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1. Neonatal outcomes for women at risk of preterm delivery given half dose versus full dose of antenatal betamethasone: a randomised, multicentre, double-blind, placebo-controlled, non-inferiority trial

Author

Thomas Schmitz, Muriel Doret-Dion, Loic Sentilhes, Olivier Parant, Olivier Claris, Laurent Renesme, Julie Abbal, Aude Girault, Héloïse Torchin, Marie Houllier, Nolwenn Le Saché, Alexandre J Vivanti, Daniele De Luca, Norbert Winer, Cyril Flamant, Claire Thuillier, Pascal Boileau, Julie Blanc, Véronique Brevaut, Pierre-Emmanuel Bouet, Géraldine Gascoin, Gaël Beucher, Valérie Datin-Dorriere, Stéphane Bounan, Pascal Bolot, Christophe Poncelet, Corinne Alberti, Moreno Ursino, Camille Aupiais, Olivier Baud, Philippe Boize, Charles Garabédian, Florence Flamein, Maela Le Lous, Alain Beuchée, Jean Gondry, Pierre Tourneux, Perrine Coste-Mazeau, Antoine Bedu, Denis Gallot, Karen Coste, Céline Chauleur, Hugues Patural, Gilles Kayem, Delphine Mitanchez, Hélène Heckenroth, Farid Boubred, Jeanne Sibiude, Luc Desfrère, Caroline Bohec, Thierry Mansir, Antoine Koch, Pierre Kuhn, Nadia Tillouche, Fabrice Lapeyre, Franck Perrotin, Géraldine Favrais, Edouard Lecarpentier, Xaxier Durrmeyer, Véronique Equy, Thierry Debillon, Luc Rigonnot, Stéphanie Lefoulgoc, Claudia Brie, Anne-Sophie Pagès, Romy Rayssiguier, Gilles Cambonie, Corinne Cudeville, Doriane Madeleneau, Olivier Morel, Jean-Michel Hascoet, Vincent Letouzey, Massimo Di Maio, Laurent J. Salomon, Alexandre Lapillonne, Hôpital Robert Debré, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), CHU Bordeaux [Bordeaux], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Maternité Port-Royal [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), AP-HP - Hôpital Antoine Béclère [Clamart], Service de Pédiatrie et Réanimations néonatales [Béclère], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Hypertension pulmonaire : physiopathologie et innovation thérapeutique (HPPIT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Physiopathologie des Adaptations Nutritionnelles (PhAN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), CHI Poissy-Saint-Germain, Physiologie et physiopathologie endocriniennes (PHYSENDO), École Nationale Supérieure de Formation de l'Enseignement Agricole de Toulouse-Auzeville (ENSFEA), Education, Formation, Travail, Savoirs (EFTS), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-École Nationale Supérieure de Formation de l'Enseignement Agricole de Toulouse-Auzeville (ENSFEA), Hôpital Nord [CHU - APHM], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier de Saint-Denis [Ile-de-France], Centre Hospitalier René Dubos [Pontoise], Hôpital Robert Debré Paris, Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Health data- and model- driven Knowledge Acquisition (HeKA), Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École Pratique des Hautes Études (EPHE), Centre d'Investigation Clinique 1426 (CIC 1426), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Maladies neurodéveloppementales et neurovasculaires (NeuroDiderot (UMR_S_1141 / U1141)), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)

Subjects
Respiratory Distress Syndrome, Newborn, Double-Blind Method, Pregnancy, [SDV]Life Sciences [q-bio], Infant, Newborn, Humans, Premature Birth, Female, Infant, Premature, Diseases, General Medicine, Betamethasone
Abstract

