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STUDY QUESTION What is the impact of BMI on uncomplicated pregnancies and healthy births in women who did or did not have medically assisted reproduction (MAR, i.e. ART or hormonal stimulation without manipulation of eggs or embryos) in the Flanders region (Belgium)? SUMMARY ANSWER Women with a higher BMI who use MAR are at the highest risk of pregnancy and birth complications. WHAT WE KNOW ALREADY Medically assisted reproduction (MAR) is used increasingly worldwide and is associated with increased risk of adverse perinatal outcomes. Obesity is also increasing globally and obese women are more likely to seek MAR since obesity is associated with infertility. When obese women undergo MAR, the risk of adverse outcomes may be enhanced but it is not clear to what extent. STUDY DESIGN, SIZE, DURATION We conducted a registry-based study using the data from the Study Centre for Perinatal epidemiology database for years 2009–2015, region of Flanders, Belgium. This included 428 336 women. PARTICIPANTS/MATERIALS, SETTING, METHODS The average age was 30.0 years (SD 4.78), 194 061 (45.31%) were nulliparous, and 6.3% (n = 26 971) conceived with MAR. We examined the association of BMI and MAR with the following composite primary outcomes: 'uncomplicated pregnancy and birth' and 'healthy baby'. We conducted Poisson regression and adjusted for maternal age, parity, gestational weight gain, smoking and previous caesarean section. MAIN RESULTS AND THE ROLE OF CHANCE In our study, 36.80% (n = 157 623) of women had an uncomplicated pregnancy and birth according to the definition used. The predicted probability of having an uncomplicated pregnancy and birth for women with a BMI of 25 kg/m2 who conceived spontaneously was 0.33 (0.32 to 0.35), while it was 0.28 (0.24 to 0.32) for women who used hormonal stimulation and 0.26 (0.22 to 0.29) for women who used IVF/ICSI. This probability reduced with increasing BMI category for both MAR and non-MAR users. For women with a BMI of 30 kg/m2, the predicted probability of having an uncomplicated pregnancy and birth was 0.28 (0.26 to 0.30) for women who conceived spontaneously, and 0.22 (0.16 to 0.29) and 0.20 (0.14 to 0.26) for women who used hormonal stimulation only or IVF/ICSI, respectively. The predicted probability of having a healthy baby for women with a BMI of 25 kg/m2 who conceived spontaneously was 0.92 (0.91 to 0.93), 0.89 (0.87 to 0.92) for women who used hormonal stimulation only and 0.85 (0.84 to 0.87) for women who used IVF/ICSI. LIMITATIONS, REASONS FOR CAUTION The database did not include data on socio-economic status, pre-pregnancy morbidities and paternal BMI. Subsequently, we could not adjust for these factors in the analysis. WIDER IMPLICATIONS OF THE FINDINGS Obese women who use MAR are at the highest risk of pregnancy and birth complications. This increase in interventions also has cost and resource implications which is relevant for funding policies. Weight loss interventions prior to MAR seem plausible but their (cost-) effectiveness needs urgent investigation. STUDY FUNDING/COMPETING INTEREST(S) F.W. received an Erasmus Plus training grant to visit A.B. L.A. and R.D. and conducted this study during this visit. The authors have no competing interest to declare. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Objective:Lifestyle intervention could help obese pregnant women to limit their weight gain during pregnancy and improve their psychological comfort, but has not yet been evaluated in randomized controlled trials. We evaluated whether a targeted antenatal lifestyle intervention programme for obese pregnant women influences gestational weight gain (GWG) and levels of anxiety or depressed mood.Design and subjects:This study used a longitudinal interventional design. Of the 235 eligible obese pregnant women, 205 (mean age (years): 29±4.5; body mass index (BMI, kg m−2): 34.7±4.6) were randomized to a control group, a brochure group receiving written information on healthy lifestyle and an experimental group receiving an additional four antenatal lifestyle intervention sessions by a midwife trained in motivational lifestyle intervention. Anxiety (State and Trait Anxiety Inventory) and feelings of depression (Edinburgh Depression Scale) were measured during the first, second and third trimesters of pregnancy. Socio-demographical, behavioural, psychological and medical variables were used for controlling and correcting outcome variables.Results:We found a significant reduction of GWG in the brochure (9.5 kg) and lifestyle intervention (10.6 kg) group compared with normal care group (13.5 kg) (P=0.007). Furthermore, levels of anxiety significantly decreased in the lifestyle intervention group and increased in the normal care group during pregnancy (P=0.02); no differences were demonstrated in the brochure group. Pre-pregnancy BMI was positively related to levels of anxiety. Obese pregnant women who stopped smoking recently showed a significant higher GWG (β=3.04; P=0.01); those with concurrent gestational diabetes mellitus (GDM) (β=3.54; P=0.03) and those who consumed alcohol on a regular base (β=3.69; P=0.04) showed significant higher levels of state anxiety. No differences in depressed mood or obstetrical/neonatal outcomes were observed between the three groups.Conclusions:A targeted lifestyle intervention programme based on the principles of motivational interviewing reduces GWG and levels of anxiety in obese pregnant women. [ABSTRACT FROM AUTHOR]

