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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2008.08.039 Byline: A. Cristina Rossi (a)(b), Vincenzo D'Addario (a) Keywords: complicated monochorionic pregnancies; selective feticide; twin-twin transfusion syndrome (TTTS); twin reversed arterial perfusion (TRAP); umbilical cord occlusion Abstract: The aim of this study was to review literature concerning selective feticide (SF) in monochorionic pregnancies complicated with twin-twin transfusion syndrome, twin reversed arterial perfusion, severe malformation, and discordant growth. The remaining twins' outcomes were stratified for indication and surgical technique. Three hundred forty-five cases of SF were reviewed. Premature rupture of membranes was described in all the procedures and complicated 76/345 (22%) pregnancies within 4 postoperative weeks (59%) or later (41%; P = .52). Fetal demise accounted for 51/345 (15%), more frequently within 2 postoperative weeks (79%) than thereafter (21%; P = .004; odds ratio [OR], 6.12; 95% confidence interval [CI], 1.81-20.70). Improved survival rate was achieved in surgeries after 18 weeks (89%) than earlier (69%; P = .02; OR, 0.28; 95% CI, 0.10-0.80) without differences for indication. Survivors were 86% after radiofrequency ablation, 82% after bipolar cord coagulation, 72% after laser cord coagulation, 70% after cord ligation. In spite of favorable outcomes, the optimal surgical approach remains undetermined. Author Affiliation: (a) IV Clinic of Obstetrics and Gynecology, University of Bari, Bari, Italy (b) Clinic of Obstetrics and Gynecology, 'San Paolo' Hospital, Bari, Italy Article History: Received 27 June 2008; Revised 9 August 2008; Accepted 19 August 2008

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2008.04.025 Byline: A. Cristina Rossi, Vincenzo D'Addario Keywords: elective repeat cesarean delivery; trial of labor; uterine dehiscence; uterine rupture; vaginal birth after cesarean section Abstract: This study reviewed maternal morbidity following trial of labor (TOL) after cesarean section, compared with elective repeat cesarean delivery (ERCS). Articles were pooled to compare women planning vaginal birth after cesarean (VBAC) with those undergoing ERCS with regard to maternal morbidity (MM), uterine rupture/dehiscence (UR/D), blood transfusion (BT), and hysterectomy. The former group was subdivided into successful VBAC (S-VBAC) and failed TOL (F-TOL). VBAC was successful in 17,905 of 24,349 patients (73%). MM, BT, and hysterectomy were similar in women planning VBAC or ERCS, whereas UR/D was different (1.3%; 0,4%). MM, UR/D, BT and hysterectomy were more common after F-TOL (17%, 4.4%, 3%; 0.5%) than after S-VBAC (3.1%, 0.2%, 1.1%; 0.1%) or ERCS (4.3%, 0.4%, 1%; 0.3%). Outcomes were more favorable in S-VBAC than ERCS. These findings show that a higher risk of UR/D in women planning VBAC than ERCS is counterbalanced by reduction of MM, UR/D. and hysterectomy when VBAC is successful. Author Affiliation: IV Clinic of Obstetrics and Gynecology, University of Bari, Bari, Italy Article History: Received 1 February 2008; Revised 2 April 2008; Accepted 12 April 2008

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.09.043 Byline: A. Cristina Rossi, Vincenzo D'Addario Keywords: amnioreduction; fetal and neonatal survival; laser therapy; neurologic morbidity; twin-twin transfusion syndrome Abstract: The objective of the study was to review current controversy on laser therapy (LT) vs serial amnioreduction (SA) performed for twin-twin transfusion syndrome (TTTS). Author Affiliation: IV Clinic of Obstetrics and Gynecology, University of Bari, Bari, Italy. Article History: Received 9 July 2007; Revised 5 September 2007; Accepted 24 September 2007

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.05.036 Byline: Edoardo Di Naro (a), Antonella Cromi (b), Fabio Ghezzi (b), Luigi Raio (c), Stefano Uccella (b), Vincenzo D'Addario (a), Giuseppe Loverro (a) Abstract: The purpose of this study was to evaluate whether there is a relationship between the sonographic fetal thymus size and the presence of an intrauterine infection in patients with preterm labor. Author Affiliation: (a) Departments of Obstetrics and Gynecology, University of Bari, Bari, Italy (b) University of Insubria, Varese, Italy (c) University of Berne, Berne, Switzerland Article History: Received 5 March 2005; Revised 7 April 2005; Accepted 6 May 2005

Chorionicity is the main determinant of the perinatal outcome in twin pregnancies: perinatal mortality and morbidity are significantly higher in monochorionic versus dichorionic twins. This is mainly due to complications associated specifically with monochorionicity, such as twin to twin transfusion syndrome (TTTS), selective fetal growth restriction (FGR) and twin reverse arterial perfusion syndrome (TRAP), consequences of the presence of inter-twin vascular anastomoses in the common placenta. For this reason the diagnosis of chorionicity in twins is of clinical importance in order to plan an increased surveillance in monochorionic gestations and to recognize the appearance of complications in their early stages.

The ultrasonographic imaging of a fetus affected by 3-M syndrome is described. This is a primordial dwarfism with low birthweight, short stature, facial dysmorphism and normal mental development. The biparietal diameter and head circumference were in accordance with the gestational age at 18 weeks. The femur and tibia lengths were on the fifth centile and the radius, ulna and humerus lengths were below the fifth centile. A second scan at 22 weeks showed slowing of growth of all long bones, with the femur, tibia, fibula, humerus, radius and ulna lengths further below the fifth centile. The pregnancy was terminated and postmortem examination confirmed the prenatal diagnosis. The differential diagnosis of skeletal dysplasias characterized by a slow growth of long bones is discussed and the conclusion reached that the detection of shortened long bones (below the fifth centile) is the only ultrasonographic finding of 3-M syndrome. Copyright © 2000 John Wiley & Sons, Ltd.