The Experts below are selected from a list of 2211 Experts worldwide ranked by ideXlab platform

Enrico Lopriore - One of the best experts on this subject based on the ideXlab platform.

  • double fatal outcome after ruptured vasa previa in Monochorionic Twins case report and review of the literature
    Journal of Maternal-fetal & Neonatal Medicine, 2015
    Co-Authors: A Van Steenis, Dick Oepkes, Depeng Zhao, Sylke J Steggerda, W J Kist, Monique C Haak, Enrico Lopriore
    Abstract:

    Vasa previa is a condition in which one or more fetal blood vessels run through the amniotic membranes and cross or run near the external orifice of the uterus. Rupture of membranes can lead to tearing of these vessels and cause acute fetal exsanguination. In Monochorionic twin (MC) pregnancies, acute exsanguination in one twin can lead to severe complications in the co-twin due to the presence of inter-twin placental vascular connections. We report a MC pair with severe perinatal asphyxia due to acute exsanguination after prenatally undetected ruptured vasa previa. This resulted in severe hemorrhagic shock in both Twins with double fatal outcome. Antenatal detection of vasa previa is of paramount importance to prevent severe morbidity and mortality, especially in MCs. A review of the literature is presented.

  • Right Ventricular Outflow Tract Obstruction in Monochorionic Twins with Selective Intrauterine Growth Restriction
    Hindawi Limited, 2012
    Co-Authors: S. B. De Haseth, Dick Oepkes, M. C. Haak, A. A. W. Roest, M. E. B. Rijlaarsdam, Enrico Lopriore
    Abstract:

    Monochorionic twin pregnancies are at increased risk of perinatal mortality and morbidity due to twin-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), and higher incidence of congenital heart malformations. The incidence of right ventricular outflow tract obstruction (RVOTO) in recipients with TTTS is known to be higher than in the general population. There is limited data on the risk of RVOTO in Monochorionic Twins with sIUGR. We report a case of RVOTO in the larger twin in a Monochorionic twin pregnancy with sIUGR, treated successfully with balloon dilatation after birth

  • Accurate and Simple Evaluation of Vascular Anastomoses in Monochorionic Placenta using Colored Dye
    Journal of visualized experiments : JoVE, 2011
    Co-Authors: Enrico Lopriore, Femke Slaghekke, Johanna M. Middeldorp, Frans J.c.m. Klumper, Jan M. M. Van Lith, Frans J. Walther, Dick Oepkes
    Abstract:

    The presence of placental vascular anastomoses is a conditio sine qua non for the development of twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS)(1,2). Injection studies of twin placentas have shown that such anastomoses are almost invariably present in Monochorionic Twins and extremely rare in dichorionic Twins(1). Three types of anastomoses have been documented: from artery to artery, from vein to vein and from artery to vein. Arterio-venous (AV) anastomoses are unidirectional and are referred to as "deep" anastomoses since they proceed through a shared placental cotyledon, whereas arterio-arterial (AA) and veno-venous (VV) anastomoses are bi-directional and are referred to as "superficial" since they lie on the chorionic plate. Both TTTS and TAPS are caused by net imbalance of blood flow between the Twins due to AV anastomoses. Blood from one twin (the donor) is pumped through an artery into the shared placental cotyledon and then drained through a vein into the circulation of the other twin (the recipient). Unless blood is pumped back from the recipient to the donor through oppositely directed deep AV anastomoses or through superficial anastomoses, an imbalance of blood volumes occurs, gradually leading to the development of TTTS or TAPS. The presence of an AA anastomosis has been shown to protect against the development of TTTS and TAPS by compensating for the circulatory imbalance caused by the uni-directional AV anastomoses(1,2). Injection of Monochorionic placentas soon after birth is a useful mean to understand the etiology of various (hematological) complications in Monochorionic Twins and is a required test to reach the diagnosis of TAPS(2). In addition, injection of TTTS placentas treated with fetoscopic laser surgery allows identification of possible residual anastomoses(3-5). This additional information is of paramount importance for all perinatologists involved in the management and care of Monochorionic Twins with TTTS or TAPS. Several placental injection techniques are currently being used. We provide a simple protocol to accurately evaluate the presence of (residual) vascular anastomoses using colored dye injection.

