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Hideto Nakao - One of the best experts on this subject based on the ideXlab platform.
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very low birth weight Monochorionic Diamniotic Twins as a risk factor for symptomatic patent ductus arteriosus
Neonatology, 2016Co-Authors: Hiroshi Yamaguchi, Masami Mizobuchi, Hitomi Sakai, Keiko Wada, Seiji Yoshimoto, Miho Nagasawa, Takefumi Kikusui, Hideto NakaoAbstract:Background: Some prior studies have shown that symptomatic patent ductus arteriosus (sPDA) is highly familial. Although it is estimated that both genetic and environmental factors may contribute to sPDA, evidence is still lacking. Objective: The aim of this study was to determine the risk factors for sPDA, focusing on the genetic and in utero environment by analyzing very low birth weight (VLBW) singletons and Twins. Methods: This retrospective case-control study reviewed the medical records of 445 VLBW infants (25 weeks ≤ gestational age Results: Stepwise multiple regression analysis showed that twin siblings (p = 0.001), gestational week (p Conclusions: The current results show that being a VLBW MD twin is an independent risk factor for sPDA, and that both genetic and in utero environmental factors may contribute to its development.
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n terminal pro brain natriuretic peptide levels in Monochorionic Diamniotic Twins with selective intrauterine growth restriction
Journal of Perinatology, 2014Co-Authors: Kazumichi Fujioka, Masami Mizobuchi, Hitomi Sakai, Sota Iwatani, Keiko Wada, Seiji Yoshimoto, Hideto NakaoAbstract:N-terminal pro-brain natriuretic peptide levels in Monochorionic Diamniotic Twins with selective intrauterine growth restriction
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n terminal pro brain natriuretic peptide levels in Monochorionic Diamniotic Twins with twin to twin transfusion syndrome treated by fetoscopic laser photocoagulation
The Kobe journal of the medical sciences, 2013Co-Authors: Kazumichi Fujioka, Masami Mizobuchi, Hitomi Sakai, Sota Iwatani, Keiko Wada, Seiji Yoshimoto, Satoshi Tanaka, Hideto NakaoAbstract:Twin-to-twin transfusion syndrome (TTTS) affects 15% of Monochorionic Diamniotic (MD) twin pregnancies, and is associated with adverse perinatal outcome. Recently, fetoscopic laser photocoagulation (FLP) has been widely accepted as the most definitive therapy to treat TTTS. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a powerful diagnostic marker of cardiac dysfunction in neonates, and is elevated in MD Twins with TTTS. However, there are no reports assessing the effect of FLP on neonatal cardiac overload in TTTS by measuring the serum NT-proBNP levels at birth. Here, we aimed to compare serum NT-proBNP levels at birth in MD Twins with TTTS treated with FLP or not. Twelve MD twin pairs with TTTS admitted to our center between October 2007 and September 2012 were enrolled in this study. The MD twin pairs were separated into two groups: seven Twins (12 newborn infants) with FLP (FLP group) and five Twins (nine newborn infants) without FLP (non-FLP group). Gestational age, birthweight, and Apgar scores were significantly higher in the FLP group than that in the non-FLP group. Serum NT-proBNP levels at birth were significantly lower in the FLP group than in the non-FLP group [1425 pg/ml (range, 466-9560) vs. 29900 pg/ml (range, 7300-77900), respectively; p=0.0003]. The serum NT-proBNP levels of larger and smaller co-Twins were significantly correlated with each other (r=0.750; p=0.026). In conclusion, serum NT-proBNP levels at birth are lower in MD Twins with TTTS after FLP treatment than in those without FLP.
Hisanori Minakami - One of the best experts on this subject based on the ideXlab platform.
