Dichorionic Diamniotic Pregnancy Research Articles

Pregnancy outcomes of monochorionic diamniotic and dichorionic diamniotic twin pregnancies conceived by assisted reproductive technology and conceived naturally: a study based on chorionic comparison

ObjectiveTo evaluate monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies conceived by assisted reproductive technology (ART) and conceived naturally.MethodsWe retrospectively analyzed the data on twin pregnancies conceived by ART from January 2015 to January 2022,and compared pregnancy outcomes of MCDA and DCDA twins conceived by ART with those of MCDA and DCDA twins conceived naturally, pregnancy outcomes between MCDA and DCDA twins conceived by ART, and pregnancy outcomes of DCT and TCT pregnancies reduced to DCDA pregnancies with those of DCDA pregnancies conceived naturally.ResultMCDA pregnancies conceived by ART accounted for 4.21% of the total pregnancies conceived by ART and 43.81% of the total MCDA pregnancies. DCDA pregnancies conceived by ART accounted for 95.79% of the total pregnancies conceived by ART and 93.26% of the total DCDA pregnancies. Women with MCDA pregnancies conceived by ART had a higher premature delivery rate, lower neonatal weights, a higher placenta previa rate, and a lower twin survival rate than those with MCDA pregnancies conceived naturally (all p < 0.05). Women with DCDA pregnancies conceived naturally had lower rates of preterm birth, higher neonatal weights, and higher twin survival rates than women with DCDA pregnancies conceived by ART and those with DCT and TCT pregnancies reduced to DCDA pregnancies (all p < 0.05).ConclusionOur study confirms that the pregnancy outcomes of MCDA pregnancies conceived by ART are worse than those of MCDA pregnancies conceived naturally. Similarly, the pregnancy outcomes of naturally-conceived DCDA pregnancies are better than those of DCDA pregnancies conceived by ART and DCT and TCT pregnancies reduced to DCDA pregnancies.

Rescue cervical cerclage in twin pregnancy with spontaneous cervical dilatation at 8-week gestation

AbstractPremature spontaneous cervical dilatation can happen among pregnant women leading to miscarriage, preterm labor, or premature delivery. We present a case of twin pregnancy with spontaneous cervical dilatation and membranes bulging into the vagina at 8-week gestation. A 34-year-old primigravida presented to our clinic with complaints of cramping pain in the lower abdomen. Her per speculum pelvic examination showed evidence of dilated cervical os and amniotic membranes bulging through the cervix into the vagina. Her sonogram suggested a dichorionic diamniotic pregnancy of 8-week gestation. Her TVS examination revealed that the internal os was dilated. Both fetuses were alive with regular fetal heart rate. Rescue cervical cerclage by modified Shirodkar’s technique was done under general anesthesia. She was administered prophylactic antibiotics and tocolytic. She was closely followed up at regular intervals and observed for signs of chorioamnionitis. She delivered at 35 weeks of gestation with two female children with birth weights 2.3 kg and 2.1 kg, respectively.

Quadruplet pregnancy outcome with and without fetal reduction: Danish national cohort study (2008-2018) and comparison with dichorionic twins.

To perform a nationwide study of quadrichorionic quadriamniotic (QCQA) quadruplet pregnancies and to compare the pregnancy outcome in those undergoing fetal reduction with non-reduced quadruplets and dichorionic diamniotic (DCDA) twin pregnancies from the same time period. This was a retrospective Danish national register-based study performed using data from the national Danish Fetal Medicine Database, which included all QCQA quadruplets and all non-reduced DCDA twin pregnancies with an estimated due date between 2008 and 2018. The primary outcome measure was a composite of adverse pregnancy outcomes, including pregnancy loss or intrauterine death of one or more fetuses. Secondary outcomes included gestational age at delivery, the number of liveborn children, preterm delivery before 28, 32 and 37 gestational weeks and birth weight. Data on pregnancy complications and baseline characteristics were also recorded. Outcomes were compared between reduced and non-reduced quadruplet pregnancies, and between DCDA pregnancies and quadruplet pregnancies reduced to twins. A systematic literature search was performed to describe and compare previous results with our findings. Included in the study were 33 QCQA quadruplet pregnancies, including three (9.1%) non-reduced pregnancies, 28 (84.8%) that were reduced to twin pregnancy and fewer than three (6.1%) that were reduced to singleton pregnancy, as well as 9563 DCDA twin pregnancies. Overall, the rate of adverse pregnancy outcome was highest in non-reduced quadruplets (66.7%); it was 50% in quadruplets reduced to singletons and 10.7% in quadruplets reduced to twins. The proportion of liveborn infants overall was 91.1% of the total number expected to be liveborn in quadruplet pregnancies reduced to twins. This was statistically significantly different from 97.6% in non-reduced dichorionic twins (P = 0.004), and considerably higher than 58.3% in non-reduced quadruplets. The rates of preterm delivery < 28, < 32 and < 37 weeks were decreased in quadruplets reduced to twins compared with those in non-reduced quadruplet pregnancies. Quadruplets reduced to twins did not achieve equivalent pregnancy outcomes to those of DCDA twins. This national study of QCQA quadruplets has shown that multifetal pregnancy reduction improves pregnancy outcome, including a decreased rate of preterm delivery and higher proportion of liveborn children. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Combined hysteroscopic Bigatti shaver (IBS) and resectoscope removal of a heterotopic cesarean scar pregnancy in the first trimester

