The latest medical research on Radiology

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Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement.

Ultrasound in Obstetrics and Gynecology

The aim of the present study was to evaluate the correlation between pelvic floor dimensions in nulliparous women at term and fetal head engagement as assessed by transperineal ultrasound.

Transperineal ultrasound was used to measure the anteroposterior diameter of the levator hiatus (APD) and the angle of progression (AoP) at rest, under maximum pelvic floor muscle contraction, and at maximum Valsalva maneuver (before and after visual feedback), in a group of nulliparous women at term before the onset of labor. We assessed the correlation between pelvic floor static and dynamic dimensions (APD and levator ani muscle coactivation) and AoP, which is an objective index of fetal head engagement.

In total, 282 women were included in the analysis. Among these, 211 women (74.8%) had a vaginal while 71 (25.2%) had a Cesarean delivery. AoP was narrower in the Cesarean delivery group at rest, at pelvic floor muscle contraction and at Valsalva, whereas no differences in APD was found between the two groups. On the other hand, we found a negative correlation between APD at rest and at Valsalva with the second stage of labor. There was a positive correlation between AoP and APD at maximum Valsalva maneuver after visual feedback (r = 0.15, p = 0.01). Women with levator ani contraction under Valsalva's maneuver (coactivation), both pre- and post-visual feedback, had narrower AoP at rest and under maximum Valsalva. After visual feedback, women with levator ani coactivation had a longer second stage of labor (80.8 min ± 61.4 vs. 62.9 min ± 43.4; p = 0.04).

Smaller pelvic floor dimensions and levator ani muscle coactivation are associated with higher fetal head station and with a longer second stage of labor in nulliparous women at term. This article is protected by copyright. All rights reserved.

Imaging in gynecological disease: clinical and ultrasound characteristics of adnexal torsion.

Ultrasound in Obstetrics and Gynecology

To describe the clinical and ultrasound characteristics of adnexal torsion.

This is a retrospective study. From the operative records of the eight participating gynecological ultrasound centers, we identified patients with a surgically confirmed diagnosis of adnexal torsion (surgical evidence of twisted ovarian pedicle and/or twisted paraovarian cyst and/or tube on its own axis), who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 2008 and 2018. Only cases having at least two available ultrasound images or videos (one gray-scale and one with Doppler evaluation) were included. Clinical, ultrasound, surgical and histological information was retrospectively retrieved from each patient's medical record and then entered into an Excel file by the principal investigator at each center. In addition, two authors retrospectively reviewed all available ultrasound images and videos of the twisted adnexa with regard to the presence of four predefined ultrasound features reported to be characteristic of adnexal torsion: 1) ovarian stromal edema with or without peripherally displaced antral follicles, 2) follicular ring sign, 3) whirlpool sign, and 4) absence of vascularization in the twisted organ.

A total of 315 cases of adnexal torsion were identified. The median age of the patients was 30 (range 1-88) years. Most of them presented with acute or subacute pelvic pain (305/315, 96.8%). The surgical approach was laparoscopic in 239/312 (76.6%) patients and conservative surgery (untwisting or untwisting plus excision of a lesion) was performed in 149/315 (47.2%) of cases. According to the original ultrasound reports, the median of the largest diameter of the twisted organ was 83 (range 30-349) mm. Free fluid in the pouch of Douglas was detected in 196/275 patients (71.6%). "Ovarian stromal edema with or without peripherally displaced antral follicles" was reported in the original ultrasound report in167/241 (69.3%) patients, the "whirlpool sign" in 178/226 (78.8%), absent color Doppler signals in 119/269 (44.2%), and the "follicular ring sign" in 51/134 (38.1%). On retrospective review of images, the "ovarian stromal edema with or without peripherally displaced antral follicles" sign (201/254; 79.1%) and the "whirlpool sign" (139/153; 90.8%) were the most commonly detected features of adnexal torsion.

Most patients with surgically confirmed adnexal torsion are of reproductive age and present with acute or subacute pain. Common ultrasound signs are an enlarged organ, the "whirlpool sign", and "ovarian stromal edema with or without peripherally displaced antral follicles", and free fluid in the pelvis. The "follicular ring sign" and absence of Doppler signals are slightly less common signs. Recognizing ultrasound signs of adnexal torsion is important so that correct treatment, i.e. surgery without delay, can be offered. This article is protected by copyright. All rights reserved.

Cordocentesis-associated fetal loss and risk factors: experience of 6650 cases from a single center.

