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Sample records for twin pregnancies review

  1. Twin pregnancy

    DEFF Research Database (Denmark)

    Sperling, Lene; Tabor, A

    2001-01-01

    Determination of chorionicity is one of the most important issues in the management of twin pregnancy. Modern ultrasound equipment has made it possible to accurately assess placentation already in the first trimester with the lambda sign. With regard to prenatal diagnosis, it is important to know...... for clinicians caring for twin pregnancies....

  2. Fetal Behavior and Heart Rate in Twin Pregnancy : A Review

    NARCIS (Netherlands)

    Tendais, Iva; Visser, Gerard H. A.; Figueiredo, Barbara; Montenegro, Nuno; Mulder, Eduard J. H.

    2013-01-01

    Fetal movements and fetal heart rate (FHR) are well-established markers of fetal well-being and maturation of the fetal central nervous system. The purpose of this paper is to review and discuss the available knowledge on fetal movements and heart rate patterns in twin pregnancies. There is some evi

  3. A short review of twin pregnancy and how oxytocin receptor expression may differ in multiple pregnancy.

    Science.gov (United States)

    Turton, Peter; Neilson, James P; Quenby, Siobhan; Burdyga, Theodor; Wray, Susan

    2009-05-01

    During a multiple pregnancy, the mother and her fetuses are exposed to a variety of risks during both pregnancy and labour. The most notable of these risks is that of pre-term labour and its associated sequelae. Whilst much research has been directed towards understanding the mechanisms of uterine contractility, very little research has focussed on how contractility in multiple pregnancy differs from contractility in the singleton pregnancy. The aim of this paper is to review the changing prevalence and risks of a twin pregnancy, as well as reviewing what is known about myometrium from multiple pregnancies. The paper ends by discussing how oxytocin receptor expression may differ in twin pregnancy, based on the evidence of animal models, as well as presenting our own evidence of how oxytocin affects myometrium from twin pregnancies. We highlight the lack of the basic information needed to characterize human myometrium in twin pregnancies. Of particular note is the lack of supporting data for the hypothesis that stretch is responsible for earlier activation of the uterus in multiple pregnancy. New hypotheses based on increased experimental work are called for. Such information may throw light on specific mechanisms leading to the increased incidence of pre-term delivery in twins.

  4. Prospective Risk of Stillbirth and Neonatal Complications in Twin Pregnancies : Systematic Review and Meta-analysis

    NARCIS (Netherlands)

    Cheong-See, Fiona; Schuit, Ewoud; Arroyo-Manzano, David; Khalil, Asma; Barrett, Jon; Joseph, K. S.; Asztalos, Elizabeth; Hack, Karien; Lewi, Liesbeth; Lim, Arianne; Liem, Sophie; Norman, Jane E.; Morrison, John; Combs, C. Andrew; Garite, Thomas J.; Maurel, Kimberly; Serra, Vicente; Perales, Alfredo; Rode, Line; Worda, Katharina; Nassar, Anwar; Aboulghar, Mona; Rouse, Dwight; Thom, Elizabeth; Breathnach, Fionnuala; Nakayama, Soichiro; Russo, Francesca Maria; Robinson, Julian N.; Dodd, Jodie M.; Newman, Roger B.; Bhattacharya, Sohinee; Tang, Selphee; Mol, Ben Willem J; Zamora, Javier; Thilaganathan, Basky; Thangaratinam, Shakila

    2017-01-01

    Twin pregnancies are at increased risk of stillbirth. Uncomplicated twin pregnancies are commonly delivered earlier to prevent stillbirth; however, there is a risk of neonatal complications associated with being born prior to 39 weeks’ gestation. The optimal gestational age for delivery in twin

  5. Twin pregnancies in the Niger Delta of Nigeria: a four-year review

    Directory of Open Access Journals (Sweden)

    Ibrahim I

    2012-05-01

    Full Text Available Isa Ibrahim,1 Abisoye Oyeyemi,2 Abhulimen Obilahi21Department of Obstetrics, 2Epidemiology Division, Department of Public Health, Ministry of Health, Bayelsa State, NigeriaBackground: The female is programmed to nurture one fetus and to take care of one neonate at a time; hence, twin pregnancy is associated with an increased risk of preterm deliveries, perinatal morbidity, and mortality and maternal complications. This study aimed to determine the twinning rate, and maternal and fetal outcomes of all twin pregnancies managed at the Niger Delta University Teaching Hospital Okolobiri.Methods: The study is a 4-year descriptive retrospective evaluation of twin pregnancies managed at the Niger Delta University Teaching Hospital Okolobiri. Records of all pregnancies, booked and unbooked, managed from January 1, 2007 to December 31, 2010 were reviewed. Details of delivery and maternal and fetal outcomes were obtained using a pro forma designed for the study. Epi Info version 3.5.3 was used for statistical analysis. The Chi-square test was used to test for associations between variables. The level of significance was set at P ≤ 0.05.Results: A total of 1341 deliveries including 41 cases of twin deliveries were recorded during the study period, giving an incidence of 30.6/1000. Twenty-nine (70.7% of the patients were unbooked. The mean gestational age was 33.3 ± 2.6 weeks, and the mean fetal weight was 2.34 ± 0.54 kg. There were 13 perinatal deaths, with a perinatal mortality rate of 158.5/1000. There was no association between booking status and perinatal mortality rate (χ2 = 0.017, P = 1.000. Prematurity was the chief cause of perinatal death (65.4%. Maternal morbidities included anemia, wound infection, and genital sepsis. There were no maternal deaths.Conclusion: The twinning rate was high. There was a high perinatal mortality rate, with prematurity accounting for most of the mortality. There is a need for improved incubation/neonatal care for

  6. Hypertensive disorders in twin pregnancy

    NARCIS (Netherlands)

    J.G. Santema (Job); E. Koppelaar (Elin); H.C.S. Wallenburg (Henk)

    1995-01-01

    textabstractObjective: To compare the incidence and severity of pregnancy-induced hypertensive disorders in twin pregnancy and in singleton gestation. Study design: Case-control study in the setting of a University Hospital. Each pregnancy of a consecutive series of 187 twin pregnancies attending th

  7. Maternal nutrition in twin pregnancy.

    Science.gov (United States)

    Campbell, D M; MacGillivray, I; Tuttle, S

    1982-01-01

    Energy and protein intake as measured by 24-hour urinary nitrogen values are similar in twin and singleton pregnancies. The relationship between urinary nitrogen and nitrogen intake is equally significant in twin and singleton pregnancies. Dietary zinc, copper, and iron are not different in women with twins, nor are the levels of these elements in plasma. These observations are surprising in view of the extra fetal demands on the mother and the different adaptation of twin pregnancies.

  8. Twin Pregnancy with Hydatidiform Mole and Coexisting Fetus: Report of Three Cases and Review of Literature

    Directory of Open Access Journals (Sweden)

    Fariba Yarandi

    2009-03-01

    Full Text Available A twin pregnancy with a coexisting complete hydatidiform mole and a healthy fetus (CMCF is rare. Here we report three cases of CMCF with different clinical courses but similar outcome without a surviving neonate. Two women required uterine evacuation before 20 weeks of gestational age because of vaginal bleeding and medical complications and the other patient underwent termination of her pregnancy at 24 weeks of gestation due to severe pre-eclampsia. The pathologic diagnosis of complete hydatidiform mole was confirmed in each case and the chromosome complement was 46XX in two molar gestations and 46XY in one gestation. One of the three women required chemotherapy for treatment of low-risk gestational trophoblastic disease. The hCG level was normalized after 4 cycles and the patient was free of disease at 1 year follow-up. Review of the literature discussing the diagnostic tools, clinical features, management and outcome of pregnancies with CMCF are presented.

  9. Nutrition in twin pregnancy.

    Science.gov (United States)

    MacGillivray, I

    1979-01-01

    The urinary nitrogen output appears to be related to both protein and energy intake, so that women having heavier babies probably eat more, although this may simply mean that they are larger women. Women with twin pregnancies have been found to have a lesser urinary nitrogen output, but it seems unlikely that this be due to lower intakes. They might simply utilize their diet more efficiently--a hypothesis that is now being tested.

  10. Hypertensive disorders in twin pregnancy

    OpenAIRE

    Santema, Job; Koppelaar, Elin; Wallenburg, Henk

    1995-01-01

    textabstractObjective: To compare the incidence and severity of pregnancy-induced hypertensive disorders in twin pregnancy and in singleton gestation. Study design: Case-control study in the setting of a University Hospital. Each pregnancy of a consecutive series of 187 twin pregnancies attending the antenatal clinic and booked before a gestational age of 24 weeks was matched for maternal age, parity, and gestational age at delivery with a singleton pregnancy delivered in the same year. Prima...

  11. Both babies with sirenomelia' in twin pregnancy: a case report and review of literature

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    Soham Chowdhury

    2015-06-01

    Full Text Available Sirenomelia, also called as and lsquo;Mermaid syndrome', is a rare congenital malformation of uncertain aetiology. It is characterised by fusion of the lower limbs and commonly associated with severe urogenital and gastrointestinal malformation. We report a case of twin pregnancy with both babies had sirenomelia. No previous case of and lsquo;both babies with sirenomelia' in twin pregnancy has been reported till date. [Int J Reprod Contracept Obstet Gynecol 2015; 4(3.000: 908-910

  12. Optimal nutrition for improved twin pregnancy outcome.

    Science.gov (United States)

    Goodnight, William; Newman, Roger

    2009-11-01

    Twin pregnancies contribute a disproportionate degree to perinatal morbidity, partly because of increased risks of low birth weight and prematurity. Although the cause of the morbidity is multifactorial, attention to twin-specific maternal nutrition may be beneficial in achieving optimal fetal growth and birth weight. Achievement of body mass index (BMI)-specific weight gain goals, micronutrient and macronutrient supplementation specific to the physiology of twin gestations, and carbohydrate-controlled diets are recommended for optimal twin growth and pregnancy outcomes. The daily recommended caloric intake for normal-BMI women with twins is 40-45 kcal/kg each day, and iron, folate, calcium, magnesium, and zinc supplementation is recommended beyond a usual prenatal vitamin. Daily supplementation of docosahexaenoic acid and vitamin D should also be considered. Multiple gestation-specific prenatal care settings with a focus on nutritional interventions improve birth weight and length of gestation and should be considered for the care of women carrying multiples. Antepartum lactation consultation can also improve the rate of postpartum breastfeeding in twin pregnancies. Twin gestation-specific nutritional interventions seem effective in improving the outcome of these pregnancies and should be emphasized in the antepartum care of multiple gestations. This review examines the available evidence and offers recommendations for twin pregnancy-specific nutritional interventions.

  13. Case of twin pregnancy complicated by idiopathic thrombocytopenic purpura treated with intravenous immunoglobulin: Review of the literature.

