Fetal Diagnosis and Therapy最新文献

{"title":"Diagnosis and Treatment of Inherited Renal Tubular Dysgenesis Caused by ACE Gene Mutation: A Single-Center Experience.","authors":"Xiaosong Xu, Qian Xie, Zeliang Xu, Xiaosong Xu","doi":"10.1159/000545879","DOIUrl":"10.1159/000545879","url":null,"abstract":"<p><strong>Introduction: </strong>Autosomal recessive renal tubular dysgenesis (ARRTD) is a rare and severe condition, and current methods for early diagnosis and treatment of this disease remain unclear. Here, we describe 3 patients with ARRTD.</p><p><strong>Case presentation: </strong>The 3 cases come from three independent pedigrees and harbor completely different ACE gene mutation types. Two infants died of the disease shortly after birth despite treatment attempts, while one infant showed improvement with symptomatic therapies including blood pressure elevation, respiratory support, diuretics, and CRRT and was discharged. During the 27-month follow-up, this patient exhibited normal renal function and ultrasound findings.</p><p><strong>Conclusion: </strong>For fetuses with diagnosed ARRTD, symptomatic treatment for oligohydramnios and interventions to promote fetal maturation before preterm birth are important. Postnatally, critical management strategies include respiratory support, blood pressure stabilization, and renal support/replacement. With effective treatment, ARRTD patients have the potential to achieve long-term survival and normal renal function.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"483-488"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Volume of Fluid Corresponding to Each Centimeter of Amniotic Fluid Index Changes throughout Pregnancy: A Prospective Cohort Observational Study.","authors":"Edgar Hernandez-Andrade, Edgar Hernandez-Andrade, Kevin Magee, Donatella Gerulewicz-Vannini, Percy Pacora, Ramesha Papanna, Eric P Bergh, Jimmy Espinoza, Anthony Johnson","doi":"10.1159/000545784","DOIUrl":"10.1159/000545784","url":null,"abstract":"<p><strong>Introduction: </strong>The normal values of the amniotic fluid index (AFI) throughout pregnancy have been established as 5-24 cm. However, a similar AFI may correspond to a different AF volume at different gestational ages. The aim of this study was to calculate the amount of fluid corresponding to each cm of AFI when a known volume of fluid is infused into the uterine cavity.</p><p><strong>Methods: </strong>This was a secondary analysis of a prospective cohort observational study. Serial amnioinfusions (AIs) were performed between 10 and 34 weeks of gestation in 19 fetuses with anhydramnios due to severe renal damage. The AFI was measured just before and after AI, and the volume of fluid/AFI cm was estimated as infused fluid (mL)/AFI final-AFI initial. Mean and standard deviation per gestational week were obtained, and amniotic fluid volumes corresponding to AFIs of 5 cm, 18 cm, and 24 cm were calculated.</p><p><strong>Results: </strong>A total of 279 AIs were performed (median/case n = 15, range 3-22). The mean volume of fluid per cm of AFI at 20 weeks was 25.08 mL (SD 5.72 mL), 40.61 mL (SD 27.4 mL) at 30 weeks, and 34.64 mL (SD 14.8 mL) at 34 weeks. There was a 61% increment in AF fluid per AFI cm from 20 to 30 weeks of gestation, and a reduction of 14.7% between 30 and 34 weeks of gestation. Extrapolating these calculations, the volume of fluid corresponding to an AFI of 18 cm at 20 weeks was 451.4 mL, at 30 weeks 731.0 mL, and at 34 weeks, 623.5 mL.</p><p><strong>Conclusion: </strong>The volume of amniotic fluid per cm of AFI changes during gestation. The definition of poly or oligohydramnios based on the same AFI can vary up to 61% in fluid volume from 20 to 30 weeks of gestation.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"461-467"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound Guidance to Replicate Transuterine BioGlue Injection in the Fetal Hydrocephalus Sheep Model.","authors":"Ayssa Teles Abrao Trad, Rodrigo Ruano, Liang Zhang, Julian Rechberger, David J Daniels, Amy B Kolbe, Muhammad Yasir Qureshi, Katherine W Arendt, Leal Segura, Eniola R Ibirogba, Amy G Andrews, Adam Loudermilk, Elizabeth Ann L Enninga, Edward S Ahn, Mauro Schenone","doi":"10.1159/000540578","DOIUrl":"10.1159/000540578","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital hydrocephalus often results in irreversible and severe damage to the brain despite postnatal interventions. The potential for prenatal intervention to mitigate these deleterious effects underscores the importance of a suitable animal model. We aimed assess the results of an ultrasound-guided transuterine approach to replicate the BioGlue injection fetal hydrocephalus model.