Ultrasound in Obstetrics and Gynecology

To identify the risk factors of fetal loss associated with cordocentesis METHODS: Based on our prospective database, a retrospective cohort study was conducted on pregnancies undergoing cordocentesis at mid-pregnancy from a single center (a tertiary hospital, teaching school). All consecutive cases were validated to retrieve those meeting the inclusion criteria, including 1) low risk pregnancies; 2) singleton pregnancies; 3) availability of the data of pregnancy outcomes; and 4) normal fetuses (no structural / chromosomal abnormalities and severe disorders). The cases with therapeutic termination of pregnancy were excluded. The various potential risk factors of fetal loss secondary to cordocentesis were tested, including effect of cordocentesis model training, procedure difficulty, placenta penetration, prolonged bleeding, fetal bradycardia, puncture site, and early gestation.

A total of 10,343 procedures were performed during the study period. Of them, 6,650 met the inclusion criteria and were available for analysis. In evaluation of influence of model training, the fetal loss rate in the first 60 cases of practice (early learning curve) of 6 performers who had no prior model training (n=360 procedures) was significantly higher than that of 18 performers with prior model training (n=1,080 procedures) (6.9% vs 1.6%, p<0.001), whereas the loss rate during the next 60 cases of practice was comparable between both groups. After excluding the first 60 procedures in the groups of no prior model training, the overall fetal loss rate was still significantly higher than that of the control (1.6% vs 1.0%; p < 0.001). Penetration of the placenta (OR=2.65;95%CI:1.71-4.10), prolonged bleeding (OR=10.85;95%CI:5.27-22.36) and fetal bradycardia (OR=3.32;95%CI:1.83-6.04) were an independent risk factor of fetal loss.

Cordocentesis model training, the only one modifiable factor, markedly reduces fetal loss in early learning curve of practice. Thus, practice without prior model training is no longer acceptable. Other significant risk factors are placental penetration, prolonged bleeding and bradycardia following the procedures. Cordocentesis-related fetal loss may be only 0.6%, much lower than that previously reported. This article is protected by copyright. All rights reserved.

Copeptin and mid-regional pro-ANP in women with suspected or confirmed pre-eclampsia: comparison with the sFlt-1/PlGF ratio.

Ultrasound in Obstetrics and Gynecology

Arginine vasopressin (AVP) and atrial natriuretic peptide (ANP) may contribute to the pathogenesis of preeclampsia, but their role remains to be elucidated. We aimed to evaluate their role as biomarkers and whether they associate with angiogenic markers and/or clinical manifestations of preeclampsia.

We measured their surrogates C-terminal pro-AVP (Copeptin) and mid-regional pro-ANP (MR-proANP) making use of a retrospective analysis of a prospective cohort study involving 526 women with suspected or confirmed preeclampsia, originally aimed to evaluate the use of soluble Fms-like tyrosine kinase-1/Placental growth factor (sFlt-1/PlGF) ratio.

Women with preeclampsia displayed elevated serum copeptin and MR-proANP in comparison with women suspected of preeclampsia. To discriminate maternal complications on top of traditional predictors (gestational age, parity, diastolic blood pressure and proteinuria), the sFlt-1/PlGF ratio displayed a higher C-index than copeptin and MR-proANP (0.76, 0.63 and 0.67, respectively, vs. 0.60 for the traditional predictors only), and the same was true for the discrimination of fetal/neonatal complications (C-index = 0.83, 0.79 and 0.80 vs. 0.79). When subdividing women according to sFlt-1/PlGF ratio (≥ 85 versus <85), no differences in copeptin levels were observed, while MR-proANP levels was elevated in women with a ratio ≥ 85. Multiple regression analysis revealed that copeptin and MR-proANP were independent determinants of proteinuria.

Copeptin and MR-proANP have limited value to predict preeclampsia-related complications when compared with the sFlt-1/PlGF ratio. However, our data suggests that both copeptin and MR-proANP contribute to the occurrence of proteinuria, with copeptin exerting this effect independently of sFlt-1/PlGF ratio. This article is protected by copyright. All rights reserved.

Role of prenatal magnetic resonance imaging in fetuses with isolated mild or moderate ventriculomegaly in the era of neurosonography: a multicenter study.

Ultrasound in Obstetrics and Gynecology

To assess the role of fetal magnetic resonance imaging (MRI) in detecting associated anomalies in fetuses presenting with mild and moderate isolated ventriculomegaly (VM) undergoing multiplanar ultrasound (US) evaluation of fetal brain.

