Search

Objective: To assess perinatal cardiac function in offspring of women with previous bariatric surgery and examine its association with maternal glucose control. Design: Prospective study. Setting: Maternity unit, UK. Population: Fifty‐four fetuses/neonates; 29 of post‐bariatric surgery women and 25 of women without surgery. Methods: Prospective, longitudinal observational study of pregnant women with and without previous bariatric surgery, matched for early pregnancy body mass index. Cardiac function of all offspring was assessed by two‐dimensional conventional, spectral tissue Doppler and speckle‐tracking echocardiography at 35–37 weeks of gestation and at 5–7 weeks of age. Maternal glycated haemoglobin (HbA1c) was measured at 27–30 weeks of gestation. Maternal demographics and fetal/infant cardiac function indices were compared between the groups. Correlation coefficient (r) is reported. Main outcome measures: Fetal/infant cardiac function indices. Results: Compared with no‐bariatric neonates, offspring of post‐bariatric women were smaller at birth (birthweight centiles: 64.96 ± 36.41 versus 40.17 ± 27.99; p = 0.007). There were no significant differences in fetal/infant cardiac function indices and perinatal cardiac changes, between groups. There was a positive correlation between maternal HbA1c and fetal left ventricular (LV) longitudinal strain (r = 0.33) and LV longitudinal strain rate (r = 0.29), suggesting an inverse relation between HbA1c and fetal LV systolic function, but this was mainly seen in offspring of women with no previous bariatric surgery (r = 0.56 and r = 0.50, respectively). Conclusions: Maternal bariatric surgery does not appear to inadvertently affect the offspring cardiac performance. We found an inverse correlation between maternal HbA1c levels and fetal LV systolic function but this was mainly seen in the no‐bariatric pregnancies. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of an adjuvant allogenic umbilical cord mesenchymal stromal cell (UC‐MSC) patch applied during fetal surgery on motor and sphincter function in the ovine MMC model. Design: MMC defects were surgically created at 75 days of gestation and repaired 14 days later. Population: Ovine MMC model: fetal lambs. Methods: We compared lambs that received a UC‐MSC patch with a control group of lambs that received an acellular patch. Main Outcome Measures: Clinical neurological assessment was performed at 2 and 24 hours of life and included determination of the Sheep Locomotor Rating scale (SLR), which has been validated in the ovine MMC model. Electrophysical examinations, spine scans and histological analyses were also performed. Results: Of the 13 operated lambs, nine were born alive: five had of these had received a UC‐MSC patch and four an acellular patch. At 24 hours of life, lambs in the UC‐MSC group had a significantly higher score (14 versus 5, P = 0.04). Amyotrophy was significantly more common in the control group (75% versus 0%, P = 0.02). All the lambs in the control group and none of those in the UC‐MSC group were incontinent. No significant differences were observed between the UC‐MSC and control groups in terms of the presence of spontaneous EMG activity, nerve conduction or spinal evoked potentials. In the microscopic examination, lambs in the UC‐MSC group had less fibrosis between the spinal cord and the dermis (mean thickness, 453 versus 3921 μm, P = 0.03) and around the spinal cord (mean thickness, 47 versus 158 μm, P < 0.001). Examination of the spinal cord in the area of the MMC defect showed a higher large neuron density in the UC‐MSC group (14.5 versus 5.6 neurons/mm2, P < 0.001). No tumours were observed. Conclusions: Fetal repair of MMC using UC‐MSC patches improves motor and sphincter function as well as spinal preservation and reduction of fibrosis. Linked article: This article is commented on by Anna L. David, pp. 768 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17730. [ABSTRACT FROM AUTHOR]

