Preeclampsia significantly contributes to maternal and perinatal morbidity and mortality, with twin pregnancies increasing this risk. Severe preeclampsia often requires pregnancy termination to protect maternal health. We report two cases of IVF-conceived twin pregnancies complicated by early preeclampsia. The first case involved a 34 year-old woman, gravida-2, abortion-1 at 21 weeks gestation with monochorionic twins, blood pressure of 150/80 mmHg, and proteinuria of 1600 mg. She underwent radiofrequency ablation of one twin at 22 weeks and delivered a healthy infant at 37 weeks. The second case involved a 34 year-old woman diagnosed with preeclampsia at 22 weeks, who experienced severe placental abruption in the third trimester, resulting in preterm delivery and a neonate admitted to the NICU. Selective fetal reduction may be a viable therapeutic option in managing twin pregnancies complicated by early severe preeclampsia. Such interventions should be performed with full maternal consent and a strong desire to continue the pregnancy.

Pregnant women who have undergone fetal reduction may experience a series of psychological reactions, identifying those women's experiences is helpful for improving pregnancy outcomes. However, the relevant studies and evidence are still lacking in China. This study aimed to explore the experiences of pregnant women who have undergone fetal reduction in China. A descriptive qualitative design was conducted for this study. From June to October 2025, qualitative data was collected through a semi-structured face-to-face in-depth interview from 12 pregnant women who have undergone fetal reduction in a tertiary hospital in Henan province, China. Two investigators analyzed qualitative data independently, and data was analyzed following qualitative content analysis. The experiences of pregnant women who have undergone fetal reduction were described under three themes: complex emotional experiences, multiple coping strategies, and multidimensional needs. Five sub-themes emerged from the complex emotional experiences: unacceptance and regret, distress and anxiety, ambivalence and fear, guilt, and worrying about the safety of the remaining fetus and oneself. Three sub-themes identified from multiple coping strategies: hiding inner feelings, accepting reality, and seeking help from family. Five sub-themes explained the multidimensional needs of pregnant women who have undergone fetal reduction: informational need, psychological need, accessible healthcare need, mental health service need, and financial support need. Pregnant women who have undergone fetal reduction have various psychological emotions, coping styles, and diversified needs. Screening and intervention of psychological emotions, promoting positive coping styles and addressing unmet needs based on multi-dimensional levels (e.g., policymakers, family members, professionals) are crucial for improving mental health of pregnant women who have undergone fetal reduction.

To compare Twin Anemia Polycythemia Sequence (TAPS) cases by treatment modality. Single-center, retrospective review of TAPS without Twin to Twin Transfusion Syndrome undergoing expectant management (EM), intrauterine transfusion +/- partial exchange transfusion (IUT/pET), fetoscopic laser surgery (FLS), or selective fetal reduction (SFR). In 52 TAPS cases, 36 (69%) were spontaneous and 16 (31%) postlaser. 15 (29%) underwent EM, 9 (17%) IUT/pET, 22 (42%) FLS, and 6 (12%) SFR. FLS and SFR groups had higher median middle cerebral artery (MCA) discordance (p=0.007). IUT/pET had later median gestational age (GA) at diagnosis (weeks): 20.9 for FLS, 18.0 for SFR, 21.4 for EM, and 25.6 for IUT/pET (p=0.001). FLS was associated with isolated polyhydramnios (p=0.027), and SFR with isolated oligohydramnios (p=0.005). Treatment to delivery interval (weeks) was 5.4 for IUT/pET, 11.0 for FLS, and 20.6 for SFR (p<0.001). Median GA at delivery was latest in SFR (p=0.003). Perinatal survival for EM, IUT/pET, FLS and SFR was 93.3%, 94.4%, 87.5%, and 50%, respectively. Gestational age, fluid abnormalities, and MCA discordance differed across treatment groups. Placentation, TAPS etiology, and coexisting sFGR were more evenly distributed across management strategies indicating they were less influential factors in management decisions. Outcomes were overall favorable and did not differ across management groups.

