OBJECTIVE: The purpose of this study was to evaluate neonatal outcome of monochorionic twin pregnancies complicated by twin anemia-polycythemia sequence (TAPS). STUDY DESIGN: A cohort of... Show moreOBJECTIVE: The purpose of this study was to evaluate neonatal outcome of monochorionic twin pregnancies complicated by twin anemia-polycythemia sequence (TAPS). STUDY DESIGN: A cohort of consecutive monochorionic twins with TAPS with double survivors was included in the study. Each twin pair with TAPS was compared with 2 monochorionic twin pairs who were unaffected by TAPS or twin-to-twin transfusion syndrome and who were matched for gestational age at birth. Neonatal death, severe morbidity, and cerebral injury were studied. RESULTS: We included 19 twin pairs in the TAPS group and 38 control twin pairs. The incidence of neonatal death and severe neonatal morbidity was similar in the TAPS group and control group (3% [1/38] vs 1% [1/76] and 24% [9/38] vs 28% [21/76], respectively). Severe cerebral injury was detected in 1 infant (5%) in the TAPS group and 1 infant (2%) in the control group. CONCLUSION: Neonatal mortality and morbidity rates in a select population of TAPS neonates are similar to control neonatal rates. Show less
OBJECTIVE: We sought to assess blood flow in relation to jugular lymphatic distension in fetuses with increased and normal nuchal translucency (NT). STUDY DESIGN: In all, 72 fetuses with normal NT... Show moreOBJECTIVE: We sought to assess blood flow in relation to jugular lymphatic distension in fetuses with increased and normal nuchal translucency (NT). STUDY DESIGN: In all, 72 fetuses with normal NT and 71 fetuses with NT >95th percentile were evaluated. NT size, jugular lymphatic sacs (JLS), jugular vein and ductus venosus pulsatility index for veins (PIV), and intracardiac velocities were measured. RESULTS: JLS were visualized in 22/72 fetuses with normal and in 55/71 fetuses with increased NT. Jugular vein and ductus venosus PIV was higher in fetuses with increased NT compared to normal NT (P < .01). Visibility of JLS was associated with a higher ductus venous PIV (P < .05), but not with a higher jugular vein PIV. Larger NT and larger JLS volumes were associated with higher jugular vein and ductus venosus PIV (P < .05). CONCLUSION: This study shows a relation among increased NT, jugular lymphatic distension, and altered blood flow in jugular vein and ductus venosus. Show less
OBJECTIVE: The purpose of this study was to assess the incidence, case fatality rates, and risk factors of peripartum hysterectomy and arterial embolization for major obstetric hemorrhage. STUDY... Show moreOBJECTIVE: The purpose of this study was to assess the incidence, case fatality rates, and risk factors of peripartum hysterectomy and arterial embolization for major obstetric hemorrhage. STUDY DESIGN: This was a 2-year prospective nationwide population-based cohort study. All pregnant women in the Netherlands during the same period acted as reference cohort (n = 371,021). RESULTS: We included 205 women; the overall incidence was 5.7 per 10,000 deliveries. Arterial embolization was performed in 114 women (incidence, 3.2 per 10,000; case fatality rate, 2.0%). Peripartum hysterectomy was performed in 108 women (incidence, 3.0 per 10,000; case fatality rate, 1.9%). Seventeen women underwent hysterectomy after failure of embolization. Cesarean delivery (relative risk, 6.6; 95% confidence interval, 5.0-8.7) and multiple pregnancy (relative risk, 6.6; 95% confidence interval, 4.2-10.4) were the most important risk factors in univariable analysis. CONCLUSION: The rate of obstetric hemorrhage that necessitates hysterectomy or arterial embolization in the Netherlands is 5.7 per 10,000 deliveries; fertility is preserved in 46% of women by successful arterial embolization. Show less