  • long term neurodevelopmental outcome in Monochorionic Twins after fetal therapy
    Early Human Development, 2011
    Co-Authors: Jeanine M M Van Klink, Dick Oepkes, Frans J. Walther, Hendrik M Koopman, Enrico Lopriore
    Abstract:

    Monochorionic (MC) Twins are at risk for several disorders, including twin-twin transfusion syndrome (TTTS), Twin Reverse Arterial Perfusion (TRAP) and selective intrauterine growth restriction (sIUGR). Several fetal interventions, such as serial amnioreduction (AR), fetoscopic laser coagulation of placental anastomoses (FLC) and selective feticide have lead to improved perinatal morbidity and mortality rates. Nevertheless, the rate of cerebral lesions in MC Twins after fetal therapy appears to be high. Follow-up studies show a high incidence of cerebral palsy (CP) and neurodevelopmental impairment (NDI). We performed a systematic review on the long-term neurodevelopmental outcome in MC Twins with TTTS following AR and FLC and MC Twins following selective feticide of the co-twin due to TTTS, TRAP, sIUGR and congenital anomalies.

  • Monochorionic Twins with ruptured vasa previa double trouble
    Fetal Diagnosis and Therapy, 2010
    Co-Authors: D Papathanasiou, Frans J. Walther, Dick Oepkes, Ruben S G M Witlox, K W M Bloemenkamp, Enrico Lopriore
    Abstract:

    Velamentous cord insertion and vasa previa occur more frequently in Monochorionic twin pregnancies than in singleton pregnancies. Both have been linked with poor perinatal outcome due to the increased risk of rupture of the velamentous vessels. We present a case of acute fetal distress in 2 fetuses in a Monochorionic twin pregnancy caused by ruptured vasa previa that was not detected antenatally. Both infants were severely anemic at birth. Acute blood loss in twin 1 through the ruptured vessels, led to an acute feto-fetal transfusion from the co-twin through the placental vascular anastomoses. In Monochorionic Twins, ruptured vasa previa and acute hemorrhage in one fetus can lead to acute feto-fetal transfusion and result in severe hypovolemic shock and acute anemia in both fetuses. Increased awareness for vasa previa and the characteristic placental angioarchitecture in Monochorionic twinning is of paramount importance.

Eduard Gratacós - One of the best experts on this subject based on the ideXlab platform.

  • cord occlusion in Monochorionic Twins with early selective intrauterine growth restriction and abnormal umbilical artery doppler a consecutive series of 90 cases
    Fetal Diagnosis and Therapy, 2016
    Co-Authors: M Parracordero, E Eixarch, M Bennasar, Jose Maria Martinez, X Torres, Eduard Gratacós
    Abstract:

    Objective: To describe perinatal outcomes achieved with cord occlusion (CO) in Monochorionic Twins with severe selective intrauterine growth restriction (sIUGR) a

  • selective intrauterine growth restriction in Monochorionic Twins pathophysiology diagnostic approach and management dilemmas
    Seminars in Fetal & Neonatal Medicine, 2010
    Co-Authors: Fatima Crispi, Dan V Valsky, E Eixarch, Josep M Martinez, Eduard Gratacós
    Abstract:

    summary Selective intrauterine growth restriction (sIUGR) in Monochorionic Twins is associated with a substantial increase in perinatal mortality and morbidity for both Twins. Clinical evolution depends on the combination of the effects of placental insufficiency in the IUGR twin with inter-twin blood transfer through placental anastomoses. Classification of sIUGR into types according to the characteristics of umbilical artery diastolic flow in the IUGR twin permits the differentiation of clinical and prognostic groups. sIUGR type I has normal diastolic flow and relatively good outcome. Type II is defined by persistently absent/ reverse end-diastolic flow and is associated with a high risk of intrauterine demise of the IUGR twin and/ or very preterm delivery. Type III is defined by the presence of intermittent absent/reverse end-diastolic flow (iAREDF), and is associated with 10e20% risk of unexpected fetal demise of the smaller twin and 10e20% risk of neurological injury in the larger twin. The management strategy for sIUGR with abnormal umbilical artery Doppler (types II and III) remains a challenge, and may include elective fetal therapy or close surveillance with fetal therapy or elective delivery in the presence of severe fetal deterioration. Small clinical series reporting the use of cord occlusion or laser therapy in severe cases suggest that the outcome of the larger twin might be improved. There is probably no single optimal strategy, since decisions will ultimately be influenced by the severity of IUGR, gestational age, parents’ wishes and technical issues. 2010 Published by Elsevier Ltd.

