Abstract Objective: We aimed to preliminarily assess whether low-dose aspirin（LDA）is beneficial in preventing preeclampsia in twin pregnancies. Design: An observational cohort study. Setting: Two hospital centers in Chongqing, China. Population: 932 twin-pregnant women. Methods: Among 932 participants, 277 in the First Affiliated Hospital of Chongqing Medical University were routinely treated with aspirin (100mg daily) from 12-16 weeks to 35 weeks of gestational age, while 655 in Chongqing Health Center for Women and Children were not taking aspirin during the whole pregnancy. We followed each subject and the individual details were recorded. Main Outcome Measures: The main outcome was to compare the incidence of preeclampsia in women with or without aspirin intaking. Results: LDA significantly reduced the risk of PE (OR: 0.48, 95% CI: 0.24-0.95, p=0.048) and ＜34 weeks preterm birth (OR: 0.50, 95% CI: 0.29-0.86, p=0.013), but showed possible benefits to lower the rate of SGA babies (OR: 0.74, 95% CI: 0.55-1.00, p=0.063). Moreover, the risk of postpartum hemorrhage was not increased by LDA (OR: 0.89, 95% CI: 0.35-2.26, p=1.000). Conclusions: Treatment with low-dose aspirin in women pregnant with twins could offer some protection against adverse pregnancy outcomes in the absence of any significantly increased risk of postpartum hemorrhage. Funding: The National Key Research and Development Program of China (2018YFC1002900), and National Natural Science Foundation of China (81520108013, 81771613, 81671488, 81871189). Keywords: Twin pregnancy, low-dose aspirin, preeclampsia, preterm birth, small for gestational age

Ultrasound-detected structural anomalies have an impact on fetal mortality and morbidity. Prenatal Exome Sequencing is incorporated into clinical care pathways for paediatric populations but maybe used to delineate the prognosis of fetal structural anomalies. This paper reviews the literature defining the clinical utility of prenatal ES and discusses the potential promise and challenges for implementation of this technology into clinical practice. Prospective case selection with accurate and informative pre-test counselling by multidisciplinary, clinical genetic-led teams is imperative. Robust, regulated laboratory sequencing, informative bioinformatic pathways with variant identification and conservative matching with the phenotype (within clinical review panels) is also important.

Objective: report maternal, fetal and neonatal complications associated with single intrauterine fetal death (sIUFD) in monochorionic twin pregnancies Design: prospective observational study Setting: UK Population: 81 monochorionic twin pregnancies with sIUFD after 14 weeks gestation, irrespective of cause Methods: UKOSS reporters submitted data collection forms using data from hospital records. Main outcome measures: aetiology of sIUFD; surviving co-twin outcomes: perinatal mortality, central nervous system (CNS) imaging, gestation and mode of delivery, neonatal outcomes; post-mortem findings; maternal outcomes. Results: The commonest aetiology was twin-twin transfusion syndrome (38/81, 47%), “spontaneous” sIUFD (22/81, 27%) was second commonest. Death of the co-twin was common (10/70, 14%). Preterm birth (<37 weeks gestation) was the commonest adverse outcome (77%): half were spontaneous and half iatrogenic. Only 46/75 (61%) cases had antenatal CNS imaging, of which 33 cases had known results of which 7/33 (21%) had radiological findings suggestive of neurological damage. Postnatal CNS imaging revealed an additional 7 babies with CNS abnormalities, all born at <36 weeks, including all 4 babies exhibiting abnormal CNS signs. Major maternal morbidity was relatively common, with 6% requiring ITU admission, all related to infection. Conclusions: Monochorionic twin pregnancies with single IUD are complex and require specialist care. Further research is required regarding optimal gestation at delivery of the surviving co-twin, preterm birth prevention, and classifying the cause of death in twin pregnancies. Awareness of the importance of CNS imaging, and follow-up, needs improvement.

Background: Since the declaration of the global pandemic of COVID-19 by the World Health Organization on March 11, 2020; we have continued to see a steady rise in the numbers of people infected by SARS-CoV-2. However, there is still very limited data on the course and outcomes of this serious infection in a vulnerable population of pregnant patients and their fetuses. International perinatal societies and institutions including SMFM, ACOG, RCOG, ISUOG, CDC, CNGOF, ISS/SIEOG and CatSalut have released guidelines for the care of these patients. Objectives: We aim to summarize these current guidelines in a comprehensive review for patients, healthcare workers and healthcare institutions. Search Strategy: A literature search was performed through PubMed, and direct review of professional society’s website and journal publications. A total of 15 papers were identified from 10 societies and reviewed by two authors who were in agreement. Selection Criteria: The most updated guideline including information on antepartum, intrapartum and postpartum care put forth by each society was included. Data Collection and Analysis: Data specific to antepartum, intrapartum, and postpartum were abstracted from the publications and summarized into tables 2, 3 and 4 respectively. Main Results: The summary of guidelines for management of COVID-19 in pregnancy across different perinatal societies is consistent, with some variation in the strength of recommendations. Conclusions: It is important to recognize that these guidelines are frequently updated, as we continue to learn more about the course and impact of COVID-19 in pregnancy. The references to access all these guidelines are provided.