</p><p><strong>Methods: </strong>Pregnant ewes were anesthetized at 95 days of gestation and BioGlue was injected into the fetal cisterna magna under ultrasound guidance through the uterus. Ventriculomegaly was assessed by MRI and histology.</p><p><strong>Results: </strong>Nine pregnant ewes were included in the study, and their fetuses were divided into the BioGlue intervention group (n = 9 fetuses) or the control group (n = 7 fetuses) who were not injected. Although hydrocephalus was noted in 5 of 9 fetuses in the intervention group, the ability to induce hydrocephalus went from 0% to 100% in the last 3 fetuses following technical modifications. None of the controls developed hydrocephalus. Fetal brains with hydrocephalus demonstrated increased IBA1+ compared to control animals.</p><p><strong>Conclusions: </strong>While technical challenges were noted, the ultrasound-guided transuterine approach to replicate the BioGlue fetal hydrocephalus model in sheep showed consistent and reproducible results. This model offers the advantage of directly visualizing the location of the needle tip and injection of the BioGlue. This technique offers an alternative for testing novel approaches for prenatal congenital hydrocephalus treatment.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"81-89"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal Extrahepatic Portosystemic Venous Shunts: Prenatal Diagnosis Management and Therapy - 21 Years of Evolving Insights.","authors":"Reuven Achiron, Zvi Kivilevitch, Eran Kassif, Riccardo A Superina","doi":"10.1159/000543529","DOIUrl":"10.1159/000543529","url":null,"abstract":"<p><strong>Introduction: </strong>Fetal extrahepatic portosystemic venous shunt (FEPSVS) is vascular malformations that divert placental and bowel blood from the liver into the systemic circulation. When uncorrected, it can lead to severe pathologic consequences after birth. In this study, we aim to report our method of prenatal diagnosis, the developing insight regarding prenatal counseling, and postnatal treatment.</p><p><strong>Methods: </strong>Retrospective review of fetuses diagnosed with FEPSVS, classified into Abernethy type I or II based on the absence or existence of intrahepatic portal venous system (IHPVS) flow. Two different counseling periods were compared regarding pregnancy management and postnatal outcome.</p><p><strong>Results: </strong>In the first period (2000-2010), 5 cases were diagnosed; 4 were type I with an 80% termination rate. In the second period (2011-2021), 6 cases were diagnosed; with only a 16% termination rate in type I cases. Two type II cases were reclassified to type I postnatally and corrected successfully. Of the 6 born alive, 5 had early surgical/endovascular corrections, and 1 experienced spontaneous closure. All the cases resulted in a successful rescue of the IHPVS with good outcomes.</p><p><strong>Conclusion: </strong>During our developing insights we realized that: (1) the adult classification according to the IHPSVS is not relevant for prenatal prognostic counseling; (2) prenatal diagnosis of FEPSVS is essential in promoting early postnatal investigation and corrective intervention, which might prevent the appearance of postnatal complications.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"337-345"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monochorionic Monoamniotic Multiple Gestations with Twin-Twin Transfusion Syndrome: A Case Series of 6 Laser Surgery Patients and Management Considerations.","authors":"Jinnen Masri, Raphael C Sun, Sami R Chmait, Grace Hamadeh, Andrew H Chon","doi":"10.1159/000545505","DOIUrl":"10.1159/000545505","url":null,"abstract":"<p><strong>Introduction: </strong>Twin-twin transfusion syndrome (TTTS) is a rare occurrence in monochorionic monoamniotic (MCMA) multiple gestations. Clinical management remains challenging due to increased technical difficulty of selective laser photocoagulation of communicating vessels and limited data regarding outcomes after laser surgery. Our objective was to present the outcomes of MCMA multiple gestations with TTTS who underwent laser surgery.</p><p><strong>Methods: </strong>Retrospective study of all MCMA multiple gestations between 2006 and 2024 across two institutions treated with laser surgery for TTTS. Results are presented as median (range).