  • Monochorionic Twins with selective intrauterine growth restriction and intermittent absent or reversed end diastolic flow type iii feasibility and perinatal outcome of fetoscopic placental laser coagulation
    Ultrasound in Obstetrics & Gynecology, 2008
    Co-Authors: Eduard Gratacós, Liesbeth Lewi, Eugenia Antolin, J M Martinez, Edgar Hernandezandrade, Ruthy Acostarojas
    Abstract:

    Objectives To assess the feasibility and impact on perinatal outcome of fetoscopic laser coagulation of placental anastomoses in Monochorionic Twins with selective intrauterine growth restriction (sIUGR) and intermittent absent or reversed end-diastolic flow (iAREDF) in the umbilical artery (Type III), in comparison with expectant management. Methods This is a descriptive study of the outcome of 18 cases of Monochorionic Twins with Type III sIUGR treated with laser, and 31 pregnancies managed expectantly over the same period. All newborns underwent neonatal brain ultrasound scans. Perinatal outcome and the incidence of neurological damage were compared between the two groups. Results Laser coagulation could be performed in only 88.9% (16/18) of cases owing to technical difficulties, and in 12.5% (2/16) a second procedure was required to achieve complete coagulation of the large artery-to-artery anastomosis. Mean gestational age at delivery was 31.0 (range, 26–33) weeks in the expectant management group and 32.6 (range, 23–38) weeks in the laser group (P = 0.32). Overall perinatal survival was 85.5% (53/62) and 63.9% (23/36), respectively (P = 0.02). Intrauterine demise of the smaller twin occurred in 19.4% (6/31) and 66.7% (12/18), respectively (P = 0.001), and was associated with death of the cotwin in 50% (3/6) and 0% (0/12) of these cases, respectively (P = 0.02). The prevalence of periventricular leukomalacia in the larger fetus was 4/28 (14.3%) in the expectant management group and 1/17 (5.9%) in the laser group (P = 0.63). Conclusions Laser coagulation in sIUGR-iAREDF pregnancies is technically difficult and not always feasible. Placental dichorionization significantly increases the proportion of fetuses with intrauterine death of the growth-restricted twin, but it protects the normal twin from its cotwin's death in the event of demise of the growth-restricted twin. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.

  • prevalence of neurological damage in Monochorionic Twins with selective intrauterine growth restriction and intermittent absent or reversed end diastolic umbilical artery flow
    Ultrasound in Obstetrics & Gynecology, 2004
    Co-Authors: Eduard Gratacós, Liesbeth Lewi, E Carreras, J Becker, Goya Enriquez, J Perapoch, T Higueras, L Cabero, Jan Deprest
    Abstract:

    Objective To assess the incidence of parenchymal lesions on early and late neonatal brain scans and its association with the presence or absence of intermittent absent or reversed end-diastolic umbilical artery flow velocity (A/REDV) in Monochorionic Twins complicated by selective intrauterine growth restriction (IUGR), as compared to dichorionic Twins and Monochorionic Twins without selective IUGR. Methods This was a prospective cohort study involving 42 Monochorionic Twins diagnosed with selective IUGR and managed expectantly. The presence or absence of intermittent A/REDV was recorded in all cases. This study group was compared to dichorionic Twins (n = 29) and Monochorionic Twins without selective IUGR (n = 32) delivered at 26–34 weeks during the study period. All infants underwent an early neonatal brain scan (at or before the fourth day of postnatal life) and at least one follow-up scan during the first 28 days of postnatal life. Perinatal outcome and the incidence of neurological damage were compared between the study groups. Results The incidence of intrauterine fetal death (IUD) and periventricular leukomalacia was significantly increased in Monochorionic Twins complicated with selective IUGR, as compared with the other study groups. Intermittent A/REDV was observed in 22/42 (52.4%) twin pairs, and was always present in the growth-restricted twin. The incidence of IUD (overall 9/44 (20.5%) vs. 0/40, P < 0.001; smaller twin 6/22 (27.3%) vs. 0/20, P < 0.05) and parenchymal brain damage (overall 7/35 (20.0%) vs. 2/40 (5.0%), P = 0.07; larger twin 7/19 (36.8%) vs. 1/20 (5.0%), P < 0.05) was significantly higher in pregnancies with intermittent A/REDV than in those without intermittent A/REDV. Brain damage usually occurred in the larger twin, irrespective of whether the smaller twin was liveborn or not. Conclusions The presence of intermittent A/REDV in Monochorionic Twins with selective IUGR identifies a subgroup with an elevated risk of intrauterine demise of the smaller twin and neurological damage in the larger twin; this latter finding is not restricted to cases with IUD of the cotwin. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

  • Monochorionic diamniotic Twins complications and management options
    Current Opinion in Obstetrics & Gynecology, 2003
    Co-Authors: Liesbeth Lewi, Eduard Gratacós, Dominique Van Schoubroeck, Ingrid Witters, Dirk Timmerman, Jan Deprest
    Abstract:

    Purpose of review Monochorionic compared with dichorionic Twins have disproportionately high fetal loss rates, perinatal mortality and morbidity. This is because of the unpredictable vascular anastomoses and the often asymmetrical distribution of the single placenta between both Twins. Recent findings The pathophysiology of twin-to-twin transfusion syndrome is usually explained on an angioarchitectural basis, although certain hemodynamic and hormonal factors also may be involved. The results of the large randomized trials on amnioreduction, fetoscopic laser coagulation and septostomy are still awaited. An update is given on hardware and instruments required for fetoscopic laser. Subsequently, the problem of the Monochorionic twin set with severe early discordant growth is addressed. Several etiological mechanisms have been proposed, but little is known of its natural history. Also, umbilical artery Doppler waveforms may not have the same predictive value as in singletons. Prophylactic laser coagulation of the vascular anastomoses to protect against the adverse effects of single intrauterine demise, has so far not been shown to confer any benefit in outcome. Finally, pathophysiology and management of discordant structural and chromosomal anomalies in Monochorionic Twins are discussed. Laser and monopolar coagulation, which can be introduced through a needle, may be used for selective feticide in early pregnancy or low hemodynamic conditions. Bipolar coagulation seems more effective at later gestational ages and normal hemodynamic conditions. Summary Our insight into the complications associated with Monochorionic Twins has increased in recent years. It is hoped that this will lead to better surveillance and ultimately an improved outcome for these high-risk pregnancies.

Jan Deprest - One of the best experts on this subject based on the ideXlab platform.

  • the pregnancy and long term neurodevelopmental outcome of Monochorionic diamniotic twin gestations a multicenter prospective cohort study from the first trimester onward
    American Journal of Obstetrics and Gynecology, 2009
    Co-Authors: Els Ortibus, Jan Deprest, Enrico Lopriore, Frans J. Walther, Kurt Hecher, Frank P H A Vandenbussche, Anke Diemert, Lieven Lagae, Paul De Cock, Paul Lewi
    Abstract:

    Objectives We sought to document the pregnancy and neurodevelopmental outcome in Monochorionic diamniotic twin pregnancies and to identify risk factors for death and impairment. Study Design We conducted a prospective cohort study of 136 Monochorionic Twins followed up from the first trimester until infancy. Results A total of 122 (90%) pregnancies resulted in 2 survivors, 6 (4%) in 1 survivor and 8 (6%) in no survivor. In all, 230 (92%) of 250 surviving infants were assessed at a mean age of 24 months. Neurodevelopmental impairment was present in 22 (10%) infants. Death or impairment of 1 or both infants occurred in 28 (22%) of 126 pregnancies. Twin-to-twin transfusion syndrome and assisted conception increased the risk of both death and impairment, whereas early-onset discordant growth only increased the risk of death. Conclusion The mortality in this prospective series was 8% and neurodevelopmental impairment occurred in 10% of infants.

  • assessment of fetal cardiac function before and after therapy for twin to twin transfusion syndrome
    American Journal of Obstetrics and Gynecology, 2009
    Co-Authors: Tim Van Mieghem, Liesbeth Lewi, P Klaritsch, Leonardo Gucciardo, Elisa Done, Paul Lewi, Johan Verhaeghe, Jan Deprest
    Abstract:

    Objective We sought to assess fetal cardiac function in Monochorionic Twins before and after therapy for twin-to-twin transfusion syndrome (TTTS) and compare it with control subjects. Study Design We conducted prospective longitudinal assessment of fetal cardiac function in cases undergoing curative fetal therapy for TTTS (n = 39) until 4 weeks postoperatively and in uncomplicated Monochorionic Twins (n = 23). Fetal cardiac function was assessed by the left and right ventricular myocardial performance index, atrioventricular valve flow pattern, ductus venosus a-wave, and umbilical vein pulsations. Results Nomograms for the myocardial performance index were constructed. Fetal cardiac function was grossly abnormal in recipient Twins of TTTS when compared with control subjects ( P Conclusion The cardiac dysfunction in the recipient twin of TTTS normalizes within 1 month after laser. The donor develops a transient impairment of cardiac function postoperatively.