    Science.gov (United States)

    Zhao, W X; Yang, X F; Lin, J H

    2017-01-01

    Idiopathic thrombocytopenic purpura (ITP) is an acquired thrombocytopenia without other clear cause of thrombocytopenia. It is not common in a singleton pregnancy and less common in twin pregnancy. We report a 33-year-old ITP pluripara whose first pregnancy was uneventful. She carried twin pregnancy, complicated by recurrent very low platelets, and gave birth to preterm twins. This patient received multiple courses of intravenous immunoglobulin (IVIG) and showed a significant platelet count improvement with IVIG therapy.

  14. Conservative treatment for interstitial monochorionic twin pregnancy: case report and review of the published work.

    Science.gov (United States)

    Berretta, Roberto; Merisio, Carla; Dall'Asta, Andrea; Verrotti, Carla; Rolla, Martino; Bruni, Stefano; Bacchi Modena, Alberto

    2014-03-01

    Interstitial pregnancy is considered one of the most hazardous types of ectopic pregnancies, with a mortality rate of 2-2.5%. We describe a case of a viable monochorionic twin pregnancy in a 35-year-old woman successfully treated with systemic methotrexate associated with bilateral uterine arteries' embolization. β-hCG was undetectable 67 days after the first administration of methotrexate and the ultrasonography performed on day 67 showed the remnant of the gestational sac in the right uterine horn, a thin endometrium and a normal myometrial vascularization. Conservative treatment allowed us to avoid surgical treatment and to preserve the patient's fertility.

  15. Monochorionic twin pregnancies

    NARCIS (Netherlands)

    Hack, K.E.A.

    2008-01-01

    Following widespread application of assisted reproductive technology modalities and the increased age of motherhood, the incidence of twin gestations has increased markedly. Twins are either monozygotic or dizygotic. Dizygotic (i.e. fraternal) twins result from the fertilization of two different egg

  16. CONSERVATIVE MANAGEMENT OF TWIN PREGNANCY WITH SINGLE FETAL DEATH

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective. Analysis of the cause of intrauterine death of one fetus of twin and to evaluate the outcome of conservative management of twin pregnancy with single fetal death.Method.A retrospective review was undertaken on PUMC hospital records of women who delivered twin between Jan. 1987 and Dec. 1998.Result.During the recent 12 years, 99 pregnant women were documented as twin pregnancies. Of the twin pregnancies during this period, 13 were complicated by a single intrauterine death. Four women suffered this complication during their first trimester. In the remain 9 cases one fetus died during second or third trimester. The cesarean section was given in three pregnant women soon after a single intrauterine death because of the survival fetal distress. No consumptive coagulopathy was apparent in all 13 pregnant women. It is wise that the pregnancy was managed conservatively, with regular coagulation parameters obtained.Conclusion.Our results support conservative management in twin pregnancies complicated by single fetal death.

  17. CONSERVATIVE MANAGEMENT OF TWIN PREGNANCY WITH SINGLE FETAL DEATH

    Institute of Scientific and Technical Information of China (English)

    刘俊涛; 杨佳欣; 边旭明; 张羽

    2000-01-01

    Objective. Analysis of the cause of intrauterine death of one fetus of twin and to evaluate the outcome of conservative management of twin pregnancy with single fetal death. Method. A retrospective review was undertaken on PUMC hospital records of women who delivered twin between Jan. 1987 and Dec. 1998. Result. During the recent 12 years, 99 pregnant women were documented as twin pregnancies. Of the twin pregnancies during this period, 13 were complicated by a single intrauterine death. Four women suffered this complication during their first trimester. In the remain 9 cases one fetus died dm-ing second or third trimester.The cesarean section was given in three pregnant women soon after a single intrauterine death because of the survival fetal distress. No consumptive coagulopathy was apparent in all 13 pregnant women. It is wise that the pregnancy was managed conservatively, with regular coagulation parameters obtained. Condosion. Our results suptmrt conservative management in twin pregnancies complicated by single fetal death.

  18. Monochorionic and dichorionic twin pregnancies discordant for fetal anencephaly: a systematic review of prenatal management options.

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    Lust, Annelies; De Catte, Luc; Lewi, Liesbeth; Deprest, Jan; Loquet, Philippe; Devlieger, Roland

    2008-04-01

    The aim of this study was to evaluate the effect of selective feticide (SF) compared to expectant management (EM) on perinatal outcome in dichorionic and monochorionic twins discordant for anencephaly. For this purpose, we conducted a systematic review of literature and added ten unpublished cases. As a result, we found that in dichorionic twins, mean gestational age (GA) at birth in the SF group was 38.0 weeks versus 34.9 weeks (P = 0.0002). Mean birth weight was 2922 g in the SF group versus 2474 g (P = 0.03). In monochorionic twins, mean GA at birth was 35.2 weeks versus 32.7 weeks (P = 0.1). Mean birth weight was 2711 g versus 1667 g (P = 0.0001). We conclude that while SF does not reduce perinatal mortality, it does result in significantly longer gestations and higher birth weight, and appears to be the management of choice in dichorionic twins discordant for anencephaly. In monochorionic twins, SF also increases birth weight, but in view of the complexity of this group, no clear recommendations can be made.

  19. Amelia in Twin Pregnancy

    Directory of Open Access Journals (Sweden)

    Davari Tanha Fatemeh

    2009-04-01

    Full Text Available Limb bud first appears during the third week of gestation with the upper limb buds appearing a few days before the lower limb buds. Complete absence of one or more limbs, called Amelia, occurs prior to the eighth week of gestation. We report a case of Amelia in a twin gestation.

  20. Prospective risk of stillbirth and neonatal complications in twin pregnancies

    DEFF Research Database (Denmark)

    Cheong-See, Fiona; Schuit, Ewoud; Arroyo-Manzano, David

    2016-01-01

    OBJECTIVE: To determine the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, and Cochrane databases (until December 2015). REVIEW METHODS: ...

  1. TWIN PREGNANCY WITH ACARDIUS ANCEPS

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    Padma

    2014-02-01

    Full Text Available Acardiac twin is an anomaly unique to monochorionic multiple pregnancies, characterized by formation of malformed fetus with an absent or rudimentary (nonfunctional heart. Acardiac twinning, often results from abnormal placental vascular anastomoses. A 20 year old primigravida admitted to the department of Obstetrics and Gynecology S .S. Medical College, Rewa, on 26th July 2012 at the gestation of 34 week with spontaneous monochorionic monoamniotic twin pregnancy and fetal acardius with oligohydramnios. Patient was taking her treatment from private Hospital; acardius was diagnosed at 27 week due to late booking. In view of oligohydramnios and hypoxic changes in color Doppler, elective LSCS was done on 28/7/13 at 34 week 2 day, after betnesol coverage. She delivered a live, healthy, female child with good APGAR score having apparently no congenital anomaly, with a birth weight of 2.3 kg .The other twin was fetus acardius, of about900 gm. with head and face partially developed . Upper limb was rudimentary and lower limb was partially developed and malformed. External genitalia were developed as female. Placenta was monochorionic and monoamniotic, weighing500 gm. The umbilical cord of the normal twin was20 cm with central attachment, while the other umbilical cord was10 cm long with peripheral attachment

  2. Do assisted-reproduction twin pregnancies require additional antenatal care?

    Science.gov (United States)

    Jauniaux, E; Ben-Ami, I; Maymon, R

    2013-02-01

    Iatrogenic twinning has become the main side-effect assisted reproduction treatment. We have evaluated the evidence for additional care that assisted-reproduction twins may require compared with spontaneous twins. Misacarriages are increased in women with tubal problems and after specific treatments. Assisted-reproduction twin pregnancies complicated by a vanishing twin after 8 weeks have an increased risk of preterm delivery and of low and very low birthweight compared with singleton assisted-reproduction pregnancies. Monozygotic twin pregnancies occur at a higher rate after assisted reproduction treatment and are associated with a higher risk of perinatal complications. The incidence of placenta praevia and vasa praevia is increased in assisted-reproduction twin pregnancies. Large cohort studies do not indicate a higher rate of fetal congenital malformations in assisted-reproduction twins. Overall, assisted-reproduction twins in healthy women assisted-reproduction twins is only increased in women with a pre-existing medical condition such as hypertensive disorders and diabetes and most of these risks can be avoided with single-embryo transfer. Following the birth of the first IVF baby, rumours started to spread in both the medical literature and the media about the long-term health effects for children born following assisted reproduction treatment. However, after more than 30 years, the most common complications associated with IVF treatment remain indirect and technical such as the failure of treatment and ovarian hyperstimulation. Iatrogenic twinning has become the main side-effect of assisted reproduction treatment and the increasing number of twin pregnancies, in particular in older women, has generated numerous debates on the need for additional healthcare provision. In this review, we have evaluated the evidence for additional care that assisted-conception twin pregnancies may require compared with spontaneous twin pregnancies. Twin pregnancies are

  3. [The diagnostic algorithm in twin pregnancy].

    Science.gov (United States)

    Ropacka-Lesiak, Mariola; Szaflik, Krzysztof; Breborowicz, Grzegorz H

    2015-03-01

    This paper presents the diagnostic algorithm in twin pregnancy. The most important sonographic parameters in the assessment of twins have been discussed. Moreover, the most significant complications of twin pregnancy as well as diagnostic possibilities and management, have been also presented and defined.

  4. Fetal Cholelithiasis: Antenatal Diagnosis and Neonatal Follow-Up in a Case of Twin Pregnancy – A Case Report and Review of the Literature

    Science.gov (United States)

    Hurni, Yannick; Vigo, Francesco; von Wattenwyl, Begoña Lipp; Ochsenbein, Nicole; Canonica, Claudia

    2017-01-01

    Fetal cholelithiasis is a rare finding during a third-trimester ultrasound with an average incidence rate of 0.07–1.15%. We report a case of fetal cholelithiasis in twins, observed in a patient with monochorionic diamniotic twin pregnancy hospitalized at our unit for signs of premature labor. We present the outcome of the 2 neonates with a clinical and sonographic follow-up. In addition, we offer a comprehensive review of the literature available to date. PMID:28210714

  5. Invasive treatment in complicated monochorionic twin pregnancies

    DEFF Research Database (Denmark)

    Sundberg, Karin; Søgaard, Kirsten; Jensen, Lisa Neerup;

    2012-01-01

    Objective. Monochorionic twin pregnancies are associated with increased risk of severe complications. Umbilical cord occlusion (UCO) and fetoscopic selective laser coagulation (FSLC) are used as invasive treatment. The study aim was to document treatment indications and pregnancy outcome where UCO...... and FSLC were used for treating fetal discrepancies and twin-to-twin transfusion syndrome (TTTS). Design. Cohort study of all consecutively treated monochorionic twin pregnancies 2004-2010. Setting. Tertiary care center. Population. One hundred and twenty pregnancies treated by FSLC (55) or UCO (65...