Microcystic or solid-looking fetal lung lesions associated with hydrops are associated with a high mortality rate. The most common of these lesions are microcystic congenital cystic adenomatoid malformations and pulmonary sequestrations (PS). Performing open fetal surgery by hysterotomy and lobectomy has, until now, been the only therapeutic option available following diagnosis of these lesions in the second trimester. Here we describe a new minimally invasive technique for the treatment of PS in the second trimester. Laser coagulation of the feeding systemic artery of the sequestration was performed under ultrasound guidance. The blood flow to the lung tumor was successfully arrested and hydrops reversed. The child was born at term and, at the time of writing, was alive and well at 2 years of age. Large PS with hydrops can be treated successfully by ultrasound-guided minimally invasive laser surgery. It is therefore important to utilize color Doppler ultrasound imaging for identification of a systemic feeding blood vessel in solid fetal lung tumors. [ABSTRACT FROM AUTHOR]

Objectives: To define and grade fetal and maternal adverse events following fetal surgery for spina bifida and to report on the impact of engaging patients in collecting follow‐up data. Methods: This prospective single‐center audit included 100 consecutive patients undergoing fetal surgery for spina bifida between January 2012 and December 2021. In our setting, patients return to their referring unit for further pregnancy care and delivery. On discharge, referring hospitals were requested to return outcome data. For this audit, we prompted patients and referring hospitals to provide data in cases of missing outcomes. Outcomes were categorized as missing, returned spontaneously or returned following additional request, by the patient and/or referring center. Postoperative maternal and fetal complications until delivery were defined and graded according to Maternal and Fetal Adverse Event Terminology (MFAET) and the Clavien–Dindo classification. Results: There were no maternal deaths, but severe maternal complications occurred in seven women (anemia in pregnancy, postpartum hemorrhage, pulmonary edema, lung atelectasis, urinary tract obstruction and placental abruption). No cases of uterine rupture were reported. Perinatal death occurred in 3% of fetuses and other severe fetal complications in 15% (perioperative fetal bradycardia/cardiac dysfunction, fistula‐related oligohydramnios, chorioamnionitis and preterm prelabor rupture of membranes (PPROM) before 32 weeks). PPROM occurred in 42% of patients and, overall, delivery took place at a median gestational age of 35.3 weeks (interquartile range, 34.0–36.6 weeks). Information provided following additional request, from both centers and patients but mainly from the latter, reduced missing data by 21% for gestational age at delivery, 56% for uterine‐scar status at birth and 67% for shunt insertion at 12 months. Compared with the generic Clavien–Dindo classification, the MFAET system ranked complications in a more clinically relevant way. Conclusions: The nature and rate of severe complications following fetal surgery for spina bifida were similar to those reported in other large series. Spontaneous return of outcome data by referring centers was low, yet patient empowerment improved data collection. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on ultrasound visualization of fetal membrane detachment at the uterine cervix.

Discusses the case of a pregnant patient with preterm premature rupture of the fetal membranes diagnosed using color Doppler ultrasonography. Signs and symptoms; Transabdominal ultrasound; Turbulence of the amniotic fluid accumulating at the internal os of the cervix.

Outcome of monochorionic twin pregnancy with selective fetal growth restriction at 16, 20 or 30 weeks according to new Delphi consensus definition Keywords: definition; discordance; growth restriction; monochorionic twin pregnancy; outcome EN definition discordance growth restriction monochorionic twin pregnancy outcome 821 830 10 12/03/20 20201201 NES 201201 CONTRIBUTION B What are the novel findings of this work? More specifically, a pregnancy with sFGR complicated by TTTS at 19 weeks was included in the 16-week analysis but not in the 20- or 30-week analysis, as this pregnancy would no longer be diagnosed with isolated sFGR. In 44/177 (25%) sFGR pregnancies, the smaller twin had continuous or intermittent absent or reversed end-diastolic umbilical artery flow, which was classified as sFGR Type II in 11 and Type III in 33 pregnancies, with survival rates of 55% (12/22) and 83% (55/66), respectively ( I P i = 0.006). [Extracted from the article]