  • Monochorionic and dichorionic twin pregnancies discordant for fetal anencephaly a systematic review of prenatal management options
    Prenatal Diagnosis, 2008
    Co-Authors: Annelies Lust, Jan Deprest, Liesbeth Lewi, Luc De Catte, Philippe Loquet, Roland Devlieger
    Abstract:

    The aim of this study was to evaluate the effect of selective feticide (SF) compared to expectant management (EM) on perinatal outcome in dichorionic and Monochorionic Twins discordant for anencephaly. For this purpose, we conducted a systematic review of literature and added ten unpublished cases. As a result, we found that in dichorionic Twins, mean gestational age (GA) at birth in the SF group was 38.0 weeks versus 34.9 weeks (P = 0.0002). Mean birth weight was 2922 g in the SF group versus 2474 g (P = 0.03). In Monochorionic Twins, mean GA at birth was 35.2 weeks versus 32.7 weeks (P = 0.1). Mean birth weight was 2711 g versus 1667 g (P = 0.0001). We conclude that while SF does not reduce perinatal mortality, it does result in significantly longer gestations and higher birth weight, and appears to be the management of choice in dichorionic Twins discordant for anencephaly. In Monochorionic Twins, SF also increases birth weight, but in view of the complexity of this group, no clear recommendations can be made.

  • prevalence of neurological damage in Monochorionic Twins with selective intrauterine growth restriction and intermittent absent or reversed end diastolic umbilical artery flow
    Ultrasound in Obstetrics & Gynecology, 2004
    Co-Authors: Eduard Gratacós, Liesbeth Lewi, E Carreras, J Becker, Goya Enriquez, J Perapoch, T Higueras, L Cabero, Jan Deprest
    Abstract:

    Objective To assess the incidence of parenchymal lesions on early and late neonatal brain scans and its association with the presence or absence of intermittent absent or reversed end-diastolic umbilical artery flow velocity (A/REDV) in Monochorionic Twins complicated by selective intrauterine growth restriction (IUGR), as compared to dichorionic Twins and Monochorionic Twins without selective IUGR. Methods This was a prospective cohort study involving 42 Monochorionic Twins diagnosed with selective IUGR and managed expectantly. The presence or absence of intermittent A/REDV was recorded in all cases. This study group was compared to dichorionic Twins (n = 29) and Monochorionic Twins without selective IUGR (n = 32) delivered at 26–34 weeks during the study period. All infants underwent an early neonatal brain scan (at or before the fourth day of postnatal life) and at least one follow-up scan during the first 28 days of postnatal life. Perinatal outcome and the incidence of neurological damage were compared between the study groups. Results The incidence of intrauterine fetal death (IUD) and periventricular leukomalacia was significantly increased in Monochorionic Twins complicated with selective IUGR, as compared with the other study groups. Intermittent A/REDV was observed in 22/42 (52.4%) twin pairs, and was always present in the growth-restricted twin. The incidence of IUD (overall 9/44 (20.5%) vs. 0/40, P < 0.001; smaller twin 6/22 (27.3%) vs. 0/20, P < 0.05) and parenchymal brain damage (overall 7/35 (20.0%) vs. 2/40 (5.0%), P = 0.07; larger twin 7/19 (36.8%) vs. 1/20 (5.0%), P < 0.05) was significantly higher in pregnancies with intermittent A/REDV than in those without intermittent A/REDV. Brain damage usually occurred in the larger twin, irrespective of whether the smaller twin was liveborn or not. Conclusions The presence of intermittent A/REDV in Monochorionic Twins with selective IUGR identifies a subgroup with an elevated risk of intrauterine demise of the smaller twin and neurological damage in the larger twin; this latter finding is not restricted to cases with IUD of the cotwin. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

  • Monochorionic diamniotic Twins complications and management options
    Current Opinion in Obstetrics & Gynecology, 2003
    Co-Authors: Liesbeth Lewi, Eduard Gratacós, Dominique Van Schoubroeck, Ingrid Witters, Dirk Timmerman, Jan Deprest
    Abstract:

    Purpose of review Monochorionic compared with dichorionic Twins have disproportionately high fetal loss rates, perinatal mortality and morbidity. This is because of the unpredictable vascular anastomoses and the often asymmetrical distribution of the single placenta between both Twins. Recent findings The pathophysiology of twin-to-twin transfusion syndrome is usually explained on an angioarchitectural basis, although certain hemodynamic and hormonal factors also may be involved. The results of the large randomized trials on amnioreduction, fetoscopic laser coagulation and septostomy are still awaited. An update is given on hardware and instruments required for fetoscopic laser. Subsequently, the problem of the Monochorionic twin set with severe early discordant growth is addressed. Several etiological mechanisms have been proposed, but little is known of its natural history. Also, umbilical artery Doppler waveforms may not have the same predictive value as in singletons. Prophylactic laser coagulation of the vascular anastomoses to protect against the adverse effects of single intrauterine demise, has so far not been shown to confer any benefit in outcome. Finally, pathophysiology and management of discordant structural and chromosomal anomalies in Monochorionic Twins are discussed. Laser and monopolar coagulation, which can be introduced through a needle, may be used for selective feticide in early pregnancy or low hemodynamic conditions. Bipolar coagulation seems more effective at later gestational ages and normal hemodynamic conditions. Summary Our insight into the complications associated with Monochorionic Twins has increased in recent years. It is hoped that this will lead to better surveillance and ultimately an improved outcome for these high-risk pregnancies.

