syndrome or twin anemia polycythemia sequence (TAPS); and those delivered before 32 weeks' gestation, were excluded. SGA was defined as EFW or BW below the 10th centile. The main study outcome was composite neonatal morbidity, which was stratified to mild or severe for sensitivity analysis. Mixed-effects logistic regression analysis with random pregnancy level intercepts was used to test the association between different SGA classifications and adverse neonatal outcomes. Results: a total of 1329 twin pregnancies were identified, and 913 twin pregnancies (1826 infants) included in the analysis. Of these, 723 (79.2%) were dichorionic and 190 (20.8%) monochorionic. Using the singleton charts, 33.3% and 35.7% were classified as SGA by the singleton chart when using EFW and BW, respectively. The corresponding figures were 5.9% and 5.8% when using the twin specific charts. EFW SGA according to the twin charts, had a significant association with neonatal morbidity (OR 4.78, 95% CI 1.47-14.7, P=0.007), when compared to AGA twins. However, EFW below the 10th percentile according to singleton standards did not have a significant association with neonatal morbidity (OR 1.36, 95% CI 0.63-2.88, P=0.424). SGA classification of EFW using twin specific standards significantly better model fit than using singleton standard, NA

For the last two decades, exogenous progesterone administration has been used as luteal phase support (LPS) in connection with controlled ovarian stimulation combined with use of the human chorionic gonadotropin (hCG) trigger for the final maturation of follicles. The introduction of the GnRHa trigger to induce ovulation showed that exogenous progesterone administration without hCG supplementation was insufficient to obtain satisfactory pregnancy rates. This has prompted development of alternative strategies for LPS. Augmenting the local endogenous production of progesterone by the multiple corpora lutea has been one focus with emphasis on one hand to avoid development of ovarian hyper-stimulation syndrome and, on the other hand, to provide adequate levels of progesterone to sustain implantation. The present study evaluates the use of micro-dose hCG for LPS support and examines the potential advances and disadvantages. Based on the pharmacokinetic characteristics of hCG, the mathematical modelling of the concentration profiles of hCG during the luteal phase has been evaluated in connection with several different approaches for hCG administration as LPS. It is suggested that the currently employed LPS provided in connection with the GnRHa trigger (i.e. 1.500 IU) is too strong, and that daily micro-dose hCG administration is likely to provide an optimised LPS with the current available drugs. Initial clinical results with the micro-dose hCG approach are presented.

Le malattie del trofoblasto di origine gestazionale (GTD) rappresentano una complicanza rara della gravidanza. Esse si dividono in forme benigne (mola idatiforme parziale e completa) e maligne (tumori del trofoblasto, GTN). Nonostante la prognosi favorevole che attualmente accompagna tale diagnosi, la natura stessa di queste malattie costituisce una considerevole fonte di stress per le pazienti che ne sono affette. Metodi. Trentuno pazienti affette da GTD hanno completato una batteria di questionari autosomministrati volti a valutare il ruolo dei meccanismi di difesa nell’influenzare l’adattamento psicologico alla malattia, in particolare la presenza di sintomi ansiosi e depressivi e lo stress legato all’infertilità. Risultati. Le pazienti affette da tumori del trofoblasto riportano un maggiore utilizzo di meccanismi di difesa maturi rispetto alle pazienti con mola idatiforme. Le analisi di regressione evidenziano che, al netto di variabili demografiche e mediche correlate alla patologia, i meccanismi di difesa immaturi mantengono una relazione specifica con l’ansia di stato e con lo stress legato all’infertilità riportato dalle pazienti. Conclusioni. I risultati suggeriscono l’importanza di considerare, nella progettazione di interventi clinici, gli specifici meccanismi di difesa messi in atto dalle pazienti, in quanto significativamente coinvolti nel modulare l’adattamento psicologico alle GTD, Gestational Trophoblastic Disease (GTD) is a group of disorders that derive from the placenta and arise after a rare gestational event. They can be divided into pre-malignant forms (partial and complete hydatidiform mole) and malignant forms called Gestational Trophoblastic Neoplasia (GTN). Despite a favourable prognosis, the nature of this group of disorders can be a source of stress for patients who are affected by this disease. Methods. Thirty-one patients diagnosed with GTD completed a battery of self-administered questionnaires aimed at analysing the psychological adaptation of the patients to the disease. The variables analysed were the following: defense mechanisms, anxiety, depression and infertility-related stress. Results. Patients with GTN use mature defense mechanisms significantly more than patients with hydatidiform mole. Regression analyses highlight that, considering demographic and clinical variables, immature defense mechanisms are significantly related to state anxiety. Immature defence mechanisms also significantly predict infertility-related global stress. Conclusions. The results show the importance of taking into consideration defense mechanisms used by patients, as they are involved in the modulation of psychological adaptation to GTD.

Gestational trophoblastic neoplasia (GTN) is a rare and aggressive tumour that is usually sensitive to chemotherapy. The usefulness of conventional imaging modalities in evaluating treatment response is limited, mainly due to the difficulty in differentiating between residual tumour tissue and necrosis. The aim of the present study was to evaluate the role of FDG PET or PET/CT in primary staging and in monitoring treatment efficacy. The effect of FDG PET and combined PET/CT on the management of patients with GTN was also evaluated comparing the differences between standard treatments based on conventional imaging and alternative treatments based on PET.