To explore the ultrasound finding, pregnancy outcome, and follow-up of fetuses with 16p11.2 microdeletion/microduplication to provide a basis for genetic counseling. Thirteen fetuses with 16p11.2 microdeletion/microduplication detected by chromosomal microarray analysis (CMA) at the Genetic Testing Center of Women's and Children's Hospital Affiliated to Qingdao University between January 2021 and March 2024 were selected as study subjects. Prenatal ultrasound finding, results of genetic testing and family verification, pregnancy outcome, and postnatal conditions were retrospectively analyzed. Data were analyzed using descriptive statistical analysis. This study was approved by the Medical Ethics Committee of the hospital (Ethics No.: QFELL-YJ-2024-159). Among 4 985 fetuses undergoing prenatal diagnosis, 13 (0.26%) were detected with 16p11.2 microdeletion/microduplication. Among these, 8 were microdeletions with a size ranging from 0.174 Mb to 0.84 Mb, and 5 were microduplications with a size ranging from 0.59 Mb to 0.89 Mb. The main prenatal ultrasound findings included cardiovascular abnormalities, vertebral developmental abnormalities, and nuchal translucency thickening. Parental tracing was performed in 12 of the 13 fetuses, with five cases verified to have a de novo origin, and seven originated from a phenotypically normal parent. Following genetic counseling, eight couples had opted induced labor, one couple with twin pregnancy had selected reduction of the abnormal fetus, whilst four couples had chosen to continue with the pregnancy. At follow-up, the liveborn infants were aged between 16 and 26 months, with one diagnosed with congenital heart disease, one with infantile epilepsy, and two showing no abnormality in growth and development. CMA testing holds a significant value for the prenatal diagnosis of 16p11.2 microdeletion/microduplication. For fetuses with positive results, it is necessary to consult and conduct long-term follow-up in conjunction with prenatal ultrasound and parental tracing results in order to provide appropriate guidance for pregnancy decision and selection of reproductive methods.

Transcranial motor-evoked potential alert status and 2-year neurological outcomes after postoperative neurological deficits in spinal deformity surgery.

The inferior longitudinal fasciculus (ILF) is a major occipitotemporal white matter bundle involved in higher-order visual and cognitive functions. However, its anatomical consistency, structural organization, and distinction from adjacent tracts remain controversial. The aim of this study was to address these debates by investigating the dual nature of occipitotemporal connections, refining the classification of ILF subcomponents, and reassessing the inclusion of the dorsolateral occipital cortex component (DLOCC) in the ILF. Cadaveric dissection was performed on 10 hemispheres from 5 neurologically healthy donors. Specimens were fixed, frozen, and dissected under an operating microscope according to Klingler's technique. The superficial U-fibers were peeled away to expose long associative fibers, and their cortical origins, trajectories, and relationships with surrounding structures were documented. Complementary diffusion tensor imaging (DTI) was performed in 5 subjects with no evidence of neurological disease and 20 subjects from the Human Connectome Project database. DTI data were acquired and analyzed with deterministic fiber tracking. Manual region-of-interest placement, length-based filtering, and shape analysis enabled reconstruction of short and long fiber tracts, corresponding to those identified in anatomical dissections. The integration of ex vivo and in vivo findings allowed detailed mapping and classification of occipitotemporal pathways. The investigation revealed consistent indirect U-fiber chains and direct long-range fascicles. The vertical occipital fasciculus and a distinct occipito-fusiform fasciculus (OFF) were identified, the latter of which connected the superior occipital gyrus to the anterior fusiform and inferior temporal gyrus. The fusiform component was found to be a thin intragyral tract with selective termination in the anterior fusiform gyrus. Furthermore, the cuneolingual component, which combines the lingual and cuneal fibers, was defined and showed common temporal terminations and overlapping anatomy. The DLOCC, while anatomically consistent, exhibited greater similarity and overlap with the middle longitudinal fasciculus (MdLF) than with the core ILF. Tractography confirmed these findings, showing diverging courses and terminations. These findings support a dual-model framework of occipitotemporal connectivity, comprising both direct and indirect fibers. The ILF should be redefined to include only the fusiform and cuneolingual components, with the DLOCC more accurately attributed to a distinct parietotemporal system alongside the MdLF. The OFF represents a separate underrecognized tract. This refined anatomical framework enhances the understanding of occipitotemporal pathways and might inform future functional and clinical studies.