Multicenter, retrospective, cohort study involving 15 referral fetal medicine centers in Italy, United Kingdom, and Spain. Inclusion criteria were fetuses affected by isolated VM on US, defined as VM with normal karyotype and no other additional central nervous system (CNS) and extra-CNS anomalies on US, undergoing detailed assessment of fetal brain via a multiplanar approach as suggested by ISUOG guidelines on fetal neurosonogram. The primary outcome of the study was to report the rate of additional CNS anomalies detected exclusively at prenatal MRI and missed at US, while the secondary aim was to estimate the incidence of additional anomalies detected exclusively after birth and missed at prenatal imaging (US and MRI). Sub-group analyses according to the gestational age at MRI (< vs ≥ 24 weeks of gestation), laterality of VM (unilateral vs bilateral), and severity of dilatation (mild vs moderate VM) were also performed.

Five-hundreds and fifty-six fetuses with a prenatal diagnosis of isolated fetal VM on US were included in the analysis. Additional structural anomalies were detected at prenatal MRI and missed at US in 5.4% (95% CI 3.8-7.6) of cases. When considering the type of anomalies, supra-tentorial intra-cranial hemorrhage was detected on MRI in 26.7% of fetuses, while polymicrogyria and lissencephaly in 20.0% and 13.3% of cases, respectively. Hypoplasia of the corpus callosum was detected at MRI in 6.7% of cases, while dysgenesis in 3.3%. Fetuses with an associated anomaly detected only at MRI were more likely to have moderate compared to mild VM (60.0% vs 17.7%, p<0.001), while there was no significant difference between the proportion of cases with bilateral VM between the two groups (p=0.2). The results of the logistic regression analysis showed that maternal body mass index (OR: 0.85, 95% CI 0.7-0.99, p= 0.030), the presence of moderate VM (OR: 5.8, 95% CI 2.6-13.4, p<0.001) and gestational age at MRI ≥24 weeks of gestation (OR: 4.1, 95% CI 1.1-15.3, p= 0.038) were independently associated with the probability of detecting associated anomalies at MRI. Associated anomalies were detected exclusively at birth and missed at prenatal imaging in 3.8% of cases.

The rate of associated fetal anomalies missed at US and detected only at fetal MRI in fetuses with isolated mild and moderate VM undergoing neurosonography is lower than that previously reported. The large majority of these anomalies are difficult to detect on ultrasound. The findings from this study support the practice of MRI assessment in every fetus with a prenatal diagnosis of VM, although parents can be reassured of the low risk of associated anomalies, when VM is isolated on US. This article is protected by copyright. All rights reserved.

Detection of fetal cardiac anomalies: is increasing the number of cardiac views cost-effective?

Ultrasound in Obstetrics and Gynecology

To perform a cost-effectiveness analysis of prenatal screening strategies for major congenital heart disease (CHD).

A decision-analytic model comparing 4 screening strategies-3 views, 5 views, 5 axial views, and 6 views-identified fetuses with major CHD in a theoretical cohort of 4,000,000 births. Outcomes related to neonatal mortality and neuro-developmental disability were calculated. The analysis was performed from a healthcare system perspective with a cost-effectiveness threshold set at $100,000 per quality-adjusted life year (QALY). Base case, one-way sensitivity analysis, and Monte Carlo simulation were performed.

In our base-case model, 5-axial view screening was the optimal strategy. It detected 3520 more CHDs and resulted in 259 fewer children with neuro-developmental disability, 40 fewer neonatal deaths, and slightly higher costs compared to screening with 3 views. Screening with 6 views was more effective, but also cost more than 5 axial views, and had an incremental cost of $490,023 /QALY, which was over the willingness-to-pay threshold. The final strategy, 5 views, was more costly and less effective compared to the other three strategies. The data were robust when tested with Monte Carlo and one-way sensitivity analysis.

Although current guidelines recommend 3 views as the minimum strategy for detecting CHD during the mid-trimester anatomy scan, 5 axial views is the cost-effective strategy that may lead to better outcomes than 3-view screening. This article is protected by copyright. All rights reserved.

Outcome of selective intrauterine growth restriction in monochorionic twin pregnancies at 16, 20 or 30 weeks according to the new consensus definition.

