Perinatal- and procedure-related outcomes following radiofrequency ablation in monochorionic pregnancy.

OBJECTIVE: We sought to assess the efficacy, complication rates, and outcomes for complex monochorionic pregnancies undergoing selective fetal reduction using radiofrequency ablation (RFA). STUDY DESIGN: In this prospective observational study, 100 consecutive cases of selective fetal reduction using RFA were analyzed. All cases were managed at the Centre for Fetal Care at Queen Charlotte's and Chelsea Hospital in London. Indications for offering RFA, details of the procedure, and pregnancy outcomes were collected and analyzed. RESULTS: The main indications for RFA were discordant fetal anomaly and twin-twin transfusion syndrome. Overall live birth rate was 78% and the median gestation at delivery was 35.15 weeks. Delivery <32 weeks' gestation occurred in 17.9% of cases. Postprocedure abnormal antenatal magnetic resonance imaging occurred in 3% of cases. There was no statistical difference in outcomes with regard to gestation when the procedure was performed or the indication for the RFA. CONCLUSION: RFA appears to be a reasonable option for selective fetal reduction in complex monochorionic pregnancies with an overall survival rate of 78%.

Maternal and perinatal outcomes following peripartum hysterectomy from a single tertiary centre.

BACKGROUND: We investigated the indications for and maternal and perinatal outcomes following peripartum hysterectomy in a single large tertiary centre. MATERIALS AND METHODS: All cases of peripartum hysterectomy between 2000 and 2011 were investigated. Data regarding maternal demographics, previous obstetric and gynaecological history, indications for hysterectomy, and details of haemorrhage, surgical complications and neonatal outcomes were collected. RESULTS: There were 47 cases of peripartum hysterectomy of 55 262 births giving an incidence of 0.85 per 1000 births. Forty-one cases were total hysterectomies, while six were subtotal procedures. A total of 70.2% of cases were performed because of a morbidly adherent placenta, 27.7% for uterine atony and 2.1% for uterine rupture. The median estimated blood loss was 7290 mL. The overall surgical complication rate was 44.6% with bladder injury (19.1%) and sepsis (12.8%) commonest. Intensive care admission was required in 57.4% of women. CONCLUSIONS: Peripartum hysterectomy is a major procedure carrying a high morbidity rate. In this series, maternal survival was 100%.

Postnatal outcome of prenatally diagnosed severe fetal renal pelvic dilatation.

OBJECTIVE: We correlated the prenatal severity with the postnatal outcome of prenatally detected renal pelvic dilatation (RPD). METHODS: Cases of prenatally detected RPD referred between January 2002 and December 2008 were included. Severe RPD was defined as an anterior-posterior diameter of 15 mm, mild and moderate dilatation was defined as 6 to <10 mm and 10 to <15 mm, respectively. Postnatal diagnosis, the need for surgery and the correlation with the prenatal severity was ascertained. RESULTS: Of the 762 patients with RPD, 492 (64.5%) were mild, 167 (21.9%) were moderate, and 103 (13.5%) were severe. The male:female ratio for the severe cohort was 5:1. Of the sever cases, 68% had progressive dilatation. Of the mild/moderate cases, 5% progressed to severe dilatation. PUJ obstruction was confirmed in 48 cases (60.8%), severe VUR in 11 cases (14%), VUJ obstruction in 5 cases (6%), PUV in 2 cases (2.5%), and a nonidentifiable cause in 13 cases (16.5%). Ten of the 48 (20.8%) babies with PUJ obstruction required surgery within the first year of life. CONCLUSION: An obstructive cause is usually present in severe cases, which are more likely to require surgery if there is PUJ obstruction. A high male:female ratio was present in this group.

Managing the difficult case of fetal anemia.

OBJECTIVES: To describe a series of complex fetal anemia cases, detail the appropriate investigations and management, and review the literature. METHODS: Four cases of non-red cell alloimmunization or infective cases of fetal anemia are presented. RESULTS: Of the four cases presented, one was a neonatal death, one pregnancy was terminated, one case was diagnosed with Diamond Blackfan anemia, and one case was due to recurrent feto-maternal hemorrhages despite negative Kleihauer tests. CONCLUSIONS: Non-alloimmune causes of fetal anemia can be difficult to manage. Some cases require repeated and frequent intrauterine transfusions. The perinatal mortality and preterm delivery rates are increased, and some cases require considerable long-term treatment including regular transfusions. We present our experience of a series of non-immune fetal anemia managed in a tertiary unit, review the literature, and suggest appropriate management.