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5. ISUOG Practice Guidelines (updated): performance of the routine mid‐trimester fetal ultrasound scan

Author

Salomon, L. J., primary, Alfirevic, Z., additional, Berghella, V., additional, Bilardo, C. M., additional, Chalouhi, G. E., additional, Da Silva Costa, F., additional, Hernandez‐Andrade, E., additional, Malinger, G., additional, Munoz, H., additional, Paladini, D., additional, Prefumo, F., additional, Sotiriadis, A., additional, Toi, A., additional, and Lee, W., additional

Published
2022
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7. FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction.

Author

Melamed, N, Baschat, A, Yinon, Y, Athanasiadis, A, Mecacci, F, Figueras, F, Berghella, V, Nazareth, A, Tahlak, M, McIntyre, HD, Da Silva Costa, F, Kihara, AB, Hadar, E, McAuliffe, F, Hanson, M, Ma, RC, Gooden, R, Sheiner, E, Kapur, A, Divakar, H, Ayres-de-Campos, D, Hiersch, L, Poon, LC, Kingdom, J, Romero, R, Hod, M, Melamed, N, Baschat, A, Yinon, Y, Athanasiadis, A, Mecacci, F, Figueras, F, Berghella, V, Nazareth, A, Tahlak, M, McIntyre, HD, Da Silva Costa, F, Kihara, AB, Hadar, E, McAuliffe, F, Hanson, M, Ma, RC, Gooden, R, Sheiner, E, Kapur, A, Divakar, H, Ayres-de-Campos, D, Hiersch, L, Poon, LC, Kingdom, J, Romero, R, and Hod, M

Abstract

Fetal growth restriction (FGR) is defined as the failure of the fetus to meet its growth potential due to a pathological factor, most commonly placental dysfunction. Worldwide, FGR is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Ongoing advances in clinical care, especially in definitions, diagnosis, and management of FGR, require efforts to effectively translate these changes to the wide range of obstetric care providers. This article highlights agreements based on current research in the diagnosis and management of FGR, and the areas that need more research to provide further clarification of recommendations. The purpose of this article is to provide a comprehensive summary of available evidence along with practical recommendations concerning the care of pregnancies at risk of or complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this condition. To achieve these goals, FIGO (the International Federation of Gynecology and Obstetrics) brought together international experts to review and summarize current knowledge of FGR. This summary is directed at multiple stakeholders, including healthcare providers, healthcare delivery organizations and providers, FIGO member societies, and professional organizations. Recognizing the variation in the resources and expertise available for the management of FGR in different countries or regions, this article attempts to take into consideration the unique aspects of antenatal care in low-resource settings (labelled “LRS” in the recommendations). This was achieved by collaboration with authors and FIGO member societies from low-resource settings such as India, Sub-Saharan Africa, the Middle East, and Latin America.

Published
2021

8. A literature review and best practice advice for second and third trimester risk stratification, monitoring, and management of pre-eclampsia: Compiled by the Pregnancy and Non-Communicable Diseases Committee of FIGO (the International Federation of Gynecology and Obstetrics).

Author

Poon, LC, Magee, LA, Verlohren, S, Shennan, A, von Dadelszen, P, Sheiner, E, Hadar, E, Visser, G, Da Silva Costa, F, Kapur, A, McAuliffe, F, Nazareth, A, Tahlak, M, Kihara, AB, Divakar, H, McIntyre, HD, Berghella, V, Yang, H, Romero, R, Nicolaides, KH, Melamed, N, Hod, M, Poon, LC, Magee, LA, Verlohren, S, Shennan, A, von Dadelszen, P, Sheiner, E, Hadar, E, Visser, G, Da Silva Costa, F, Kapur, A, McAuliffe, F, Nazareth, A, Tahlak, M, Kihara, AB, Divakar, H, McIntyre, HD, Berghella, V, Yang, H, Romero, R, Nicolaides, KH, Melamed, N, and Hod, M