First-trimester fetal reduction using microwave ablation in high-order pregnancies with a monochorionic component: Feasibility and outcomes.

Neurodevelopmental disorders following fetal reduction of triplet pregnancies: a nationwide cohort study.

We aimed to evaluate perinatal outcomes in triplet pregnancies and compare outcomes between pregnancies managed expectantly and those undergoing fetal reduction. This retrospective study included triplet pregnancies confirmed by ultrasound at Asan Medical Center between January 2020 and May 2025. Pregnancies were classified into an expectant management group or a fetal reduction group (reduction to twins or a singleton). Maternal characteristics, obstetric complications, and perinatal outcomes were compared. Within the fetal reduction group, outcomes were further analyzed by indication-multifetal pregnancy reduction versus selective fetal termination-and method-intracardiac injection versus radiofrequency ablation. A total of 208 triplet pregnancies were included; 133 (63.9%) were managed expectantly, and 75 (36.1%) underwent fetal reduction. In the expectant management group, the mean gestational age at delivery was 33.2 weeks, with preterm birth before 32 weeks in 21.6%, and neonatal intensive care unit (NICU) admission in 76.7%. Fetal loss of at least one fetus before 24 weeks occurred in 7.8%, and the incidence of nonviable pregnancy loss was 2.3%. Compared with expectant management, the fetal reduction group demonstrated more favorable perinatal outcomes, including higher Apgar scores and lower rates of oxygen therapy (18.4% vs. 50.2%, p < 0.0001) and NICU admission (34.6% vs. 76.7%, p < 0.0001). No nonviable pregnancy loss or stillbirth occurred after reduction, whereas both were observed in the expectant group. Survival rates were similarly high in both groups (100% vs. 98.4%). Within the reduction group, outcomes did not differ significantly by indication or procedure type. Triplet pregnancies carry significant maternal and neonatal risks. Fetal reduction appears safe and may improve perinatal outcomes by extending gestation. These findings individualized prenatal counseling and management strategies for triplet pregnancies.