Frans J. Walther - One of the best experts on this subject based on the ideXlab platform.

  • Accurate and Simple Evaluation of Vascular Anastomoses in Monochorionic Placenta using Colored Dye
    Journal of visualized experiments : JoVE, 2011
    Co-Authors: Enrico Lopriore, Femke Slaghekke, Johanna M. Middeldorp, Frans J.c.m. Klumper, Jan M. M. Van Lith, Frans J. Walther, Dick Oepkes
    Abstract:

    The presence of placental vascular anastomoses is a conditio sine qua non for the development of twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS)(1,2). Injection studies of twin placentas have shown that such anastomoses are almost invariably present in Monochorionic Twins and extremely rare in dichorionic Twins(1). Three types of anastomoses have been documented: from artery to artery, from vein to vein and from artery to vein. Arterio-venous (AV) anastomoses are unidirectional and are referred to as "deep" anastomoses since they proceed through a shared placental cotyledon, whereas arterio-arterial (AA) and veno-venous (VV) anastomoses are bi-directional and are referred to as "superficial" since they lie on the chorionic plate. Both TTTS and TAPS are caused by net imbalance of blood flow between the Twins due to AV anastomoses. Blood from one twin (the donor) is pumped through an artery into the shared placental cotyledon and then drained through a vein into the circulation of the other twin (the recipient). Unless blood is pumped back from the recipient to the donor through oppositely directed deep AV anastomoses or through superficial anastomoses, an imbalance of blood volumes occurs, gradually leading to the development of TTTS or TAPS. The presence of an AA anastomosis has been shown to protect against the development of TTTS and TAPS by compensating for the circulatory imbalance caused by the uni-directional AV anastomoses(1,2). Injection of Monochorionic placentas soon after birth is a useful mean to understand the etiology of various (hematological) complications in Monochorionic Twins and is a required test to reach the diagnosis of TAPS(2). In addition, injection of TTTS placentas treated with fetoscopic laser surgery allows identification of possible residual anastomoses(3-5). This additional information is of paramount importance for all perinatologists involved in the management and care of Monochorionic Twins with TTTS or TAPS. Several placental injection techniques are currently being used. We provide a simple protocol to accurately evaluate the presence of (residual) vascular anastomoses using colored dye injection.

  • long term neurodevelopmental outcome in Monochorionic Twins after fetal therapy
    Early Human Development, 2011
    Co-Authors: Jeanine M M Van Klink, Dick Oepkes, Frans J. Walther, Hendrik M Koopman, Enrico Lopriore
    Abstract:

    Monochorionic (MC) Twins are at risk for several disorders, including twin-twin transfusion syndrome (TTTS), Twin Reverse Arterial Perfusion (TRAP) and selective intrauterine growth restriction (sIUGR). Several fetal interventions, such as serial amnioreduction (AR), fetoscopic laser coagulation of placental anastomoses (FLC) and selective feticide have lead to improved perinatal morbidity and mortality rates. Nevertheless, the rate of cerebral lesions in MC Twins after fetal therapy appears to be high. Follow-up studies show a high incidence of cerebral palsy (CP) and neurodevelopmental impairment (NDI). We performed a systematic review on the long-term neurodevelopmental outcome in MC Twins with TTTS following AR and FLC and MC Twins following selective feticide of the co-twin due to TTTS, TRAP, sIUGR and congenital anomalies.

  • Monochorionic Twins with ruptured vasa previa double trouble
    Fetal Diagnosis and Therapy, 2010
    Co-Authors: D Papathanasiou, Frans J. Walther, Dick Oepkes, Ruben S G M Witlox, K W M Bloemenkamp, Enrico Lopriore
    Abstract:

    Velamentous cord insertion and vasa previa occur more frequently in Monochorionic twin pregnancies than in singleton pregnancies. Both have been linked with poor perinatal outcome due to the increased risk of rupture of the velamentous vessels. We present a case of acute fetal distress in 2 fetuses in a Monochorionic twin pregnancy caused by ruptured vasa previa that was not detected antenatally. Both infants were severely anemic at birth. Acute blood loss in twin 1 through the ruptured vessels, led to an acute feto-fetal transfusion from the co-twin through the placental vascular anastomoses. In Monochorionic Twins, ruptured vasa previa and acute hemorrhage in one fetus can lead to acute feto-fetal transfusion and result in severe hypovolemic shock and acute anemia in both fetuses. Increased awareness for vasa previa and the characteristic placental angioarchitecture in Monochorionic twinning is of paramount importance.

