Objectives: To investigate time‐interval variables of ductus venosus (DV) flow velocity waveforms (FVWs) in twin‐to‐twin transfusion syndrome (TTTS), comparing the results with reference ranges from normal singleton fetuses. The impact of laser surgery and the effect of prognostic factors were also evaluated.Methods: In 107 TTTS cases, DV‐FVWs of both recipients and donors were recorded 1 day before and 2 days after laser therapy. Time intervals for systolic (S) and early diastolic (D) peaks were analyzed retrospectively with regard to acceleration time (acc‐S and acc‐D for S and D, respectively) and deceleration time (dec‐S and dec‐D for S and D, respectively). For each variable, Z‐scores were calculated with respect to previously reported normal reference ranges.Results: Z‐scores for all variables showed statistically significant differences from those observed previously in normal fetuses, with the exception of dec‐S of donors. The most striking differences were observed in longer dec‐S of recipients (P < 0.001) and longer dec‐D of donors (P < 0.001). Laser therapy showed significant impact on dec‐S and acc‐D in recipients and on all variables in donors. Regarding the short‐term prognosis, acc‐S and dec‐S showed significant differences for the prediction of intrauterine fetal demise in donors (P = 0.009 and P = 0.011, respectively).Conclusion: This study demonstrates that time‐interval variables of DV‐FVWs may differentiate the characteristic hemodynamic changes caused by unbalanced blood volume between recipients and donors. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Aim: Incarcerated gravid uterus is a rare obstetrical complication that leads to adverse outcomes, especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery. However, there is no consensus regarding the optimal management of this complication because of its rarity. In this study, we aimed to elucidate the incidence of incarcerated gravid uterus, as well as its natural courses and perinatal outcomes. Methods: We retrospectively reviewed medical records of patients who had incarcerated gravid uterus and managed at Osaka City University Hospital between April 2011 and March 2021. Incarcerated gravid uterus was defined as a retroverted or retroflexed uterus after 16 weeks of gestation. Results: There were 14 incarcerated cases among 6958 pregnant women, and 13 of them had some kind of gynecological complication and/or history. Spontaneous resolution of incarcerated gravid uterus after 16 gestational weeks was observed in six cases before the late second trimester and five cases at the late second trimester to early third trimester. Three cases remained incarcerated at term or near-term. One case with adenomyosis had severe abdominal pain, although it was difficult to ascertain whether the cause of pain was triggered by adenomyosis and/or incarceration. One case was misdiagnosed as placenta previa, and the uterine cervix was subsequently injured during cesarean delivery, resulting in massive hemorrhaging. Conclusions: Approximately 1 in 2300 pregnancies continued to be in an incarcerated condition at term or near-term, and 78.5% of cases showed a spontaneous resolution after 16 weeks of gestation. Expectant management with careful attention to the incarcerated gravid uterus may be one option in situations where there are no severe symptoms related to the incarceration itself.

Objective: To investigate time intervals of the ductus venosus (DV) flow velocity waveform (FVW) and those of the cardiac cycle that correspond with each DV‐FVW component in fetuses with intrauterine growth restriction (IUGR) due to placental insufficiency.Methods: Women with a pregnancy complicated by IUGR were recruited into the study, as was a normal control group. Time intervals for systolic (S) and diastolic (D) components were measured in DV‐FVW as follows: S_DV, from the nadir of the a‐wave during atrial contraction to the nadir between the S‐wave and D‐wave; D_DV, from the nadir between S‐wave and D‐wave to the nadir of the a‐wave. Regarding cardiac cycles, the following variables were measured from ventricular inflow through the tricuspid valve (TV) and mitral valve (MV): S_TV and S_MV, from the second peak of ventricular inflow caused by atrial contraction (A‐wave) to the opening of the atrioventricular valve; D_TV and D_MV, from the opening of the atrioventricular valve to the peak of the A‐wave. In the IUGR group, only the last examination performed within 1 week of delivery was used for analysis. All variables were analyzed statistically using Z‐scores.Results: Data were obtained from 249 normal fetuses and 26 fetuses with IUGR. Compared to normal fetuses, S_DV showed a significant decrease (P < 0.001), while D_DV showed a significant increase (P < 0.001) in the IUGR group. Regarding cardiac cycles, S_TV and S_MV showed significant decreases (P = 0.014 and P < 0.001, respectively) and D_TV and D_MV showed significant increases (P = 0.008 and P = 0.002, respectively) in fetuses with IUGR.Conclusion: Time‐interval alterations of DV‐FVW in growth‐restricted fetuses reflect the hemodynamic events caused by placental insufficiency. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.