Ultrasound in Obstetrics and Gynecology

Recently, new criteria have been proposed to define selective intrauterine growth restriction (sIUGR) in monochorionic pregnancies based on the Delphi procedure. We report the outcome of sIUGR diagnosed according to this new consensus definition: either an estimated fetal weight (EFW) of 1 twin <3rd centile or 2 of the following: EFW or abdominal circumference of 1 twin <10th centile, EFW discordance ≥25% or umbilical artery pulsatility index of the smaller twin > 95th centile.

We performed a retrospective analysis of the outcome of sIUGR diagnosed at 16, 20 or 30 weeks in a cohort of monochorionic diamniotic twin pregnancies followed from the first trimester. sIUGR was defined using the Delphi consensus definition. We used uni- and multivariate generalized estimated equation modelling to identify predictors of survival.

We analysed 675 pregnancies, of which 177 (26%) were diagnosed with sIUGR at 16, 20 or 30 weeks. The overall survival rate was 313/354 (88%) with in 146/177 (82%) survival of both twins, 21/177 (12%) survival of 1 and 10/177 (6%) loss of both twins. Subsequent TAPS developed in 6/177 (3%) and TTTS in 17/177 (10%). All TAPS fetuses survived. Survival in TTTS was 22/34 (65%) compared with 279/308 (91%) in isolated sIUGR (without TAPS or TTTS) (p < 0.001). Most sIUGR cases were type I (110/177; 62%) with a survival rate of 212/220 (96%) as compared with 12/22 (55%) in type II (p < 0.001) and 55/66 (83%) in type III (p = 0.006). The majority of sIUGR pregnancies (130/177; 73%) was first diagnosed at 16 and/or 20 weeks (early-onset) with survival of 221/260 (82%) as compared to 92/94 (98%) of sIUGR first diagnosed at 30 weeks (late-onset) (p < 0.001). A major anomaly in at least one twin was present in 28/177 (16%) sIUGR cases. For these pregnancies, survival was 39/56 (70%), compared to 274/298 (92%) for those without anomalies (p < 0.001). Subsequent TTTS (OR 0.18; 95% CI [0.06-0.52]), sIUGR type II (OR 0.06; 95% CI [0.02-0.24]) and type III (OR 0.21; 95% CI [0.07-0.60]) and a major anomaly in one twin (OR 0.12; 95% CI [0.04-0.34]) independently determined survival, but not the time at first diagnosis.

Isolated sIUGR is associated with a 90% survival rate. The subsequent development of TTTS, absent or reversed end-diastolic flow in the umbilical artery of the smaller twin and the presence of a major anomaly adversely affect survival in sIUGR. This article is protected by copyright. All rights reserved.

Impact of prospective measurement of outflow tracts in the prediction of coarctation of the aorta.

Ultrasound in Obstetrics and Gynecology

Prenatal diagnosis of coarctation of the aorta (COA) is associated with reduced mortality and morbidity, however, accurate prenatal prediction remains challenging. To date, studies have measured the outflow tracts retrospectively to gauge the potential to predict COA. Our primary objective was to evaluate prospectively acquired measurements of the outflow tracts in prenatally suspected COA. A secondary aim was to report the postnatal prevalence of bicuspid aortic valve in this cohort.

Measurement of the aortic valve, pulmonary valve, distal transverse aortic arch (DTAA) and arterial duct (AD) diameters were undertaken routinely in fetuses with suspected COA between 2002-2017. Using published reference ranges based on >7000 fetuses from our own unit, z scores were computed.

COA was confirmed after birth in 77/149 (52%) cases. DTAA z score and the z score of DTAA:AD were smaller in cases with confirmed COA compared to false positive (FP) (-2.8 vs -1.9, p=0.039; -3.13 vs -2.61, p=0.005, respectively). Multiple regression analysis demonstrated that z scores of DTAA and AD were the only significant predictors (p=0.001). Bicuspid aortic valve was identified in 30% of the FP group.

Measurement of the DTAA and AD z scores can be used to attribute risk for postnatal COA in a selected cohort. The significance of the high incidence of bicuspid aortic valve in FP cases merits further study both with respect to aetiology and longer- term significance. This article is protected by copyright. All rights reserved.

Imaging in gynecological disease: clinical and ultrasound characteristics of urinary bladder malignancies.

Ultrasound in Obstetrics and Gynecology

To describe clinical and ultrasound characteristics of urinary bladder malignancies diagnosed on transvaginal ultrasound in women presenting with suspected gynecological problems.