Objective: The Management of Myelomeningocele Study (MOMS) trial demonstrated the safety and efficacy of open fetal surgery for spina bifida aperta (SBA). Recently developed alternative techniques may reduce maternal risks without compromising the fetal neuroprotective effects. The aim of this systematic review was to assess the learning curve (LC) of different fetal SBA closure techniques.Methods: MEDLINE, Web of Science, EMBASE, Scopus and Cochrane databases and the gray literature were searched to identify relevant articles on fetal surgery for SBA, without language restriction, published between January 1980 and October 2018. Identified studies were reviewed systematically and those reporting all consecutive procedures and with postnatal follow-up ≥ 12 months were selected. Studies were included only if they reported outcome variables necessary to measure the LC, as defined by fetal safety and efficacy. Two authors independently retrieved data, assessed the quality of the studies and categorized observations into blocks of 30 patients. For meta-analysis, data were pooled using a random-effects model when heterogeneous. To measure the LC, we used two complementary methods. In the group-splitting method, competency was defined when the procedure provided results comparable to those in the MOMS trial for 12 outcome variables representing the immediate surgical outcome, short-term neonatal neuroprotection and long-term neuroprotection at ≥ 12 months of age. Then, when raw patient data were available, we performed cumulative sum analysis based on a composite binary outcome defining successful surgery. The composite outcome combined four clinically relevant variables for safety (absence of extreme preterm delivery < 30 weeks, absence of fetal death ≤ 7 days after surgery) and efficacy (reversal of hindbrain herniation and absence of any neonatal treatment of dehiscence or cerebrospinal fluid leakage at the closure site).Results: Of 6024 search results, 17 (0.3%) studies were included, all of which had low, moderate or unclear risk of bias. Fetal SBA closure was performed using standard hysterotomy (11 studies), mini-hysterotomy (one study) or fetoscopy by either exteriorized-uterus single-layer closure (one study), percutaneous single-layer closure (three studies) or percutaneous two-layer closure (one study). Only outcomes for standard hysterotomy could be meta-analyzed. Overall, outcomes improved significantly with experience. Competency was reached after 35 consecutive cases for standard hysterotomy and was predicted to be achieved after ≥ 57 cases for mini-hysterotomy and ≥ 56 for percutaneous two-layer fetoscopy. For percutaneous and exteriorized-uterus single-layer fetoscopy, competency was not reached in the 81 and 28 cases available for analysis, respectively, and LC prediction analysis could not be performed.Conclusions: The number of cases operated is correlated with the outcome of fetal SBA closure, and the number of operated cases required to reach competency ranges from 35 for standard hysterotomy to ≥ 56-57 for minimally invasive modifications. Our observations provide important information for institutions looking to establish a new fetal center, develop a new fetal surgery technique or train their team, and inform referring clinicians, potential patients and third parties. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: It is not currently well known to what extent the sites of cord insertion influence the risk of complicated outcome in monochorionic twin pregnancy. The objectives of this study were to examine whether the sites of cord insertion, as determined on prenatal ultrasound examination, affect the risks of adverse outcome, twin-to-twin transfusion syndrome (TTTS) and discordant growth, and whether discordance in insertion sites or velamentous insertion in one or both twins best predicts risk.Methods: This was a retrospective cohort study of monochorionic diamniotic twin pregnancies followed from the first trimester. The cohort was divided into three groups of increasing discordance in cord insertion sites: concordant (normal-normal; marginal-marginal; velamentous-velamentous), intermediate (normal-marginal; marginal-velamentous) and discordant (normal-velamentous). Adverse outcome was defined as fetal or neonatal loss or birth prior to 32 weeks. The associations of adverse outcome, TTTS and discordant growth were assessed using logistic regression analysis with the following predictors: the three groups of insertion sites and velamentous insertion in one or both twins.Results: Included in the analysis were 518 pregnancies. On univariate analysis, both discordant and velamentous insertions in one twin increased the risk of adverse outcome, TTTS and discordant growth. Intermediate insertion only increased the risk of discordant growth. Velamentous insertion in both twins increased the risk of adverse outcome and TTTS, but not of discordant growth. Multivariate logistic regression analysis showed velamentous insertion in one or both twins to independently predict adverse outcome and TTTS. For discordant growth, both intermediate/discordant and velamentous cord insertion in one twin were independent predictors.Conclusions: Velamentous cord insertion in one or both twins increases the risk of adverse outcome and TTTS, irrespective of discordance in the insertion sites, whereas the risk of discordant growth is determined by both discordance in insertion sites and velamentous cord insertion in one twin. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: Fetoscopic laser surgery for twin-twin transfusion syndrome is a procedure for which no objective tools exist to assess technical skills. To ensure that future fetal surgeons reach competence prior to performing the procedure unsupervised, we developed a performance assessment tool. The aim of this study was to validate this assessment tool for reliability and construct validity.Methods: We made use of a procedure-specific evaluation instrument containing all essential steps of the fetoscopic laser procedure, which was previously created using Delphi methodology. Eleven experts and 13 novices from three fetal medicine centers performed the procedure on the same simulator. Two independent observers assessed each surgery using the instrument (maximum score: 52). Interobserver reliability was assessed using Spearman correlation. We compared the performance of novices and experts to assess construct validity.Results: The interobserver reliability was high (Rs  = 0.974, P < 0.001). Checklist scores for experts and novices were significantly different; the median score for novices was 28/52 (54%), whereas that for experts was 47.5/52 (91%) (P < 0.001). The procedure time and fetoscopy time were significantly shorter (P < 0.001) for experts. Residual anastomoses were found in 1/11 (9%) procedures performed by experts and in 9/13 (69%) procedures performed by novices (P = 0.005). Multivariable analysis showed that the checklist score, independent of age and gender, predicted competence.Conclusions: The procedure-specific assessment tool for fetoscopic laser surgery shows good interobserver reliability and discriminates experts from novices. This instrument may therefore be a useful tool in the training curriculum for fetal surgeons. Further intervention studies with reassessment before and after training may increase the construct validity of the tool. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic accuracy of middle cerebral artery peak systolic velocity (MCA-PSV) Doppler measurements in prediction of hemoglobin levels in twin anemia-polycythemia sequence (TAPS).Methods: This study involved a consecutive cohort comprising monochorionic twin pregnancies complicated by TAPS managed at three European fetal medicine centers between 2005 and 2013. The accuracy of MCA-PSV, measured immediately prior to fetal hemoglobin (Hb) measurement by fetal or cord blood sampling, for prediction of anemia and polycythemia was assessed using 2 × 2 tables.Results: A total of 116 measurements (74 recorded in donors and 42 in recipients) from 43 twin pregnancies complicated by TAPS were available for analysis. MCA-PSV multiples of the median (MoM) values correlated well with Hb levels (r = - 0.86; P < 0.001). The sensitivity of MCA-PSV ≥ 1.5 MoM to predict severe anemia (Hb deficit > 5 SD below the mean) in TAPS donors was 94% (95% CI, 85-98%); specificity was 74% (95% CI, 62-83%); positive and negative predictive values were 76% (95% CI, 65-85%) and 94% (95% CI, 83-98%), respectively. The sensitivity of MCA-PSV ≤ 1.0 MoM to predict polycythemia (Hb level > 5 SD above the mean) in TAPS recipients was 97% (95% CI, 87-99%); specificity was 96% (95% CI, 89-99%); positive and negative predictive values were 93% (95% CI, 81-97%) and 99% (95% CI, 93-100%), respectively.Conclusion: MCA-PSV measurement has high diagnostic accuracy for predicting abnormal Hb levels in fetuses with TAPS. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To evaluate the effect of a newly developed training curriculum on the performance of fetoscopic laser surgery for twin-twin transfusion syndrome ( TTTS) using an advanced high-fidelity simulator model. Methods Ten novices were randomized to receive verbal instructions and either skills training using the simulator (study group; n = 5) or no training (control group; n = 5). Both groups were evaluated with a pre-training and post-training test on the simulator. Performance was assessed by two independent observers and comprised a 52-item checklist for surgical performance ( SP) score, measurement of procedure time and number of anastomoses missed. Eleven experts set the benchmark level of performance. Face validity and educational value of the simulator were assessed using a questionnaire. Results Both groups showed an improvement in SP score at the post-training test compared with the pre-training test. The simulator-trained group significantly outperformed the control group, with a median SP score of 28 (54%) in the pre-test and 46 (88%) in the post-test vs 25 (48%) and 36 (69%), respectively ( P = 0.008). Procedure time decreased by 11 min (from 44 to 33 min) in the study group vs 1 min (from 39 to 38 min) in the control group ( P = 0.69). There was no significant difference in the number of missed anastomoses at the post-training test between the two groups (1 vs 0). Subsequent feedback provided by the participants indicated that training on the simulator was perceived as a useful educational activity. Conclusions Proficiency-based simulator training improves performance, indicated by SP score, for fetoscopic laser therapy. Despite the small sample size of this study, practice on a simulator is recommended before trainees carry out laser therapy for TTTS in pregnant women. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