To report a case of heterotopic cesarean scar pregnancy reduction using a combined hysteroscopic integrated Bigatti shaver (IBS) and resectoscope with the preservation of a normal gestational sac in the uterine cavity under simultaneous transabdominal ultrasound guidance. Video article. University-affiliated hospital. A 30-year-old woman, G5P2A2L2, with two previous cesarean deliveries and a history of fertility problems, was admitted with a heterotopic cesarean scar pregnancy at 7+2 gestational weeks. Ultrasound examination showed a dichorionic diamniotic pregnancy. The first gestational sac (1.7 × 1.7 × 0.6 cm) was located in the previous hysterotomy scars, with a thin layer of myometriummeasuring 0.2 cm in thickness and a rich blood supply. The second chorionic sac (2.8 × 2.4 × 1.8 cm) was observed at the uterine fundus. Normal cardiac activity and yolk sacs were observed in both gestational sacs. The couple strongly desired to preserve the intrauterine pregnancy. After Institutional Review Board approval was obtained, a hysteroscopic IBS combined with a bipolar resectoscope was used to remove the heterotopic cesarean scar pregnancy while preserving the intrauterine gestational sac under simultaneous transabdominal ultrasound guidance. The heterotopic cesarean scar pregnancy was completely resected using hysteroscopy, and the gestational sac in the uterine cavity was successfully preserved. Trophoblastic tissue was confirmed using histopathological examination. The patient had an unremarkable postoperative recovery. Subsequent serial ultrasonography confirmed a single ongoing pregnancy with normal growth parameters and a normal placental site. The inability of an IBS to perform coagulation can be offset by its combination with the bipolar resectoscope. Hysteroscopic IBS combined with resectoscope to remove a heterotopic cesarean scar pregnancy offers a short operation time and minimum blood loss. It could be an optimized approach for the management of heterotopic cesarean scar pregnancy in the first trimester when an intrauterine pregnancy needs to be preserved.

Complete mole coexisting with a normal fetus in a dichorionic diamniotic pregnancy: A case report

Background: Complete hydatidiform mole with a coexisting normal pregnancy is an exceptionally rareoccurrence with a reported incidence of 1 in 22,000-100,000 pregnancies. Management remainscontroversial due to the risk of maternal and fetal complications and limited data on optimalmanagement.Case presentation: A para 1 + 0 presented to the Maternal Fetal Unit at 19 weeks. Ultrasound revealed atwin pregnancy with a single live fetus in one sac and a second sac with multiple cystic lesions and atypical snow-storm appearance consistent with a complete molar pregnancy. The placenta of the molarpregnancy was also low-lying, covering the internal cervical os. She had several episodes of antepartumhemorrhage, which was managed expectantly because she was keen on conception. At 25 weeks, shepresented with copious vaginal bleeding and chills. Speculum examination revealed vesicles withultrasound revealing a single live fetus, but complete molar pregnancy was not observed. Afteradmission, the patient became febrile with tachycardia. Amniocentesis was performed to rule outintraamniotic infection in viable pregnancy. A decision was made to undertake an emergencyhysterotomy because of deteriorating maternal status, placenta previa, and breech presentation.Maternal blood culture was positive for group B Streptococcus, with fetal blood and amniotic fluid culturesbeing sterile. Histopathology of the placenta revealed features consistent with acute chorioamnionitis andperipheral molar pregnancy.Conclusion: This case highlights the difficulty in the management of such cases, as illustrated bymultiple episodes of antepartum hemorrhage and subsequent maternal sepsis. Multidisciplinary care andshared decision making remain integral to management.

