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Introduction: The aim of our study was to compare maternal, chorionicity and neonatal complications in monochorionic (MC) twins between spontaneously conceived (SC) and assisted reproductive technologies (ART) pregnancies., Material and Methods: This was a retrospective cohort study between January 2010 to December 2019 at a tertiary referral University center. All consecutive pregnancies with MC twins that delivered at our University hospital were included. Maternal, chorionicity and neonatal complications were recorded and compared between SC and ART pregnancies., Results: 393 MC pregnancies were included for final analysis, including 353 (89.8%) SC and 40 (10.2%) pregnancies conceived after ART. Hypothyroidism was the only maternal condition seen significantly more often in ART pregnancies (35.0% vs 12.5%, p = 0.001). There were no significant differences in chorionicity complications, such as twin-twin transfusion syndrome, selective fetal growth restriction and twin anemia-polycythemia sequence (40.0% in ART pregnancies vs 31.6% in SC pregnancies, p = 0.291). At least one congenital anomaly in one twin was seen significantly more often in ART pregnancies (18.8% vs 8.1%, p = 0.004), especially congenital heart defects (16.3% vs 6.2%, p = 0.005). There were no other significant differences in neonatal outcomes between both groups, however, there were non-significant trends in gestational age at delivery (34 weeks in ART pregnancies vs 35 weeks, p = 0.078) and birthweight (1951 g ± 747 in ART pregnancies vs 2143 g ± 579, p = 0.066)., Conclusion: This is the largest cohort study to date comparing maternal, chorionicity and neonatal complications between MC twin pregnancies after ART and after SC. Hypothyroidism was the only maternal condition occurring more frequently in pregnancies conceived after ART. There were no significant differences in chorionicity complications, in contrast to previously reported studies. While MC twins and ART pregnancies per se are known to be at risk for congenital heart defects, there seems to be a cumulative effect in MC pregnancies conceived after ART., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Aims: The aim of this official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG) was to provide consensus-based recommendations obtained by evaluating the relevant literature for the diagnostic treatment and management of women with fetal growth restriction., Methods: This S2k guideline represents the structured consensus of a representative panel of experts with a range of different professional backgrounds commissioned by the Guideline Committee of the DGGG., Recommendations: Recommendations for diagnostic treatment, management, counselling, prophylaxis and screening are presented.

We report on the successful intrauterine surgical treatment of a twin pregnancy with an acardiac fetus. At 18 weeks of gestation the patient presented with polyhydramnios and a hydropic acardius acephalus and the donor twin showed signs of congestive heart failure. Colour Doppler ultrasound allowed localisation of the communicating vessels running on the placental surface towards the umbilicus of the acardiac twin. At 20 weeks we performed endoscopic laser coagulation of the umbilical vessels of the acardiac twin. A sheath (9.8 Charriere) with a 1.9 mm diameter rigid fetoscope (field of vision 60 degrees) was introduced percutaneously under local anesthesia into the amniotic cavity of the "pump" twin. Under sonographic control the fetoscope was directed towards the communicating vessels on the placental surface. A Nd-YAG laser (0.4 mm diameter fiber) was used to coagulate two vessels, artery and vein, until interruption of the reversed arterial perfusion was accomplished. Tricuspid regurgitation of the normal twin disappeared throughout the following two weeks and no further complications occurred throughout pregnancy. At 39 weeks a healthy girl was delivered vaginally. No at the age of 3 months she is developing normally. Minimal invasive endoscopic laser coagulation of the umbilical vessels of the acardiac twin appears to be the optimal currently available treatment for the normal twin, for which otherwise a high mortality ( > 50%) and morbidity must be expected.