Published
2021

9. Outcome of twin–twin transfusion syndrome according to Quintero stage of disease: systematic review and meta‐analysis

Author

Mascio, DD, Khalil, A, D'Amico, A, Buca, D, Panici, PB, Flacco, ME, Manzoli, L, Liberati, M, Nappi, L, Berghella, V, and D'Antonio, F

Abstract

Objectives\ud To report the outcome of pregnancies complicated by twin–twin transfusion syndrome (TTTS) according to Quintero stage.\ud \ud Methods\ud MEDLINE, EMBASE and CINAHL databases were searched for studies reporting the outcome of pregnancies complicated by TTTS stratified according to Quintero stage (I–V). The primary outcome was fetal survival rate according to Quintero stage. Secondary outcomes were gestational age at birth, preterm birth (PTB) before 34, 32 and 28 weeks' gestation and neonatal morbidity. Outcomes are reported according to the different management options (expectant management, laser therapy or amnioreduction) for pregnancies with Stage‐I TTTS. Only cases treated with laser therapy were considered for those with Stages‐II–IV TTTS and only cases managed expectantly were considered for those with Stage‐V TTTS. Random‐effects head‐to‐head meta‐analysis was used to analyze the extracted data.\ud \ud Results\ud Twenty‐six studies (2699 twin pregnancies) were included. Overall, 610 (22.6%) pregnancies were diagnosed with Quintero stage‐I TTTS, 692 (25.6%) were Stage II, 1146 (42.5%) were Stage III, 247 (9.2%) were Stage IV and four (0.1%) were Stage V. Survival of at least one twin occurred in 86.9% (95% CI, 84.0–89.7%) (456/552) of pregnancies with Stage‐I, in 85% (95% CI, 79.1–90.1%) (514/590) of those with Stage‐II, in 81.5% (95% CI, 76.6–86.0%) (875/1040) of those with Stage‐III, in 82.8% (95% CI, 73.6–90.4%) (172/205) of those with Stage‐IV and in 54.6% (95% CI, 24.8–82.6%) (5/9) of those with Stage‐V TTTS. The rate of a pregnancy with no survivor was 11.8% (95% CI, 8.4–15.8%) (69/564) in those with Stage‐I, 15.0% (95% CI, 9.9–20.9%) (76/590) in those with Stage‐II, 18.6% (95% CI, 14.2–23.4%) (165/1040) in those with Stage‐III, 17.2% (95% CI, 9.6–26.4%) (33/205) in those with Stage‐IV and in 45.4% (95% CI, 17.4–75.2%) (4/9) in those with Stage‐V TTTS. Gestational age at birth was similar in pregnancies with Stages‐I–III TTTS, and gradually decreased in those with Stages‐IV and ‐V TTTS. Overall, the incidence of PTB and neonatal morbidity increased as the severity of TTTS increased, but data on these two outcomes were limited by the small sample size of the included studies. When stratifying the analysis of pregnancies with Stage‐I TTTS according to the type of intervention, the rate of fetal survival of at least one twin was 84.9% (95% CI, 70.4–95.1%) (94/112) in cases managed expectantly, 86.7% (95% CI, 82.6–90.4%) (249/285) in those undergoing laser therapy and 92.2% (95% CI, 84.2–97.6%) (56/60) in those after amnioreduction, while the rate of double survival was 67.9% (95% CI, 57.0–77.9%) (73/108), 69.7% (95% CI, 61.6–77.1%) (203/285) and 80.8% (95% CI, 62.0–94.2%) (49/60), respectively.\ud \ud Conclusions\ud Overall survival in monochorionic diamniotic pregnancies affected by TTTS is higher for earlier Quintero stages (I and II), but fetal survival rates are moderately high even in those with Stage‐III or ‐IV TTTS when treated with laser therapy. Gestational age at birth was similar in pregnancies with Stages‐I–III TTTS, and gradually decreased in those with Stages‐IV and ‐V TTTS treated with laser and expectant management, respectively. In pregnancies affected by Stage‐I TTTS, amnioreduction was associated with slightly higher survival compared with laser therapy and expectant management, although these findings may be confirmed only by future head‐to‐head randomized trials.