Selective fetal growth restriction in dichorionic diamniotic twin pregnancy: systematic review and meta-analysis of pregnancy and perinatal outcomes.

Most of the published literature on selective fetal growth restriction (sFGR) has focused on monochorionic twin pregnancies. The aim of this systematic review was to report on the outcome of dichorionic diamniotic (DCDA) twin pregnancies complicated by sFGR. MEDLINE, EMBASE and The Cochrane Library databases were searched. The inclusion criteria were DCDA twin pregnancies complicated by sFGR. The outcomes explored were intrauterine death (IUD), neonatal death and perinatal death (PND), survival of at least one and both twins, preterm birth (PTB) (either spontaneous or iatrogenic) prior to 37, 34, 32 and 28 weeks' gestation, pre-eclampsia (PE) or gestational hypertension, neurological, respiratory and infectious morbidity, Apgar score < 7 at 5 min, necrotizing enterocolitis, retinopathy of prematurity and admission to the neonatal intensive care unit (NICU). A composite outcome of neonatal morbidity, defined as the occurrence of respiratory, neurological or infectious morbidity, was also evaluated. Random-effects meta-analysis was used to analyze the data, and results are reported as pooled proportion or odds ratio (OR) with 95% CI. Thirteen studies reporting on 1339 pregnancies with sFGR and 6316 pregnancies without sFGR were included. IUD occurred in 2.6% (95% CI, 1.1-4.7%) of fetuses from DCDA pregnancies with sFGR and 0.6% (95% CI, 0.3-9.7%) of those from DCDA pregnancies without sFGR, while the respective values for PND were 5.2% (95% CI, 3.5-7.3%) and 1.7% (95% CI, 0.1-5.7%). Spontaneous or iatrogenic PTB before 37 weeks complicated 84.1% (95% CI, 55.6-99.2%) of pregnancies with sFGR and 69.1% (95% CI, 45.4-88.4%) of those without sFGR. The respective values for PTB before 34, 32 and 28 weeks were 18.4% (95% CI, 4.4-38.9%), 13.0% (95% CI, 9.5-17.1%) and 1.5% (95% CI, 0.6-2.3%) in pregnancies with sFGR and 10.2% (95% CI, 3.1-20.7%), 7.8% (95% CI, 6.8-9.0%) and 1.8% (95% CI, 1.3-2.4%) in those without sFGR. PE or gestational hypertension complicated 19.9% (95% CI, 12.4-28.6%) of pregnancies with sFGR and 12.8% (95% CI, 10.4-15.4%) of those without sFGR. Composite morbidity occurred in 28.2% (95% CI, 7.8-55.1%) of fetuses from pregnancies with sFGR and 13.9% (95% CI, 6.5-23.5%) of those from pregnancies without sFGR. When stratified according to the sFGR status within a twin pair, composite morbidity occurred in 39.0% (95% CI, 11.1-71.5%) of growth-restricted fetuses and 29.9% (95% CI, 3.5-65.0%) of appropriately grown fetuses (OR, 1.9 (95% CI, 1.7-3.1)), while the respective values for PND were 3.0% (95% CI, 1.8-4.5%) and 1.6% (95% CI, 0.9-2.6%) (OR, 2.1 (95% CI, 1.0-4.1)). On risk analysis, DCDA pregnancies complicated by sFGR had a significantly higher risk of IUD (OR, 5.2 (95% CI, 3.2-8.6)) and composite morbidity or admission to the NICU (OR, 3.2 (95% CI, 1.9-5.6)) compared to those without sFGR, while there was no difference in the risk of PTB before 34 weeks (P = 0.220) or PE/gestational hypertension (P = 0.210). DCDA twin pregnancies complicated by sFGR are at high risk of perinatal morbidity and mortality. The findings of this systematic review are relevant for counseling and management of complicated DCDA twin pregnancies, in which twin-specific, rather than singleton, outcome data should be used. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Genetic evaluation for twin pregnancies using karyotyping and single nucleotide polymorphism array analysis