International audience; BackgroundAntenatal betamethasone is recommended before preterm delivery to accelerate fetal lung maturation. However, reports of growth and neurodevelopmental dose-related side-effects suggest that the current dose (12 mg plus 12 mg, 24 h apart) might be too high. We therefore investigated whether a half dose would be non-inferior to the current full dose for preventing respiratory distress syndrome.MethodsWe designed a randomised, multicentre, double-blind, placebo-controlled, non-inferiority trial in 37 level 3 referral perinatal centres in France. Eligible participants were pregnant women aged 18 years or older with a singleton fetus at risk of preterm delivery and already treated with the first injection of antenatal betamethasone (11·4 mg) before 32 weeks’ gestation. We used a computer-generated code producing permuted blocks of varying sizes to randomly assign (1:1) women to receive either a placebo (half-dose group) or a second 11·4 mg betamethasone injection (full-dose group) 24 h later. Randomisation was stratified by gestational age (before or after 28 weeks). Participants, clinicians, and study staff were masked to the treatment allocation. The primary outcome was the need for exogenous intratracheal surfactant within 48 h after birth. Non-inferiority would be shown if the higher limit of the 95% CI for the between-group difference between the half-dose and full-dose groups in the primary endpoint was less than 4 percentage points (corresponding to a maximum relative risk of 1·20). Four interim analyses monitoring the primary and the secondary safety outcomes were done during the study period, using a sequential data analysis method that provided futility and non-inferiority stopping rules and checked for type I and II errors. Interim analyses were done in the intention-to-treat population. This trial was registered with ClinicalTrials.gov, NCT02897076.FindingsBetween Jan 2, 2017, and Oct 9, 2019, 3244 women were randomly assigned to the half-dose (n=1620 [49·9%]) or the full-dose group (n=1624 [50·1%]); 48 women withdrew consent, 30 fetuses were stillborn, 16 neonates were lost to follow-up, and 9 neonates died before evaluation, so that 3141 neonates remained for analysis. In the intention-to-treat analysis, the primary outcome occurred in 313 (20·0%) of 1567 neonates in the half-dose group and 276 (17·5%) of 1574 neonates in the full-dose group (risk difference 2·4%, 95% CI –0·3 to 5·2); thus non-inferiority was not shown. The per-protocol analysis also did not show non-inferiority (risk difference 2·2%, 95% CI –0·6 to 5·1). No between-group differences appeared in the rates of neonatal death, grade 3–4 intraventricular haemorrhage, stage ≥2 necrotising enterocolitis, severe retinopathy of prematurity, or bronchopulmonary dysplasia.InterpretationBecause non-inferiority of the half-dose compared with the full-dose regimen was not shown, our results do not support practice changes towards antenatal betamethasone dose reduction.

Published
2022

2. Evaluation of Sequential Urine Analysis when Selecting Candidates for Vesicoamniotic Shunting in Lower Urinary Tract Obstruction

Author

Romain Favre, Sophie Dreux, Nicolas Sananès, Jonathan Rosenblatt, Françoise Muller, A. S. Weingertner, Antoine Koch, M. Kohler, Ariane Zaloszyc, and Fernando Guerra

Subjects
Embryology, medicine.medical_specialty, Urethral Obstruction, Amniotic fluid, Urinary system, Urology, Renal function, Urine, Ultrasonography, Prenatal, Pregnancy, medicine, Humans, Radiology, Nuclear Medicine and imaging, Child, Retrospective Studies, business.industry, Infant, Newborn, Infant, Obstetrics and Gynecology, Retrospective cohort study, General Medicine, Amniotic Fluid, medicine.disease, Shunting, Fetal Diseases, Pediatrics, Perinatology and Child Health, Female, Urinary tract obstruction, business
Abstract

Objective: The objective of our study was to assess the utility of sequential fetal urine analysis in severe lower urinary tract obstruction (LUTO) when selecting cases suitable for vesicoamniotic shunting. Material and Methods: This was a retrospective cohort study of cases of severe LUTO treated in our fetal medicine center from 1994 to 2013. Two fetal bladder samples were taken 24–48 h apart to assess renal function. A vesicoamniotic shunt was inserted in case of improvement in urinary biochemistry between the 2 samples. We assessed perinatal morbidity and mortality and renal function at 5 years. Results: Among a total of 26 LUTO cases with sequential urine analysis, 5 showed normal urinary biochemistry, 13 were abnormal, and 8 improved between the 2 samples. These 8 cases underwent vesicoamniotic shunt placement, leading to the birth of 6/8 (75%) live infants, 5/6 (83%) of whom had normal renal function at 5 years. The 5 cases with normal biochemistry occasioned 2 neonatal deaths and 3 children with normal renal function at 5 years. Elective termination of pregnancy was requested by parents for the fetuses exhibiting abnormal biochemistry. Conclusion: An improvement in urinary biochemistry between 2 sequential fetal bladder punctures in severe LUTO could be an effective criterion in the selection of candidates for vesicoamniotic shunting. However, the benefit of a shunt in fetuses with normal amniotic fluid remains to be evaluated in clinical trials.