  6. [Twin pregnancy with complete hydatiform mole and coexistent fetus: Report of 4 cases and review of literature].

    Science.gov (United States)

    de Marcillac, F; Akladios, C Y; Hui-bon-hoa, I; Fritz, G; Nisand, I; Langer, B

    2015-11-01

    Twin pregnancy with complete hydatiform mole and coexistent fetus is a rare clinical condition, occurring in 1 in 22,000 to one in 100,000 pregnancies. Continuation of pregnancy in these cases is controversial because of a high risk of immediate and long-term maternal morbidity. It allows, however, in 33 % of the case the delivery of a healthy child. This retrospective study included all patients presenting a complete hydatiform mole coexisting with a live twin fetus antenatally diagnosed between 2007 and 2012 in the level III maternity of the Strasbourg University Hospital. Informations concerning diagnostic circumstances, pregnancy follow-up and outcome were studied. Four pregnancies were included in the study, all of them were spontaneous. Medical termination of pregnancies was related to maternal reasons in the four cases. One before 17 weeks of gestation, the three other after 2 weeks of gestation, leading to delivery of a healthy child. All patients developed a mild to severe preeclampsia. One patient developed a gestational trophoblastic disease, requiring chemotherapy by methotrexate. There was no fatal evolution. Twin pregnancy with complete hydatifom mole and coexistent fetus is associated with increased risk of gestational trophoblastic disease. This risk is not increased by continuation of pregnancy. In case of prenatal diagnosis of complete hydatiform mole coexisting with a live twin fetus, patients should be aware of the potential high risk of morbidity and a regular follow-up during and after the pregnancy should be intaured. In absence of maternal complications, continuation of the pregnancy is possible. Copyright © 2015. Published by Elsevier Masson SAS.

  7. Complications arising in twin pregnancy: findings of prenatal ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeong Ah; Cho, Jeong Yeon; Lee, Young Ho; Song, Mi Jin; Min, Jee Yeon; Lee, Hak Jong; Han, Byoung Hee; Lee, Kyung Sang; Cho, Byung Jae; Chun, Yi Kyeong [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2003-03-01

    Multifetal gestations are high-risk pregnancies involving higher perinatal morbidity and mortality, and are subject to unique complications including twin oligohydramnios- polyhydramnios sequence, twin-to-twin transfusion syndrome, acardiac twins, conjoined twins, co-twin demise, and heterotopic pregnancies. The purpose of this study is to describe the prenatal ultrasonographic and pathologic findings of these complications.

  8. Observed Rate of Down Syndrome in Twin Pregnancies.

    Science.gov (United States)

    Sparks, Teresa N; Norton, Mary E; Flessel, Monica; Goldman, Sara; Currier, Robert J

    2016-11-01

    To evaluate the observed incidence of Down syndrome in twins compared with that expected based on maternal age-matched singletons, which is the current clinical approach. This was a retrospective review of California Prenatal Screening Program participants with expected delivery dates between July 1995 and December 2012. Cases confirmed prenatally or postnatally with a genetic imbalance leading to phenotypic Down syndrome (trisomy 21, mosaic trisomy 21, or translocations) were included. Pregnancies conceived with ovum donation and women older than 45 years were excluded. We compared the observed Down syndrome incidence per pregnancy for twins with expected incidence by extrapolating from singleton data and expected zygosity as is the current clinical approach. This extrapolation assumes that monozygotic pregnancies have equivalent Down syndrome risk per pregnancy relative to maternal age-matched singletons and dizygotic pregnancies have twice the risk of at least one affected fetus. Zygosity for affected cases was presumed to be monozygotic with Down syndrome concordance and dizygotic with Down syndrome discordance. Counts were compared using cumulative Poisson distributions. Of 77,279 twin pregnancies, 182 (0.2%) had at least one fetus with Down syndrome confirmed by karyotype. The ratio of observed-to-expected Down syndrome incidence per pregnancy was 33.6%, 75.2%, and 70.0% for monozygotic, dizygotic, and all twins, respectively (PDown syndrome incidence was seen for women aged 25 to 45 years with monozygotic pregnancies and overall for women aged 25 to 45 years with dizygotic pregnancies. The observed incidence of Down syndrome in twin pregnancies is lower than expected, most notably for monozygotic pregnancies and with increasing maternal age. Risk-based counseling can strongly affect women's choices regarding testing and management during pregnancy, so an understanding of the true Down syndrome risk in twin gestations is crucial.

  9. Diabetes and perinatal mortality in twin pregnancies.

    Directory of Open Access Journals (Sweden)

    Zhong-Cheng Luo

    Full Text Available BACKGROUND: Diabetes in pregnancy has been associated with a paradoxically reduced risk of neonatal death in twin pregnancies. Risk "shift" may be a concern in that the reduction in neonatal deaths may be due to an increase in fetal deaths (stillbirths. This study aimed to clarify the impact of diabetes on the risk of perinatal death (neonatal death plus stillbirth in twin pregnancies. METHODS: This was a retrospective cohort study of twin births using the largest available dataset on twin births (the U.S. matched multiple birth data 1995-2000; 19,676 neonates from diabetic pregnancies, 541,481 from non-diabetic pregnancies. Cox proportional hazard models were applied to estimate the adjusted hazard ratios (aHR of perinatal death accounting for twin cluster-level dependence. RESULTS: Comparing diabetic versus non-diabetic twin pregnancies, overall perinatal mortality rate was counterintuitively lower [2.1% versus 3.3%, aHR 0.70 (95% confidence intervals 0.63-0.78]. Individually, both stillbirth and neonatal mortality rates were lower in diabetic pregnancies, but we identified significant differences by gestational age and birth weight. Diabetes was associated with a survival benefit in pregnancies completed before 32 weeks [aHR 0.55 (0.48-0.63] or with birth weight =2500 g [aHR 2.20 (1.55-3.13]. CONCLUSIONS: Diabetes in pregnancy appears to be "protective" against perinatal death in twin pregnancies ending in very preterm or very low birth weight births. Prospective studies are required to clarify whether these patterns of risk are real, or they are artifacts of unmeasured confounders. Additional data correlating these outcomes with the types of diabetes in pregnancy are also needed to distinguish the effects of pre-gestational vs. gestational diabetes.

  10. Oliver Sacks: Our Correspondence About Twins/Twin Research: Vanishing Twins Syndrome; Discordant Sex in MZ Twins; Pregnancy Outcomes in IVF and ICSI Conceived Twins/Print and Media: Superfetated Twins; Twins Discordant for Smoking; Twins in Fashion; Yale University Twin Hockey Players; Conjoined Twin-Visiting Professor.

    Science.gov (United States)

    Segal, Nancy L

    2017-08-01

    The late neurologist and author, Oliver Sacks, published an insightful 1986 review of Marjorie Wallace's book, The Silent Twins, in the New York Times. Taking exception to his assertion about Sir Francis Galton, I wrote a letter to the Times' editor. The letter was unpublished, but it brought a wonderful response from Sacks himself that is reproduced and examined. Next, brief reviews of twin research concerning the vanishing twin syndrome (VTS), discordant sex in a monozygotic (MZ) twin pair, and multiple pregnancy outcomes from assisted reproductive technology (ART) are presented. This section is followed by popular coverage of superfetated twins, smoking-discordant co-twins, twins in fashion, Yale University twin hockey players, and a visiting professor who was a conjoined twin.

  11. Prevention of preterm delivery in twin pregnancy.

    Science.gov (United States)

    Rode, Line; Tabor, Ann

    2014-02-01

    The incidence of twin gestation has increased markedly over the past decades, mostly because of increased use of assisted reproductive technologies. Twin pregnancies are at increased risk of preterm delivery (i.e. birth before 37 weeks of gestation). Multiple gestations therefore account for 2-3% of all pregnancies but constitute at least 10% of cases of preterm delivery. Complications from preterm birth are not limited to the neonatal period, such as in retinopathy of prematurity, intraventricular haemorrhage, necrotising enterocolitis, respiratory disorder and sepsis; they can also constitute sequelae such as abnormal neurophysiological development in early childhood and underachievement in school. Several treatment modalities have been proposed in singleton high-risk pregnancies. The mechanism of initiating labour may, however, be different in singleton and twin gestations. Therefore, it is mandatory to evaluate the proposed treatments in randomised trials of multiple gestations. In this chapter, we describe the results of trials to prevent preterm delivery in twin pregnancies.

  12. Perinatal outcomes with intrahepatic cholestasis of pregnancy in twin pregnancies.

    Science.gov (United States)

    Liu, Xiaohua; Landon, Mark B; Chen, Yan; Cheng, Weiwei

    2016-01-01

    To describe perinatal outcomes of twin pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP). We conducted a retrospective cohort study of women delivered at a large tertiary obstetric center in Shanghai, China from January 2006 to May 2014. Delivery data were abstracted from medical records of all twin gestations delivered at the hospital. A total of 129/1922(6.7%) twin and 1190/92 273 singleton (1.3%) pregnancies were complicated by ICP. An increased risk of stillbirth among twin pregnancies was observed (3.9% and 0.8% in the ICP and non-ICP groups, respectively; aOR 5.75, 95% CI 2.00-16.6). Stillbirths with ICP and twins occurred between 33 and 35 weeks gestation compared to 36-38 weeks gestation among singletons. ICP in twins was also associated with an increased risk of preterm birth (pregnancies complicated by ICP also had increased meconium staining of amniotic fluid and lower birth weight. Twin pregnancies with ICP have significantly increased risks of adverse perinatal outcomes including stillbirth and preterm birth. Stillbirth occurs at an earlier gestational age in twin gestation compared to singletons, suggesting that earlier scheduled delivery should be considered in these women.

  13. Cord entanglement in monoamniotic twin pregnancies

    DEFF Research Database (Denmark)

    Lyndrup, J; Schouenborg, Lars Øland

    1987-01-01

    Monoamniotic twin pregnancy involves a heavy risk of fatal umbilical cord entanglement. Two cases are reported. In the first case, both twins were found dead in the 36th week, and the monoamnionicity was recognized at birth. In the second case, the monoamnionicity was discovered during...

  14. Twin tubal pregnancy: A large unruptured ectopic pregnancy.

    Science.gov (United States)

    Goswami, Deepti; Agrawal, Nidhi; Arora, Vrinda

    2015-11-01

    Twin ectopic pregnancy is a rare occurrence, with an estimated incidence of 1 in 20 000 spontaneous pregnancies. We describe a case of unilateral twin ectopic pregnancy in which the gravid fallopian tube showed no signs of tubal rupture despite marked tubal distension. A 25-year-old woman presented with clinical features suggestive of large right-sided tubal ectopic pregnancy. Serum β-human chorionic gonadotropin was 10 800 IU/mL. Laparotomy revealed markedly distended right fallopian tube. There was no hemoperitoneum. The tube contained twin gestational sacs. The crown-rump length of the embryos was 2 cm. The ectopic gestation was thus unique, in that despite marked tubal distension, the trophoblastic invasion was not significant to cause tubal rupture. There may be a role for medical management based on individual gestational sac size in selected cases of twin tubal pregnancy in which there is no evidence of hemoperitoneum.