Objective: To determine the medium‐term maternal impact of open fetal spina bifida repair. Design: Prospective cohort study. Setting: University Hospitals Leuven, Belgium. Population: Mothers who had open maternal–fetal spina bifida repair between March 2012 and December 2021. Methods: A patient‐reported survey on subsequent fertility, pregnancy, and gynaecological and psychological outcomes. Main outcome measures: Complications during subsequent pregnancies, and gynaecological and psychological problems. Results: Seventy‐two out of 100 invited women completed the questionnaire (72%). Despite being advised not to, seven of 13 women attempting to conceive became pregnant within 2 years after fetal surgery and one woman delivered vaginally. Two of the 16 subsequent pregnancies were complicated by an open neural tube defect. One pregnancy was complicated by a placenta accreta and one pregnancy was complicated by a uterine rupture, both with good neonatal outcomes. Nearly half of respondents who did not attempt to conceive reported that this was because of their experience of the index pregnancy and caring for the index child. Three out of four respondents reported medium‐term psychological problems, mostly anxiety for the health of the index child, fear for recurrence in subsequent pregnancies and feelings of guilt. Conclusions: Open maternal–fetal surgery for spina bifida did not appear to affect fertility in our cohort. Half of the attempts to conceive took place within 2 years. One uterine rupture and one placenta accreta occurred in 16 subsequent pregnancies. Most respondents reported psychological problems linked to the index pregnancy, which reinforces the need for long‐term psychological support. [ABSTRACT FROM AUTHOR]

IUD occurred in 1.8% (95% CI 0.4-4.4) of DCDA pregnancies with and in 0.6% (95% CI 0.4-0.9) of those non-complicated by sFGR, while the corresponding figures for NND were 2.1% (95% CI 1.2-3.1) and 2.8% (95% 1.0-5.5). Relative risk (RR) and 95% confidence interval (CI) was calculated to assess the association between SGA and stillbirth using the two standards. OP.0024 Prenatal exome sequencing and Central Nervous System anomalies: Systematic review and meta-an... Gillian Blayney 1; Preethi Jacob 2; Caitlin Baptiste 3; Heinz Gabriel 4; Teresa Sparks 5... 1 Fetal Medicine Department, Royal Jubilee Maternity Service, Belfast Health and Social Care... B Objective: b Structural anomalies detected on ultrasound in fetuses with normal conventional karyotyping or chromosomal microarray (CMA) often pose a diagnostic and management challenge. The IG21 standard designated 3096 EFWs as SGA (1.4%) including 12 stillbirths (RR 3.4 CI 1.9-6.0), while according to the customised GROW standard, 9145 (4.2%) EFWs were SGA, with 25 stillbirths (RR 2.4; CI 1.6-3.6). [Extracted from the article]

Objective: To evaluate the effect of gestational age at laser therapy for twin‐to‐twin transfusion syndrome (TTTS) on perinatal outcome. Design and settings: Single retrospective observational cohort. Population All consecutive pregnancies affected by TTTS and referred to our department between January 2013 and August 2020. Methods: Gestational age was modelled both as a categorical and as a continuous variable. Log‐binomial regression was used to estimate the odds ratios (crude and adjusted for placental location, Quintero stage and cervical length) as well as the adjusted predicted probability of survival and fetal loss according to gestational age at laser therapy. Main outcomes: Fetal and neonatal survival, preterm prelabour rupture of membranes (PPROM). Results: Of the 503 pregnancies referred for TTTS, 431 were treated by laser therapy. Gestational age at laser therapy was positively and significantly associated with the overall survival at birth and at discharge (adjusted odds ratio [aOR] 1.12, 95% CI 1.05–1.19), as with a reduction in double fetal loss (aOR 0.81, 95% CI 0.71–0.92). Conversely, the rate of PPROM before 24 weeks was significantly higher in early cases (32% of PPROM <24 weeks when laser therapy was performed before 17 weeks versus 1.5% after 22 weeks, p < 0.001, aOR 0.60, 95% CI 0.48–0.72). Among the survivors, preterm birth before 28 weeks was significantly related to the gestational age at laser (OR 0.91, 95% CI 0.84–0.99), resulting in a significant impact on neonatal morbidity (OR 0.91, 95% CI 0.85–0.97). Conclusion: Our results suggest a significant and independent impact of the gestational age at laser surgery on perinatal survival, PPROM and neonatal morbidity. Gestational age at laser therapy for TTTS is associated with an increased risk of perinatal mortality and mortality. Linked article: This article is commented on by Mariano Lanna, pp. 2038 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17237 [ABSTRACT FROM AUTHOR]