Published
2021

3. Fetoscopic Release of Amniotic Band Syndrome

Author

Antoine Koch, Nicolas Sananès, Benedicte Costantino, Chris Minella, Anne Sophie Weingertner, Romain Favre, and Rodrigo Ruano

Subjects
medicine.medical_specialty, Amniotic Band, medicine.medical_treatment, Gestational Age, 030218 nuclear medicine & medical imaging, Fetoscopy, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Humans, Medicine, Laser fiber, Radiology, Nuclear Medicine and imaging, Fetal therapy, 030219 obstetrics & reproductive medicine, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Infant, Newborn, Fetofetal Transfusion, Surgery, Dissection, Amputation, Female, Amniotic Band Syndrome, Laser Therapy, business, Laser coagulation
Abstract

Amniotic band syndrome is a rare condition. There have been few cases reported of fetoscopic band dissection. The aim of this case series is to report 3 cases of fetoscopic treatment for amniotic band syndrome, including indication for surgery, technical aspects, complications and outcomes. Fetoscopic treatment was performed respectively at 23 5/7 , 26 5/7 and 18 3/7 weeks' gestation. Two procedures were performed with a laser fiber through a single trocar whereas one surgery was performed with scissors. In conclusion, fetoscopic release of the amniotic bands in case of amniotic band syndrome is feasible with encouraging results in order to prevent amputation and dysfunction of the extremities.

Published
2020

4. Risk factors for obstetric anal sphincter injuries (OASIS) and the role of episiotomy: A retrospective series of 496 cases

Author

François Lefebvre, Adrien Gaudineau, Sara Mahgoub, Hélène Piant, Antoine Koch, and Bruno Langer

Subjects
Adult, Male, Episiotomy, medicine.medical_specialty, medicine.medical_treatment, Protective factor, Anal Canal, Perineum, Lacerations, Body Mass Index, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Risk Factors, Prevalence, medicine, Birth Weight, Humans, Statistical analysis, Retrospective Studies, 030219 obstetrics & reproductive medicine, Vaginal delivery, business.industry, Obstetrics, Cephalic presentation, Posterior perineum, Infant, Newborn, Obstetrics and Gynecology, Delivery, Obstetric, Obstetric Labor Complications, Pregnancy Complications, Parity, medicine.anatomical_structure, Reproductive Medicine, 030220 oncology & carcinogenesis, Female, Anal sphincter, business
Abstract

The objective of this study was to determine the prevalence and identify risk factors for obstetric anal sphincter injuries (OASIS), and to determine the prevalence of episiotomy and whether it is protective for the posterior perineum.This is a retrospective case-control study carried out in a level 2 maternity unit and a level 3 maternity unit between 1 January 2006 and 31 December 2015. The sample population included all vaginal deliveries at term of a living singleton foetus in cephalic presentation. The case group comprised patients with an OASIS. The control group comprised patients without OASIS. Statistical analysis was subdivided into descriptive and inferential parts.42,626 patients were included in the study of whom 496 were cases of OASIS, i.e. a rate of 1.2%. The overall episiotomy rate was 10.0%, which reflects a restrictive practice. Episiotomy doesn't appear to be a statistically significant protective factor for OASIS (OR=0.89-95%CI [0.68-1.16]). The principal independent risk factors for OASIS were nulliparity (ORa=4.19-95%CI [3.03-5.84] - p0.001), previous caesarean (ORa=5.59-95%CI [3.68-8.44] - p0.001), uterine fundal height greater than 32cm (ORa=1.35-95%CI [1.03-1.77] - p=0.03), gestational or pre-pregnancy diabetes (ORa=1.76-95%CI [1.22-2.46] - p=0.002), birthweight of more than 3500g (ORa=1.48-95%CI [1.17-1.87] - p=0.001), assisted delivery (ORa=1.81-95%CI [1.18-2.86] - p=0.007), and use of a second instrument or obstetrical manoeuvre (ORa=1.93-95%CI [1.05-3.30] - p=0.02).Episiotomy doesn't appear to be a statistically significant protective factor on the perineal prognosis. A deeper understanding of the factors which promote OASIS and greater awareness of them would improve the perineal prognosis of parturient women.