  15. Hydropic Placenta as a First Manifestation of Twin-Twin Transfusion in a Monochorionic Diamniotic Twin Pregnancy

    NARCIS (Netherlands)

    de Laat, Monique W. M.; Manten, Gwendoline T. R.; Nikkels, Peter G. J.; Stoutenbeek, Philip

    2009-01-01

    Monochorionic twin pregnancies are at a 10% to 1.5% risk of developing twin-twin transfusion syndrome (TTTS).(1) Monitoring such pregnancies is aimed at evaluating the fetal condition by measuring the amount of amniotic fluid, Doppler parameters, and fetal growth. Twin-twin transfusion syndrome may

  16. Hydropic Placenta as a First Manifestation of Twin-Twin Transfusion in a Monochorionic Diamniotic Twin Pregnancy

    NARCIS (Netherlands)

    de Laat, Monique W. M.; Manten, Gwendoline T. R.; Nikkels, Peter G. J.; Stoutenbeek, Philip

    Monochorionic twin pregnancies are at a 10% to 1.5% risk of developing twin-twin transfusion syndrome (TTTS).(1) Monitoring such pregnancies is aimed at evaluating the fetal condition by measuring the amount of amniotic fluid, Doppler parameters, and fetal growth. Twin-twin transfusion syndrome may

  17. Hydropic Placenta as a First Manifestation of Twin-Twin Transfusion in a Monochorionic Diamniotic Twin Pregnancy

    NARCIS (Netherlands)

    de Laat, Monique W. M.; Manten, Gwendoline T. R.; Nikkels, Peter G. J.; Stoutenbeek, Philip

    2009-01-01

    Monochorionic twin pregnancies are at a 10% to 1.5% risk of developing twin-twin transfusion syndrome (TTTS).(1) Monitoring such pregnancies is aimed at evaluating the fetal condition by measuring the amount of amniotic fluid, Doppler parameters, and fetal growth. Twin-twin transfusion syndrome may

  18. Intravenous nutrition during a twin pregnancy.

    Science.gov (United States)

    Karamatsu, J T; Boyd, A T; Cooke, J; Vinall, P S; McMahon, M J

    1987-01-01

    A case is reported of a woman in the third trimester of a twin pregnancy who required intravenous nutrition because of inadequate absorption of nutrients due to a jejunoileal bypass. Weight gain was poor, and there was evidence of intrauterine growth retardation before commencement of intravenous feeding. She received overnight intravenous nutrition for 6 weeks and gained weight with ultrasound evidence of fetal growth. During the 33rd week of gestation, she was delivered of healthy twin males who were at appropriate birth weights and development for their age of gestation. The considerations in intravenous nutrition for a twin pregnancy after jejunoileal bypass are discussed.

  19. The neonatal outcome in twin versus triplet and quadruplet pregnancies

    Directory of Open Access Journals (Sweden)

    Fatemeh Nasseri

    2009-02-01

    Full Text Available

    • BACKGROUND: To assess the risk of neonatal mortality and morbidity in twin, triplet and quadruplet pregnancies.
    • METHODS: In a retrospective study, the neonatal outcome of all twin, triplet and quadruplet gestations delivered from October 2001 to September 2006 was reviewed. The neonatal outcome of triples and quadruplets was compared with a matched group of twins for gestational age.
    • RESULTS: During a 5-year period, 511 sets of twin pregnancies, 42 sets of triplet and 5 sets of quadruplet pregnancies were studied. The mean of gestational age for twins, triplets and quadruplets were 33.92 ± 3.5 weeks, 30.92 ± 3.8 weeks and 31.60 ± 2.0 weeks, respectively, (P = 0.0001. Triplets and quadruplets weighed less than twins, (P = 0.0001. Neonatal mortality was 13.5% for twins, 26.8% for triplets and 30% for quadruplets. In vitro fertilization, use of ovulation induction agents, and cesarean delivery in the women with triplet and quadruplet were significantly higher than in those with twin pregnancies, (P = 0.0001. The mean age of mothers with triplets and quadruplets was significantly higher than with twins (P = 0.026. There was not a significant difference in respiratory and non-respiratory short outcomes between triplets, quadruplets and twins when matched for gestational age. Apgar score at 1 and 5 minutes was significantly lower in triplets and quadruplets than twins. There was no influence of birth order on neonatal mortality of triplet pregnancy. Neonatal mortality of triplet births was significantly decreased over the 5 years of the study period.
    • CONCLUSIONS: Triplets and quadruplets have a similar neonatal outcome as twins when matched for gestational age. There is no influence of birth on the neonatal mortality of triplet pregnancy. It appears that outcome is mainly dependent on gestational age.
    • KEYWORDS: Neonatal

    • Interstitial twin pregnancy: A unique case presentation.

      Science.gov (United States)

      Garretto, Diana; Lee, Lan Na; Budorick, Nancy E; Figueroa, Reinaldo

      2015-09-01

      Early recognition and timely treatment of an interstitial pregnancy is imperative to avoid the high morbidity and mortality of this type of ectopic pregnancy. We report a case of twin interstitial pregnancy that was initially missed on initial sonogram and was subsequently recognized at our institution by transvaginal sonography. The patient underwent open laparoscopic surgery with cornual wedge resection but suffered infundibulopelvic ligament hemorrhage and subsequently required ipsilateral salpingo-oophorectomy. She did well and was discharged home a day later.

  1. Cord entanglement in monoamniotic twin pregnancies

    DEFF Research Database (Denmark)

    Lyndrup, J; Schouenborg, Lars Øland

    1987-01-01

    Monoamniotic twin pregnancy involves a heavy risk of fatal umbilical cord entanglement. Two cases are reported. In the first case, both twins were found dead in the 36th week, and the monoamnionicity was recognized at birth. In the second case, the monoamnionicity was discovered during an ultraso......Monoamniotic twin pregnancy involves a heavy risk of fatal umbilical cord entanglement. Two cases are reported. In the first case, both twins were found dead in the 36th week, and the monoamnionicity was recognized at birth. In the second case, the monoamnionicity was discovered during...... an ultrasound examination, and cord entanglement was suspected in the 35th week on the basis of a non-stress test (NST) with variable decelerations. Cesarean section was performed and two healthy children were delivered....

  2. Prevention of preterm delivery in twin pregnancy

    DEFF Research Database (Denmark)

    Rode, Line; Tabor, Ann

    2014-01-01

    The incidence of twin gestation has increased markedly over the past decades, mostly because of increased use of assisted reproductive technologies. Twin pregnancies are at increased risk of preterm delivery (i.e. birth before 37 weeks of gestation). Multiple gestations therefore account for 2......-3% of all pregnancies but constitute at least 10% of cases of preterm delivery. Complications from preterm birth are not limited to the neonatal period, such as in retinopathy of prematurity, intraventricular haemorrhage, necrotising enterocolitis, respiratory disorder and sepsis; they can also constitute......, it is mandatory to evaluate the proposed treatments in randomised trials of multiple gestations. In this chapter, we describe the results of trials to prevent preterm delivery in twin pregnancies....

  3. Twin pregnancy in the congenital malformed uterus.

    Science.gov (United States)

    Heinonen, Pentti K

    2016-07-01

    The frequency and outcome of twin pregnancies in women with uterine malformation were studied. The cohort comprised 13 (4.9%) women with twin pregnancy found among 263 women. They had 483 deliveries, 13 of them twins (2.7%; 95% CI 1.6-4.6%). Among 38 patients with unicornuate uterus 5 (6.8%) out of 74 deliveries were twins, 39 women with didelphic uterus 2 (3.2%) out of 62 deliveries and 147 women with septate or subseptate uterus 6 (2.3%) out of 264 deliveries were twins. The mean duration of gestation was 249 days (range 190-268 days), 5 (38%) out of 13 deliveries were premature, 25 out of 26 newborns were alive. Mean durations of gestation and mean weights of newborns did not differ when 7 cases with unicornuate or didelphic uterus were compared to 6 cases with complete or partial uterine septum. A congenital malformed uterus can bear twin pregnancy without severe complications apart from prematurity.

  4. Problem in twin pregnancy: Findings of prenatal sonography and autopsy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeong Ah; Cho, Jeong Yeon; Song, Mi Jin; Min, Jee Yeon; Lee, Young Ho; Lee, Hak Jong; Chun, Yi Kyeong; Kim, Yee Jeong; Hong, Sung Ran [Samsung Cheil Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2001-12-15

    Multifetal gestations are high risk pregnancies with higher perinatal morbidity and mortality. Multifetal gestations are subject to unique complications including conjoined twins, twin-to-twin transfusion syndrome (TTTS), acardiac twins, twin embization of co-twin demise and heterotopic pregnancies. Prenatal sonographic diagnosis of types and complications of multifetal gestations is important for antenatal care and prediction of fetal outcome. This study was performed to present the prenatal ultrasonographic findings and pathologic findings of the unique complications of twin pregnancy. Acardia is a lethal anomaly occurring in 1% of monozygotic twin. The acardiac twin has a parasitic existence and depends on the donor (pump) twin for its blood supply via placental anastomoses and retrograde perfusion of umbilical cord. This twin reversed arterial perfusion (TRAP) sequence is a most extreme manifestation on the TTTS. Doppler verification reversed flow in umbilical cord of the acardiac twin confirms the diagnosis.

  5. Pregnancy prognosis associated with an isolated single umbilical artery in twin pregnancy.

    Science.gov (United States)

    Cade, Thomas J; Da Silva Costa, Fabricio; Reidy, Karen; Doyle, Lex W; Mitchell, Sarah E; Palma-Dias, Ricardo; Umstad, Mark P

    2014-12-01

    To determine the prognosis of an isolated single umbilical artery (SUA) in a twin pregnancy, we selected twin pregnancies with a second trimester ultrasound diagnosing a SUA in at least one fetus at our tertiary hospital. This was confirmed by placental histopathology or by expert review of ultrasound images. Cases were identified by searching the hospital ultrasound database over a period of 7.5 years. Higher order multiples or coexistent aneuploidy or major anomalies were excluded. Each case of an isolated SUA was assigned three consecutive twin pregnancy controls paired for chorionicity and maternal age. Primary outcomes were preterm birth <34 weeks, small for gestational age (SGA) or perinatal death. Other outcomes included antenatal growth restriction, mode of delivery, and admission to neonatal intensive care or special care nursery. Nine pregnancies (18 fetuses) were identified for analysis as cases. Isolated SUA was associated with preterm birth <34 weeks (odds ratio = 12.2; 95% CI = 2.0-75.2; p = .005) but not for SGA. There was also no difference in SGA between the affected twin and its normal co-twin. Perinatal death was increased but after controlling for gestational age and clustering this finding was no longer significant. We conclude that isolated SUA in twins adds a degree of risk to an already high-risk pregnancy but does not increase the need for surveillance for growth restriction.