The article discusses various topics related to obstetrics and gynecology, emphasizing the importance of the principle "first do no harm." It explores controversies surrounding procedures for urinary incontinence and pelvic organ prolapse, as well as the escalating rates of caesarean deliveries globally. The long-term impacts of interventions, such as caesarean deliveries and bariatric surgery, are also examined. Additionally, the article addresses the risks and outcomes associated with the COVID-19 pandemic in relation to pregnancy. The importance of patient-centered care, education, and innovation in improving healthcare outcomes is highlighted. The article concludes by emphasizing the need for evidence-based medicine and research to guide healthcare practices. [Extracted from the article]

Linked article: This is a mini commentary on Athiel et al, pp. 759‐767 in this issue. To view this article visit https://doi.org/10.1111/1471‐0528.17624. [ABSTRACT FROM AUTHOR]

Objective: To systematically categorise all maternal and fetal intervention‐related complications after open fetal myelomeningocele (fMMC) repair of the first 124 cases operated at the Zurich Centre for Fetal Diagnosis and Therapy. Design: A prospective cohort study. Setting: Single centre. Population: Mothers and fetuses after fMMC repair. Methods: Between 2010 and 2019, we collected and entered all maternal complications following fMMC repair into the Clavien–Dindo classification. For fetal complications, a classification system based on the Medical Dictionary for Regulatory Activities terminology of Adverse Events was used including the preterm definitions of the World Health Organization. Main outcome measures: Systematic classification of maternal and fetal complications following fMMC repair. Results: Gestational ages at surgery and birth were 25.0 ± 0.8 and 35.4 ± 2.0 weeks, respectively. In 17% of all cases, no maternal complications occurred. Maternal intervention‐related complications were observed as follows: 69% grade 1, 36% grade 2, 25% grade 3, 6% grade 4 and 0% grade 5. In 34%, no fetal complications were noted; however, 43% of the fetuses developed a grade 1, 14% a grade 2, 8% a grade 3, 2% a grade 4 and 2% a grade 5 complication. Conclusion: This study raises awareness of complications following open fMMC repair; 6% of mothers and 2% of fetuses experienced a severe complication (grade 4) and perinatal death rate of 2% was observed (grade 5). These data are useful for prenatal counselling, they help to improve the system of fetal surgical care, and they allow benchmarking with other centres as well as comparison with fetoscopic approaches. Systematic classification of all maternal and fetal intervention‐related complications following open fMMC repair. Systematic classification of all maternal and fetal intervention‐related complications following open fMMC repair. [ABSTRACT FROM AUTHOR]

Objective: To identify predictors for intact motor function (MF) at birth and at 12 months of life in babies with prenatally versus postnatally repaired open spina bifida (OSB). Design: Retrospective cohort study. Setting: Texas Children's Hospital, 2011–2018. Population: Patients who underwent either prenatal or postnatal OSB repair. Methods: Prenatal MF of the lower extremities was evaluated by ultrasound following a metameric distribution at the time of diagnosis (US1), 6 weeks postoperatively (or 6 weeks after initial evaluation in postnatally repaired cases) (US2) and at the last ultrasound before delivery (US3). At birth and at 12 months, MF was assessed clinically. Intact MF (S1) was defined as the observation of plantar flexion of the ankle. Results from logistic regression analysis are expressed as odds ratios (95% confidence intervals, P values). Results: A total of 127 patients were included: 93 with prenatal repair (51 fetoscopic; 42 open hysterotomy repair) and 34 with postnatal repair. In the prenatal repair group, predictors for intact MF at birth and at 12 months included: absence of clubfeet (OR 11.3, 95% CI 3.2–39.1, P < 0.01; OR 10.8 95% CI 2.4–47.6, P < 0.01); intact MF at US1 (OR 19.7, 95% CI 5.0–76.9, P < 0.01; OR 8.7, 95% CI 2.0–38.7, P < 0.01); intact MF at US2 (OR 22, 95% CI 6.5–74.2, P < 0.01; OR 13.5, 95% 3.0–61.4, P < 0.01); intact MF at US3 (OR 13.7, 95% CI 3.4–55.9, P < 0.01; OR 12.6, 95% CI 2.5–64.3, P < 0.01); and having a flat lesion (OR 11.2, 95% CI 2.4–51.1, P < 0.01; OR 4.1, 95% CI 1.1–16.5, P = 0.04). In the postnatal repair group, the only predictor of intact MF at 12 months was having intact MF at birth (OR 15.2, 95% CI 2.0–113.3, P = 0.03). Conclusions: The detection of intact MF in utero from mid‐gestation to delivery predicts intact MF at birth and at 12 months in babies who undergo prenatal OSB repair. Detection of intact motor function in utero predicts intact motor function at birth and at 1 year in fetuses who undergo prenatal OSB repair. Detection of intact motor function in utero predicts intact motor function at birth and at 1 year in fetuses who undergo prenatal OSB repair. [ABSTRACT FROM AUTHOR]