</p><p><strong>Results: </strong>Out of 1,078 laser surgeries for TTTS, 6 (0.6%) were performed in MCMA gestations: 5 MCMA twins and 1 dichorionic diamniotic triplet. The gestational age (GA) at diagnosis was 19.5 (16.9-22.3) weeks. Quintero stage was II (n = 3) and III (n = 3). The placental cord insertion sites were proximal (<4 cm apart) in 2 (33%) cases. Despite increased technical difficulty, laser surgery was successfully completed in all cases. One case required more than 1 trocar entry to adequately evaluate the complex vascular equator. The GA at delivery was 27.2 (23.6-31.7) weeks. Indications for delivery included placental abruption (n = 2; 33%), fetal growth restriction (n = 2; 33%), chorioamnionitis (n = 1; 17%), and elective (n = 1; 17%). Dual 30-day survivorship occurred in 5 (83%) patients and dual demise occurred in 1 (17%) patient.</p><p><strong>Conclusion: </strong>Laser surgery for TTTS in MCMA multiple gestations is technically feasible. However, outcomes are guarded compared to monochorionic diamniotic twins. Additional studies are needed to investigate the optimal management of TTTS in monoamniotic multiple gestations.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"412-419"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Intrapartum Sonographic Diagnosis of Fetal Hypoxic-Ischemic Encephalopathy.","authors":"Andrea Dall'Asta, Chiara Melito, Chiara Petrolini, Serafina Perrone, Tullio Ghi","doi":"10.1159/000543851","DOIUrl":"10.1159/000543851","url":null,"abstract":"<p><strong>Introduction: </strong>Hypoxic-ischemic encephalopathy (HIE) is a syndrome involving the fetal central nervous system as the result of a perinatal hypoxic-ischemic injury. To date, transfontanellar ultrasound represents the first-line exam in neonates with clinical suspicion of HIE as it allows the showing of features indicating acute hypoxic injury and excludes potential non-hypoxic determinants of HIE; however, there is no report concerning the sonographic assessment of the brain during labor. In this clinical case, we report the intrapartum sonographic evaluation of the fetal brain as a tool for the differential diagnosis of cardiotocographic abnormalities.</p><p><strong>Case presentation: </strong>A 42-year-old para 2 woman underwent labor induction at 37 + 3 weeks due to preeclampsia. On admission, cardiotocography was normal, as was umbilical artery Doppler. De novo changes of the CTG pattern prior to the onset of labor raised the suspicion of a supervening fetal cerebral insult, leading to the decision to expedite delivery by emergency cesarean. During the preparation for delivery, intrapartum ultrasound allowed the demonstration of fetal cerebral edema representing an early sign of superimposed intrapartum acute hypoxic insult in the context of chronic antepartum hypoxia and excluding non-hypoxic conditions of cardiotocographic abnormalities.</p><p><strong>Conclusion: </strong>This is the first intrapartum sonographic demonstration of imaging findings consistent with cerebral edema in a fetus at risk for in utero hypoxia, hence suspected for fetal hypoxic-ischemic encephalopathy. Intrapartum ultrasound can assist clinicians in the differential diagnosis of intrapartum fetal hypoxia as long as it does not delay any interventions required to prevent hypoxic injury.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"397-401"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-Operative Predictors of Survival in Twin-Twin Transfusion Syndrome Undergoing Fetoscopic Laser Treatment.","authors":"Henry Galan, Henry L Galan, Michael V Zaretsky, Zhaoxing Pan, Nicholas Behrendt, S Christopher Derderian, Stephen Paul Emery, Anthony Johnson, Greg Ryan, William H Goodnight","doi":"10.1159/000546365","DOIUrl":"10.1159/000546365","url":null,"abstract":"<p><strong>Introduction: </strong>Limited data exist regarding the effect of pre-operative risk factors on fetal survival for patients undergoing fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS). The primary objective of this study was to determine the pre-operative variables predictive of single and dual fetal survival at birth for subjects treated with laser for TTTS. The secondary objective was to determine the combined effect of multiple risk factors on single and dual fetal survival at birth.