  6. A Rare Localization of Ectopic Pregnancy: Intramyometrial Pregnancy in Twin Pregnancy following IVF

    OpenAIRE

    Lahcen Boukhanni; Yassir Ait Benkaddour; Ahlam Bassir; Abdrahim Aboulfalah; Hamid Asmouki; Abderraouf Soummani

    2014-01-01

    Intramyometrial pregnancy is a rare form of ectopic pregnancy. It makes a diagnostic and therapeutic challenge. If misdiagnosed the intramyometrial pregnancy can cause a uterine rupture and become life-threatening condition. We report a case of intramyometrial pregnancy in twin pregnancy following IVF with spontaneous abortion of the first twin At 9 weeks of gestation. The 10 weeks scan showed a normal fetus which was described to be highly localized in the uterus but the diagnosis of intramy...

  7. 2ND TRIMESTER AMNIOCENTESIS IN TWIN PREGNANCIES - MATERNAL HEMOGLOBIN AS A DYE MARKER TO DIFFERENTIATE DIAMNIOTIC TWINS

    NARCIS (Netherlands)

    BEEKHUIS, [No Value; DEBRUIJN, HWA; VANLITH, JMM; MANTINGH, A

    1992-01-01

    Objective To review the use of a membrane-free haemolysate prepared from maternal blood to distinguish the amniotic sacs at amniocentesis in twin gestation. Setting University Hospital, Groningen. Method Haemoglobin solution prepared from maternal blood. Subjects 63 twin pregnancies having amniocent

  8. [Gestational diabetes insipidus during a twin pregnancy].

    Science.gov (United States)

    De Mesmay, M; Rigouzzo, A; Bui, T; Louvet, N; Constant, I

    2013-02-01

    Gestational diabetes insipidus is an uncommon clinical disease whose prevalence is approximately two to three pregnancies per 100,000. It may be isolated or associated with preeclampsia. We report a case of gestational diabetes insipidus in a twin pregnancy, originally isolated during two months, and secondarily complicated by HELLP-syndrome. We recall the specific pathophysiology of polyuric-polydipsic syndrome during pregnancy and summarize its various causes. Finally, we discuss the indications, in case of isolated gestational diabetes insipidus, of treatment by dDAVP.

  9. Acardiac Parabiotic Fetus: A Rare Complication of Twin Pregnancy

    Directory of Open Access Journals (Sweden)

    Sood S

    2015-10-01

    Full Text Available Acardiac parabiotic fetus is sequelae of complication of monochorionic monoamniotic twin pregnancy also known as Twin Reversed Arterial Perfusion Sequence (TRAP. It is rare affecting 1 in 35,000 births and 1 % of monozygotic twins. Acardiac parabiotic twin commonly known as parasite occurs rarely and may lead to high output cardiac failure, hydrops or premature delivery in the pump fetus. In this report, we present a 23 years old primigravida with twin pregnancy, with twin reversed arterial perfusion sequence with one of the twins being acardiac anceps and the other normal pump fetus. This association is relatively uncommon and therefore rarely documented.

  10. Herceptin (trastuzumab) therapy in a twin pregnancy with associated oligohydramnios.

    Science.gov (United States)

    Beale, Jennifer M A; Tuohy, Jeremy; McDowell, Simon J

    2009-07-01

    Herceptin (trastuzumab) is an adjuvant chemotherapy agent used in treatment of certain breast cancers. Limited information is available on the use of herceptin in pregnancy. This case is a twin pregnancy exposed to herceptin until 23 weeks' gestation. One twin had chronic renal failure develop, whereas the other twin did not.

  11. CLINICAL STUDY OF LABOUR IN TWIN PREGNANCY

    Directory of Open Access Journals (Sweden)

    Amudha

    2015-07-01

    Full Text Available OBJECTIVES: The objective of the present study is to analyse the incidence of preterm labour, intrapartum complications, incidence of operative delivery both vaginal and cesarean and indications for such interventions. METHODOLOGY: A total of 150 cases of twin pregnancy were analyzed between the period of September 2012 to February 2014. These cases were stud ied with respect to period of gestation at the onset of labour, fetal presentations at the onset of labour, route and mode of delivery, indications in cases of cesarean delivery, intrapartum complications and delivery interval between twins. OBSERVATIONS A ND RESULTS: In the present study there was increased incidence of preterm labour (52.6%, fetal malpresentations (43.3%, operative vaginal delivery (29.5%, cesarean delivery (17.3%. CONCLUSION: In this study it is observed that above mentioned labour ev ents and complications double up in the event of a twin pregnancy. Regular antenatal visits, planned delivery and anticipation and identification of complications will help for better pregnancy outcome.

  12. Pregnancy outcome after fetal reduction in women with a dichorionic twin pregnancy

    NARCIS (Netherlands)

    van de Mheen, L.; Everwijn, S. M. P.; Knapen, M. F. C. M.; Haak, M. C.; Engels, M. A. J.; Manten, G. T. R.; Zondervan, H. A.; Wirjosoekarto, S. A. M.; van Vugt, J. M. G.; Erwich, J. J. H. M.; Bilardo, C. M.; van Pampus, M. G.; de Groot, C. J. M.; Mol, B. W. J.; Pajkrt, E.

    2015-01-01

    STUDY QUESTION: What are the pregnancy outcomes for women with a twin pregnancy that is reduced to a singleton pregnancy? summary answer: Fetal reduction of a twin pregnancy significantly improves gestational age at birth and neonatal birthweight, however at an increased risk of pregnancy loss and p

  13. Pregnancy outcome after fetal reduction in women with a dichorionic twin pregnancy

    NARCIS (Netherlands)

    Mheen, L. van de; Everwijn, S.M.; Knapen, M.F.; Haak, M.C.; Engels, M.A.J.; Manten, G.T.; Zondervan, H.A.; Wirjosoekarto, S.A.; Vugt, J.M.G. van; Erwich, J.J.; Bilardo, C.M.; Pampus, M.G. van; Groot, C.J. de; Mol, B.W.; Pajkrt, E.

    2015-01-01

    STUDY QUESTION: What are the pregnancy outcomes for women with a twin pregnancy that is reduced to a singleton pregnancy? SUMMARY ANSWER: Fetal reduction of a twin pregnancy significantly improves gestational age at birth and neonatal birthweight, however at an increased risk of pregnancy loss and p

  14. Dichorionic Diamniotic Twin Pregnancy Discordant for Bladder Exstrophy

    OpenAIRE

    William Tu; Jane Chueh; William Kennedy

    2009-01-01

    A 38 year-old woman presented with a dichorionic diamniotic twin pregnancy at gestational age of 32 weeks concerning for an abdominal wall mass in one of the twins. Initial ultrasound evaluation was suspicious for an omphalocele, but the affected twin was found to have bladder exstrophy at birth. This illustrates the difficulties of accurate prenatal diagnosis of bladder exstrophy in a twin pregnancy at a late gestation.

  15. Dichorionic Diamniotic Twin Pregnancy Discordant for Bladder Exstrophy

    Directory of Open Access Journals (Sweden)

    William Tu

    2009-01-01

    Full Text Available A 38 year-old woman presented with a dichorionic diamniotic twin pregnancy at gestational age of 32 weeks concerning for an abdominal wall mass in one of the twins. Initial ultrasound evaluation was suspicious for an omphalocele, but the affected twin was found to have bladder exstrophy at birth. This illustrates the difficulties of accurate prenatal diagnosis of bladder exstrophy in a twin pregnancy at a late gestation.

  16. Recommendations for fetal echocardiography in twin pregnancy in 2016

    Directory of Open Access Journals (Sweden)

    Leszczyńska Katarzyna

    2016-01-01

    Full Text Available Progress in the fields of fetal cardiology and fetal surgery have been seen not only in singleton pregnancies but also in multiple pregnancies. Proper interpretation of prenatal echocardiography is critical to clinical decision making, family counseling and perinatal management for obstetricians, maternal fetal medicine specialists, neonatologists and pediatric cardiologists. Fetal echocardiography is one of the most challenging and time-consuming prenatal examinations to perform, especially in multiple gestations. Performing just the basic fetal exam in twin gestations may take an hour or more. Thus, it is not practical to perform this exam in all cases of multiple gestations. Therefore our review and recommendations are related to fetal echocardiography in twin gestation.

  17. [Spontaneous hepatic hematoma in twin pregnancy].

    Science.gov (United States)

    Quesnel, Carlos; Weber, Alejandro; Mendoza, Dalila; Garteiz, Denzil

    2012-02-01

    The hepatic hematoma or rupture appear in 1 of every 100,000 pregnancies. The most common causes of hepatic hematoma in pregnancy are severe preeclampsia and HELLP syndrome; some predisposing factors are seizures, vomiting, labor, preexistent hepatic disease and trauma. A 33 year old primigravid with a normal 33 week twin pregnancy presented abdominal pain and hypovolemic shock due to spontaneous subcapsular hepatic hematoma; laparoscopy was performed to evaluate the possibility of rupture, which was not found, later emergency cesarean section was carried out followed by hepatic hematoma drainage and abdominal packaging by laparoscopy. After surgery the flow through drainage was too high additionally hemodynamic instability and consumption coagulopathy. Abdominal panangiography was performed without identifying bleeding areas. Intesive care was given to the patient evolving satisfactorily, was discharged 19 days after the event. Seven months later she had laparoscopic cholecystectomy due to acute litiasic colecistitis. We found 5 cases in literatura about hepatic hematoma during pregnancy no related to hypertensive disorders of pregnancy; these were related to hepatoma, amebian hepatic abscess, falciform cell anemia, cocaine consumption and molar pregnancy. Hepatics hematomas have high morbidity and mortality so is significant early diagnosis and multidisciplinary approach.

  18. NOTE: Increasing cardiac output and decreasing oxygenation sequence in pump twins of acardiac twin pregnancies

    Science.gov (United States)

    van Gemert, Martin J. C.; Umur, Asli; van den Wijngaard, Jeroen P. H. M.; Van Bavel, Ed; Vandenbussche, Frank P. H. A.; Nikkels, Peter G. J.