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b type natriuretic peptide levels are correlated with birth weight discordance in Monochorionic Diamniotic Twins without twin twin transfusion syndrome
Journal of Perinatology, 2013Co-Authors: Akinori Moriichi, Kazutoshi Cho, Yuta Furuse, Takuma Akimoto, Yosuke Kaneshi, Takashi Yamada, Mamoru Morikawa, Hisanori MinakamiAbstract:B-type natriuretic peptide levels are correlated with birth-weight discordance in Monochorionic-Diamniotic Twins without twin–twin transfusion syndrome
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b type natriuretic peptide levels are correlated with birth weight discordance in Monochorionic Diamniotic Twins without twin twin transfusion syndrome
Journal of Perinatology, 2013Co-Authors: Akinori Moriichi, Kazutoshi Cho, Yuta Furuse, Takuma Akimoto, Yosuke Kaneshi, Takashi Yamada, Mamoru Morikawa, Hisanori MinakamiAbstract:To determine whether B-type natriuretic peptide (BNP) levels in umbilical cord blood (UCB) and amniotic fluid (AF) are correlated with birth-weight discordances in Monochorionic-Diamniotic Twins. The UCB–BNP and AF–BNP levels were determined at birth in 36 twin-pairs without twin–twin transfusion syndrome (TTTS). Both the UCB–BNP and the AF–BNP levels were significantly higher among Twins with either a birth-weight discordance ⩾20% (141.6 versus 52.9 pg ml−1 for UCB–BNP, 38.0 versus 17.2 pg ml−1 for AF–BNP) or cardiac dysfunction at birth (167.2 versus 56.3 pg ml−1 for UCB–BNP, 34.9 versus 19.0 pg ml−1 for AF–BNP), compared with neonates without the respective characteristics. The UCB–BNP and AF–BNP levels in both the larger and the smaller Twins were significantly correlated with birth-weight discordance. Cardiac dysfunction occurs in both larger and smaller co-Twins with increasing birth-weight discordances, even in the absence of TTTS.
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prospective risk of stillbirth Monochorionic Diamniotic Twins vs dichorionic Twins
Journal of Perinatal Medicine, 2012Co-Authors: Mamoru Morikawa, Kazutoshi Cho, Takashi Yamada, Takahiro Yamada, Shoji Sato, Hisanori MinakamiAbstract:AIMS To determine reliably the risk of stillbirth among twin pregnancies. METHODS A data analysis of 3241 and 6581 women with Monochorionic Diamniotic (MD) and dichorionic (DD) Twins, respectively, who gave birth at ≥22 weeks of gestation. RESULTS The prospective risk (per 1000 women) of stillbirth, 25.3 and 11.5 at gestational week 22, decreased to <10.0 at gestational weeks 31 and 28 among the MD and DD Twins, respectively. After single intrauterine fetal death, the co-twin died in utero or within 7 days of life more frequently among MD Twins than among DD Twins [42.7% (35/82) vs. 2.6% (2/76); relative risk, 16.2; 95% confidence interval, 4.0-65.1]. CONCLUSION Women with MD Twins were 2.2-fold more likely to experience stillbirth than women with DD Twins. The prospective risks of stillbirth were <1.0% for both groups of women at ≥32 weeks of gestation.
Kenneth J Moise - One of the best experts on this subject based on the ideXlab platform.
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fortnightly surveillance of Monochorionic Diamniotic Twins for twin to twin transfusion syndrome compliance and effectiveness
Prenatal Diagnosis, 2020Co-Authors: Anthony Johnson, Kenneth J Moise, Clifton O Brock, Baha M Sibai, Eleazar Soto, Sean C Blackwell, Edgar Hernandez AndradeAbstract:Objectives To determine the compliance and effectiveness of fortnightly ultrasound surveillance for detection of twin-twin transfusion syndrome (TTTS) in Monochorionic Diamniotic (MCDA) twin gestations. Methods This is a retrospective study of ultrasound surveillance of MCDA Twins for TTTS. Our surveillance protocol requires fortnightly ultrasounds starting at 16 weeks of gestational age (GA) continuing until delivery. Compliance was assessed by determining the GA of surveillance initiation and time between ultrasounds. GA and Quintero Stage at diagnosis were evaluated to determine whether TTTS was detected prior to advanced disease (Quintero Stage III +) or fetal demise. Results Of 442 women, 264 (59.7%) initiated surveillance after 16 weeks; follow-up ultrasounds were late in 17.4% of cases. TTTS was diagnosed in 43 (9.7%) women at a median GA of 19.7 [17.4, 23.9] weeks. Of 25/43 (58.1%) cases diagnosed during protocol compliance, 12 had advanced disease and two had fetal demise. A similar proportion of diagnoses (n = 18), made while non-compliant, exhibited advanced disease (11/18, 61.1%, P = .40). Thirteen diagnoses occurred during periods of increased ultrasound frequency due to abnormalities (ie, fluid/estimated fetal weight discrepancies or Doppler abnormalities). Conclusions In this population, fortnightly ultrasound compliance was suboptimal. Advanced disease and fetal demise occurred during protocol compliance.