  • twin anemia polycythemia sequence diagnostic criteria classification perinatal management and outcome
    Fetal Diagnosis and Therapy, 2010
    Co-Authors: Femke Slaghekke, Johanna M. Middeldorp, Frans J.c.m. Klumper, Frans J. Walther, Dick Oepkes, W J Kist, Frank P H A Vandenbussche, S A Pasman, Enrico Lopriore
    Abstract:

    Monochorionic Twins share a single placenta with intertwin vascular anastomoses, allowing the transfer of blood from one fetus to the other and vice versa. These anastomoses are the essential anatomical substrate for the development of several complications, including twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). TTTS and TAPS are both chronic forms of fetofetal transfusion. TTTS is characterized by the twin oligopolyhydramnios sequence, whereas TAPS is characterized by large intertwin hemoglobin differences in the absence of amniotic fluid discordances. TAPS may occur spontaneously in up to 5% of Monochorionic Twins and may also develop after incomplete laser treatment in TTTS cases. This review focuses on the pathogenesis, incidence, diagnostic criteria, management options and outcome in TAPS. In addition, we propose a classification system for antenatal and postnatal TAPS.

  • the pregnancy and long term neurodevelopmental outcome of Monochorionic diamniotic twin gestations a multicenter prospective cohort study from the first trimester onward
    American Journal of Obstetrics and Gynecology, 2009
    Co-Authors: Els Ortibus, Jan Deprest, Enrico Lopriore, Frans J. Walther, Kurt Hecher, Frank P H A Vandenbussche, Anke Diemert, Lieven Lagae, Paul De Cock, Paul Lewi
    Abstract:

    Objectives We sought to document the pregnancy and neurodevelopmental outcome in Monochorionic diamniotic twin pregnancies and to identify risk factors for death and impairment. Study Design We conducted a prospective cohort study of 136 Monochorionic Twins followed up from the first trimester until infancy. Results A total of 122 (90%) pregnancies resulted in 2 survivors, 6 (4%) in 1 survivor and 8 (6%) in no survivor. In all, 230 (92%) of 250 surviving infants were assessed at a mean age of 24 months. Neurodevelopmental impairment was present in 22 (10%) infants. Death or impairment of 1 or both infants occurred in 28 (22%) of 126 pregnancies. Twin-to-twin transfusion syndrome and assisted conception increased the risk of both death and impairment, whereas early-onset discordant growth only increased the risk of death. Conclusion The mortality in this prospective series was 8% and neurodevelopmental impairment occurred in 10% of infants.

Dick Oepkes - One of the best experts on this subject based on the ideXlab platform.

  • Stable Image Registration for In-Vivo Fetoscopic Panorama Reconstruction
    Journal of Imaging, 2018
    Co-Authors: Floris Gaisser, S. H. P. Peeters, Boris Lenseigne, Pieter Jonker, Dick Oepkes
    Abstract:

    A Twin-to-Twin Transfusion Syndrome (TTTS) is a condition that occurs in about 10% of pregnancies involving Monochorionic Twins. This complication can be treated with fetoscopic laser coagulation. The procedure could greatly benefit from panorama reconstruction to gain an overview of the placenta. In previous work we investigated which steps could improve the reconstruction performance for an in-vivo setting. In this work we improved this registration by proposing a stable region detection method as well as extracting matchable features based on a deep-learning approach. Finally, we extracted a measure for the image registration quality and the visibility condition. With experiments we show that the image registration performance is increased and more constant. Using these methods a system can be developed that supports the surgeon during the surgery, by giving feedback and providing a more complete overview of the placenta.

  • double fatal outcome after ruptured vasa previa in Monochorionic Twins case report and review of the literature
    Journal of Maternal-fetal & Neonatal Medicine, 2015
    Co-Authors: A Van Steenis, Dick Oepkes, Depeng Zhao, Sylke J Steggerda, W J Kist, Monique C Haak, Enrico Lopriore
    Abstract:

    Vasa previa is a condition in which one or more fetal blood vessels run through the amniotic membranes and cross or run near the external orifice of the uterus. Rupture of membranes can lead to tearing of these vessels and cause acute fetal exsanguination. In Monochorionic twin (MC) pregnancies, acute exsanguination in one twin can lead to severe complications in the co-twin due to the presence of inter-twin placental vascular connections. We report a MC pair with severe perinatal asphyxia due to acute exsanguination after prenatally undetected ruptured vasa previa. This resulted in severe hemorrhagic shock in both Twins with double fatal outcome. Antenatal detection of vasa previa is of paramount importance to prevent severe morbidity and mortality, especially in MCs. A review of the literature is presented.