    2005-02-01

    An acardiac twin pregnancy is a rare but serious complication of monochorionic twinning and consists of an acardiac twin and a pump twin. The acardiac twin is a severely malformed fetus that lacks most organs, particularly a heart, but grows during pregnancy because it is perfused by the developmentally normal pump twin via a set of arterioarterial and venovenous placental anastomoses. Pump twins die intrauterine or neonatally in about 50% of the cases. Because the effects of an acardiac mass on the pump twin's development are incompletely known, methods for outcome prognosis are currently not available. We sought to derive simple relations for the pump twin's excess cardiac output and decreased oxygenation and to use available clinical cases for a preliminary test of the model. As a method, we used a theoretical flow model to represent the fetoplacental circulation of an acardiac twin pregnancy and estimated blood deoxygenation and reoxygenation following perfusion of the two bodies and placentas, respectively. The results show the pump twin's excess cardiac output and decrease of venous oxygen saturation to depend on the ratio of pump twin to acardiac twin umbilical blood flow, whose ratio can be measured by ultrasonography. The clinical cases show a decreasing umbilical flow ratio with gestation. In conclusion, prospective serial study is necessary to test whether measurement of umbilical flow ratios allows monitoring the pump twin's pathophysiologic development, possibly resulting in a guideline for prognosis of pump twin survival.

  19. Increasing cardiac output and decreasing oxygenation sequence in pump twins of acardiac twin pregnancies

    Energy Technology Data Exchange (ETDEWEB)

    Gemert, Martin J C van [Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Umur, Asli [Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Wijngaard, Jeroen P H M van den [Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); VanBavel, Ed [Department of Medical Physics, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Vandenbussche, Frank P H A [Department of Obstetrics, Leiden University Medical Center, Leiden (Netherlands); Nikkels, Peter G J [Department of Pathology, University Medical Center, Utrecht (Netherlands)

    2005-02-07

    An acardiac twin pregnancy is a rare but serious complication of monochorionic twinning and consists of an acardiac twin and a pump twin. The acardiac twin is a severely malformed fetus that lacks most organs, particularly a heart, but grows during pregnancy because it is perfused by the developmentally normal pump twin via a set of arterioarterial and venovenous placental anastomoses. Pump twins die intrauterine or neonatally in about 50% of the cases. Because the effects of an acardiac mass on the pump twin's development are incompletely known, methods for outcome prognosis are currently not available. We sought to derive simple relations for the pump twin's excess cardiac output and decreased oxygenation and to use available clinical cases for a preliminary test of the model. As a method, we used a theoretical flow model to represent the fetoplacental circulation of an acardiac twin pregnancy and estimated blood deoxygenation and reoxygenation following perfusion of the two bodies and placentas, respectively. The results show the pump twin's excess cardiac output and decrease of venous oxygen saturation to depend on the ratio of pump twin to acardiac twin umbilical blood flow, whose ratio can be measured by ultrasonography. The clinical cases show a decreasing umbilical flow ratio with gestation. In conclusion, prospective serial study is necessary to test whether measurement of umbilical flow ratios allows monitoring the pump twin's pathophysiologic development, possibly resulting in a guideline for prognosis of pump twin survival. (note)

  20. STUDY OF OBSTETRIC COMPLICATIONS & OUTCOME OF TWIN PREGNANCY

    Directory of Open Access Journals (Sweden)

    Swati

    2014-10-01

    Full Text Available : INTRODUCTION: Twin pregnancy is a rare phenomenon and significantly related to increased maternal & fetal morbidity and mortality as compared to singleton pregnancy. It is important that every physician must know the complications related to twin pregnancy and how to manage these complications. DESIGN: Prospective observational study AIMS AND OBJECTIVE: (1 To study incidence of various obstetric complications in twin pregnancy (2 To study outcome of twin pregnancy in terms of average duration of gestation, mode of delivery & neonatal outcome. METHODS: 59 Patients with sonographically confirmed twin pregnancy attending ante-natal care outpatient department (ANC OPD & labor room at a tertiary care hospital in our Unit in specified period of 18 months as mentioned above were enrolled in this study and followed till delivery and thereafter in the neonatal period. RESULTS: In this study twin pregnancies were slightly more in multigravida. The rate of preterm delivery was 77.9%.PIH & Anaemia was more common in primigravida. Monochorionic twins had more complications than dichorionic twins. NICU admission rate in this study was 23.6%, perinatal mortality rate was 16.9% and neonatal mortality rate was 12.2%. CONCLUSION: Twinning in pregnancy is a high risk factor which can cause various maternal as well fetal complications. Prompt ANC care and timely intervention is required to avoid these complications.

  1. Successful twin pregnancy outcome after in utero exposure to FOLFOX for metastatic colon cancer: a case report and review of the literature

    DEFF Research Database (Denmark)

    Jeppesen, Johanne Bakker; Østerlind, Kell

    2011-01-01

    many dilemmas and concerns for the physician and patient. A delay in treatment may compromise maternal survival; however, therapy for the cancer may be harmful to the fetus. We present a case of a 26-year-old woman pregnant with twins who was diagnosed with metastatic colon cancer and treated with 5......There is limited experience in treating advanced colorectal cancer diagnosed during pregnancy because it is a rare occurrence; however, the incidence of colorectal cancer complicating pregnancy is expected to increase in the future. The combination of cancer and pregnancy is complicated and causes......-fluorouracil, leukovorin, and oxaliplatin (FOLFOX) from 13 weeks gestational age to birth. The patient gave birth to healthy twins without malformations at 33 weeks gestational age. At follow-up examination, the 2-year-old twins are developing normally. The patient herself died 1 year after the initial cancer...

  2. Cervical length measurement for the prediction of preterm birth in symptomatic women with a twin pregnancy: a systematic review and meta-analysis.

    Science.gov (United States)

    Liem, S M S; van de Mheen, L; Bekedam, D J; van Pampus, M G; Opmeer, B C; Lim, A C; Mol, B W J

    2013-01-01

    Objective. The aim of this study was to assess whether cervical length measurement (CL) could predict preterm birth (PTB) in symptomatic women with a twin pregnancy. Methods. We searched MEDLINE and EMBASE to identify studies investigating the accuracy of CL measurement in predicting PTB in symptomatic women with a twin pregnancy. We extracted data to construct two-by-two tables and used bivariate meta-analysis to generate point estimates of sensitivity and specificity. Results. Five studies (N = 226) were included. Variation in definition of PTB and cut-off points for CL was strong. One study investigated delivery within seven days, demonstrating a sensitivity of 1.0 (95% CI: 0.83-1.0) and a specificity of 0.31 (95% CI 0.2-0.43) for a CL cutoff at 25 mm. Three studies reported on predicting PTB twin pregnancy, especially on the most important outcome, that is, delivery within 7 days.

  3. A Rare Localization of Ectopic Pregnancy: Intramyometrial Pregnancy in Twin Pregnancy following IVF

    Directory of Open Access Journals (Sweden)

    Lahcen Boukhanni

    2014-01-01

    Full Text Available Intramyometrial pregnancy is a rare form of ectopic pregnancy. It makes a diagnostic and therapeutic challenge. If misdiagnosed the intramyometrial pregnancy can cause a uterine rupture and become life-threatening condition. We report a case of intramyometrial pregnancy in twin pregnancy following IVF with spontaneous abortion of the first twin At 9 weeks of gestation. The 10 weeks scan showed a normal fetus which was described to be highly localized in the uterus but the diagnosis of intramyometrial pregnancy was not suspected. The patient was admitted at 14 weeks of gestation with pelvic pain, hemorrhage, and shock. She was operated and the diagnosis of ruptured intramyometrial pregnancy was done and managed conservatively. This case illustrates the diagnostic difficulties of intramyometrial pregnancy. We discuss pathophysiology, diagnosis, and treatment of this exceptional form of ectopic pregnancy.

  4. Maternal postpartum complications according to delivery mode in twin pregnancies

    Directory of Open Access Journals (Sweden)

    Sonia Leme Stach

    2014-07-01

    Full Text Available OBJECTIVE:We aimed to examine maternal postpartum complications of twin deliveries according to mode of delivery and investigate the associated risk factors.METHODS:This was a retrospective cohort review of twin pregnancies with delivery after 26 weeks at a tertiary teaching hospital (1993-2008. The rates of maternal postpartum complications were compared among vaginal, elective cesarean and emergency cesarean deliveries. Significant predictors of complications were investigated with stepwise regression analysis and relative risks were calculated.RESULTS:A total of 90 complications were observed in 56/817 (6.9% deliveries: 7/131 (5.3% vaginal, 10/251 (4.0% elective cesarean and 39/435 (9.0% emergency cesarean deliveries. Significant predictors included high-risk pregnancy, gestational age at birth and delivery mode. The occurrence of complications was significantly increased in emergency compared to elective cesarean deliveries (RR = 2.34.CONCLUSIONS:Maternal postpartum complications in twin pregnancies are higher in emergency compared to elective cesarean deliveries and are also related to preexisting complications and earlier gestational age at delivery.

  5. Acardiac Twinning (Twin Reversed Arterial Perfusion Sequence: A Review of Prenatal Management

    Directory of Open Access Journals (Sweden)

    Chih-Ping Chen

    2005-06-01

    Full Text Available Acardiac twinning, or the twin reversed arterial perfusion (TRAP sequence, occurs in 1% of monozygotic twins, or 1 in 35,000 births. It is caused by the development of arterioarterial vascular anastomoses between the umbilical arteries of monozygotic twins early in embryogenesis. The pump twin may be associated with congenital anomalies and chromosomal abnormalities. Therefore, it is recommended that prenatal genetic testing be offered whenever pregnancy is complicated by acardiac twinning. The treatment options for acardiac twinning include observation, medical management, amniodrainage, and invasive treatment such as hysterotomy with selective delivery of the acardiac twin, intrafetal ablation of the acardiac twin by alcohol, laser, thermocoagulation or radiofrequency, fetoscope-guided funicular occlusion by ligation, laser or thermocoagulation, and ultrasound-guided funicular occlusion by ligation, cord compression, thermocoagulation or intrafunicular embolization with foreign bodies. If invasive treatment is indicated, the simplicity, safety, and efficacy of the chosen technique should be considered. An intrafetal approach has been shown to be superior to a funicular occlusion approach. Ultrasound-guided intrafetal laser ablation or radiofrequency ablation is believed to be the treatment of choice based on currently available data. This review emphasizes the necessity to carefully search for any possible associated anomaly in the pump twin by both genetic testing and sonographic examination, and to prudently consider invasive treatment only in pregnancies which would potentially benefit from the prenatal intervention.

  6. Spontaneous Live Twin Tubal Ectopic Pregnancy: A Case Report

    Directory of Open Access Journals (Sweden)

    R Benn

    2016-02-01

    Full Text Available We report the case of a 29-year old G3P1+1 woman with a spontaneously conceived live twin tubal ectopic pregnancy. Her history was significant for infertility for 11 years after an induced abortion. Pelvic ultrasound scan showed live twin ectopic pregnancy and a partial salpingectomy was done.

  7. Cytokines and the Risk of Preterm Delivery in Twin Pregnancies

    DEFF Research Database (Denmark)

    Rode, Line; Klein, Katharina; Larsen, Helle

    2012-01-01

    To estimate the association between cytokine levels in twin pregnancies and risk of spontaneous preterm delivery, including the effect of progesterone treatment.......To estimate the association between cytokine levels in twin pregnancies and risk of spontaneous preterm delivery, including the effect of progesterone treatment....