When considering any treatment that may be life-changing, it is important to have as much information as possible on long-term outcomes. These issues first emerged in spina bifida in the 1960s. At that time neurosurgical centres offering closure of the back within the first 24 to 48 hours after birth showed a reduction in mortality by age 2 years from >90% to <40%.1 However, although mildly affected individuals showed improved survival with less disability, it became increasingly evident that neurological deficits present at birth could not be reversed by treatment. This led to the survival of individuals with severe disability and problems with mobility, hydrocephalus, cognition, and continence. These complications were treated with multiple operations including cerebrospinal fluid shunts, and orthopaedic and urological procedures. It became increasingly evident that for the most severely affected infants, their quality of life and the burden imposed on themselves and their families made it difficult to justify intensive treatment.1 Cohorts of individuals who had been treated non-selectively from birth were studied to identify predictors of long-term survival and associated disability.2 Evidence-based selection criteria were published, including Lorber's four major adverse criteria: gross hydrocephalus, kyphosis, thoracolumbar sac, and complete paraplegia.1 Early surgery was recommended only for those with fewer than two criteria. Our group was able to develop a simpler means of predicting long-term outcome using the sensory level, which was accurately identifiable at birth and showed long-term stability.2 Data from our cohort of 117 consecutive cases of open spina bifida with 99% follow-up over 50 years are freely available at: https://doi.org/10.24376/rd.sgul.14438780.v1. Management of spina bifida has moved on from the priorities of the 1970s. In high-income countries, routine advice for folate supplements in females planning pregnancy and folate fortification of food has reduced the prevalence of spina bifida; and fetal ultrasound scans have facilitated selective termination of those with identifiable anatomical abnormalities. This means that many fewer infants are born with severe spina bifida. The next goal is to focus on quality of life for the current, generally more mildly affected generation of individuals with spina bifida. Quality of life includes achieving major life goals such as living independently, walking, having a job, and driving a car.3, 4 Shavelle et al. analysed the life expectancy at different ages in a cohort of 1659 individuals born with open spina bifida.5 Their data derived from the Client Development Evaluation Reports of individuals with spina bifida who had received services from the California Department of Developmental Services from 1986 to 2019. Their data covered 22 102 client years and included 356 deaths. They based their analysis on three major functional abilities: walking, feeding, and continence. They expressed their life expectancy data for males and females in different age brackets by seven descriptive permutations. The main weakness of the research is the limited parameters available for analysis and that these do not necessarily remain stable over time. For example, mobility tends to decline with age and weight gain.3 They were also unable to evaluate the anatomical level of the lesion as this was recorded in only 20%. In addition, theirs is not a birth cohort and excludes individuals with severe disabilities who died before age 5 years. But Shavelle et al. successfully estimated life expectancy for individuals with spina bifida of different ages and levels of disability. One way forward is to improve recording of clinical parameters available for analysis. We suggest that sensory level might serve as a single parameter that is stable over time and has demonstrable value in predicting important clinical outcomes.2-4 Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australasian University Librarians. Not required.

Monochorionicity refers to the condition in which twins share a single placenta. Selective fetal growth restriction (sFGR) in monochorionic (MC) twin pregnancy poses significant challenges due to its association with high risks of perinatal mortality and morbidity. Managing sFGR poses a particular challenge, as affected pregnancies require more frequent monitoring compared to uncomplicated singleton or twin pregnancies. Expectant management is typically applied for type I cases, which generally have favorable outcomes. In contrast, more severe cases (type II and III) may require invasive management, such as fetoscopic laser photocoagulation (FLP) or selective termination. However, how to best manage this complicated pregnancy remains debated, as no evidence-based guidance is currently available. This review aims to summarize the underlying pathophysiology, various diagnostic criteria, classification systems, and current management strategies for sFGR. These include the perinatal outcomes associated with expectant and invasive management in sFGR.

To assess the associations between vanishing twin (VT) and fetal reduction (FR) with obstetric and perinatal outcomes following in vitro fertilization (IVF)-frozen embryo transfer (FET). This was a retrospective cohort study involving women who had undergone FR or experienced VT during the period from 2012 to 2022. Cohorts were stratified by timing into early (< 15weeks) and late (≥ 15weeks) VT/FR. Controls comprised primary singletons and non-reduced twins. The primary outcome measurements were maternal and birth complications. Among 33,238 ongoing pregnancies, there were 24,316 primary singletons, 7452 non-reduced twins, 1354 VTs, and 116 FRs. Multivariable analyses showed birth outcomes in the study groups were similar to or better than non-reduced twin deliveries. Compared to primary singletons, both early and late FRs were associated with increased risk of preterm birth (PTB); late FR also increased the risk of low birthweight (LBW). Early and late VTs similarly had higher risks of PTB and LBW versus primary singletons. Obstetric complications were generally comparable or lower in the study groups versus twin deliveries; however, late FR was linked to a higher risk of hypertensive disorders of pregnancy compared with primary singletons, and late VT was associated with increased abnormal placentation versus primary singletons and twins. In this large IVF-FET cohort, most birth and maternal outcomes were comparable or better than in non-reduced twins, but certain complications remained more common in both VT and FR groups. Both exposures were linked to adverse perinatal outcomes versus primary singletons. Moreover, VT and FR appear to be more problematic when these occur later in pregnancy.

