The COVID-19 pandemic has stressed patients and healthcare givers alike and challenged our practice of antenatal care, including fetal diagnosis and therapy. This document aims to review relevant... Show moreThe COVID-19 pandemic has stressed patients and healthcare givers alike and challenged our practice of antenatal care, including fetal diagnosis and therapy. This document aims to review relevant recent information to allow us to optimize prenatal care delivery. We discuss potential modifications to obstetric management and fetal procedures in SARS-CoV2-negative and SARS-CoV2-positive patients with fetal anomalies or disorders. Most fetal therapies are time sensitive and cannot be delayed. If personnel and resources are available, we should continue to offer procedures of proven benefit, acknowledging any fetal and maternal risks, including those to health care workers. There is, to date, minimal, unconfirmed evidence of spontaneous vertical transmission, though it may theoretically be increased with some procedures. Knowing a mother's preoperative SARS-CoV-2 status would enable us to avoid or defer certain procedures while she is contagious and to protect health care workers appropriately. Some fetal conditions may alternatively be managed neonatally. Counseling regarding fetal interventions which have a possibility of additional intra- or postoperative morbidity must be performed in the context of local resource availability. Procedures of unproven benefit should not be offered. We encourage participation in registries and trials that may help us to understand the impact of COVID-19 on pregnant women, their fetuses, and neonates. Show less
Increasing body of evidence shows that perinatal outcomes in MC twins are strongly associated with the complications resulting from the unique angioarchitecture in MC placentas, in particular... Show moreIncreasing body of evidence shows that perinatal outcomes in MC twins are strongly associated with the complications resulting from the unique angioarchitecture in MC placentas, in particular the placental vascular anastomoses. Due to the extensive application of prenatal ultrasound examination, an increasing number and types of complication dedicated for MC twins are being diagnosed. Delineation of the placental characteristics classified by specific complications may shed light on the pathophysiology of various complications in MC twins. One of the great successes in fetal therapy is the introduction of fetoscopic laser coagulation of vascular anastomoses for the treatment of twin–twin transfusion syndrome (TTTS). The investigation on postoperative complications in TTTS placentas is crucial for the further improvement of fetoscopic laser surgery and improvement of perinatal outcome. Since 2002, all MC placentas delivered at the Leiden University Medical Center (LUMC) are consecutively being examined and injected with colored dye. This large database of MC placentas (n=940 in 2016) allows detailed investigation of the pathogenesis and clinical outcome of these rare diseases. Show less