</p><p><strong>Methods: </strong>This was a prospective cohort study of TTTS pregnancies treated with FLP between 2001 and 2023. Cases were identified through the Monochorionic Twin Pregnancy Registry of the North American Fetal Therapy Network. Several pre-operative risk factors were evaluated, including maternal body mass index, gestational age at laser, fetal growth restriction (FGR), cervical length, placental location, and TTTS stage. Higher order multiples, fetal anomalies, karyotypic abnormalities, and cases with missing data were excluded. Risk factors influencing survival were assessed with uni- and multi-variate regression analyses. The predicted probability of single/dual survival based on these risk factors was assessed with multiple logistic regression analysis.</p><p><strong>Results: </strong>Of 2,728 FLP cases, 1,066 met inclusion criteria. Dual survival is reduced in stage 3 and 4 disease compared to stage 1 and 2 (OR 0.75: 0.58, 0.98; p = 0.032) with the lowest survival in all stages occurring with FGR. An anterior placenta (aOR 0.58: 0.37, 0.91; p = 0.017) and FGR <10th percentile (aOR 0.57: 0.35, 0.92; p = 0.02) were independent predictors of reduced survival. With regression modeling, sequential addition of any pre-operative risk factor progressively reduces survival of at least one or both twins.</p><p><strong>Conclusions: </strong>In this large registry, anterior placental location and FGR were most predictive of reduced survival for both twins. As the number of pre-operative risk factors increases for a given TTTS case, there is a progressive reduction in survival probability and these reported probability rates may be useful in counseling patients.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"498-508"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Twin Reversed Arterial Perfusion Sequence: A Systematic Review and Meta-Analysis.","authors":"Michael A Stellon, Devashish S Joshi, Michael J Beninati, Glen Leverson, Qiuyu Yang, Kathleen M Antony, Leslie Christensen, J Louis Hinshaw, Eric Monroe, Inna N Lobeck","doi":"10.1159/000542841","DOIUrl":"10.1159/000542841","url":null,"abstract":"<p><strong>Introduction: </strong>Twin reversed arterial perfusion (TRAP) sequence is a rare complication of monochorionic twin pregnancies characterized by placental anastomoses between a normally developed twin and an acardiac mass. Though several treatment modalities exist, the optimal management strategy is unclear. This study aimed to compare the various treatment strategies for TRAP sequence.</p><p><strong>Methods: </strong>A systematic review of the literature was performed using PRISMA guidelines including PubMed, Scopus, Web of Science, and the Cochrane Library. Studies were imported into Covidence, where they were independently screened by two authors. Studies included described interventions for TRAP sequence. Those excluded were unavailable in English and lacked differentiation between intervention strategies for TRAP and other monochorionic twin pregnancies. Fisher's exact test and random effects modeling were used for statistical analysis.</p><p><strong>Results: </strong>A total of 2,340 abstracts were screened, of which 218 articles progressed to full review and 120 qualified for data extraction. Overall, 757 twin pregnancies were described. Most were treated with radiofrequency ablation (RFA) (n = 363, 47.95%) and laser ablation (n = 220, 29.06%). Statistically significant differences among the modalities were seen in technical success (p = 0.005), gestational age at presentation (p < 0.01), intervention (p = 0.01), and delivery (p = 0.01), respectively, and time between treatment and delivery (p < 0.01). Notably, pump twin survival did not differ based on treatment modality used (p = 0.196). Overall, complication rates were low with no differences in preterm premature rupture of membranes (p = 0.66), preterm labor (p = 0.58), or maternal hemorrhage between modalities (p = 0.28). Suture cord ligation, however, had a greater hemorrhage rate than RFA (p = 0.03).</p><p><strong>Conclusions: </strong>This embodies the first meta-analysis comparing treatment modalities for TRAP sequence with outcomes and complications. RFA is the most technically successful strategy. Prospective data are required to further understand the optimal modality and gestational age at treatment to ensure best overall outcomes.