We aimed to evaluate the current clinical practice regarding selective termination of pregnancy in dichorionic (DC) twin pregnancies in Italy to establish a national protocol. This was a retrospective, multicentre analysis of selective termination in DC twin pregnancies from 2010 to 2021 performed under ultrasonographic guidance using a transabdominal injection of potassium chloride via an 18- or 20-gauge needle at a gestational age (GA) before fetal viability. Maternal and fetal characteristics and perinatal outcomes were collected accordingly. The primary outcome was preterm delivery before 32weeks of gestation. A total of 253 patients underwent selective termination at a mean GA of 17.6weeks. Follow-up information was available for 199 patients. The rates of fetal (6%) and neonatal (0.5%) deaths were low. The mean GA at delivery was 36.5weeks (24-42) with 23/199 (11.5%) preterm deliveries before 32weeks. The only variable associated with primary outcome was GA at procedure, >18weeks (odds ratio, 2.95 [95% confidence interval 1.07-8.09]). This is the first Italian multicentre evaluation of selective termination of pregnancy in DC pregnancies. Our data suggest that the risk of preterm delivery can be reduced if the procedure is performed before 18weeks of GA.

Copepods are a group of marine plankton that play an essential role in the energy transfer within marine ecosystems. They serve as vital prey for the larvae of numerous economically important fish, shrimp, and crabs species. Bestiolina amoyensis, a copepod species inhabiting nearshore warm waters, possesses numerous commercial advantages for aquaculture due to its small size, rapid reproduction, and strong adaptability, that make it well-suited for use as live prey in aquaculture systems. In this study, a breeding program targeting high fertility was designed and implemented. Fifty pairs of adult B. amoyensis were randomly selected to establish the base population (G0), with the total egg production used as the breeding index. In the selected group, offspring from maternal lines that ranked in the top 30% for total egg production were selected and eggs laid on the 4th day by these selected pairs were used to establish breeding pairs for subsequent generations. In the control group, breeding pairs were established by randomly mating offspring of the G0 population. The selection procedure was repeated for five consecutive generations, with consistent selection criteria maintained only for the selected group. Additionally, the stability of selection effect was investigated by tracking both groups for an another 5, 10, 15 generations after the termination of artificial selection. After five generations of selection, the selected group showed a significant increase in total egg production, whereas no significant change was observed in the control group. By the fifth generation (G5), the selected group exhibited a 23.99% increase in total egg production compared with the control group, with a heritability (h2) of 0.46 ± 0.11. At the G5 generation, the population densities of the selected and control groups were 9075.00 ± 193.18 ind/L and 7200.33 ± 249.18 ind/L, respectively. After rearing for another 5, 10, and 15 generations without selection, the total egg production of the selected groups was 167.50 ± 2.47 eggs/female, 164.23 ± 2.46 eggs/female and 158.23 ± 3.14 eggs/female, respectively, indicating a gradual decrease. However, the selected group maintained significantly higher egg production than the control group (p < 0.05). The results demonstrate that the reproductive capacity of B. amoyensis can be enhanced through continuous selection, providing technical support for the large-scale and high-density cultivation of this copepod species.

Expectant management versus selective fetal reduction in dichorionic-diamniotic twins following mid-trimester, preterm premature rupture of membranes in 1 twin: Review of literature and meta-analysis.

