Search

Objective: To investigate the outcome of pregnancies with small baby, including both small for gestational age (SGA) and late fetal growth restriction (FGR) fetuses, undergoing induction of labor (IOL) with Dinoprostone, Misoprostol or mechanical methods. Study design: Medline, Embase and Cochrane databases were searched. Inclusion criteria were non-anomalous singleton pregnancies complicated by the presence of a small fetus, defined as a fetus with estimated fetal weight (EFW) or abdominal circumference (AC) <10th centile undergoing IOL from 34 weeks of gestation with vaginal Dinoprostone, vaginal misoprostol, or mechanical methods (including either Foley or Cook balloon catheters). The primary outcome was a composite measure of adverse intrapartum outcome. Secondary outcomes were the individual components of the primary outcome, perinatal mortality and morbidity. All the explored outcomes were reported in three different sub-groups of pregnancies complicated by a small fetus including: all small fetuses (defined as those with an EFW and/or AC <10th centile irrespective of fetal Doppler status), late FGR fetuses (defined as those with EFW and/or AC <3rd centile or AC/EFW <10th centile associated with abnormal cerebroplacental Dopplers) and SGA fetuses (defined as those with EFW and/or AC <10th but >3rd centile with normal cerebroplacental Dopplers). Quality assessment of each included study was performed using the Risk of Bias in Non-randomized Studies-of Interventions tool (ROBINS-I), while the GRADE methodology was used to assess the quality of the body of retrieved evidence. Meta-analyses of proportions and individual data random-effect logistic regression were used to analyze the data. Results: 12 studies (1711 pregnancies) were included. In the overall population of small fetuses, composite adverse intra-partum outcome occurred in 21.2 % (95 % CI 10.0−34.9) of pregnancies induced with Dinoprostone, 18.0 % (95 % CI 6.9−32.5) of those with Miso

OBJECTIVES: To assess the role of fetal magnetic resonance imaging (MRI) in detecting associated anomalies in fetuses presenting with mild and moderate isolated ventriculomegaly (VM) undergoing multiplanar ultrasound (US) evaluation of fetal brain. METHODS: Multicenter, retrospective, cohort study involving 15 referral fetal medicine centers in Italy, United Kingdom, and Spain. Inclusion criteria were fetuses affected by isolated VM on US, defined as VM with normal karyotype and no other additional central nervous system (CNS) and extra-CNS anomalies on US, undergoing detailed assessment of fetal brain via a multiplanar approach as suggested by ISUOG guidelines on fetal neurosonogram. The primary outcome of the study was to report the rate of additional CNS anomalies detected exclusively at prenatal MRI and missed at US, while the secondary aim was to estimate the incidence of additional anomalies detected exclusively after birth and missed at prenatal imaging (US and MRI). Sub-group analyses according to the gestational age at MRI (< vs ≥ 24 weeks of gestation), laterality of VM (unilateral vs bilateral), and severity of dilatation (mild vs moderate VM) were also performed. RESULTS: Five-hundreds and fifty-six fetuses with a prenatal diagnosis of isolated fetal VM on US were included in the analysis. Additional structural anomalies were detected at prenatal MRI and missed at US in 5.4% (95% CI 3.8-7.6) of cases. When considering the type of anomalies, supra-tentorial intra-cranial hemorrhage was detected on MRI in 26.7% of fetuses, while polymicrogyria and lissencephaly in 20.0% and 13.3% of cases, respectively. Hypoplasia of the corpus callosum was detected at MRI in 6.7% of cases, while dysgenesis in 3.3%. Fetuses with an associated anomaly detected only at MRI were more likely to have moderate compared to mild VM (60.0% vs 17.7%, p<0.001), while there was no significant difference between the proportion of cases with bilateral VM between the two groups (p=

Objectives To explore the outcome of monochorionic monoamniotic (MCMA) twin pregnancies affected by twin-to-twin transfusion syndrome (TTTS).Methods MEDLINE and EMBASE databases were searched for studies reporting the outcome of MCMA twin pregnancies complicated by TTTS. The primary outcome was intrauterine death (IUD); secondary outcomes were miscarriage, single IUD, double IUD, neonatal death (NND), perinatal death (PND), survival of at least one twin, survival of both twins and preterm birth (PTB) before 32 weeks' gestation. Outcomes were assessed in MCMA twins affected by TTTS not undergoing intervention and in those treated with amniodrainage, laser therapy or cord occlusion. Subgroup analysis was performed including cases diagnosed before 24 weeks. Random-effects meta-analysis of proportions was used to analyze the data.Results Fifteen cohort studies, including 888 MCMA twin pregnancies, of which 44 were affected by TTTS, were included in the review. There was no randomized trial comparing the different management options in MCMA twin pregnancies complicated by TTTS. In cases not undergoing intervention, miscarriage occurred in 11.0% of fetuses, while the incidence of IUD, NND and PND was 25.2%, 12.2% and 31.2%, respectively. PTB complicated 50.5% of these pregnancies. In cases treated by laser surgery, the incidence of miscarriage, IUD, NND and PND was 19.6%, 27.4%, 7.4% and 35.9%, respectively, and the incidence of PTB before 32weeks' gestation was 64.9%. In cases treated with amniodrainage, the incidence of IUD, NND and PND was 31.3%, 13.5% and 45.7% respectively, and PTB complicated 76.2% of these pregnancies. Analysis of cases undergoing cord occlusion was affected by the very small number of included cases. Miscarriage occurred in 19.2%, while there was no case of IUD or NND of the surviving twin. PTB before 32weeks occurred in 50.0% of these cases.Conclusions MCMA twin pregnancies complicated by TTTS are at high risk of perinatal mortality and PTB. Furt