Published
2019

5. Morbidity associated with planned cesarean deliveries performed before the scheduled date: A cohort study

Author

Antoine Koch, Patrick Rozenberg, Floriane Jochum, Lise Lecointre, Laure Haller, Nicolas Sananès, Biomatériaux et Bioingénierie (BB), Université de Strasbourg (UNISTRA)-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Strasbourg, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
medicine.medical_specialty, Cesarean performed on the scheduled date, Neonatal morbidity, Maternal morbidity, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Elective Cesarean Delivery, Medicine, Rupture of membranes, Humans, Vaginal bleeding, 030212 general & internal medicine, reproductive and urinary physiology, Planned cesarean delivery, Retrospective Studies, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Cesarean Section, Medical record, Infant, Newborn, Obstetrics and Gynecology, Gestational age, Infant, Cesarean performed before the scheduled date, Delivery, Obstetric, female genital diseases and pregnancy complications, 3. Good health, Reproductive Medicine, Elective cesarean delivery, Female, medicine.symptom, Morbidity, business, Cohort study
Abstract

International audience; Objective: Women with planned cesareans can require delivery before the scheduled date. However, data describing the morbidity associated with planned cesarean deliveries performed before the originally scheduled date is lacking. The objective of this study was to compare the morbidity associated with planned cesarean delivery performed before compared with on the scheduled date. Study design: This retrospective single-center cohort study included all 3595 women with singleton pregnancies and cesarean deliveries after 36+6 weeks. All cases were reviewed individually to identify the initial intended mode of delivery, determined before 37 weeks. We excluded the 2145 (59.7%) unplanned cesareans initially planned as vaginal deliveries. Finally, the analysis included 1450 women with planned cesareans: 1232 (85.0%) performed as scheduled, and 218 (15.0%) before that date. The composite outcomes of maternal morbidity was one or more of the morbidity measures, including surgical complications, postpartum hemorrhage, infection and thrombo-embolism. Neonatal morbidity measures included 5 min Apgar score < 7, arterial cord blood pH < 7.00, and admission to the neonatal intensive care unit (NICU). Results: Reasons for performing planned cesarean delivery before the scheduled date were as follows: onset of labor (n = 109; 50.0%), rupture of membranes (n = 85; 39.0%), preeclampsia (n = 9; 4.1%), scar pain in women with a previous cesarean (n = 6; 2.8%), unexplained vaginal bleeding (n = 5; 2.3%), and nonreassuring fetal heart rate (n = 4; 1.8%). Mean gestational age for planned cesarean deliveries before the scheduled date was 38.7 weeks ± 0.8 versus 39.2 weeks ± 0.7 for those performed when scheduled (P < 0.0001). The maternal morbidity composite outcome rate was significantly higher among planned cesareans performed early compared with those on the scheduled date: 18.3% vs 9.7%, respectively, P = 0.0002. It was still higher in the multivariable analysis: aOR 2.17, 95% CI 1.46–3.21, P = 0.0001. The neonatal composite outcome did not differ significantly between the two groups. Conclusion: In planned cesarean deliveries, maternal morbidity is higher for cesareans performed before rather than on the scheduled date. Studies without accurate intent-to-treat analyses underestimate the morbidity associated with planned cesareans. Accordingly, medical records must make it possible to distinguish planned cesarean deliveries performed before the scheduled date from those performed as planned.