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outcome of fetoscopic laser ablation for twin to twin transfusion syndrome in dichorionic triamniotic triplets compared with Monochorionic Diamniotic Twins
Ultrasound in Obstetrics & Gynecology, 2014Co-Authors: Pedro S Argoti, Ramesha Papanna, Michael Bebbington, Ahmet Baschat, Anthony Johnson, N Kahlek, Kenneth J MoiseAbstract:Objective To compare outcome of dichorionic–triamniotic (DCTA) triplet gestations with that of a paired cohort of Monochorionic–Diamniotic (MCDA) twin gestations undergoing laser therapy for treatment of twin-to-twin transfusion syndrome (TTTS). Methods All DCTA triplets treated at four referral centers between specified dates were included. A matched cohort group of MCDA twin gestations affected by TTTS was used for comparison. Results Sixteen sets of DCTA triplets treated with laser photocoagulation of placental anastomoses were compared with 32 matched sets of MCDA Twins. All of the ‘singleton’ fetuses in the triplet gestations survived to birth and to the end of the neonatal period. There were no differences in single or double survival or the rate of non-survivors to birth and at age 28 days. A mean 3-week difference was found in the procedure-to-delivery interval in DCTA triplets vs MCDA Twins (60 ± 35.8 days vs 83.6 ± 33.2 days; P = 0.029). A mean difference of 3 weeks was also found in the gestational age at delivery in DCTA triplets vs MCDA Twins (28.5 ± 3.5 weeks vs 31.9 ± 5 weeks; P = 0.024). A similar post-laser fetal growth pattern in donors and recipients of both groups was noted. Conclusions DCTA triplet gestations with TTTS have a similar rate of post-laser survival but deliver earlier than can be expected for Twins treated with laser. These findings have potential implications for the risk of prematurity and long-term outcomes. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
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444 outcomes of laser photocoagulation for feto fetal transfusion syndrome in dichorionic triamniotic triplet gestations as compared to Monochorionic Diamniotic Twins
American Journal of Obstetrics and Gynecology, 2013Co-Authors: Pedro S Argoti, Ramesha Papanna, Michael Bebbington, Nahla Khalek, Ahmet Baschat, Anthony Johnson, Kenneth J MoiseAbstract:pressing its function. The aim of our analysis was to evaluate the potential role of placental dysfunction, defined by values of PlGF, sFlt-1 and sFlt-1/PlGF ratio, in the pathogenesis of IUGR. STUDY DESIGN: A case-control study collecting 90 fetal and maternal serum samples from singleton pregnancies was performed at our Institution between 2005 and 2007. Pregnancies complicated by presence of IUGR (18 mothers and their own newborns IUGR group) were compared to controls with normally grown fetuses (27 mothers and their own babies NORMAL GROWTH group). Mann Whitney U test was used for statistical analysis, with p .05 considered significant. RESULTS: The Table and Figure show results for the analysed markers in maternal and fetal serum. sFlt-1 value was higher in serum of mothers with a pregnancy complicated by IUGR than of patients with normally grown fetuses, whereas no differences were found between these 2 groups in fetal serum. PlGF showed a lower level in IUGR than in NORMAL GROWTH group both in maternal and in fetal samples. sFlt-1/PlGF ratio displayed the same trend of sFlt-1. CONCLUSION: Theresultsofourstudysupport thepivotal roleofplacental dysfunction in determining IUGR. PlGF appeared to be the most powerful marker for identifying this fetal disease, both in the maternal and in the fetal compartment. 