ObjectiveTo evaluate procedure-related preterm birth (PTB) following third-trimester selective termination (ST) in DC twins and to compare delivery timing with expectantly managed discordant DC twins and non-anomalous DC twins.MethodsA retrospective cohort study was conducted of all DC twin pregnancies undergoing third-trimester ST (> 28 weeks) at a tertiary care center (2003–2023). Pregnancies were classified as having procedure-related complications (delivery ≤ 4 weeks) or uneventful (delivery > 4 weeks). Comparator cohorts included expectantly managed discordant DC twins and non-anomalous DC twins. Outcomes included timing of delivery, cumulative incidence of PTB, and risk factor analysis.Results90 women with DC twin pregnancies elected for ST and 85 procedures were completed. Outcome was available for 81 cases; 48 (59.3%) delivered ≤ 4 weeks after ST and 33 (40.7%) delivered later. Clinical chorioamnionitis was more common within the group delivered ≤ 4 weeks (35.4% vs. 0%; p = 0.001). Cumulative PTB incidence showed accelerated delivery between 32 and 34 weeks after ST. Independent risk factors for delivery ≤ 4 weeks included polyhydramnios (OR 5.68) and reduction of the presenting fetus (OR 6.51). Comparator cohorts exhibited substantially lower PTB incidence.ConclusionThird-trimester ST in DC twins is associated with high PTB risk, but excellent co-twin survival. The first 4 weeks after ST represent a critical vulnerability period, and risk is strongly influenced by identifiable preprocedural factors. These findings support individualized counseling, later scheduling in high-risk pregnancies, should be considered.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00404-026-08305-6.

Twin gestations are subjected to higher rates of growth abnormalities. Accurate, locally customized reference values may contribute to an accurate diagnosis of abnormal growth. We aimed to determine reference values for sonographically estimated fetal weight (sEFW) and biometry in twin gestations. A multicenter retrospective longitudinal analysis of sEFW and biometric measurements evaluations of twin gestations was performed between 2010 and 2022 in 11 medical centers in Israel. The sEFW at 14-40 gestational weeks was calculated using the Hadlock 1985 formula. Only data from viable twins delivered at or above 34 gestational weeks were included. Cases that underwent early fetal reduction or cases that were diagnosed with major congenital fetal anomalies or genetic aberrations were excluded. The non-parametric Quantile Generalized Additive Model (QGAM) approach was employed for building the growth curves. A total of 7,060 fetuses and 18,248 measurements were incorporated in the sEFW and biometry growth curves. The cohort included 3,449 (49%) dichorionic twins contributing 7,192 (40%) of measurements. The rest were monochorionic twins (536, 8% of twins; 1,866, 10% of measurements) or with unknown chorionicity (3,066, 43% of twins; 9,171, 50% of measurements). The cohort included 49% females and 51% males when gender was reported (N=10,945 evaluations). Similar growth curves were observed when curves were split according to chorionicity, when the cohort included only twins delivered after 36 gestational weeks, and following the exclusion of discordant twins above 30%. Reference values for twins' sEFW and biometric measurements are presented for the Israeli population for clinical and research use. Since sEFW and biometry reference values determine fetal growth assessment and subsequent pregnancy management, this study has significant implications for Israeli health policy related to twin pregnancy care.

Background: Requests for reduction from twins to singleton are being faced more frequently in the recent times. This study aims to assess the outcomes of fetal reduction from DCDA twins to singleton where both fetuses looked anatomically normal for gestation. Materials &amp; Methods: This is a case series carried out in a single fetal medicine unit in Kolkata over a period of 36 months. Internal ethics committee approval was obtained for this retrospective review. Women carrying dichorionic diamniotic twins where there were no obvious medical indications were included in the study. The only reason for performing these procedures was maternal request. All cases were performed trans-abdominally at 11-14 weeks gestation by a single operator with considerable experience. The primary objective of this study was to assess the risk of procedure related pregnancy loss. The secondary objective was to assess the overall pregnancy outcome for these cases. Results: 31 cases were performed in this study period but one was lost to follow up. Hence 30 cases were analysed retrospectively. We did not have any pregnancy loss before 24 weeks in this series. Three underwent premature delivery before 34 weeks but all other pregnancies could be continued till term and delivered after 37 weeks with good perinatal outcome. Conclusion: Our study results, when compared with published literature appeared comparable in terms of the risk of miscarriage, gestational age at delivery and birth weight. Fetal reduction remains an effective option in cases to DCDA twins to those who prefer to give birth to one child only.

Prenatal diagnosis of Miller–Dieker syndrome: Integrated application of ultrasound, MRI, and genetic analysis

Live birth following transabdominal fetal reduction in an in vitro fertilization-assisted monochorionic triamniotic triplet pregnancy: A case report