Background: Abnormal intracranial findings are often detected at mid-trimester ultrasound (US) in fetuses with myelomeningocele (MMC). It is unclear whether these findings constitute a spectrum of the disease or are an independent finding, which should contraindicate fetal surgery.Objective: To ascertain the spectrum and frequency of US-detected cranial findings in fetuses with MMC.Search Strategy: MEDLINE, Embase, Web of Science and CENTRAL were searched from January 2000 to June 2020.Selection Criteria: Study reporting incidence of cranial US findings in consecutive cases of second-trimester fetuses with MMC.Data Collection and Analysis: Publication quality was assessed by Newcastle-Ottawa Scale (NOS) and modified NOS. Meta-analysis could not be performed as a result of high clinical diversity and study heterogeneity.Main Results: Fourteen cranial US findings were reported in 15 studies. Findings in classic Chiari II malformation (CIIM) spectrum included posterior fossa funnelling (96%), small transcerebellar diameter (82-96%), 'banana' sign (50-100%), beaked tectum (65%) and 'lemon' sign (53-100%). Additional cranial findings were small biparietal diameter (BPD) and head circumference (HC) (<5th centile; 53 and 71%, respectively), ventriculomegaly (45-89%), abnormal pointed shape of the occipital horn (77-78%), thinning of the posterior cerebrum, perinodular heterotopia (11%), abnormal gyration (3%), corpus callosum disorders (60%) and midline interhemispheric cyst (42%).Conclusions: We identified 14 cranial findings by second-trimester US in fetuses with MMC. The relatively high incidence of these findings and their unclear prognostic significance might not contraindicate fetal surgery in the case of normal fetal genetic testing. Some cranial findings may independently affect postnatal outcome, however. Long-term detailed follow-up is required to investigate this.Tweetable Abstract: A high rate of cranial abnormalities found on second-trimester ultrasound in fetuses with myelomeningocele. [ABSTRACT FROM AUTHOR]

Objectives: (1) To compare brain findings between large and non-large neural tube defect (NTD); (2) to evaluate the impact of large lesion on the surgical parameters; (3) to study any associations between the size of the lesions and brain findings 6 weeks postoperatively and neurological short-term outcomes.Design: Retrospective cohort study.Setting: Texas Children's Hospital, between 2011 and 2018.Population: Patients who underwent prenatal NTD repair.Methods: Large lesion was defined when the lesion's surface was >75th centile of our cohorts' lesions.Main Outcome Measures: Time of referral: ventriculomegaly and anatomical level of the lesion; surgery: duration and need for relaxing incisions. 6 weeks postoperative: hindbrain herniation (HBH) and ventriculomegaly. After delivery: dehiscence, need for hydrocephalus treatment and motor function.Results: A total of 99 patients were included, 25 of whom presented with large lesions. Type of lesion and ventriculomegaly were comparable between individuals with large and non-large lesions. Individuals with large lesions were associated with increased need for relaxing incisions by 5.4 times (95% CI 1.3-23.2, P = 0.02). Six weeks postoperatively, having a large lesion decreased by ten times the likelihood of having a postoperative reversal of HBH (odds ratio = 0.1, 95% CI 0.1-0.4, P < 0.01). At birth, larger lesions increased the risk for repair dehiscence by 6.1 times (95% CI 1.6-22.5, P < 0.01) and the risk of dehiscence or leakage of cerebrospinal fluid at birth by 5.5 times (95% CI 1.6-18.9, P < 0.01).Conclusion: Prenatal repair of patients with large NTD presents a lower proportion of HBH reversal 6 weeks after the surgery, a higher risk of dehiscence and a higher need for postnatal repair.Tweetable Abstract: Evaluation of the size of fetal NTD can predict adverse neurological outcomes after prenatal NTD repair. [ABSTRACT FROM AUTHOR]