An abstract of the article "Prenatal treatment of posterior urethral valves by cystoscopic laser ablation" by N. Masoller, R. Devlieger and E. Passchyn and others is presented.

ABSTRACT Objective To determine, by expert consensus, the essential substeps of fetoscopic laser surgery ( FLS) for twin-twin transfusion syndrome ( TTTS) that could be used to create an authority-based curriculum for training in this procedure among fetal medicine specialists. Methods A Delphi survey was conducted among an international panel of experts ( n = 98) in FLS. Experts rated the substeps of FLS on a five-point Likert-type scale to indicate whether they considered them to be essential, and were able to comment on each substep, using a dedicated online platform accessed by the invited tertiary care facilities that specialize in fetal therapy. Responses were returned to the panel until consensus was reached (Cronbach's α ≥ 0.80). All substeps that were rated ≥ 4 by 80% of the experts were included in the evaluation instrument. Results After the first iteration of the Delphi procedure, a response rate of 74% (73/98) was reached, and in the second and third iterations response rates of 90% (66/73) and 81% (59/73) were reached, respectively. Among a total of 81 substeps rated in the first round, 21 substeps had to be re-rated in the second round. Finally, from the initial list of substeps, 55 were agreed by experts to be essential. In the third round, the 18 categorized substeps were ranked in order of importance, with 'coagulation of all anastomoses that cross the equator' and 'determination of fetoscope insertion site' as the most important. Conclusions A total of 55 substeps of FLS for TTTS were defined by a panel of experts to be essential in the procedure. This list is the first authority-based evidence to be used in the development of a final training model for future fetal surgeons. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To evaluate the application of a pocket-sized ultrasound machine ( PUM) in a routine antenatal third-trimester scan compared with a high-specification ultrasound machine ( HSUM). Methods This was an observational cohort study of 53 unselected women who came for their routine third-trimester ultrasound scan. The first scan was performed by an experienced ultrasonographer on an HSUM for fetal growth, fetal wellbeing and placental location. A second experienced operator performed the measurements on the PUM. Both operators were blinded to the other's findings and measurement results. Results Fifty-one patients were eligible and scanned at a median gestational age of 31 + 1 (range, 27 + 2 to 36 + 0) weeks. Mean pregestational body mass index was 22.9 ± 3.1 (range, 17.6-35.7) kg/m2. In the comparison between measurements made using the PUM and HSUM, perfect agreement was found for fetal position, fetal bladder and stomach visualization (all κ 1.0) and very good agreement was found for placental position (κ 0.86). Measurements of deepest vertical pocket correlated moderately (intraclass correlation coefficient ( ICC) 0.38 (95% CI, 0.12-0.59); Bland-Altman bias, 2.43 (95% limits of agreement ( LoA), −22.65 to 27.51)). For fetal growth measurements there was very good agreement for biparietal diameter ( ICC, 0.93 (95% CI, 0.88-0.96), Bland-Altman bias, −1.06 (95% LoA, −5.07 to 2.95)), and good agreement for femur length ( ICC, 0.66 (95% CI, 0.48-0.79), Bland-Altman bias 0.56 (95% LoA, −5.97 to 7.08)) and transcerebellar diameter ( ICC, 0.65 (95% CI, 0.46-0.78), Bland-Altman bias, −0.84 (95% LoA, −7.77 to 6.09)). Conclusion A battery-driven PUM can be used in third-trimester obstetrics for routine assessment of fetal growth (biparietal diameter, transcerebellar diameter and femur length) and for assessment of fetal wellbeing. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the application of a pocket-sized ultrasound machine (PUM) in a routine antenatal third-trimester scan compared with a high-specification ultrasound machine (HSUM). METHODS: This was an observational cohort study of 53 unselected women who came for their routine third-trimester ultrasound scan. The first scan was performed by an experienced ultrasonographer on an HSUM for fetal growth, fetal wellbeing and placental location. A second experienced operator performed the measurements on the PUM. Both operators were blinded to the other's findings and measurement results. RESULTS: Fifty-one patients were eligible and scanned at a median gestational age of 31 + 1 (range, 27 + 2 to 36 + 0) weeks. Mean pregestational body mass index was 22.9 ± 3.1 (range, 17.6-35.7) kg/m(2) . In the comparison between measurements made using the PUM and HSUM, perfect agreement was found for fetal position, fetal bladder and stomach visualization (all [kappa] 1.0) and very good agreement was found for placental position ([kappa] 0.86). Measurements of deepest vertical pocket correlated moderately (intraclass correlation coefficient (ICC) 0.38 (95% CI, 0.12-0.59); Bland-Altman bias, 2.43 (95% limits of agreement (LoA), -22.65 to 27.51)). For fetal growth measurements there was very good agreement for biparietal diameter (ICC, 0.93 (95% CI, 0.88-0.96), Bland-Altman bias, -1.06 (95% LoA, -5.07 to 2.95)), and good agreement for femur length (ICC, 0.66 (95% CI, 0.48-0.79), Bland-Altman bias 0.56 (95% LoA, -5.97 to 7.08)) and transcerebellar diameter (ICC, 0.65 (95% CI, 0.46-0.78), Bland-Altman bias, -0.84 (95% LoA, -7.77 to 6.09)). CONCLUSION: A battery-driven PUM can be used in third-trimester obstetrics for routine assessment of fetal growth (biparietal diameter, transcerebellar diameter and femur length) and for assessment of fetal wellbeing. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To investigate the efficacy of collagen plugs at reducing the risk of preterm premature rupture of membranes ( PPROM) after fetoscopic surgery for congenital diaphragmatic hernia ( CDH). Methods This was a single-center cohort study on all consecutive cases undergoing fetoscopic endoluminal tracheal occlusion ( FETO) for severe or moderate CDH, between April 2002 and May 2011 (n = 141). Cases either received a collagen plug for sealing the fetal membrane defect after FETO or did not, depending on the operating surgeon. The principal outcome measure was the time from fetal surgery to PPROM, further referred to as 'latency'. A multivariable Cox regression model was used to investigate the association between collagen plug and latency while adjusting for risk factors for PPROM. Results Of the 141 cases, 54 (38%) received a collagen plug and 87 (62%) did not. Sixty cases experienced PPROM, 26 among cases with and 34 among cases without a plug (48 vs 39%). The hazard ratio of plug use was 1.29 (95% CI, 0.76-2.19), which does not exclude a potentially increased risk for PPROM when a collagen plug is used. For cases with a plug, 24% had PPROM before balloon removal and 24% had PPROM after elective balloon removal. For cases without a plug, these rates were 30 and 9%, respectively. Perinatal outcomes were similar in both groups. Conclusions No evidence was found that collagen plugs reduce the risk of PPROM after FETO for CDH. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