We performed 77 Doppler blood flow studies of the umbilical artery in 45 foetuses with malformations and/or chromosomal abnormalities. 20 foetuses had chromosomal abnormalities and 34 records of the second and third trimester were analysed. In 25 foetuses with malformations, but without chromosomal abnormalities, 43 investigations were performed between 21st and 40th weeks of gestation. In the second trimester, 3 of 11 foetuses with chromosomal abnormalities had an absence of enddiastolic flow velocities, whereas the other foetuses had pulsatility indices within the range for foetuses with a normal karyotype. In the third trimester, 7 of 10 foetuses with chromosomal abnormalities had pathological Doppler findings. Four cases had absent or reversed enddiastolic (ARED) flow velocities. Altogether 10 of 13 foetuses beyond the 19th weeks of gestation had pathological Doppler findings (sensitivity = 77%). The structure and the function of the placenta is influenced by the abnormal karyotype, which is demonstrated by pathological Doppler findings. Only 3 of 43 investigations in foetuses with malformations but normal karyotype, showed abnormal PI values and there was no case of ARED flow. In a group of 24 foetuses with ARED flow, 6 foetuses had chromosomal abnormalities. All foetuses with malformations and ARED flow had an abnormal karyotype. Prenatal chromosome analyses of foetuses with suspicious sonographic findings, revealed a rate of 29% chromosomal abnormalities, nearly all of them with a maternal age under 35 years. Whereas Doppler sonography cannot exclude chromosomal abnormalities before the 20th weeks of gestation, there is a good correlation between chromosomal abnormalities and abnormal Doppler findings later on.(ABSTRACT TRUNCATED AT 250 WORDS)

The case reports of 70 patients (including 12 cases of endometrial carcinoma operated by the same method) were evaluated for postoperative complications such as pathological changes in the iv-pyelograms, incidence of haemorrhage or haematomas at the operation site, and for the frequency of lymphatic cysts. In addition, the amount of secretion and the duration of drainage were recorded. In 26 patients, the wounds of the parietal peritoneum were sutured, in 44 women, the pelvic peritoneum was left open after primary occlusion of the vaginal vault. If the two groups are compared with respect to the incidence of complications, the results are: pathologic postoperative ivP: 3.4:1; haemorrhage or haematomas: 5:1; lymphatic cysts: 1.6:1. The duration of drainage was almost the same in both groups (1.1:1), but the amount of liquid drained was less in the peritonealised group (0.5:1). These data and the fact, that the overall morbidity in the "open peritoneum" group was significantly lower, leads us to recommend strongly that leaving the pelvic peritoneum open provides evident advantages compared with the traditional procedure. In addition, a marked reduction of the operation time is achieved. Negative consequences, such as postoperative ileus, did not occur.

In 110 pregnancies, repeated examinations of unconjugated E3 and HPL levels in maternal serum were carried out as well as repeated duplex pulsed doppler flow measurements in the umbilical artery and the fetal aorta. In 30 cases the fetuses were suspected to be growth retarded (group A), 5 small for date babies were not detected by routine ultrasound (group B) and 75 were normal control cases (group C). 17 fetuses of group A proved to be really SGA-babies (birthweight less than 10. percentile). The evaluation of the results indicates a higher sensitivity of the flow measurements in the diagnosis of growth retardation compared with the hormonal parameters (flow: 65%, E3: 12%, HPL: 29%). Above all, Doppler sonography is very reliable in distinguishing between growth retarded fetuses, at risk or not at risk.

249 blood-flow measurements were carried out with pulsed Doppler-ultrasound in the umbilical arteries and the descending aorta of 188 fetuses. The PI and the RI of the recorded flowpatterns were calculated. In a retrospective study we then calculated the validity of the prediction of a pathological fetal outcome, i.e. a SGA-fetus and/or perinatal morbidity, for both indices. The sensitivity of the PI is 63%, the specificity was 98%, the sensitivity of the RI was 40%, and the specificity 98%. Therefore the sensitivity of the PI is significantly higher than that of the RI (p less than 0.05). In the second, prospective part of the study these results could be verified by means of an equivalent number of measurements to the first group (n = 249) with 178 fetuses. All the jeopardized fetuses with IUGR and perinatal morbidity (n = 13) were detected by an increased PI, but even in this group the sensitivity of the RI was only 54%. The possible reasons for these results are discussed, taking into account the different characteristics of the two indices and the influence of the heart rate on both of them.