Objectives: To review perinatal and neurodevelopmental outcome (NDO) following selective fetoscopic laser coagulation (SFLC), cord coagulation (CC) or expectant management of monochorionic diamniotic twin pregnancies complicated with selective intrauterine growth restriction (sIUGR) and absent or reverse end-diastolic flow (AREDF) in the umbilical arteries (UA).Design and Setting: Single-centre retrospective observational study.Population: 108 cases of sIUGR diagnosed before 26+6  weeks' gestation with AREDF in the UA.Methods: Survival rate and potential risk factors were analysed. NDO was assessed using parental questionnaires.Main Outcomes Measures: Survival, gestational age at delivery and NDO.Results: SFLC, CC and EM were performed in 13, 50 and 45 cases, respectively, with an overall survival of 23.1, 40 and 77.8% and intrauterine demise of the co-twin of 30.8, 10 and 6.7% respectively. Intrauterine demise of the sIUGR twin occurred in 76.9 and 17.8% following SFLC and EM, respectively. The discordance in EFW at diagnosis was higher and absent/negative a-wave in the ductus venosus (DV) was more prevalent in the surgical groups. NDO in survivors at follow up was abnormal in 0 and 18% in the smaller twin following SFLC and EM, respectively, and in 25, 24 and 21% in the larger twin following SFLC, CC and EM, respectively.Conclusion: SFLC yielded a poor result. EM seems a valid option when EFW discordance is <30% and a-wave in DV is positive. Otherwise, CC should be considered to protect the AGA co-twin. The long-term outcome of both small and large twins seems unaffected by the choice in primary prenatal management strategy.Tweetable Abstract: In type II sIUGR in MC twins, long-term neurodevelopment is normal in over 80% of the survivors. [ABSTRACT FROM AUTHOR]

Objective: To investigate cerebral anomalies other than Chiari type 2 malformation in fetuses with myelomeningocele (MMC).Design: A retrospective cohort study in a single tertiary centre.Setting: A review of associated cerebral anomalies in cases with prenatal diagnosis of myelomeningocele.Population: Seventy cases of fetal myelomeningocele.Methods: Ultrasound and MRI images were blindly reviewed. Postnatal imaging and results of the postmortem results were also reviewed. The association between cerebral anomalies and the following ultrasound findings was measured: level of the defect, ventriculomegaly, microcephaly and fetal talipes.Main Outcome Measures: A microcephaly was observed in 32/70 cases (46%) and a ventriculomegaly was observed in 39/70 cases (56%). Other cerebral anomalies were diagnosed in 47/70 (67%).Results: Other cerebral anomalies were represented by 42/70 cases with abnormal CC (60%), 8/70 cases with perinodular heterotopia (PNH; 11%), 2/70 cases with abnormal gyration (3%). MRI performed only in fetal surgery cases confirmed the ulltrasound findings in all cases and provided additional findings in two cases (PNH). Risk ratios of fetal cerebral anomalies associated with MMC did not reach significance for microcephaly, ventriculomegaly, talipes or the level of the defect There was an overall good correlation between pre- and postnatal findings with a Kappa value of 0.79 [95% CI 0.57-1] and 82% agreement.Conclusion: Fetal brain anomalies other than Chiari type 2 malformation are frequently observed in fetuses with myelomeningocele, predominantly represented by CC anomalies. Whether these associated cerebral anomalies have an impact on selecting cases eligible for fetal surgery needs further evaluation.Tweetable Abstract: Fetal cerebral anomalies other than Chiari type 2 malformation, microcephaly, and ventriculomegaly may be associated with MMC in up to 67% of the cases. [ABSTRACT FROM AUTHOR]