Published
2020

10. Weight discordance and perinatal mortality in monoamniotic twin pregnancy: analysis of MONOMONO, NorSTAMP and STORK multiple‐pregnancy cohorts

Author

Saccone, G, Khalil, A, Thilaganathan, B, Glinianaia, SV, Berghella, V, D'Antonio, F, MONOMONO, NorSTAMP, and STORK research collaboratives

Abstract

Objectives\ud The primary objective was to quantify the risk of perinatal mortality in non‐anomalous monochorionic monoamniotic (MCMA) twin pregnancies complicated by birth‐weight (BW) discordance. The secondary objectives were to investigate the effect of inpatient vs outpatient fetal monitoring on the risk of mortality in weight‐discordant MCMA twin pregnancies, and to explore the predictive accuracy of BW discordance for perinatal mortality.\ud \ud Methods\ud This analysis included data on 242 MCMA twin pregnancies (484 fetuses) from three major research collaboratives on twin pregnancy (MONOMONO, STORK and NorSTAMP). The primary outcomes were the risks of intrauterine (IUD), neonatal (NND) and perinatal (PND) death, according to weight discordance at birth from ≥ 10% to ≥ 30%. The secondary outcomes were the association of inpatient vs outpatient fetal monitoring with the risk of mortality in weight‐discordant pregnancies, and the accuracy of BW discordance in predicting mortality. Logistic regression and receiver‐operating‐characteristics‐curve analyses were used to analyze the data.\ud \ud Results\ud The risk of IUD was significantly increased in MCMA twin pregnancies with BW discordance ≥ 10% (odds ratio (OR), 2.2; 95% CI, 1.1–4.4; P = 0.022) and increased up to an OR of 4.4 (95% CI, 1.3–14.4; P = 0.001) in those with BW discordance ≥ 30%. This association remained significant on multivariate logistic regression analysis for BW‐discordance cut‐offs ≥ 20%. However, weight discordance had low predictive accuracy for mortality, with areas under the receiver‐operating‐characteristics curve of 0.60 (95% CI, 0.46–0.73), 0.52 (95% CI, 0.33–0.72) and 0.57 (95% CI, 0.45–0.68) for IUD, NND and PND, respectively. There was no difference in the risk of overall IUD, single IUD, double IUD, NND or PND between pregnancies managed as an inpatient compared with those managed as an outpatient, for any BW‐discordance cut‐off.\ud \ud Conclusions\ud MCMA twin pregnancies with BW discordance are at increased risk of fetal death, signaling a need for increased levels of monitoring. Despite this, the predictive accuracy for mortality is low; thus, detection of BW discordance alone should not trigger intervention, such as iatrogenic delivery. The current data do not demonstrate an advantage of inpatient over outpatient management in these cases.

Published
2020

13. Erratum to 'The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention' [Int J Gynecol Obstet 145 Suppl. 1 (2019) 1-33].

Author

Poon, LC, Shennan, A, Hyett, JA, Kapur, A, Hadar, E, Divakar, H, McAuliffe, F, da Silva Costa, F, von Dadelszen, P, McIntyre, HD, Kihara, AB, Di Renzo, GC, Romero, R, D'Alton, M, Berghella, V, Nicolaides, KH, Hod, M, Poon, LC, Shennan, A, Hyett, JA, Kapur, A, Hadar, E, Divakar, H, McAuliffe, F, da Silva Costa, F, von Dadelszen, P, McIntyre, HD, Kihara, AB, Di Renzo, GC, Romero, R, D'Alton, M, Berghella, V, Nicolaides, KH, and Hod, M

Published
2019

18. Reply

Author

Saccone, G., primary, Di Spiezio Sardo, A., additional, and Berghella, V., additional

Published
2017
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22. Reply

Author

Berghella, V., primary, Dugoff, L., additional, and Ludmir, J., additional

Published
2017
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