An abstract of the article "Outcome of hydropic Parvo-B19 infected fetuses referred for intrauterine transfusion (IUT)," by L. De Catte and colleagues is presented.

Objective Fetuses with congenital diaphragmatic hernia (CDH) and for whom additional ultrasound findings are abnormal typically are considered to have a dismal prognosis. Our aim was to assess the outcome of fetuses with CDH and associated intrafetal fluid effusions. Methods This was a retrospective bicentric cohort study on the perinatal management of fetuses with CDH and intrafetal fluid effusions. Results The incidence of effusions was 5.2% ( n = 14) in 269 consecutive cases of left-sided CDH and 29.2% ( n = 14) in 48 cases of right-sided CDH. Hydrothorax ( n = 19 (68%)) and ascites ( n = 16 (57%)) were the most common effusions. A combination of both was present in 11 (39%) fetuses. Of 20 ongoing pregnancies with CDH and fluid effusions, without other anomalies, five with moderate or mild pulmonary hypoplasia were managed without fetoscopic endoluminal tracheal occlusion (FETO). The 15 other cases underwent FETO because of severe pulmonary hypoplasia. Neonatal survival rate was similar in both groups ( n = 2/5 and n = 6/15, respectively ( P = 1.0)). Survival among those who underwent FETO was similar to previously published results concerning isolated cases undergoing FETO. Conclusions Our observations do not support the view that intrafetal effusions are an adverse prognostic factor in fetuses with CDH. In CDH fetuses with effusions and severe pulmonary hypoplasia treated with FETO, neonatal survival is similar to that in isolated cases undergoing the intervention. Whether pleural effusions should be addressed by thoracic drainage procedures remains unproven. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives To predict neonatal survival and pulmonary hypertension by measurement of fetal pulmonary artery reactivity to maternal hyperoxygenation in fetuses with severe congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO). Methods Thirty-eight fetuses underwent FETO at around 28 weeks' gestation and the balloon was removed at 34 weeks in most cases. We performed a hyperoxygenation test and measured the lung-to-head ratio of each fetus before and after each procedure. Outcome measures were neonatal survival, occurrence of pulmonary hypertension and its response to inhaled nitric oxide (iNO). Results Fetuses that survived had a larger increase in lung size and decrease of resistance in the first branch of the main pulmonary artery than did those that died. Both measures were also predictive of pulmonary hypertension unresponsive to iNO. The hyperoxygenation test and lung-to-head ratio were both best predictive for neonatal survival when measured following removal of the balloon (P < 0.002). Discriminant analysis confirmed that these two parameters are independent predictors of outcome. Conclusions In fetuses undergoing FETO, pulmonary vascular reactivity in relation to oxygen and lung size are independent predictors of neonatal survival and pulmonary hypertension. The hyperoxygenation test merits further study in expectantly managed cases. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the validity of the myocardial performance index (MPI) in the assessment of fetal cardiac function in the second and third trimesters of gestation. The index was measured in relation to the systolic and diastolic indices of 117 healthy fetuses and 14 fetuses suspected for cardiac failure. It concludes that MPI is an indicator of the diastolic and systolic functions of fetal left ventricular valve.