The study aimed to assess chromosomal abnormalities in twin pregnancies using karyotyping and SNP array analysis. The research involved 530 twin pregnancies from two prenatal diagnosis centers between October 2012 and October 2022. Two types of twin pregnancies were considered: monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA), with a total of 177 MCDA and 353 DCDA cases. Chromosomal abnormalities were examined based on chorionic and amniotic sac properties and clinical indications. Among 42 twin pregnancies, 50 fetuses showed chromosomal abnormalities by karyotyping, with 35 cases of aneuploidy in DCDA and 10 in MCDA. Trisomy 21 was the most common aberration, affecting 15 fetuses in DCDA and 4 in MCDA. The rate of discordant karyotypes in MCDA and DCDA groups was 1.1% and 8.8%, respectively. Ultrasound abnormalities and advanced maternal age were frequent indications (55.3% and 39.2%, respectively). Aneuploidy frequencies in DCDA and MCDA pregnancies with advanced maternal age were 10.6% and 4.5%. Cardiac defects and increased nuchal translucency were common anomalies, with higher incidences of chromosomal abnormalities in DCDA (12.5% and 6.9%) and MCDA groups (23.5% and 3.7%). SNP array identified 1.6% clinically significant copy number variants in DCDA fetuses with ultrasound abnormalities, while no significant CNVs were found in MCDA pregnancies. Chromosomal aneuploidies were the primary abnormalities in twin pregnancies, with detectable abnormalities and clinically significant CNVs more likely in DCDA pregnancies, especially those with ultrasound abnormalities.

EXIT-to-airway for obstructing fetal neck masses: a singular methodology for monochorionic and dichorionic twin pregnancies

INTRODUCTION: Fetal airway obstruction in one twin of a diamniotic pregnancy presents unique challenges. Very few cases of Ex-Utero-Intrapartum-Treatment (EXIT) procedures for twin pregnancy have been reported and only in dichorionic pregnancies. We report a singular methodology for EXIT-to-airway procedures in two pregnancies involving monochorionic and dichorionic twins. CASE PRESENTATION: Two cases of EXIT-to-airway in twin pregnancies were performed in 2018-2019 at a regional fetal treatment center. Case 1 involved a giant cervical teratoma in a monochorionic-diamniotic twin pregnancy with preterm labor at 29 weeks. Case 2 involved a dichorionic-diamniotic pregnancy with a large cervical lymphatic malformation with preterm labor at 36 weeks. In each case, the polyhydramnios caused the affected twin’s amniotic sac to be the presenting sac for the surgical approach. Bronchoscopy and successful intubation was completed after 22 and 10 minutes of uteroplacental bypass, respectively. The bystander twins were delivered second without intubation and resuscitated without perinatal distress. CONCLUSION: EXIT-to-airway appears to be a reasonable option for twins including monochorionic pregnancies, via delivery of the affected twin first followed by delivery of the bystander twin. Thoughtful preparation and counseling by an experienced multidisciplinary team permits an EXIT-to-airway approach for twin pregnancies even in an emergent setting.

Relationship between one-carbon metabolism and fetal growth in twins: A cohort study.

We investigated the associations of one-carbon metabolism (OCM)-related metabolites, including choline, betaine, dimethylglycine (DMG), and methionine with fetal growth of twins. This hospital-based cohort study included dichorionic twin gestations. Blood samples were collected at a median of 14.7 weeks of gestation. Blood plasma metabolite levels were measured using high-performance liquid chromatography-triple quadrupole mass spectrometry. Generalized estimating equations and mixed effects models were used to explore associations between plasma metabolite levels and fetal growth. In total, 115 women with dichorionic diamniotic pregnancies were included. The maternal plasma DMG level was negatively correlated with fetal birth weight (β = -43.5, 95% confidence interval [CI] = -74.1 to -12.8, p < .05) and head circumference (β = -0.23, 95% CI = -0.39 to -0.07, p < .05). Other metabolites were not significantly associated with birth weight, body length, head circumference (HC), or chest circumference. Analysis of the relationships between plasma metabolite levels and fetal biological parameters on ultrasound revealed that the maternal choline level was negatively correlated with fetal abdominal circumference (AC) (β = -0.12, 95% CI = 0.24 to -0.004, p < .05); the maternal DMG level was negatively correlated with fetal AC (β = -0.17, 95% CI = 0.28-0.07, p < .05), femur length (β = 0.02, 95% CI = 0.04-0.003, p < .05), and estimated fetal weight (β = 26.4, 95% CI = -41.6 to -11.2, p < .05), but not with HC. The maternal methionine level was negatively correlated with HC (β = -0.08, 95% CI = -0.14 to -0.02, p < .05). The plasma level of the OCM-related metabolite DMG during the second trimester was negatively correlated with fetal intrauterine growth and birth weight. However, further studies with larger samples are needed.