Published
2021

6. 3D-printed simulator for nasopharyngeal swab collection for COVID-19

Author

Massimo Lodi, Axel Sananes, Nicolas Lefebvre, Lise Lecointre, Christian Debry, Nicolas Sananès, Antoine Koch, Biomatériaux et Bioingénierie (BB), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), CHU Strasbourg, Centre for Integrative Biology - CBI (Inserm U964 - CNRS UMR7104 - IGBMC), Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Université de Strasbourg (UNISTRA)-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and univOAK, Archive ouverte

Subjects
3d printed, Coronavirus disease 2019 (COVID-19), Short Communication, Nasopharyngeal swab collection, 3D printing, Context (language use), 03 medical and health sciences, COVID-19 Testing, 0302 clinical medicine, Nasopharynx, Humans, Medicine, Training, Segmentation, 030223 otorhinolaryngology, Pandemics, Simulation, [SDV.IB] Life Sciences [q-bio]/Bioengineering, SARS-CoV-2, business.industry, COVID-19, General Medicine, Soft materials, Visualization, Coronavirus, Otorhinolaryngology, 030220 oncology & carcinogenesis, Printing, Three-Dimensional, Simulator, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Sample collection, business
Abstract

Introduction: Testing for COVID-19 is a cornerstone of pandemic control. If conducted inappropriately, nasopharyngeal swab collection can be painful and preanalytical sample collection errors may lead to false negative results. Our objective was to develop a realistic and easily available synthetic simulator for nasopharyngeal swab collection.Materials and methods: The nasopharyngeal swab collection simulator was designed through different development steps: segmentation, computer-aided design (CAD), and 3D printing. The model was 3D printed using PolyJet technology, which allows multi-material printing using hard and soft materials.Results: The simulator splits in the parasagittal plane close to the septum to allow better visualization and understanding of nasal cavity landmarks. The model is able to simulate the softness and texture of different structural elements. The simulator allows the user to conduct realistic nasopharyngeal swab collection. A colored pad on the posterior wall of the nasopharynx provides real-time feedback to the user. The simulator also permits incorrect swab insertion, which is of obvious benefit from a training perspective. Comprehensive 3D files for printing and full instructions for manufacturing the simulator is freely available online via an open access link.Conclusion: In the context of the COVID-19 pandemic, we developed a nasopharyngeal swab collection simulator which can be produced by 3D printing via an open access link, which offers complete operating instructions.

Published
2020
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7. De-escalating systemic therapy in triple negative breast cancer: The example of secretory carcinoma

Author

J.-P. Bellocq, Carole Mathelin, F. Stoll, S. Molière, Antoine Koch, and J.-C. Benabu

Subjects
0301 basic medicine, Oncology, medicine.medical_specialty, Breast Neoplasms, Triple Negative Breast Neoplasms, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Internal medicine, Biopsy, Carcinoma, medicine, Humans, Triple-negative breast cancer, Aged, Proto-Oncogene Proteins c-ets, medicine.diagnostic_test, business.industry, Not Otherwise Specified, Obstetrics and Gynecology, Gene rearrangement, medicine.disease, Repressor Proteins, 030104 developmental biology, Reproductive Medicine, 030220 oncology & carcinogenesis, Female, Triple-Negative Breast Carcinoma, business, Secretory Breast Carcinoma
Abstract

Triple negative breast cancers have the highest relapse risk and the least favourable prognosis of all breast cancer subtypes, leading to an escalation of chemotherapy, substantially during recent years. Secretory carcinoma of the breast is a rare triple negative neoplasm, first described in children but more often presenting in adults. We report a case of a 70-years-old woman, initially diagnosed on the biopsy with a triple negative infiltrating Not Otherwise Specified (NOS) carcinoma of the breast, before it was later correctly identified as a secretory carcinoma, notably because of an abundant intra and extracellular secretory material. This new diagnosis, confirmed by fluorescence in-situ hybridization analysis showing ETS variant 6 (ETV6) gene rearrangement, allowed the de-escalation of chemotherapy therapy. Four years later, the patient is free of recurrences.

