PubMed · 8148726
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M Joffe. 1994-03-05. Variation in caesarean section rates. What difference does it make.. https://pubmed.ncbi.nlm.nih.gov/8148726/
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OBJECTIVE: To relate prenatal data of monochorionic pregnancies complicated by Twin-Twin transfusion syndrome (TTTS) with survival rates and neurological morbidity. STUDY DESIGN: Thirty-two cases of TTTS underwent biweekly ultrasound examinations. Amnioreduction was the standard of care. Mortality and neurological morbidity were evaluated; the children had neurodevelopmental follow-up with a mean follow-up time of 24 months. RESULTS: Ten out of 32 pregnancies terminated before 24 weeks of gestation, six after induction and four after spontaneous abortion. Among the 22 pregnancies followed up after 24 weeks, the overall survival rate at 28 days was 70% (31/44) with 10 intrauterine deaths including three cases of single selective terminations, and with three neonatal deaths. Eighteen out of 31 babies (58%) had a normal neurological development, eight cases had major and five cases minor neurological disabilities. Neonatal survival was not related to gestational age at diagnosis, number of amnioreductions or weeks at delivery. Absence of end diastolic flow in the umbilical artery, either in the donor or the recipient twin, and birth weight <1000 g were both associated with a higher perinatal mortality. Number of amnioreductions (>2) and birth weight <1000 g were both associated with abnormal neurological follow-up. CONCLUSION: In TTTS, absent end diastolic flow in the umbilical artery and birth weight can predict perinatal survival; neurological development is correlated with number of amnioreductions and birth weight.
To determine airway ion transport in term infants on the first day of postnatal life, and to test the hypothesis that infants born without labor have reduced sodium absorption, we measured nasal potential difference using a modified perfusion protocol suitable for newborn infants. We examined maximal stable baseline potential difference, the change after perfusion with 10(-4) M amiloride (Deltaamil), and the change after perfusion with a zero-chloride solution (Deltazero Cl-) in infants born after elective cesarean section (n = 21) or normal labor (n = 20). Maximal stable baseline potential difference was not different in the two cohorts (-24.0 mV, range -9 to -64 mV versus -25.5 mV, range -6 to -44 mV). The majority of infants in both cohorts showed a substantial fall in potential difference after amiloride perfusion, and there was little capacity for chloride secretion. These results demonstrate a fluid absorptive pattern in the airways on the first postnatal day. In these well infants, the ion transport phenotype was not dependent on the presence or absence of labor.
As a result of the impressive progress in perinatal medicine the frontier of extrauterine viability has been shifted to a continuously decreasing gestational age. Optimal results require a close collaboration between obstetrician and neonatologist following well defined protocols. The quality of interdisciplinary efforts in perinatal medicine is not only measured by survival rates but by the number of survivors with good chances of normal development. Before 24 weeks survival rate drops below 10% and more than half of the few survivors show signs of more or less severe handicaps. Interventional medicine, be it prenatally, during or after birth, is not recommended. Comfort care and support is given to the parents as well as the infant after birth. Beyond 26 weeks chances of survival rapidly increase above 50% while the rate of handicapped among the survivors drops below 50%. Starting with 26 weeks full monitoring of the fetus and operative interventions for delivery of the fetus together with expert neonatal treatment to assure optimal survival are recommended. In the grey zone of 24 and 25 weeks management must be individualized considering the special circumstances of the individual case and taking into account the basic expectations of the parents. Prenatally the most common clinical scenarios can be assigned to one of three categories, which are described in some detail.