444 Outcomes of laser photocoagulation for feto-fetal transfusion syndrome in dichorionic-triamniotic triplet gestations as compared to Monochorionic-Diamniotic Twins Pedro Argoti, Ramesha Papanna, Michael Bebbington, Nahla Khalek, Ahmet Baschat, Anthony Johnson, Kenneth Moise University of Texas Health Science Center at Houston, Department of Obstetrics, Gynecology, and Reproductive Sciences; Houston, TX,, Houston, TX, Yale University, Ob/Gyn & Reprod Sci, New Haven, CT, The Children’s Hospital of Philadelphia, The Center for Fetal Diagnosis and Treatment, Philadelphia, PA, University of Maryland School of Medicine, Obstetrics, Gynecology, and Reproductive Sciences, Baltimore, MD OBJECTIVE: To compare the outcomes of dichorionic-triamniotic (DC,TA) triplet gestations with the outcomes of a paired cohort of Monochorionic-Diamniotic twin (MC,DA) gestations undergoing laser photocoagulation of placental anastomosis for treatment of fetofetal transfusion syndrome. STUDY DESIGN: All DC,TA triplets treated by at 3 referral centers were included; a matched cohort group of MC,DA twin gestations affected by feto-fetal transfusion syndrome were used for comparison. 16 triplet cases and 32 twin controls were matched for demographic variables including maternal age, race, smoking status, BMI; fetal variables including gestational age at the time of the procedure, weight discrepancies, presenting Quintero stage, presenting DVP in donor and recipient, Doppler abnormalities, placental location and operative variables including operative time, cannula diameter and use of Solomon technique, amnioreduction and amnioinfusion. The Chi Square statistical test was used to compare categorical variables and the unpaired t-test to compare equality of means. Results with a p value 0.05 were considered statistically significant. RESULTS: Appropriate matching was confirmed by the absence of statistical differences between compared variables. All of the “singleton” fetuses in the triplet gestations survived to birth and to the end of the neonatal period (Table). CONCLUSION: This study shows an increased general risk of prematurity after laser treatment for DC, TA triplets compared to MC, DA twin (three-week difference). A shorter interval from surgery to delivery in triplets also confirms the increased risk. Despite the increased prematurity risk in triplets, no difference in survival to birth or neonatal survival was found after laser. These findings have important implications regarding long term outcomes when counseling patients with dichorionic-triamniotic triplet gestations considering laser therapy. Statistical significant markers’ level in maternal and fetal serum
Kazumichi Fujioka - One of the best experts on this subject based on the ideXlab platform.