Published
2018

8. Unusual twin anemia-polycythemia sequence in a dichorionic diamniotic pregnancy

Author

Antoine Koch, M Zilliox, Nicolas Sananès, Romain Favre, univOAK, Archive ouverte, CHU Strasbourg, Biomatériaux et Bioingénierie (BB), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et nanosciences d'Alsace (FMNGE), and Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, medicine.medical_specialty, Placenta, MEDLINE, Gestational Age, Polycythemia, Ultrasonography, Prenatal, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Diseases in Twins, Humans, Medicine, Twin Anemia-Polycythemia Sequence, 030219 obstetrics & reproductive medicine, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Cesarean Section, business.industry, Obstetrics, Arteriovenous Anastomosis, Obstetrics and Gynecology, Gestational age, Anemia, medicine.disease, 3. Good health, Reproductive Medicine, 030220 oncology & carcinogenesis, Pregnancy, Twin, Female, Ultrasonography, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

No abstract available

Published
2019

9. Expectant management and laser photocoagulation in isolated selective intra-uterine growth restriction: A single-center series

Author

A. S. Weingertner, Romain Favre, G. Fritz, Fernando Guerra, B. Viville, M. Kohler, B Langer, Lise Lecointre, Nicolas Sananès, Antoine Koch, Adrien Gaudineau, Biomatériaux et Bioingénierie (BB), Université de Strasbourg (UNISTRA)-Matériaux et nanosciences d'Alsace (FMNGE), and Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, medicine.medical_specialty, Single Center, Ultrasonography, Prenatal, 03 medical and health sciences, 0302 clinical medicine, Growth restriction, Pregnancy, Diseases in Twins, Overall survival, Humans, Medicine, 030212 general & internal medicine, Expectant management, Retrospective Studies, Fetal Growth Retardation, Laser Coagulation, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Pregnancy Outcome, Obstetrics and Gynecology, Retrospective cohort study, Chorion, Surgery, Perinatal morbidity, Outcome and Process Assessment, Health Care, Reproductive Medicine, Pregnancy, Twin, Feasibility Studies, Gestation, Female, business, Intra uterine, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Introduction: The objective was to report on a consecutive series of monochorionic diamniotic pregnancies complicated by selective Intra-Uterine Growth Restriction (sIUGR) and to describe perinatal outcomes based on whether or not there were umbilical Doppler findings, and specifically to study those pregnancies treated by laser. Material and methods: This was a retrospective cohort study enrolling monochorionic diamniotic pregnancies presenting isolated sIUGR after 16 weeks' gestation (WG). Results: Of the 25 cases of sIUGR, 16 were type I and 9 type II or III. Types II and III occurred earlier than type I (22.3 versus 24.3 WG), were more severe (discordance of 37% versus 23%), and delivered earlier (31.3 versus 33.9 WG). Survival was 12/18 (66.7%) for types II or III versus 32/32 (100%) for type I. Five laser photocoagulation procedures were attempted and allowed the survival of both twins in 2 cases. Overall survival after laser was 6/10 (60%). Discussion: Isolated sIUGR is associated with high perinatal morbidity and mortality. Laser photocoagulation treatment is feasible and may enable survival of both twins in some cases, but may be technically difficult. Keywords: Bichorionization; Laser photocoagulation; Monochorionic diamniotic pregnancies; Selective intra-uterine growth restriction; Umbilical Doppler.

Published
2017

10. Adolescent Endometriosis: Report of a Series of 55 Cases With a Focus on Clinical Presentation and Long-Term Issues

Author

Alain Audebert, Antoine Koch, Karolina Afors, Lise Lecointre, Cherif Akladios, and Arnaud Wattiez

Subjects
Infertility, medicine.medical_specialty, Adolescent, media_common.quotation_subject, Endometriosis, Private Practice, Fertility, Pelvic Pain, Adnexal mass, Gynecologic Surgical Procedures, Recurrence, medicine, Humans, Sex organ, Laparoscopy, Retrospective Studies, media_common, medicine.diagnostic_test, business.industry, Obstetrics and Gynecology, Retrospective cohort study, medicine.disease, Surgery, Treatment Outcome, Female, France, Presentation (obstetrics), business, Infertility, Female
Abstract