P-761 Live-birth and neonatal outcomes from BEYOND, a randomised controlled trial comparing efficacy and safety of individualised follitropin delta dosing in GnRH agonist versus antagonist protocols

Abstract Study question What are the live birth and neonatal outcomes following an individualised follitropin delta dosing regimen in either a long GnRH agonist or GnRH antagonist protocol? Summary answer Live birth rates and neonatal outcomes were similar, supporting the efficacy and safety of follitropin delta in both GnRH agonist and antagonist protocols. What is known already Follitropin delta is used for ovarian stimulation and is administered as a fixed daily dose, individualised based on bodyweight and anti-Müllerian (AMH) levels. Registrational trials for follitropin delta used a GnRH antagonist protocol. Preliminary study data shows that individualized follitropin delta is efficacious when used with a long GnRH agonist protocol (RAINBOW trial); however, there is no comparative data for the effects on live birth rates and neonatal outcomes with individualised follitropin delta in a long GnRH agonist versus an antagonist protocol. Study design, size, duration This RCT compared the efficacy and safety of individualised follitropin delta dosing using a long GnRH agonist versus an antagonist protocol and was conducted between May 2019 and February 2022. The trial was designed to describe potential differences in the number of oocytes retrieved between the two GnRH analogue protocols (reported separately). A total of 437 participants were randomised, with a post-trial follow-up period to 4 weeks after birth to record birth and neonatal outcomes. Participants/materials, setting, methods Participants were 18–40 years old with AMH ≤35 pmol/L, undergoing their first ovarian stimulation cycle for IVF/ICSI at specialist reproductive health clinics in Austria, Denmark, Israel, Italy, the Netherlands, Norway and Switzerland.Live birth rates were compared using a logistic regression model with age and AMH at screening as factors. Multiple imputation was used for randomised subjects withdrawing before start of stimulation. Subjects with transfer cancellation due to COVID-19 related reasons were excluded. Main results and the role of chance All participants had a single blastocyst transferred, except two participants ≥38 years in the agonist group who received a double transfer resulting in one dichorionic diamniotic pregnancy for one subject, complicated by maternal hypertension and preterm birth at 33 weeks. All 133 participants with ongoing pregnancies (138 fetuses) were included in this post-trial follow-up analysis. Late pregnancy losses (after confirmed ongoing pregnancy) were similar in the agonist and antagonist groups (2.7% and 1.7%). There were 130 live births (agonist group: 75 neonates [67 singletons; 4 sets of twins]; antagonist group: 60 neonates [58 singletons; 1 set of twins]). Estimated live-birth rates were 35.8% and 28.7% in the agonist and antagonist groups, respectively, per started cycle (treatment difference 7.15%; 95% CI: –2.02; 16.31; p = 0.1265). There were two neonatal deaths in the agonist group – a set of monochorionic twins born at gestational age 24 weeks + 2 days died shortly after birth due to prematurity. The two treatment groups were comparable with respect to neonatal health data for singletons and twins, and incidence of congenital malformations (2.7% and 3.3%, respectively). Neonatal admissions to intensive care units were similar for both groups (10 and six neonates, respectively). Limitations, reasons for caution Double blastocyst transfer was permitted for participants ≥38 years with no good-quality blastocysts. Neonatal health is dependent on singleton/twin status. Outcomes of transfers with cryopreserved blastocysts were not followed up – the cumulative live birth rates and neonatal outcomes after cryo-transfer are not known. Wider implications of the findings The safety profile of individualised follitropin delta dosing was similar in GnRH agonist and antagonist protocols. Live birth rates following individualised follitropin delta were also similar for both GnRH protocols. There were no safety concerns with respect to the neonatal health after ovarian stimulation with follitropin delta. Trial registration number ClinicalTrials.gov identifier: NCT03809429; EudraCT number: 2017-002783-40

Reconsidering the effectiveness of low-dose aspirin in prevention of pre-eclampsia among otherwise low risk twin gestations: A historical cohort study.