  8. Dichorionic twin pregnancy discordant for fetal anencephaly: a case report.

    Science.gov (United States)

    Taşcı, Yasemin; Karasu, Yetkin; Erten, Ozlem; Karadağ, Burak; Göktolga, Umit

    2012-01-01

    Dichorionic twin pregnancy discordant for fetal anencephaly is a serious condition that threatens the normal co-twin's life by causing polyhydramniosis, preterm labor and sudden death of one or both of the fetuses. We report a case of dichorionic twin pregnancy discordant for fetal anencephaly delivered at the 32(nd) week of gestation because of preterm labor and nonreassuring fetal monitoring. The aim of this case report is to summarize management options in this situation.

  9. [Intrauterine fetal transfusion in twin pregnancy with Rh isoimmunization].

    Science.gov (United States)

    Vasileva, Iu; Poissonier, M E

    1989-01-01

    Two women with twin pregnancy and with Rhesus isoimmunization were described. The disease of these women was so grave that intrauterine transfusions were made in both fetuses (from all 86 pregnancies treated with transfusions). Twins of one of the women were born alive, but the other twins died in utero. Difficulties and problems of this rarely encountered combination of two independent one from the other pathologies are discussed.

  10. MRI findings in multifetal pregnancies complicated by twin reversed arterial perfusion sequence (TRAP)

    Energy Technology Data Exchange (ETDEWEB)

    Guimaraes, Carolina V.A.; Kline-Fath, Beth M.; Linam, Leann E.; Calvo Garcia, Maria A.; Rubio, Eva I. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Lim, Foong-Yen [Cincinnati Children' s Hospital Medical Center, Division of Pediatric Surgery, Cincinnati, OH (United States)

    2011-06-15

    Twin reversed arterial perfusion sequence (TRAP) is a rare complication in multifetal monochorionic pregnancies in which a normal ''pump'' twin provides circulation to an abnormal acardiac co-twin, resulting in high-output cardiac dysfunction in the pump twin. To define fetal MRI findings of TRAP sequence. Fetal MR images were retrospectively reviewed in 35 pregnancies complicated by TRAP sequence. Abnormalities of the pump twin, acardiac twin, umbilical cord, placenta and amniotic fluid were reviewed. Acardiac twins were classified as: acephalus (51%), anceps (40%), amorphus (9%), acormus (0%). Common findings in acardiac twins include subcutaneous edema (77%), absent cardiac structures (86%), absent or abnormal thoracic cavity (100%), abnormal abdominal organs (100%), superior limbs absent (46%) or abnormal (51%), and inferior limbs present but abnormal (83%). There were pump twin findings of cardiac dysfunction in 43% and intracranial ischemic changes in 3%. Umbilical cord anomalies were present in 97%. Acardiac twins present with a predictable pattern of malformation with poorly developed superior structures, more normally formed inferior structures and absent or rudimentary heart. Although usually absent, abnormal heart structures can be seen and do not exclude TRAP sequence. Pump twins are commonly normal with exception of findings of cardiac dysfunction and possible brain ischemia. (orig.)

  11. Carbohydrate metabolism in women with a twin pregnancy.

    Science.gov (United States)

    Spellacy, W N; Buhi, W C; Birk, S A

    1980-06-01

    Carbohydrate metabolism was evaluated in 24 women with a twin pregnancy and 24 women with a singleton pregnancy. The groups were of similar age, parity, weight, and gestational age. In each woman an intravenous glucose tolerance test was done using a 25-g glucose load in the last half of gestation. Both blood glucose and plasma insulin levels were measured and statistically compared. The plasma human placental lactogen levels were significantly higher in the women with the twin gestation (7.3 +/- 0.7 versus 4.7 +/- 0.3 microgram/ml). Although the glucose disappearance rates (K) were not different, there was a significantly lower fasting as well as 5- and 15-minute blood glucose value in the twin pregnancy group. There was also a significantly lower 15-minute insulin level in the twin group. The importance of these findings to the clinical management of twin pregnancies and to the understanding of the metabolic changes in pregnancy is discussed.

  12. Effective treatment of cervical incompetence in a monochorionic monoamniotic twin pregnancy with a rescue cervical cerclage and pessary--a case report and review of literature.

    Science.gov (United States)

    Kosińska-Kaczyńska, Katarzyna; Szymusik, Iwona; Bomba-Opoń, Dorota; Brawura-Biskupski-Samaha, Robert; Wegrzyn, Piotr; Wielgoś, Mirosław

    2012-12-01

    A monochorionic monoamniotic (MCMA) twin pregnancy is the rarest form of twin gestation, accounting for around 1:10000 to 1:20000 of all deliveries regardless of the region of the world. All multiple gestations have a higher risk of preterm delivery due to either preterm uterine contractions or asymptomatic cervical shortening (cervical incompetence). A case of a 28-year-old primigravida in MCMA twin pregnancy with cervical incompetence diagnosed at 22 weeks of gestation is presented. After obtaining cervical swabs, negative laboratory infection parameters and confirming concordant gestational age on ultrasound scan with no structural abnormalities of both fetuses, the patient was qualified for an emergency cervical cerclage according to Wurm-Hefner method. Five days after the procedure, a cervical pessary was additionally inserted. She was administered antibiotics and steroids. The wellbeing of both fetuses was strictly monitored by means of cardiotocography tracing and ultrasound examinations, on which they were both eutrophic, with no abnormalities in Doppler blood flow patterns. Spontaneous premature rupture of membranes took place at 32 weeks of gestation, a cesarean section was performed and two female fetuses of 1740 g and 1760 g were delivered. They both required antibiotics because of congenital pneumonia, but no respiratory support was necessary The twins were discharged from the hospital 22 days after birth in good general condition. This case of a rescue cervical cerclage and pessary used simultaneously can be an example of an effective method of cervical incompetence treatment in twin pregnancies.

  13. Severe intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnancies.

    Science.gov (United States)

    Raz, Yael; Lavie, Anat; Vered, Yaffa; Goldiner, Ilana; Skornick-Rapaport, Avital; Landsberg Asher, Ysca; Maslovitz, Sharon; Levin, Ishai; Lessing, Joseph B; Kuperminc, Michael J; Rimon, Eli

    2015-09-01

    Intrahepatic cholestasis of pregnancy (ICP) is known to be associated with fetal complications. It recently was suggested to be associated possibly with preeclampsia (PET) as well. The objective of this study was to investigate that possibility. The study group included 78 women (54 singleton and 24 twin pregnancies) who had been diagnosed with ICP based on clinical presentation, elevated liver enzymes, and elevated total bile acids (>10 μmol/L). Disease severity was based on total bile acids levels as being severe (>40 μmol/L), moderate (20-40 μmol/L), or mild (10-20 μmol/L). The course of disease was reviewed carefully in each case. The control groups were comprised of apparently healthy women with singleton (n = 200) and twin (n = 100) pregnancies that were drawn randomly from a computerized registry of all the deliveries in our institution during the study period. The total incidence of PET was significantly higher for the patients with ICP who had singleton and twin pregnancies compared with the control groups (singletons: 7.4% vs 1.5%; P pregnancies compared with control subjects. Severe ICP, but not mild ICP, was a major risk factor for PET among women with either singleton or twin pregnancies. The timing of the initial presentation of ICP had no effect on PET incidence rates. Preeclampsia occurred usually 2-4 weeks after the diagnosis of ICP, and proteinuria preceded elevated blood pressure in all cases. Moreover, the total bile acid levels among 33 women who were diagnosed as having PET, but not ICP, were within normal range. ICP increases the incidence of PET; severe disease was a major risk factor for preeclampsia. Therefore, we strongly suggest including routine evaluation for preeclampsia in the treatment of women with moderate and severe ICP. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Haemodynamic resistance model of monochorionic twin pregnancies complicated by acardiac twinning

    Energy Technology Data Exchange (ETDEWEB)

    Umur, Asli [Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam(Netherlands); Gemert, Martin J C van [Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Wijngaard, Jeroen P H M van den [Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Ross, Michael G [Department of Obstetrics and Gynecology, Harbor University of California-Los Angeles Medical Center, Torrence, CA 9050 (United States); Nikkels, Peter G J [Department of Pathology, University Medical Center, Utrecht (Netherlands)

    2004-07-21

    An acardiac twin is a severely malformed monochorionic twin fetus that lacks most organs, particularly a heart. It grows during pregnancy, because it is perfused by its developmentally normal co-twin (called the pump twin) via a set of placental arterioarterial and venovenous anastomoses. The pump twin dies intrauterine or neonatally in about 50% of the cases due to congestive heart failure, polyhydramnios and prematurity. Because the pathophysiology of this pregnancy is currently incompletely understood, we modified our previous haemodynamic model of monochorionic twins connected by placental vascular anastomoses to include the analysis of acardiac twin pregnancies. We incorporated the fetoplacental circulation as a resistance circuit and used the fetal umbilical flow that perfuses the body to define fetal growth, rather than the placental flow as done previously. Using this modified model, we predicted that the pump twin has excess blood volume and increased mean arterial blood pressure compared to those in the acardiac twin. Placental perfusion of the acardiac twin is significantly reduced compared to normal, as a consequence of an increased venous pressure, possibly implying reduced acardiac placental growth. In conclusion, the haemodynamic analysis may contribute to an increased knowledge of the pathophysiologic consequences of an acardiac body mass for the pump twin. (note)

  15. Incidence and mode of delivery of twin pregnancies in Uyo, Nigeria

    Directory of Open Access Journals (Sweden)

    Aniekan M Abasiattai

    2010-01-01

    Full Text Available Background: Twin pregnancy continues to be a focus of interest the world over due to its increasing incidence and also the high maternal and perinatal mortality and morbidity associated with it. Objective: To determine the incidence and mode of delivery of twin pregnancies at the University of Uyo Teaching Hospital, Uyo. Methodology: A 5-year retrospective review of twin deliveries at the University of Uyo Teaching Hospital. Results: There were 6,344 deliveries out of which 164 were twin deliveries resulting in an incidence of 2.6%. The modal age group of the patients was 20-29 years (66.5%, majority (71.3% of the patients were multiparous, 79.3% booked and had regular antenatal care in the hospital while 49.4% of the patients delivered at term. Eighty-four patients (51.2% were delivered by caesarean section and malpresentation of the first twin (18.2% and hypertensive disorders of pregnancy (10.4% were the most common indications. The perinatal mortality rate was 207/1000 and there was one maternal death which was from eclampsia. Conclusion: The incidence of twin pregnancy and its attendant perinatal mortality is high in our center. In addition, caesarean section is the most common mode of delivery with malpresentation of the first twin and hypertensive disorders of pregnancy as the most common indications. We advocate widespread public enlightenment on the increased risk associated with twin pregnancy. Community leaders should ensure that women with twin pregnancy should book early and obtain antenatal care in specialized units.