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n terminal pro brain natriuretic peptide levels in Monochorionic Diamniotic Twins with selective intrauterine growth restriction
Journal of Perinatology, 2014Co-Authors: Kazumichi Fujioka, Masami Mizobuchi, Hitomi Sakai, Sota Iwatani, Keiko Wada, Seiji Yoshimoto, Hideto NakaoAbstract:N-terminal pro-brain natriuretic peptide levels in Monochorionic Diamniotic Twins with selective intrauterine growth restriction
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n terminal pro brain natriuretic peptide levels in Monochorionic Diamniotic Twins with twin to twin transfusion syndrome treated by fetoscopic laser photocoagulation
The Kobe journal of the medical sciences, 2013Co-Authors: Kazumichi Fujioka, Masami Mizobuchi, Hitomi Sakai, Sota Iwatani, Keiko Wada, Seiji Yoshimoto, Satoshi Tanaka, Hideto NakaoAbstract:Twin-to-twin transfusion syndrome (TTTS) affects 15% of Monochorionic Diamniotic (MD) twin pregnancies, and is associated with adverse perinatal outcome. Recently, fetoscopic laser photocoagulation (FLP) has been widely accepted as the most definitive therapy to treat TTTS. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a powerful diagnostic marker of cardiac dysfunction in neonates, and is elevated in MD Twins with TTTS. However, there are no reports assessing the effect of FLP on neonatal cardiac overload in TTTS by measuring the serum NT-proBNP levels at birth. Here, we aimed to compare serum NT-proBNP levels at birth in MD Twins with TTTS treated with FLP or not. Twelve MD twin pairs with TTTS admitted to our center between October 2007 and September 2012 were enrolled in this study. The MD twin pairs were separated into two groups: seven Twins (12 newborn infants) with FLP (FLP group) and five Twins (nine newborn infants) without FLP (non-FLP group). Gestational age, birthweight, and Apgar scores were significantly higher in the FLP group than that in the non-FLP group. Serum NT-proBNP levels at birth were significantly lower in the FLP group than in the non-FLP group [1425 pg/ml (range, 466-9560) vs. 29900 pg/ml (range, 7300-77900), respectively; p=0.0003]. The serum NT-proBNP levels of larger and smaller co-Twins were significantly correlated with each other (r=0.750; p=0.026). In conclusion, serum NT-proBNP levels at birth are lower in MD Twins with TTTS after FLP treatment than in those without FLP.
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renin is activated in Monochorionic Diamniotic Twins with birthweight discordance who do not have twin to twin transfusion syndrome
Journal of Perinatology, 2012Co-Authors: Kazumichi Fujioka, Ichiro Morioka, Akihiro Miwa, Tomoyuki Yokota, Kiyomi Matsuo, Satoru Morikawa, Masahiro Enomoto, Akio Shibata, Mayumi Morizane, Naoki YokoyamaAbstract:Renin is activated in Monochorionic Diamniotic Twins with birthweight discordance who do not have twin-to-twin transfusion syndrome
Akinori Moriichi - One of the best experts on this subject based on the ideXlab platform.
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b type natriuretic peptide levels are correlated with birth weight discordance in Monochorionic Diamniotic Twins without twin twin transfusion syndrome
Journal of Perinatology, 2013Co-Authors: Akinori Moriichi, Kazutoshi Cho, Yuta Furuse, Takuma Akimoto, Yosuke Kaneshi, Takashi Yamada, Mamoru Morikawa, Hisanori MinakamiAbstract:B-type natriuretic peptide levels are correlated with birth-weight discordance in Monochorionic-Diamniotic Twins without twin–twin transfusion syndrome
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b type natriuretic peptide levels are correlated with birth weight discordance in Monochorionic Diamniotic Twins without twin twin transfusion syndrome
Journal of Perinatology, 2013Co-Authors: Akinori Moriichi, Kazutoshi Cho, Yuta Furuse, Takuma Akimoto, Yosuke Kaneshi, Takashi Yamada, Mamoru Morikawa, Hisanori MinakamiAbstract:To determine whether B-type natriuretic peptide (BNP) levels in umbilical cord blood (UCB) and amniotic fluid (AF) are correlated with birth-weight discordances in Monochorionic-Diamniotic Twins. The UCB–BNP and AF–BNP levels were determined at birth in 36 twin-pairs without twin–twin transfusion syndrome (TTTS). Both the UCB–BNP and the AF–BNP levels were significantly higher among Twins with either a birth-weight discordance ⩾20% (141.6 versus 52.9 pg ml−1 for UCB–BNP, 38.0 versus 17.2 pg ml−1 for AF–BNP) or cardiac dysfunction at birth (167.2 versus 56.3 pg ml−1 for UCB–BNP, 34.9 versus 19.0 pg ml−1 for AF–BNP), compared with neonates without the respective characteristics. The UCB–BNP and AF–BNP levels in both the larger and the smaller Twins were significantly correlated with birth-weight discordance. Cardiac dysfunction occurs in both larger and smaller co-Twins with increasing birth-weight discordances, even in the absence of TTTS.