This is a multicenter retrospective study of women with histological diagnosis of urinary bladder malignancy that was suspected on transvaginal ultrasound examination. The cases were collected from three centers which specialize in the use of pelvic ultrasound between January 2007 and October 2018. Clinical data were obtained from the computer databases and all tumor images were assessed by two authors (DJ and JK) to look for characteristic sonographic patterns. We have compared the characteristics of tumors seen in women presenting with symptoms suspicious of urinary bladder malignancy and those without such symptoms.

Thirty women with a confirmed diagnosis of urinary bladder malignancy on histological examination were included. Median age at diagnosis was 70.5 years (range 36-88). The most common presenting symptom was postmenopausal bleeding which was recorded in 18 women (60%). Ten women (33%) had symptoms suspicious of bladder malignancy: six had unexplained visible hematuria, three had unexplained recurrent urinary tract infections and one woman had dysuria and microhematuria. On histological examination 23 women (77%) were diagnosed with primary bladder malignancy whilst seven women (23%) had metastases in the bladder from other primary tumors. Out of 23 primary tumors, 21 (91%) were of urothelial origin (12 low-grade and 9 high-grade). Most low-grade urothelial carcinomas appeared on ultrasound as irregular papillary growth (11/12, 92%) and they were moderately to highly vascular on color Doppler examination (8/12, 67%). The ultrasound appearances of primary non-urothelial and metastatic tumors varied without a clear common morphological tumor pattern. The tumors found in women with symptoms suggestive of bladder malignancy did not differ unequivocally from those detected in other women in their size, ultrasound morphology, vascularity or histological type.

Urinary bladder malignancies can be detected in patients undergoing transvaginal ultrasound examination for suspected gynecological problems. Primary urothelial cancers have relatively uniform morphological pattern, whilst the appearances of other bladder malignancies are more variable. This article is protected by copyright. All rights reserved.

Diagnosis of major heart defects by routine first-trimester ultrasound examination: association with high nuchal translucency, tricuspid regurgitation and abnormal flow in the ductus venosus.

Ultrasound in Obstetrics and Gynecology

To examine the association between fetal major heart defects and high nuchal translucency thickness (NT), tricuspid regurgitation and abnormal flow in the ductus venosus in a large population of singleton pregnancies undergoing a routine ultrasound examination at 11-13 weeks' gestation.

This was a retrospective study of prospectively collected data from singleton pregnancies attending for a routine ultrasound scan at 11-13 weeks' gestation which included examination of fetal anatomy, measurement of NT, and assessment of blood flow across the tricuspid valve and in the ductus venosus according to a standardized protocol. The incidence of fetal NT ≥95th and NT ≥99th percentile, tricuspid regurgitation and reversed a-wave in the ductus venosus in fetuses with and without major heart defects was determined and the performance of each marker and their combination in the detection of major heart defects was calculated.

The study population of 93,209 pregnancies with no apparent chromosomal abnormality included 211 (0.23%) with major heart defects and 92,998 morphologically normal neonates. In 113 (53.6%) of the major heart defects the diagnosis was made at the 11-13 weeks scan, in 82 (38.9%) at the 18-24 weeks scan, in 10 (4.7%) at the third-trimester scan and in 6 (2.8%) postnatally. At the 11-13 weeks scan we diagnosed all cases of tricuspid or pulmonary atresia and polyvalvular dysplasia, >90% of cases of hypoplastic left heart syndrome or atrioventricular septal defect, about 60% of complex heart defects and left atrial isomerism (interrupted inferior vena cava with normal intracardiac anatomy), 30-40% of tetralogy of Fallot and arch abnormalities, 25% of tricuspid valve abnormalities, about 15% of transposition of great arteries, but none of aortic or pulmonary stenosis and common arterial trunk. Fetal NT ≥95th percentile, NT ≥99th percentile, tricuspid regurgitation, or abnormal ductus venosus flow was observed in 77 (36.5%), 45 (21.3%), 61 (28.9%), and 58 (27.5%) of the fetuses with major heart defects, respectively, and in 5,678 (6.1%), 857 (0.9%), 1,136 (1.2%), and 1,644 (1.8%) of those without heart defects. Any one of NT ≥95th , tricuspid regurgitation or abnormal flow in the ductus venosus was found in 117 (55.5%, 95% CI 48.5-62.3%) of the fetuses with heart defects and in 8,166 (8.8%, 95% CI 8.6-9.0%) of those without heart defects. Any one of NT ≥99th percentile and the other two markers was found in 99 of the fetuses with heart defects (46.9%, 95% CI 40.0-53.9%) and in 3,517 of those without heart defects (3.8%, 95% CI 3.7-3.9%).