Objective: Describe outcomes of open fetal surgery for myelomeningocele (MMC) repair in two Brazilian hospitals and the impact of surgical experience on outcome.Design: Retrospective cohort study.Setting: Sao Paulo, Brazil.Population: 237 pregnant women carrying a fetus with an open spinal defect.Methods: Surgical details, and maternal and fetal outcomes collected from all patients.Main Outcome Measures: Analysis of surgical and perinatal outcome parameters.Results: Total surgical time was 119 ± 7.6 minutes. Preterm labour occurred in 24.2%, premature rupture of membranes in 26.7%, placental abruption in 0.8%, need for a blood transfusion at delivery in 2.1%, and dehiscence at the repair site in 2.5%. Reversal of hindbrain herniation at birth occurred in 71.4%. There were no maternal deaths or severe maternal morbidities. The failure rate with the patient anaesthetised was 0.42% and perinatal mortality was 2.1% (three intrauterine demises and two neonatal deaths). Comparing results from our study in the first 3 years with the last 3 years demonstrated improvement in the total surgical time (121.2 ± 6.4 versus 118.5 ± 8.2 minutes, P = 0.005) and an increase in reversal of hindbrain herniation at birth (64.0 versus 77.1%, P = 0.042).Conclusion: Our open fetal surgical approach for MMC was effective and results were comparable to past studies. Improvements in surgical performance and perinatal outcome increased as the surgical team became more familiar with the procedure.Funding: The study was funded solely by institutional funds.Tweetable Abstract: Brazilian experience of in utero open surgery for myelomeningocele repair. [ABSTRACT FROM AUTHOR]

Objective: In utero fetal surgery to correct incomplete closure of the spinal cord lessens the extent of permanent damage but is associated with preterm prelabour rupture of membranes (PPROM). We determined whether compounds in amniotic fluid collected at the time of surgery predicted subsequent development of PPROM.Design: Prospective study.Setting: Hospitals in Sao Paulo, Brazil.Population: Twenty-four consecutive pregnant women at 24-26 weeks of gestation seen between February and October 2017 with a singleton pregnancy underwent in utero surgery to correct an open spinal defect in their fetus.Methods: Amniotic fluid was tested for lactic acid, matrix metalloproteinase 2 (MMP-2), MMP-8, MMP-9 and interleukin-6 (IL-6) by enzyme-linked immunosorbent assay. Clinical data were collected after completion of all laboratory studies.Main Outcome Measure: Amniotic fluid concentration of compounds in women with or without PPROM.Results: Preterm prelabour rupture of membranes occurred in seven (29.2%) women. There were no differences in maternal age, gravidity, parity, race, history of caesarean sections or fetal gender between women with or without PPROM. Length of surgery, days of wound healing and length of hospital stay were also indistinguishable. The median concentrations of MMP-8 (1.7 versus 0.6 ng/ml; P = 0.0041) and lactic acid (7.1 versus 5.9 mm; P = 0.0181) were higher in women with PPROM. The amniotic fluid MMP-8 level was also negatively correlated with gestational age at delivery (Spearman r = -0.4217, P = 0.0319).Conclusion: Differences in susceptibility to develop PPROM are present before fetal surgery. An increase in anaerobic glycolysis, evidenced by the intra-amniotic lactic acid level, may enhance MMP-8 production and weaken maternal and fetal membranes.Tweetable Abstract: Matrix metalloproteinase-8 and lactic acid in amniotic fluid predict preterm prelabour rupture of membranes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of the hands and knees position during the first stage of labour to facilitate the rotation of the fetal head to the occiput anterior position.Design: Randomised controlled trial.Setting: Geneva University Hospitals, Switzerland.Population: A total of 439 women with a fetus in the occiput posterior position during the first stage of labour.Methods: The women in the intervention group were invited to take a hands and knees position for at least for 10 minutes. Women allocated to the control group received the usual care. For both groups, 15 minutes after randomisation, women completed a short questionnaire to report their perceived pain and the comfort of their position.Main Outcome Measures: The rotation of the fetal head in occiput anterior position confirmed by ultrasonography 1 hour after randomisation.Results: One hour after the randomisation, 35 of 203 (17%) fetuses were diagnosed as being in the occiput anterior position in the intervention group compared with 24 of 209 (12%) in the control group. This difference was not statistically significant (relative risk 1.50; 95% CI 0.93-2.43; P = 0.13). The change in the evaluation of comfort between the randomisation and 15 minutes after showed an improvement in 70 and 39 women, no change in 82 and 78 women and a decrease in 56 and 86 women in the intervention and control groups, respectively (P = 0.02).Conclusions: This study could not demonstrate a benefit of the hands and knees position to correct the occiput posterior position of the fetus during the first stage of labour, but the women reported an increase in their comfort level.Tweetable Abstract: Hands and knees position does not facilitate rotation into occiput anterior but increases the comfort level of women. [ABSTRACT FROM AUTHOR]