Study Objective To report the clinical presentation and long-term issues of adolescent endometriosis. Design Retrospective cohort study. Setting Single private clinical center, Bordeaux, France. Patients Adolescents with a confirmed diagnosis of endometriosis. Interventions Surgical excision or ablation or lesions performed at laparoscopy. Measurements and Main Results Fifty-five adolescents, ages from 12 to 19 years (mean age 17.8), who were diagnosed with endometriosis from March 1998 to April 2013 were included in the study. Pain of various types was the leading symptom in all patients, except 2. Twenty-three patients had an adnexal mass identified preoperatively, and 5 had an associated infertility issue at the time of diagnostic laparoscopy. Four patients had an associated genital malformation. Fifty-one percent of the patients had a history of appendectomy. A familial history of endometriosis was reported by 19 patients (34.5%), with a first-degree relative affected in 14 cases (25.45%), and 47.3% of patients were smoking at least 5 cigarettes a day. Superficial implants was encountered in 31 cases (56.4%), endometriomas in 18 cases (32.72%), and deep infiltrating endometriosis (DIE) in 6 cases (10.90%). Sixty percent of patients were scored as stages I to II and 40% as stages III to IV. Five patients were lost to follow-up, and 37 had a follow-up ranging from 36 to 315 months (mean follow-up 125.5 months). Among the 50 patients not lost to follow-up, 13 (26%) had either no pain, or improved and had acceptable pain with medical treatment. Seventeen patients of the 50 adolescents not lost to follow-up (34%) underwent a repeat laparoscopy. A subsequent laparoscopic and/or magnetic resonance imaging scan was performed in 35 patients because of persistent pain. Among these, there was 12 endometriomas (7 recurrences) and 12 DIEs (3 recurrences), giving recurrence rates for endometriomas and DIEs of 36.84% and 50%, respectively. During the study, 18 patients wished to have a child. Thirteen had a delivery (72.2%), and 9 pregnancies occurred in patients who initially presented with stage I to II endometriosis. Of the 11 patients who had subfertility, 6 successfully conceived (54.5%). Conclusions Adolescent endometriosis is not a rare condition. In our study a familial history was reported in more than one-third of patients. Among those patients treated for DIE, there was a trend for higher rates of recurrences (symptoms or lesions) that required repeat laparoscopy. However, the impact on subsequent fertility appeared to have been limited.

Published
2015

11. Usefulness of diffusion-weighted imaging for diagnosis of adrenal ischemia during pregnancy: a preliminary report

Author

Adrien Gaudineau, Francis Veillon, Sébastien Molière, Marie-Noëlle Roedlich, Antoine Koch, and Thomas Leroi

Subjects
Adult, medicine.medical_specialty, Ischemia, 030218 nuclear medicine & medical imaging, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Preliminary report, Pregnancy, Adrenal Glands, medicine, Retrospective analysis, Effective diffusion coefficient, Humans, Radiology, Nuclear Medicine and imaging, 030219 obstetrics & reproductive medicine, business.industry, Adrenal gland, medicine.disease, Pregnancy Complications, medicine.anatomical_structure, Diffusion Magnetic Resonance Imaging, Emergency Medicine, Female, Radiology, Differential diagnosis, business, Diffusion MRI
Abstract

This case report aims to illustrate the clinical usefulness of diffusion-weighted imaging for diagnosis of bilateral adrenal ischemia during pregnancy. We also provide a retrospective analysis of adrenal gland diffusion data in a control group of 12 pregnant women with no adrenal dysfunction, to assess the normal range of apparent diffusion coefficient of adrenal gland during pregnancy.

Published
2017

12. Pilot randomised controlled trial comparing the risk of neonatal respiratory distress in elective caesarean section at 38 weeks' gestation following a course of corticosteroids versus caesarean at 39 weeks

Author

Germain Aissi, Michèle Weil, Ahmad Bakri, Romain Favre, Nicolas Sananès, Bruno Langer, Christophe Vayssière, Benoît Escande, G. Fritz, Adrien Gaudineau, Chantal Bolender, Pierre Kuhn, Israël Nisand, Emmanuel Roth, Antoine Koch, Nicolas Meyer, Biomatériaux et Bioingénierie (BB), Université de Strasbourg (UNISTRA)-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut des Neurosciences Cellulaires et Intégratives (INCI), and Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Male, medicine.medical_specialty, Neonatal intensive care unit, medicine.drug_class, Gestational Age, Pilot Projects, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Adrenal Cortex Hormones, Pregnancy, Risk Factors, Intensive Care Units, Neonatal, Medicine, Humans, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, Respiratory Distress Syndrome, Newborn, 030219 obstetrics & reproductive medicine, Respiratory distress, business.industry, Obstetrics, Cesarean Section, Infant, Newborn, Obstetrics and Gynecology, Neonatal respiratory distress, 3. Good health, Intention to Treat Analysis, Reproductive Medicine, Relative risk, Case-Control Studies, Gestation, Corticosteroid, Female, Elective caesarean section, business
Abstract