  • Right Ventricular Outflow Tract Obstruction in Monochorionic Twins with Selective Intrauterine Growth Restriction
    Hindawi Limited, 2012
    Co-Authors: S. B. De Haseth, Dick Oepkes, M. C. Haak, A. A. W. Roest, M. E. B. Rijlaarsdam, Enrico Lopriore
    Abstract:

    Monochorionic twin pregnancies are at increased risk of perinatal mortality and morbidity due to twin-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), and higher incidence of congenital heart malformations. The incidence of right ventricular outflow tract obstruction (RVOTO) in recipients with TTTS is known to be higher than in the general population. There is limited data on the risk of RVOTO in Monochorionic Twins with sIUGR. We report a case of RVOTO in the larger twin in a Monochorionic twin pregnancy with sIUGR, treated successfully with balloon dilatation after birth

  • Accurate and Simple Evaluation of Vascular Anastomoses in Monochorionic Placenta using Colored Dye
    Journal of visualized experiments : JoVE, 2011
    Co-Authors: Enrico Lopriore, Femke Slaghekke, Johanna M. Middeldorp, Frans J.c.m. Klumper, Jan M. M. Van Lith, Frans J. Walther, Dick Oepkes
    Abstract:

    The presence of placental vascular anastomoses is a conditio sine qua non for the development of twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS)(1,2). Injection studies of twin placentas have shown that such anastomoses are almost invariably present in Monochorionic Twins and extremely rare in dichorionic Twins(1). Three types of anastomoses have been documented: from artery to artery, from vein to vein and from artery to vein. Arterio-venous (AV) anastomoses are unidirectional and are referred to as "deep" anastomoses since they proceed through a shared placental cotyledon, whereas arterio-arterial (AA) and veno-venous (VV) anastomoses are bi-directional and are referred to as "superficial" since they lie on the chorionic plate. Both TTTS and TAPS are caused by net imbalance of blood flow between the Twins due to AV anastomoses. Blood from one twin (the donor) is pumped through an artery into the shared placental cotyledon and then drained through a vein into the circulation of the other twin (the recipient). Unless blood is pumped back from the recipient to the donor through oppositely directed deep AV anastomoses or through superficial anastomoses, an imbalance of blood volumes occurs, gradually leading to the development of TTTS or TAPS. The presence of an AA anastomosis has been shown to protect against the development of TTTS and TAPS by compensating for the circulatory imbalance caused by the uni-directional AV anastomoses(1,2). Injection of Monochorionic placentas soon after birth is a useful mean to understand the etiology of various (hematological) complications in Monochorionic Twins and is a required test to reach the diagnosis of TAPS(2). In addition, injection of TTTS placentas treated with fetoscopic laser surgery allows identification of possible residual anastomoses(3-5). This additional information is of paramount importance for all perinatologists involved in the management and care of Monochorionic Twins with TTTS or TAPS. Several placental injection techniques are currently being used. We provide a simple protocol to accurately evaluate the presence of (residual) vascular anastomoses using colored dye injection.

  • long term neurodevelopmental outcome in Monochorionic Twins after fetal therapy
    Early Human Development, 2011
    Co-Authors: Jeanine M M Van Klink, Dick Oepkes, Frans J. Walther, Hendrik M Koopman, Enrico Lopriore
    Abstract:

    Monochorionic (MC) Twins are at risk for several disorders, including twin-twin transfusion syndrome (TTTS), Twin Reverse Arterial Perfusion (TRAP) and selective intrauterine growth restriction (sIUGR). Several fetal interventions, such as serial amnioreduction (AR), fetoscopic laser coagulation of placental anastomoses (FLC) and selective feticide have lead to improved perinatal morbidity and mortality rates. Nevertheless, the rate of cerebral lesions in MC Twins after fetal therapy appears to be high. Follow-up studies show a high incidence of cerebral palsy (CP) and neurodevelopmental impairment (NDI). We performed a systematic review on the long-term neurodevelopmental outcome in MC Twins with TTTS following AR and FLC and MC Twins following selective feticide of the co-twin due to TTTS, TRAP, sIUGR and congenital anomalies.