To investigate the effectiveness of low-dose aspirin (LDA) in the prevention of pre-eclampsia (PE) among otherwise low-risk twin gestations. A historical cohort study consisting of all pregnant individuals with dichorionic diamniotic (DCDA) twin pregnancy who delivered between 2014 and 2020. Patients treated with LDA were matched by a 1:4 ratio to individuals who were not treated with LDA by age, body mass index and parity. During the study period, 2271 individuals carrying DCDA pregnancies delivered at our center. Of these, 404 were excluded for one or more additional major risk factors. The remaining cohort consisted of 1867 individuals of whom 142 (7.6%) were treated with LDA and were compared with a 1:4 matched group of 568 individuals who were not treated. The rate of preterm PE did not differ significantly between the two groups (18 [12.7%] in the LDA group vs. 55 [9.7%] in the no-LDA group; P= 0.294, adjusted odds ratio 1.36, 95% confidence interval 0.77-2.40). There were no other significant between-group differences. Low-dose aspirin treatment in pregnant individuals with DCDA twin gestations without additional major risk factors was not associated with a reduction in the rate of preterm PE.

Early Mobility for Antepartum Post VA-ECMO Patient with Non-Traumatic Spinal Cord Injury: A Case Report

<h3>Research Objectives</h3> To describe mobility progression of a post VA-ECMO non-traumatic spinal cord injured patient immediately antepartum with prolonged hospitalization. <h3>Design</h3> Cardiac arrest represents approximately 56.6% of complications in the immediate antepartum period where extracorporeal membrane oxygenation (ECMO)is indicated. ECMO cannulations include veno-arterial (VA), veno-venous (VV), and venous-arterial-venous (VAV), where large-bore catheters are placed into large vessels and connected to a circuit. A membrane oxygenator pumps blood to exchange oxygen and carbon dioxide. Spinal cord tumors develop inside the spinal canal and are intramedullary or extramedullary. They can impact motor and sensory neurons, triggering pain, loss of movement, sensory changes, and bowel and bladder dysfunction. Dichorionic diamniotic gestation occurs when each fetus has a separate placenta and amniotic sac. Mothers remain at increased risk of premature labor and delivery. <h3>Setting</h3> 746 bed university affiliated tertiary hospital. <h3>Participants</h3> 31-year-old Dominican obese female with spinal cord tumor at 25 weeks 5 days gestation with dichorionic diamniotic pregnancy. Placed on VA-ECMO following cardiac arrest secondary to massive pulmonary embolism. <h3>Interventions</h3> Physical therapy (PT) initiated in the intensive care unit (ICU) following VA-ECMO decannulation. Interventions included cognitive stimulation, positioning, bed mobility, strengthening, cycle ergometry, and out of bed tolerance. Sessions were 15-60 minutes and progressed following standard safety measures. <h3>Main Outcome Measures</h3> FSS-ICU, AM-PAC, and RASS scores; manual muscle strength; number of therapy sessions; and mechanical ventilation (MV) days. <h3>Results</h3> PTs collected data in the hospital-based setting. Patient demonstrated improvement on outcome measures, although statistical significance was not calculated. FSS-ICU from un-scorable to 8/35, AM-PAC from 6/24 to 7/24, RASS score from -5 to 0, manual muscle strength from 0/5 throughout to 3+/5 to 4-/5 in the upper extremities and 0/5 in the lower extremities by discharge. 15 total PT sessions, including 13 in the ICU. 5 mobility sessions while on MV. <h3>Conclusions</h3> PT was deemed safe, and patient demonstrated improved functional mobility . Additional research is warranted for this population, although this case may serve as a framework given lack of complex patients to compare protocols to. <h3>Author(s) Disclosures</h3> No disclosures.

A HIGH KIDSCORE EMBRYO THAT RESULTED IN MONOZYGOTIC DICHORIONIC DIAMNIOTIC PREGNANCY AFTER SINGLE EUPLOID EMBRYO TRANSFER

To report a case of a monozygotic dichorionic diamniotic pregnancy after single euploid embryo transfer with high KIDScore.