Introduction The objective of this study was to compare neonatal respiratory morbidity and rate of emergency caesarean section between elective caesarean sections at 38 gestational weeks following a course of corticosteroids and planned caesarean sections at 39 gestational weeks. Material and methods This was a multicentre randomised controlled trial. The study was conducted between 2007 and 2013 in level 2 and 3 maternity units in France. A total of 208 women with an indication for elective caesarean section were enrolled and 200 analysed in per-protocol analysis. Women were randomised to either elective caesarean section at 38 gestational weeks after a course of corticosteroids (trial group) or elective caesarean section at 39 weeks (control group). The primary outcome was the rate of admission to the neonatal intensive care unit for respiratory distress. Results Two (2.1%) newborn in the tested group were admitted because of respiratory distress versus four (3.8%) in the control group. The relative risk was 0.54 in favour of the corticosteroid group (95% CI: 0.10; 2.86). There were fewer emergency caesareans in the trial group than in the control group: 12 (12.69%) versus 28 (26.67%), p = 0.01. Conclusions Our study suggests that planning caesarean sections at 38 gestational weeks after a course of corticosteroids would enable a significant reduction in the number of emergency caesareans without increasing the risk of neonatal respiratory distress. Limitations of this study include difficulties in patient recruitment and the small number of subjects.

Published
2016

13. Vascular pattern in monochorionic placentas with spontaneous TAPS and TTTS with residual anastomoses after laser: a case-control study

Author

Romain, Favre, Antoine, Koch, Aenn-Sophie, Weingertner, Nicolas, Sananes, Ngoc Tu, Trieu, Monique, Kohler, Fernando, Guerra, and Israel, Nisand

Subjects
Adult, Laser Coagulation, Placenta Diseases, Arteriovenous Anastomosis, Placenta, Anemia, Fetofetal Transfusion, Polycythemia, Twins, Monozygotic, Young Adult, Pregnancy, Case-Control Studies, Diseases in Twins, Pregnancy, Twin, Humans, Female
Abstract

This study aimed to compare the angio-architecture of monochorionic placentas of spontaneous twin anaemia-polycythemia sequence (TAPS) with placenta of twin-to-twin transfusion syndrome (TTTS) with residual anastomoses after laser coagulation and placentas of uncomplicated monochorionic twin pregnancies.This case-control study compares the angio-architecture of monochorionic placentas of spontaneous TAPS (n = 12) with that of monochorionic placentas of TTTS treated by laser coagulation with residual anastomoses (TTTS + RA; n = 20) and placentas of monochorionic pregnancies without complications (n = 24), matched for gestational age. Placental sharing and angio-architecture were assessed by injection of colored dye.The median diameter of the arterio-venous (AV) anastomoses in TAPS placentas was 2.26, 0.215 with TTTS + RA and 4.17 mm in normal monochorionic pregnancies (p .03). The mean diameter of the arterio-arterial (AA) anastomoses in monochorionic placentas with spontaneous TAPS was 0.2 mm versus 0.15 mm in TTTS + RA and 2.0 mm in normal pregnancies, respectively (p 0.03, p 0.007). The number of AA anastomoses was lower with TAPS (0.3 versus 0.50 and 1, respectively, p 0.015, p 0.0001). Besides, unequal sharing was more frequent in TAPS as compared with monochorionic normal pregnancies (75% versus 29%, p = 0.03).Age matched placentas of spontaneous TAPS are characterized by very small AV anastomoses and very few AA anastomoses of smaller diameter than placentas of monochorionic twins with TTTS or without obvious complications.

Published
2012

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