At 11-13 weeks' gestation measurement of fetal NT and assessment of flow across the tricuspid valve and in the ductus venosus can lead to the early diagnosis of major heart defects. This article is protected by copyright. All rights reserved.

Revisiting the short and long outcome after fetal first-trimester primary cytomegalovirus infection in relation to prenatal imaging findings.

Ultrasound in Obstetrics and Gynecology

To determine the short- and long-term outcome of pregnancies with proven 1st trimester fetal CMV infection in a large prospective cohort.

Serological diagnosis of primary CMV infection was documented by seroconversion. Vertical CMV transmission was identified by amniocentesis. After birth fetal infection was re-tested by PCR for the CMV genome from neonatal urine or saliva samples. All patients underwent serial prenatal ultrasound scans and fetal MRI at 32-34 weeks gestation. All neonates underwent ocular fundus examination, ultrasound brain scan and hearing evaluation, and were then followed periodically. Follow-up information was obtained from hospital charts and by telephone interviews with parents.

Primary CMV infection in the 1st trimester occurred in 123 patients. The rate of US findings was 30.9% and the rate of abnormal MRI was 30.1%, with a rate of 14.1% for the subgroup of patients with normal US. Of the 85 patients with normal US, 12 had MRI findings with five (5.9%) true anatomical findings. Fifteen patients decided to terminate the pregnancy due to abnormal prenatal findings on either US or MRI. Altogether the rate of postnatal and childhood sequelae was 27.8%, with a rate of 16.6% for sensory neural hearing loss (SNHL) and 11.1% for neurological abnormalities, mostly slight motor or verbal delay. Interestingly, approximately half of these cases didn't have any abnormal prenatal imaging findings. Abnormal prenatal findings on ultrasound were not significantly associated with hearing loss, neurodevelopmental delay or clinical-composite outcome (P= 0.084, 0.109 and 0.176 respectively) but were associated with composite outcome including TOP (p<0.001). We did identify a trend with a higher rate of SNHL in the group with abnormal US compared to normal US. For abnormal MRI findings we found a correlation only to neurological abnormalities and composite outcome (P=0.014 and <0.001, respectively).

The risk of childhood sequelae after first trimester fetal infection is most probably associated with abnormal prenatal imaging findings. However, normal imaging doesn't rule out the development of hearing loss and minor neurodevelopmental abnormalities. This article is protected by copyright. All rights reserved.

Prevalence of placental dichotomy, fetal cardiomegaly and starry-sky liver in twin anemia polycythemia sequence.

Ultrasound in Obstetrics and Gynecology

To investigate the prevalence of additional ultrasound markers including placental dichotomy, cardiomegaly, and starry-sky liver in pregnancies with twin anemia polycythemia sequence (TAPS).

All monochorionic twins antenatally diagnosed with TAPS at our center between 2006-2019 were retrospectively reviewed for the presence of placental dichotomy, cardiomegaly in the donor and a starry-sky liver in the recipient. TAPS was diagnosed based on delta middle cerebral artery - peak systolic velocity > 0.5 multiples of the median. The primary outcome was the prevalence of placental dichotomy, cardiomegaly, starry-sky liver and at least one of these markers in both spontaneous and post-laser TAPS. Secondary outcome included the prevalence of these ultrasound markers per antenatal TAPS stage.

Between 2006 and 2019, 91 monochorionic twins with TAPS were eligible for analysis. Placental dichotomy was observed in 44% (43/91) of TAPS cases. A total of 70% (64/91) of the TAPS donors developed cardiomegaly. A starry-sky liver was identified in 66% (53/80) of the TAPS recipients. The prevalence of cardiomegaly and starry-sky liver was roughly comparable between spontaneous TAPS and post-laser TAPS. Spontaneous TAPS showed a higher prevalence of placental dichotomy than post-laser TAPS twins, 63% (30/48) vs. 23% (10/43) respectively. In 86% (78/91) of the TAPS cases, at least one additional ultrasound finding was detected, meaning that 14% (13/91) of the cases presented solely with discordant MCA-PSV values. For all ultrasound markers, prevalence increased with incrementing antenatal TAPS stage.

Placental dichotomy, fetal cardiomegaly and a starry-sky liver are commonly found in TAPS pregnancies. Looking for these ultrasound markers can be of additional help in improving antenatal detection of TAPS in monochorionic twin pregnancies. This article is protected by copyright. All rights reserved.