Foetal acardius amorphus – A rare finding in placenta

We present the case of a placental nodule from a 34-year-old female with an in vitro fertilisation pregnancy. Early ultrasound showed a dichorionic diamniotic pregnancy. A later ultrasound noted one foetus demised. Macroscopically, a nodule was on the foetal surface of the placenta. Microscopic examination showed mature intestinal epithelium, neural elements including ganglion cells and glial tissue. The nodule demonstrated squamous epithelium with adnexal structures, smooth muscle, vessels, lymphatics, bone and lymphoid aggregates.

Hemophagocytic Lymphohistiocytosis and Severe Hypoxemia in a Preterm Infant.

Hemophagocytic Lymphohistiocytosis and Severe Hypoxemia in a Preterm Infant.

Giant myoma associated with uterine prolapse during the second trimester of twin pregnancy: case report

A 38-years-old primigravida with twin dichorionic diamniotic pregnancy at 18 weeks of gestational age, had a giant myoma attached to the uterine fundus, resulting in uterine prolapse and restrictive gastric capacity. The patient went through a myomectomy at 18 weeks of gestational age. After the surgery, the patient was able to eat without vomiting and had a complete regression of uterine prolapse. One of the fetuses died two weeks after surgery, and the other was delivered by a C-section on the 36 3/7 weeks. The postoperative period was uneventful, and the mother and newborn were discharged four days later.

The association between maternal complications and small for gestational age in twin pregnancies using singleton and twin birth weight references

Introduction In singleton pregnancies, maternal complications, such as preeclampsia and thyroid dysfunction are associated with small for gestational age (SGA). However, data on the association between SGA and maternal complications in twin pregnancies are limited and conflicting. Small sample size and the application of singleton birth weight reference (SBWR) to define SGA in twins may be reasons for the inconsistent conclusions. Purpose of this study was to define SGA in dichorionic diamniotic (DCDA) and monochorionic diamniotic (MCDA) twin pregnancies using both SBWR and twin birth weight reference (TBWR) and to determine whether certain maternal complications are associated with SGA in twin pregnancies. Materials and methods This retrospective cohort study included all twins delivered in a single tertiary center between 2013 and 2018. SGA was defined as a twin with birth weight <10th centile for gestational age using either SBWR or TBWR. The association between SGA and maternal complications was analyzed separately for DCDA and MCDA twin pregnancies, expressed as odds ratio (OR) and adjusted odds ratio (aOR) with 95% confidence interval (95%-CI). Results A total of 2005 DCDA and 467 MCDA twin pregnancies were enrolled. In DCDA pregnancies, SGA was significantly associated with PE according to TBWR (22.73 vs. 14.56%, aOR 1.823, 95%-CI 1.137–2.922). This association was even more pronounced between SGA and severe PE (9.09 vs. 4.54%, aOR 2.234, 95%-CI 1.115–4.479). In turn, PE was associated with higher risk of SGA defined according to TBWR (8.31 vs. 4.99%, aOR 1.825, 95%-CI 1.139–2.925). No association was detected between SGA and other maternal complications. Using SBWR, no association was found between preeclampsia and SGA. In MCDA pregnancies, according to TBWR, SGA was associated only with severe PE (12.5 vs. 4.06%, aOR 3.470, 95%-CI 1.256–9.587) and lower risk of PROM (aOR 0.067, 95%-CI 0.014–0.322). Conclusion PE was associated with SGA in DCDA pregnancies only when TBWR was used, suggesting that DCDA pregnancies complicated with PE should be closely monitored for signs of SGA and vice versa. In MCDA pregnancies, SGA defined according to TBWR was associated with only severe PE (but not with all PE) and lower risk of PROM. More basic experiments are needed to investigate the mechanisms underlying PE and SGA in DCDA and MCDA twin pregnancies respectively.

