Abstracts

Abstract
In August 2004, the National Institutes of Health organized a 'Workshop on Fetal Therapy' to develop a plan for the maternal-fetal, surgical, and neonatal evaluation and treatment of pregnancies that might benefit from in-utero therapy. At the completion of the workshop several recommendations were made, foremost of which was the 'formation of a cooperative group of clinical investigators to help set a national agenda for research and clinical progress in the field of fetal therapy'. Somewhat by coincidence, a multidisciplinary 'Fetal Therapy Working Group' that had been formed earlier in the year was well-positioned to accept this national mandate and proposed development of a North American Fetal Therapy Network (NAFTNet) to foster collaborative research between active fetal diagnosis and treatment centers in both the USA and Canada, develop a peer review mechanism for study proposals, explore ways to centralize data collection and study development, and establish an educational agenda for medical professionals and the public as well as training of future leaders in the field. NAFTNet represents a new paradigm and approach to international collaborative research. Early success has resulted in the recognition of the power of collaborative research efforts in studying rare congenital anomalies and intervention strategies to improve outcomes and survivals in such limited populations. By abandoning 'competitive research' for a cooperative, collaborative environment of research partnership, NAFTNet strives to be more responsible and effective in using limited resources and improving care for pregnancies and children born with congenital anomalies.
Copyright 2009 Elsevier Ltd. All rights reserved.

Skupski DW, Luks FI, Walker M, Papanna R, Bebbington M, Ryan G, O'Shaughnessy R, Moldenhauer J, Bahtiyar O; North American Fetal Therapy Network (NAFTNet). Preoperative predictors of death in twin-to-twin transfusion syndrome treated with laser ablation of placental anastomoses. Am J Obstet Gynecol. 2010 Oct;203(4):388.e1-388.e11. Epub 2010 Aug 9.
Abstract
OBJECTIVE: To determine preoperative predictive factors for donor and recipient death after laser ablation of placental vessels in twin-to-twin transfusion syndrome.
STUDY DESIGN: Retrospective analysis of North American Fetal Therapy Network center laser procedures, 2002-2009. Factors associated with donor and recipient death were identified by regression analysis.
RESULTS: There were 466 patients from 8 centers. Factors significantly associated with donor fetal death were low donor estimated fetal weight (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.55-0.87) and reversed end diastolic velocity in the umbilical artery (OR, 4.0; 95% CI, 1.54-10.2); for recipient fetal death-low recipient estimated fetal weight (OR, 0.65; 95% CI, 0.44-0.95), recipient reversed "a" wave in the ductus venosus (OR, 2.39; 95% CI, 1.27-4.51) and hydrops (OR, 3.7; 95% CI, 1.1-12.7); for recipient neonatal death-low donor estimated fetal weight (OR, 0.54; 95% CI, 0.30-0.95), high recipient estimated fetal weight (OR, 1.55; 95% CI, 1.06-2.26) and recipient reversed end diastolic velocity in the umbilical artery (OR, 7.8; 95% CI, 1.03-59.3).
CONCLUSION: Preoperative findings predict fetal and neonatal demise in twin-to-twin transfusion syndrome treated with laser therapy.
Copyright © 2010 Mosby, Inc. All rights reserved.

Molina S, Papanna R, Moise KJ Jr, Johnson A. Management of Stage I twin-to-twin transfusion syndrome: an international survey. Ultrasound Obstet Gynecol. 2010 Jul;36(1):42-7.

Abstract
OBJECTIVE: To determine practice patterns for evaluation and treatment of Stage I twin-to-twin transfusion syndrome (TTTS) among international physicians.
METHODS: An e-mail cross-sectional survey of members from the IFMSS, NAFTNet and SMFM societies and participants at a Eurofoetus-sponsored TTTS meeting was undertaken between May 2008 and November 2008. Questionnaires consisted of physician demographics and their recommendations for managing Stage I TTTS. Alternative therapies to expectant management were assessed based on the following special circumstances of the patient: residence more than 200 miles from the center, severe symptoms, or a cervical length of </= 15 mm.
RESULTS: Eighty-one surveys were returned, giving a response rate of 84%. Five surveys were excluded as a result of duplication or missing data. Of the remaining 76 surveys, 48 were from North America, 20 were from Europe and eight were from other continents. Expectant management was the predominant recommendation (78%), followed by amnioreduction (11%), laser ablation (11%) and septostomy (1%). Recommendations for amnioreduction were exclusively from North American centers. Laser centers recommended expectant management more frequently than non-laser facilities (89% vs. 59%; P < 0.01). When examples of special patient circumstances were presented, North American centers changed their recommendation from expectant management to amnioreduction more often than did European centers. However, a greater proportion of European centers recommended laser surgery for special patient circumstances.
CONCLUSION: Expectant management remains the predominant management of Stage I TTTS. In some patient circumstances, North American centers are more likely to recommend amnioreduction while European centers are more likely to recommend laser therapy. A randomized controlled trial will be necessary to evaluate the most efficacious management strategy for Stage I TTTS.
Copyright 2010 ISUOG. Published by John Wiley & Sons, Ltd.

Chescheir NC, Socol M. The National Institutes of Health Workshop on Fetal Treatment: needs assessment and future directions. Obstet Gynecol. 2005 Oct;106(4):828-33.
Abstract
The National Institute of Child Health and Human Development and Office of Rare Diseases convened a multidisciplinary group of experts on August 16-17, 2004, for a workshop entitled ''Fetal Treatment: Needs Assessment and Future Directions.'' The purpose of the workshop was to develop a plan for the surgical, obstetric, neonatal, and maternal-fetal fields for the evaluation and dissemination of maternal-fetal surgical innovations and to further the scientific evaluation of maternal-fetal surgery. This article highlights the discussions and outlines recommendations for the future. An overarching recommendation was for the formation of a cooperative group of investigators and clinicians to help set a national agenda for research and clinical progress, as well as emphasize ethical issues.
© 2005 The American College of Obstetricians and Gynecologists