Are complicated monochorionic twins more susceptible to indomethacin-induced fetal ductal constriction? Two cases of laser surgery for Twin-Twin Transfusion syndrome.

Indomethacin is a commonly used medication against preterm delivery. Several reports of fetal ductal constriction have been described after indomethacin use in the literature; however, there are no previously documented reports describing an association between Twin-Twin Transfusion syndrome and a constrictor effect of indomethacin on the ductus arteriosus. Two patients were referred to our department for Twin-Twin Transfusion syndrome and each underwent placental laser surgery. Constriction of the ductus arteriosus occurred as early as 20 and 24 weeks' gestation following maternal use of indomethacin after laser surgery. Spontaneous amelioration was observed after discontinuation of the drug. The constrictor effect of indomethacin on the ductus arteriosus can be observed even after a single dose and as early as 20 weeks of gestation in complicated monochorionic twin pregnancies. We emphasize meticulous use of indomethacin in complicated monochorionic twin pregnancies because the constrictive effect seems to be independent of gestational age.

Outcome after prenatal diagnosis of fetal urinary tract abnormalities: A tertiary center experience

Objective: With the widespread use of ultrasonography for fetal screening, the detection and management of congenital urinary tract abnormalities has become crucial. In this study, we aimed to describe the clinical approaches in patients with prenatally detected urinary tract abnormalities. Material and Methods: This study is a retrospective, single-center study performed at a perinatology unit of a university hospital, between 2010 and 2016. The outcomes of 124 patients who were prenatally diagnosed as having urinary tract abnormalities are reported. Variables included in the analysis were fetal sex, birth week and weight, persistency, and necessity surgery after birth for renal pelvic dilatation. Low-risk renal pelvic dilatation was determined as an anterior-posterior (AP) diameter of 4-7 mm at 16-28 weeks, 7-10 mm after 28 weeks, whereas high-risk dilatation was defined as AP measurements of ≥7 mm at 16-28 weeks, ≥10 mm after 28 weeks, respectively. Results: The majority of patients consisted of male fetuses with bilateral pelviectasis (62.9%, 20.2%, respectively). The mean age was 28.8±6.4 years. The mean gestational age at birth was 34.2±7.8 weeks. The mean birth weight was 2593±1253.3 g. The need for surgery was greater in high-risk patients than in low-risk patients (58.3% vs. 8.7%) (p<0.002). Conclusion: Patients with high-risk antenatal renal pelvic dilatation require surgical treatment after delivery. Close prenatal and postnatal follow-up is mandatory in specialized centers. Perinatologists, neonatologists, pediatricians and pediatric nephrologists, and radiologists should treat these children with a multidisciplinary approach.