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"207-222"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ectopic Atrial Beats May Cause a ZigZag Pattern at Intrapartum Recording of the Fetal Heart Rate Using Fetal Scalp Electrode.","authors":"Andrea Dall'Asta, Chiara Melito, Stefania Fieni, Tullio Ghi","doi":"10.1159/000542935","DOIUrl":"10.1159/000542935","url":null,"abstract":"<p><strong>Introduction: </strong>Fetal scalp electrode (FSE) is considered the gold standard for the intrapartum monitoring of the fetal heart rate (FHR) being associated with the lowest rate of signal loss and artifacts including the recording of the maternal heart rate. FSE acquires a fetal electrocardiogram and evaluates the time intervals between successive R waves. As such, it allows the recording of the beat-to-beat fluctuation of the FHR. However, due to the precise estimation of the inter-beat interval, FSE may also demonstrate recurrent atrial ectopic beats and register a highly oscillatory FHR pattern mimicking a saltatory or ZigZag appearance.</p><p><strong>Case presentation: </strong>We herein describe a case of intrapartum supraventricular ectopic beats leading to the recording of a saltatory appearance of the FHR that could be demonstrated using FSE only and precluded a reliable assessment of intrapartum fetal oxygenation. Transabdominal gray-scale and M-mode ultrasound assessment of the fetal heart documented supraventricular ectopic beats recurring in 1 out of 10-12 beats, thus supporting the hypothesis that the abnormal FHR pattern on the CTG trace was secondary to fetal arrhythmia and not to rapidly evolving fetal hypoxia.</p><p><strong>Conclusion: </strong>In supraventricular fetal arrhythmia, the use of FSE for continuous intrapartum FHR monitoring differently from external ultrasound transducer may capture a highly variable CTG pattern which is caused by the registration of the ectopic atrial beats and not by a rapidly evolving hypoxia.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"314-319"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Serial Amnioinfusion Strategies for Isolated Early-Onset Fetal Renal Anhydramnios.","authors":"Joyce M Cheng, Ahmet A Baschat, Meredith A Atkinson, Mara Rosner, Michelle L Kush, Denise Wolfson, Sarah Olson, Kristin Voegtline, Lindsey Goodman, Angie C Jelin, Jena L Miller","doi":"10.1159/000539732","DOIUrl":"10.1159/000539732","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal protocol for serial amnioinfusions to maintain amniotic fluid in pregnancies with early-onset fetal renal anhydramnios before 22 weeks is not known. We compared the performance of two different approaches.</p><p><strong>Methods: </strong>A secondary analysis was conducted of serial amnioinfusions performed by a single center during the external pilot and feasibility phases of the Renal Anhydramnios Fetal Therapy (RAFT) trial. During the external pilot, higher amnioinfusion volumes were given less frequently; in the feasibility study, smaller volume amnioinfusions were administered more frequently. Procedural details, complications, and obstetric outcomes were compared between the two groups using Pearson's χ2 or Fisher's exact tests for categorical variables and Student's t tests or Wilcoxon rank-sum tests for continuous variables. The adjusted association between procedural details and chorioamniotic separation was obtained through a multivariate repeated measure logistic regression model.</p><p><strong>Results: </strong>Eleven participants underwent 159 amnioinfusions (external pilot: 3 patients, 21 amnioinfusions; feasibility: 8 patients, 138 amnioinfusions). External pilot participants had fewer amnioinfusions (7 vs. 19.5 in the feasibility group, p = 0.04), larger amnioinfusion volume (750 vs. 500 mL, p < 0.01), and longer interval between amnioinfusions (6 [4-7] vs. 4 [3-5] days, p < 0.01). In the external pilot, chorioamniotic separation was more common (28.6% vs. 5.8%, p < 0.01), preterm prelabor rupture of membranes (PPROM) occurred sooner after amnioinfusion initiation (28 ± 21.5 vs. 75.6 ± 24.1 days, p = 0.03), and duration of maintained amniotic fluid between first and last amnioinfusion was shorter (38 ± 17.3 vs. 71 ± 19 days, p = 0.03), compared to the feasibility group. While delivery gestational age was similar (35.1 ± 1.7 vs. 33.8 ± 1.5 weeks, p = 0.21), feasibility participants maintained amniotic fluid longer.</p><p><strong>Conclusion: </strong>Small volume serial amnioinfusions performed more frequently maintain normal amniotic fluid volume longer because of delayed occurrence of PPROM.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"155-163"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}