Objective To report a recent update on fetuses with right-sided congenital diaphragmatic hernia ( RCDH) in the era of fetal surgery. Design Retrospective review of prospectively collected data. Setting Fetal treatment centres in Leuven and Barcelona. Population Consecutive cases of RCDH between 2002 and 2012. Methods Data on prenatal imaging, genetic testing, pregnancy and neonatal outcomes were extracted from our databases, including structural and genetic anomalies, candidate outcome predictors such as lung size, liver herniation ratio, polyhydramnios, cervical length, preterm prelabour rupture of membranes and gestational age at birth. Main outcome measures Survival and oxygen dependency at discharge. Results Ten out of 86 fetuses with RCDH had associated abnormalities. Of 76 isolated pregnancies, eight women opted for termination of pregnancy, most with severe hypoplasia and one was lost to follow up. Nineteen pregnancies were expectantly managed and delivered at a mean gestational age of 36.0 ± 3.0 weeks. Survival at discharge was 53% (10/19), one being oxygen dependent. In the fetal surgery group ( n = 48), mean gestational age at delivery was 34.5 ± 3.0 weeks. In our recent experience not previously published ( n = 23) survival rate was 52 and 39% were oxygen dependent at discharge. Pooling these data with earlier reported observations by our group we observed a 42% survival rate in 57 fetuses. Lung size on magnetic resonance imaging and an interval of >24 hours between reversal of tracheal occlusion and delivery were predictors of outcome. Conclusions Right-sided CDH seems to have a poorer outcome than that reported for fetuses with left-sided CDH with similar lung size before birth. Survival rates after expectant management with observed/expected lung-to-head ratio values ≤45 and ≤30% were 17 and 0%, respectively. In those undergoing fetal surgery (observed/expected lung-to-head ratio ≤45%) there was an apparent increase (42%). [ABSTRACT FROM AUTHOR]

Minimal invasive intrauterine interventions have gained their place in fetal medicine. Interventions on the placenta, umbilical cord, fetal membranes or on the fetus require special endoscopes with their respective sheaths, cannulas and additional instruments. Instruments for fetal therapy are purpose designed for the procedure of interest and most gynaecologists are therefore not familiar with them. We review the currently available instrumentation used during operations for complicated monochorionic multiple pregnancies, congenital diaphragmatic hernia, amniotic band syndrome, urinary tract obstruction and hydrothorax. [ABSTRACT FROM AUTHOR]

Re: Rethinking the time interval to embryo transfer after uterus transplantation - DUETS (Dallas UtErus Transplant Study) Therefore, this commentary on the time interval to ET after UTx and shortening of the recipient graft time is particularly important for decreasing the burden on recipients. 1 Johannesson L, Wall A, Putman JM, Zhang L, Testa G, Diaz-Garcia C. Rethinking the time interval to embryo transfer after uterus transplantation - DUETS (Dallas UtErus Transplant Study). [Extracted from the article]

Should you recommend growth ultrasound for patients in the third trimester with a history of bariatric surgery? Authors' conclusions Fetuses of women with previous bariatric surgery are smaller during pregnancy than those of women without such surgery. [Extracted from the article]

The article discusses the issues relating to the premature preterm rupture of the membranes (PPROM) in fetal surgery. It mentions the potential effects of performing the hysterotomy. It also mentions the implications of measurement of maternal blood contamination of the amniotic fluid and the genetic amniocentesis.

The article focuses on the prenatal management of spina bifida. Topics discussed include improvement and decreasing surgery-related morbidity; issues relating to the prenatal surgery and child birth; and the information on the complications of obstetrical prognosis along with the endoscopic surgery.

The article focuses on the study of the outcome of the treatment of congenital diaphragmatic hernia (CDH) through fetal endotracheal occlusion (FETO). Topics include the determination of the prognostic factor on right-sided CDH (RCDH), the significant of FETO in increasing the survival of fetus without the increase in pre-term birth, and the aspects of the relationship between the intervention and outcome.