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Belgium has reported a proportionally high number of COVID-19-related deaths (Table S1, Figure S1)[1]. According to the classification system of Wu I et al i . for severity of COVID-19 symptoms, 37 (86.0%) patients had mild symptoms and four (9.3%) had severe symptoms, and two (4.7%) were admitted to the intensive care unit (ICU)[3]. No patients developed severe symptoms and there were therefore no ICU admissions or deaths, and no patients developed symptoms during hospitalization. [Extracted from the article]

Abstract Objective To evaluate the impact of fetoscopic laser coagulation of placental anastomoses in severe twin–twin transfusion syndrome on fetal Doppler indices and umbilical vein blood flow volume as calculated with Doppler and two-dimensional ultrasound. Methods Thirty-two cases of second-trimester severe twin–twin transfusion undergoing laser therapy were examined with serial ultrasound before and 1, 3 and 5 days after therapy. Pulsatility indices in the umbilical artery and ductus venosus were measured. Blood volume flow at the level of the intra-abdominal umbilical vein was calculated by means of Doppler and two-dimensional ultrasound. The development of hydropic signs in donors was recorded. Perinatal outcome in terms of neonatal survival was recorded for all cases. Results In recipients, ductus venosus pulsatility index decreased progressively after therapy and, by day 5, median pulsatility index was significantly lower than that before therapy (0.97 vs. 0.82, P < 0.0001). Umbilical vein blood flow volume in recipient twins showed no significant variations before and after laser. In donors, umbilical artery pulsatility index decreased significantly by the first day following therapy (2.1 vs. 1.6, P < 0.0001). Previously absent or reverse umbilical end-diastolic flow reappeared after therapy in 46% (7/15) of donors. Ductus venosus pulsatility index in donors increased significantly by day 1 after therapy (0.99 vs. 1.35, P < 0.0001) but, over days 3 and 5, it returned towards preoperative values. Umbilical vein flow volume measurements (mL/min/kg) in the donor increased by approximately 50% the day after treatment (151 vs. 232, P < 0.0001) and remained elevated. Umbilical vein flow volume before laser therapy was significantly lower in donors compared to recipients (151 vs. 260, P < 0.0001), but the difference was non-significant after treatment (240 vs. 267). One or more hydropic signs developed in eight (25%) donors during the 5... [ABSTRACT FROM AUTHOR]

Abstract Objective To evaluate the incidence, characteristics, and impact on perinatal outcome of the development of hydropic signs in the donor fetus after laser coagulation for severe twin–twin transfusion syndrome in the second trimester. Methods Forty cases of second-trimester severe twin–twin transfusion underwent fetoscopic laser coagulation of placental anastomoses and were followed up with serial ultrasound up to 14 days after therapy. Ultrasound scans were performed just before, and on days 1, 3, 5 and 14 after therapy, and fetuses were monitored for the presence of hydropic signs (skin edema, pleural effusion, ascites and pericardial effusion). Response to therapy and perinatal outcome in terms of neonatal survival were recorded for all cases. Results Four recipients (10%) and three donors (7.5%) died over the first 72 h after therapy. During the study period, two recipients (5.5%) developed frank hydrops fetalis, and eventually died in utero . Ten donors (27.0%) developed one or more hydropic signs. In nine (90%), signs were mild or moderate and transient (mean, 3.2 days), while in one case hydrops worsened and the fetus eventually died. No donors with transient hydrops died in utero , and two died postnatally due to extreme prematurity. Gestational age at procedure and deepest amniotic fluid vertical pocket were similar between hydropic and non-hydropic donors. Discrepancy in estimated fetal weight at procedure was significantly lower in donors developing hydrops (9.6 (SD, 6.4) vs. 17.8 (14.4)%,P = 0.018). In pregnancies with hydropic donors, gestational age at delivery (33.1 (3.4) vs. 29.7 (3.5) weeks,P = 0.015) and birth weight for recipient (2392 (423) vs. 1631 (576) g, P < 0.001) and donor (1908 (774) vs. 1281 (583) g,P = 0.021) were significantly higher. The development of transient hydrops had no influence on neonatal survival at 28 days nor on the rate of clinical resolution of intertwin transfusion. Conclusions Transient... [ABSTRACT FROM AUTHOR]