949 EXIT-to-airways for fetal neck mass: extending the procedure to diamniotic-monochorionic twin gestation

Fetal airway obstruction in one twin of a diamniotic pregnancy presents unique challenges especially when a single placenta is shared between the fetuses. Very few cases of Ex-Utero-Intrapartum-Treatment (EXIT) in twin pregnancies have been reported, and only in dichorionic pregnancies. We report a single methodology for EXIT-to-airway procedures in monochorionic and dichorionic twins. We review two EXIT-to-airway in twin pregnancies with a giant cervical mass in one fetus. Two cases of EXIT-to-airway in twin pregnancies were performed in 2018-2019 at a regional fetal treatment center. A multi-disciplinary evaluation was completed, and treatment options developed to accommodate parental goals balancing the risks for both fetuses. Case 1 involved a dichorionic-diamniotic pregnancy with a large cervical lymphatic malformation with labor at 36 weeks. Case 2 involved a giant cervical teratoma in a monochorionic-diamniotic twin pregnancy with preterm labor at 29 weeks. In each case, the polyhydramnios caused the affected twin’s amniotic sac to be the presenting sac for the surgical approach. Continuous monitoring of both fetuses was obtained via pulse-oximetry and intermittent transthoracic echocardiography and continuous transuterine echocardiography. Bronchoscopy and intubation were completed after 10 and 22 minutes of uteroplacental bypass respectively. In each case, the affected fetus was transferred to adjacent operating room for complete mass resection. The unaffected twins were delivered as second without intubation and resuscitated without any perinatal distress. Twins and mothers recovered without complications. EXIT-to-airway appears to be a reasonable option for the safe transition of complicated twins even in the setting of significant prematurity in a monochorionic pregnancy. Continuous monitoring permits safe algorithm-based airway management of the affected twin first and subsequent delivery of the unaffected twin. Thoughtful preparation by an experienced multidisciplinary team permits an EXIT-to-airway approach for twin pregnancies in an emergency setting.

The relationship between fetal thymus volume and preterm birth in dichorionic diamniotic pregnancies

Background: The aim of this study was to compare fetal thymus volume in women who delivered at &lt;36 weeks of pregnancy versus those who did not. Methods: A total of 32 dichorionic-diamniotic twin pregnant women were included in the prospective cohort study. The fetal thymus volumes were measured in the second trimester for each fetus using the VOCAL ultrasonography program. The data of women who experienced preterm labor (delivered at &lt;36 weeks of pregnancy) and the control group (delivered at ≥36 weeks of pregnancy) were compared. Results: The mean thymus volume of each fetus was statistically significantly lower in preterm delivery cases than in the control group. Mean fetal thymus volume could be used as a marker for predicting preterm birth in the study group. The parameter of fetal thymus volume measured in twins at 18–24 weeks can be used as a predictive factor (P &lt; 0.001). When the fetal thymus volume, measured 3-dimensionally by ultrasonography in conjunction with the VOCAL program, was used as a marker for predicting preterm delivery, the cut-off value was found to be 0.5245 cm3, with 83.3% sensitivity and 85.8% specificity (AUC 0.905, P &lt; 0.001, 95% CI, 0.798–0.930). Conclusion: By predicting preterm delivery via measuring the fetal thymus volume in twins, physicians can suggest strategies to prevent preterm delivery at 18–24 weeks of pregnancy. In this way, fetal mortality/morbidity related to preterm delivery may be prevented.

Monozygotic dichorionic-diamniotic pregnancies following single frozen-thawed blastocyst transfer: a retrospective case series

BackgroundThe primary aim of the study is to report cases of monozygotic dichorionic-diamniotic (DC-DA) pregnancies after single frozen-thawed blastocyst transfer.MethodsThis is a retrospective case series. All single frozen-thawed blastocyst transfer cycles performed between June 2013 and December 2018 at the Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China, were reviewed retrospectively. We included frozen embryo transfer (FET) cycles which clinical pregnancy was confirmed with multiple gestational sacs showed on ultrasonography at around 6 to 7 weeks of gestation. We then conducted an in-depth analysis to further exclude cases which contained newborns of different genders or natural FET cycles.ResultsFive thousand four hundred fifteen frozen-thawed single blastocyst transfer cycles were preformed between June 2013 and December 2018 at the Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Of these, fourteen women underwent a single blastocyst transfer and then achieved clinical pregnancy with an ultrasound diagnosis of multi-chorionic pregnancy. With one natural cycle FET excluded, we finally included thirteen single blastocyst transfer cycles performed in down-regulated controlled FET or hormone replacement FET, in which the possibility of concurrently spontaneous pregnancy was extremely small. These included 13 cases reveal the phenomenon of monozygotic DC-DA twinning after single blastocyst transfer, which challenges the classical theory that only monochorionic pregnancy could happen after 3 days of fertilization.ConclusionThis case series suggest that single blastocyst transfer could result DC-DA pregnancies during IVF treatment.