The blood circulations of monochorionic twins are connected through vascular anastomoses on the shared placenta. In about 10% of the monochorionic twin pregnancies, a disbalance occurs in blood... Show moreThe blood circulations of monochorionic twins are connected through vascular anastomoses on the shared placenta. In about 10% of the monochorionic twin pregnancies, a disbalance occurs in blood flow from the placenta to the children: one child, the recipient, receives more blood than the other child, the donor. This situation is called twin-twin transfusion syndrome (TTTS) and is often lethal for both twins. Fetoscopic laser therapy is the preferred and only causal treatment for TTTS and since the introduction in the 90’s, has improved survival rates from 65 to 90%. However, fetoscopic laser therapy is not always successful and residual anastomoses can persist, which can cause recurrence of TTTS or TAPS. In addition, fetoscopic laser therapy can induce pregnancy complications. In this thesis rates and risk factors for complications as intertwin membrane rupture, placental abruption and post-procedural amniotic band syndrome are investigated. We studied short-term and long-term outcomes and evaluated neurodevelopmental impairment at age 2 and 5 years. Show less
Introduction: Twin-twin transfusion syndrome (TTTS) is a complication in monochorionic twin pregnancies which is preferably treated with fetoscopic laser surgery. A few small studies suggested a... Show moreIntroduction: Twin-twin transfusion syndrome (TTTS) is a complication in monochorionic twin pregnancies which is preferably treated with fetoscopic laser surgery. A few small studies suggested a possible association between the Solomon laser technique and placental abruption. Methods: The objective of this study is to compare the rate of and to explore potential risk factors for placental abruption in TTTS treated with fetoscopic laser surgery according to the Selective and Solomon laser technique. We conducted a large retrospective cohort study of consecutive TTTS-cases treated with fetoscopic laser surgery in Shanghai, China, and Leiden, The Netherlands treated with either the Selective laser technique (Selective group) or Solomon laser technique (Solomon group). Results: The rate of placental abruption in the Selective group versus the Solomon group was 1.7% (5/289) and 3.4% (15/441), respectively (p = 0.184). No risk factors for placental abruption were identified. Placental abruption was associated with lower gestational age at birth (p = 0.003) and severe cerebral injury (p = 0.003). Conclusion: The prevalence of placental abruption in TTTS after fetoscopic laser surgery is low, although it appears higher than in the overall population. Placental abruption is associated with a lower gestational age at birth, which is associated with severe cerebral injury. The rate of placental abruption was not significantly increased with the use of the Solomon technique. Continued research of placental abruption in TTTS is necessary to determine why the rate is higher than in the overall population. Show less
Heitkamp, A.; Aronson, S.L.; Akker, T. van den; Vollmer, L.; Gebhardt, S.; Roosmalen, J. van; ... ; Theron, G. 2020
BackgroundMajor obstetric haemorrhage is a leading cause of maternal mortality and accounts for one-third of maternal deaths in of Africa. This study aimed to assess the population-based incidence,... Show moreBackgroundMajor obstetric haemorrhage is a leading cause of maternal mortality and accounts for one-third of maternal deaths in of Africa. This study aimed to assess the population-based incidence, causes, management and outcomes of major obstetric haemorrhage and risk factors associated with poor maternal outcome.MethodsWomen with major obstetric haemorrhage who met the WHO maternal near-miss criteria or died in the Metro East region, Cape Town, South Africa, were evaluated from November 2014-November 2015. Major obstetric haemorrhage was defined as haemorrhage in pregnancies of at least 20weeks' gestation or occurring up to 42days after birth, and leading to hysterectomy, hypovolaemic shock or blood transfusion of >= 5units of Packed Red Blood Cells. A logistic regression model was used to analyse associations with poor outcome, defined as major obstetric haemorrhage leading to massive transfusion of >= 8units of packed red blood cells, hysterectomy or death.ResultsThe incidence of major obstetric haemorrhage was 3/1000 births, and the incidence of massive transfusion was 4/10.000 births in the Metro East region (32.862 births occurred during the studied time period). Leading causes of haemorrhage were placental abruption 45/119 (37.8%), complications of caesarean section 29/119 (24.4%) and uterine atony 13/119 (10.9%). Therapeutic oxytocin was administered in 98/119 (82.4%) women and hysterectomy performed in 33/119 (27.7%). The median numbers of packed red blood cells and units of Fresh Frozen Plasma transfused were 6 (interquartile range 4-7) and 3 (interquartile range 2-4), ratio 1.7:1. Caesarean section was independently associated with poor maternal outcome: adjusted OR 4.01 [95% CI 1.58, 10.14].ConclusionsAssessment of major obstetric haemorrhage using the Maternal Near Miss approach revealed that placental abruption and complications of caesarean section were the major causes of major obstetric haemorrhage. Caesarean section was associated with poor outcome. Show less