ABSTRACTObjectiveTo establish by Doppler ultrasound the effects of acute blockage of umbilical cord vessels on the fetal central circulation. DesignExperimental study in anesthetized pregnant sheep. MethodsIn 11 anesthetized pregnant sheep (0.66 of gestation), Doppler velocity profiles and/or venous flow rates were recorded in the ductus venosus, the fetal aorta, the umbilical arteries and the umbilical vein. This involved three phases. In Phase 1, the abdominal wall was closed (n = 9); Phase 2 was during fetoscopy after laparotomy (n = 8); Phase 3 was after coagulation of one of the umbilical arteries (n = 10). As an additional intervention in six fetuses, the umbilical cord was clamped for 5–15 s while blood flow velocity changes in the ductus venosus were observed. ResultsThere were no significant differences between Doppler recordings in Phases 1 and 2. During Phase 3, the pulsatiltiy index of the aorta and of the coagulated umbilical artery increased significantly. The umbilical vein blood flow rate was significantly reduced from a median of 408 (range, 243–575) mL/min/kg in Phase 1 to a median of 173 (range, 107–426) mL/min/kg in Phase 3, but the blood flow rate in the ductus venosus (median, 94; range, 56–148 mL/min/kg vs. median, 92; range, 33–237 mL/min/kg) remained unchanged. The ductus venosus/umbilical vein ratio increased from a median of 0.22 (range, 0.13–0.41) to 0.56 (range, 0.17–0.97) (P < 0.05). Compression of the cord (5–15 s) immediately reduced the time averaged maximum velocity in the ductus venosus from a mean of 51 (standard deviation, 11) cm/s to 20 (standard deviation, 6) cm/s (P < 0.001) without significant changes of the velocity profile. However, the pulsatiltiy index increased from a mean of 0.55 (standard deviation, 0.19) to 1.89 (standard deviation, 0.73) (P < 0.001). ConclusionCentral venous flows in anesthetized fetal sheep are unaffected by laparotomy and hysterotomy. Obliteration of one umbilical artery increases the ductus venosus/umbilical vein volume flow (mL/min/kg) ratio. Compression of the umbilical cord shifts down blood flow velocity profiles in the ductus venosus, and the pulsatiltiy index thus increases. [ABSTRACT FROM AUTHOR]

ABSTRACT Monochorionic ( MC) twin pregnancies are at increased risk of adverse outcome because of the vascular anastomoses that connect the two fetal circulations. MC monoamniotic ( MA) twins are at an even higher risk because of their almost universal cord entanglement and possible compression, which can cause an acute transfusion imbalance between the twins. Chorionicity and amnionicity should be determined during the first-trimester ultrasound examination to identify high-risk MC and MA twin pregnancies for which a fortnightly follow-up may improve outcome. Although this can be achieved readily by assessing and counting the membranes that separate the twins, some pitfalls may occur. We present our observations of two monozygotic twin pairs with an intermediate type of monodichorionic and monodiamniotic twin pregnancy. The first was recognized during the first-trimester scan and the second during the second-trimester scan. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "Cytomegalovirus: a retrospective comparative analysis of fetal ultrasound and magnetic resonance imaging in predicting fetal outcome," by L. Lannoo and colleagues is presented.

An abstract of the conference paper "Middle cerebral artery peak systolic velocities in twin-twin transfusion syndrome fetuses around the time of fetoscopic laser coagulation," by L. Gucciardo and colleagues is presented.

An abstract of the conference paper "Premature fetal closure of the arterial duct: clinical presentation and outcome" by L. De Catte and colleagues is presented.

An abstract of the conference paper "Rate of amniorrhexis is not affected by fetoscopic access cannula diameter" by S. Petersen and colleagues is presented.

An abstract of the article "A controlled study on subsequent fertility, pregnancy and gynecological outcomes after fetal surgery for isolated congenital diaphragmatic hernia" by C. Gréegoire and colleagues is presented.

An abstract of the research paper "Sealing of Iatrogenic Fetal Membrane Defects After Fetoscopic Surgery for Congenital Diaphragmatic Hernia by Collagen Plugs" by A. Engels and colleagues is presented.

An abstract of the article "Short and long term outcome after prenatal diagnosis of obstructive megacystis," by E. Passchyn, A. Hindryckx, L. De Catte, J. A. Deprest, E. Levtchenko, D. Trouet, and R. Devlieger is presented.

An abstract of the article "Socio-demographic determinants and fetal sonographic measurements in patients with primary infection with cytomegalovirus during pregnancy," by R. H. Van Nuland, L. De Catte, L. Lewi, B. De Becker, E. Martens, and R. Devlieger is presented.

An abstract of the article "The influence of maternal body mass index and subsequent weight gain pattern on fetal growth," by A. Pexsters and colleagues is presented.

An abstract of the conference paper "The influence of pre-pregnancy BMI and maternal weight gain in pregnancy on fetal size at 12 weeks: a cross sectional analysis," by J. Luts and colleagues is presented.

An abstract of the conference paper "The effect of BMI on first trimester CRL growth: a longitudinal analysis," by Y. Abdallah and colleagues, is presented.

An abstract of the conference paper "Maternal hyperoxygenation test in fetuses treated prenatally for severe isolated congenital diaphragmatic hernia," by E. Do and colleagues is presented.

An abstract of the conference paper "Outcomes of different anesthetic techniques in fetoscopic laser treatment for TTTS," by F. Debuck and colleagues is presented.

An abstract of the conference paper "Flow of patients with isolated congenital diaphragmatic hernia following referral to a fetal surgery unit" by E. Done and colleagues is presented.

An abstract of the conference paper "The twin anemia polycythemia sequence from a prenatal perspective" by L. Gucciardo and colleagues is presented.