  16. Maternal and perinatal complications in triplet compared with twin pregnancy

    NARCIS (Netherlands)

    J.G. Santema (Job); P. Bourdrez (Petra); H.C.S. Wallenburg (Henk)

    1995-01-01

    textabstractObjective: To compare maternal and perinatal complications in triplet and twin pregnancies. Study design: Case-controlled study in the setting of a University Hospital. Each pregnancy of a consecutive series of 40 triplet pregnancies of 20 weeks or more was matched for parity and materna

  17. Trends in the obstetric features and management of twin pregnancies.

    LENUS (Irish Health Repository)

    Smith, K E

    2010-03-01

    There are no reports outlining the trends in obstetric features and clinical management of twin pregnancies in an Irish obstetric population. The aim of this study was to investigate these factors for all twin pregnancies delivered during the 19 year period between 1989 and 2007, at Galway University Hospital (GUH). There were 52,199 infants delivered at GUH, of which 1594 infants (3.05% of births) were twins, related to 797 twin pregnancies. The overall incidence of twin pregnancies was 1.52%, increasing from 0.8%-1.0% in the early years of the study to 1.7-1.8% in the latter years of the study (P<0.001). There was a significant increase in incidence of twins born to mothers aged 30-39 years, alongside a significant reduction to mothers aged 20-29 years (P<0.01). The caesarean section rate overall was 41.5% (331\\/797), of which 54% (n=179) were elective, and 46% (n=152) were emergency, representing an emergency caesarean section rate of 19.1% of all twin pregnancies, and of 24.6% after exclusion of elective caesarean sections. The caesarean section rate for twins increased from 30% in 1989 to greater than 50% in the latter years of the study (P<0.01), related largely to a significant increase in elective caesarean sections (P<0.01). The combined vaginal-caesarean delivery rate was remarkably low at 0.75% of all twin pregnancies, and 1% after exclusion of elective caesarean sections. The preterm delivery rates were 4.1% (<32 weeks), and 16.3% (<36 weeks), with an overall perinatal mortality rate of 37 per 1000. These findings highlight the altered demographic and clinical aspects of twin pregnancies in an Irish obstetric population.

  18. Consequences of vanishing twins in IVF/ICSI pregnancies

    DEFF Research Database (Denmark)

    Pinborg, Anja Bisgaard; Lidegaard, Ojvind; la Cour Freiesleben, Nina

    2005-01-01

    Spontaneous reductions are a possible cause of the increased morbidity in IVF singletons. The aim of this study was to assess incidence rates of spontaneous reductions in IVF/ICSI twin pregnancies and to compare short- and long-term morbidity in survivors of a vanishing co-twin with singletons...

  19. Consequences of vanishing twins in IVF/ICSI pregnancies

    DEFF Research Database (Denmark)

    Pinborg, Anja Bisgaard; Lidegaard, Ojvind; la Cour Freiesleben, Nina;

    2005-01-01

    Spontaneous reductions are a possible cause of the increased morbidity in IVF singletons. The aim of this study was to assess incidence rates of spontaneous reductions in IVF/ICSI twin pregnancies and to compare short- and long-term morbidity in survivors of a vanishing co-twin with singletons...

  20. Twin pregnancy in a liver transplant recipient with HIV infection.

    Science.gov (United States)

    Van Schalkwyk, McI; Westbrook, R H; O'Beirne, J; Wright, A; Gonzalez, A; Johnson, M A; Kinloch-de Loës, S

    2016-10-05

    We are not aware of a report detailing the complex obstetrical and medical management of twin pregnancy in the context of HIV infection and early post-liver transplantation period. Here we describe the successful outcome of a twin pregnancy in a 28-year-old HIV-positive female receiving antiretroviral therapy and immunosuppressive therapy who was the recipient of a liver transplant for previous drug-induced liver failure.

  1. FIRST-TRIMESTER PRENATAL-DIAGNOSIS IN TWIN PREGNANCIES

    NARCIS (Netherlands)

    CHRISTIAENS, GCML; Oosterwijk, JC; STIGTER, RH; DEUTZTERLOUW, PP; KNEPPERS, ALJ; BAKKER, E

    Two twin pregnancies at risk for a sex-linked disorder are described. Both pregnancies were dichorionic. Transabdominal sampling was chosen for prenatal diagnosis. Molecular genetic techniques raised suspicion with regard to the accuracy of the samples in one case. Second-trimester amniocentesis

  2. FIRST-TRIMESTER PRENATAL-DIAGNOSIS IN TWIN PREGNANCIES

    NARCIS (Netherlands)

    CHRISTIAENS, GCML; Oosterwijk, JC; STIGTER, RH; DEUTZTERLOUW, PP; KNEPPERS, ALJ; BAKKER, E

    1994-01-01

    Two twin pregnancies at risk for a sex-linked disorder are described. Both pregnancies were dichorionic. Transabdominal sampling was chosen for prenatal diagnosis. Molecular genetic techniques raised suspicion with regard to the accuracy of the samples in one case. Second-trimester amniocentesis con

  3. Coffee and smoking as risk factors of twin pregnancies

    DEFF Research Database (Denmark)

    Morales-Suárez-Varela, Maria M; Bech, Bodil Hammer; Christensen, Kaare

    2007-01-01

    Twinning rates have changed substantially over time for reasons that are only partly known. In this study we studied smoking, coffee and alcohol intake, and their possible interaction with obesity as potential determinants of twinning rates using data from the Danish National Birth Cohort between...... their prepregnancy weight and height, coffee and alcohol intake, smoking habits, and potential confounding factors at early stages of pregnancy. We identified smoking (> 10 cigarettes/day) as a possible determinant of twinning, particularly for dizygotic twinning rates (same sex) and furthermore corroborated...... that obesity and the mother's age are strong correlates of twinning. Others have found coffee intake to increase twinning rates but that is not seen in these data....

  4. Fetal behavior in normal dichorionic twin pregnancy

    NARCIS (Netherlands)

    Mulder, E. J. H.; Derks, J. B.; de Laat, M. W. M.; Visser, G. H. A.

    2012-01-01

    Objectives: A prospective study was performed to compare fetal behavioral development in healthy dichorionic twins and singletons, and identify twin intra-pair associations (synchrony) of fetal movements and rest-activity cycles using different criteria to define synchrony. Subjects and methods: Twe

  5. Classification of discordant fetal growth may contribute to risk stratification in monochorionic twin pregnancies

    NARCIS (Netherlands)

    van Gemert, MJC; Vandenbussche, FPHA; Schaap, AHP; Zondervan, HA; Nikkels, PGJ; van Wijngaarden, WJ; van Zalen-Sprock, RM; Sollie-Szarynska, KM; Stoutenbeek, PH

    2000-01-01

    Objectives To determine whether classification of discordant growth between fetal twins allows risk stratification in monochorionic twin pregnancies. Methods In 12 twin-to-twin transfusion syndrome (TTTS) pregnancies and 12 cases that were suspected of developing the syndrome, fetal growth was deter

  6. Cesarean section in twin pregnancies in two Danish counties with different cesarean section rates

    DEFF Research Database (Denmark)

    Henriksen, T B; Sperling, Lene; Hedegaard, M

    1994-01-01

    OBJECTIVE: Based on a comparison of the clinical indications for cesarean section (CS) in two Danish counties and a review of the literature regarding this issue the aim of this study was to discuss possible explanations for variations in CS rates in twin pregnancies. The comparison of indications...

  7. Gestational Weight Gain and Peripartum Cardiomyopathy in a Twin Pregnancy

    Directory of Open Access Journals (Sweden)

    Hiroko Matsumiya

    2015-01-01

    Full Text Available Preeclamptic twin pregnancy with larger gestational weight gain (GWG is suggested to have a higher risk of peripartum cardiomyopathy (PPCM. This was true in a 5-year experience at a single center. A primiparous woman with twins and prepregnancy weight of 51.0 kg exhibited hypertension at gestational week (GW 32−6/7 and GWG of 18.3 kg (6.0 kg and 2.9 kg during the last four weeks and one week of gestation, resp. concomitant with generalized edema, gave birth at GW 34−4/7, developed proteinuria, cough, and dyspnea postpartum, and was diagnosed with preeclampsia and PPCM showing left ventricular ejection fraction of 34% and plasma BNP level of 1530 pg/mL. This was the only case of PPCM among 101 (12 with preeclampsia and 3266 women with twin and singleton pregnancies, respectively. Thus, PPCM occurred significantly more often in women with preeclamptic twin pregnancies than in women with singleton pregnancies (8.3% [1/12] versus 0.0% [0/3266], P=0.0355. This patient showed the greatest weight gain of 6.0 kg during the last four weeks of gestation and the greatest weight loss of 19.2 kg during one month postpartum among 90 women with twin deliveries at GW ≥ 32.

  8. Progestogens to prevent preterm birth in twin pregnancies

    DEFF Research Database (Denmark)

    Schuit, Ewoud; Stock, Sarah; Groenwold, Rolf H H;

    2012-01-01

    Preterm birth is the principal factor contributing to adverse outcomes in multiple pregnancies. Randomized controlled trials of progestogens to prevent preterm birth in twin pregnancies have shown no clear benefits. However, individual studies have not had sufficient power to evaluate potential b...... benefits in women at particular high risk of early delivery (for example, women with a previous preterm birth or short cervix) or to determine adverse effects for rare outcomes such as intrauterine death....

  9. Modelling the influence of amnionicity on the severity of twin-twin transfusion syndrome in monochorionic twin pregnancies

    Energy Technology Data Exchange (ETDEWEB)

    Wijngaard, Jeroen P H M van den [Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Umur, Asli [Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Ross, Michael G [Department of Obstetrics and Gynecology, Harbor University of California-Los Angeles Medical Center, Torrance, CA 90502 (United States); Gemert, Martin J C van [Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands)

    2004-03-21

    Clinical treatment for diamniotic-monochorionic twin-twin transfusion syndrome (TTTS) may include conversion of diamniotic pregnancies to a monoamniotic-monochorionic state by disrupting the amnion septum. We sought to test the underlying hypothesis, i.e. that a monoamniotic state reduces the severity of TTTS. With use of our previously developed mathematical model of two equal fetoplacental circulatory units connected by various sizes and types of placental anastomoses, we compared the haemodynamic and amniotic fluid dynamics of monoamniotic and diamniotic twins that develop TTTS. We used three anastomotic patterns that produce severe, moderate or mild forms of TTTS, respectively, in our diamniotic-monochorionic twin model. Monoamnionicity was modelled by adding the two amniotic fluid volumes and using the volume-averaged amniotic fluid osmolality. The results were as follows: for severe TTTS, small differences develop between diamniotic and monoamniotic donor twins in fetal urine production, swallowed volume, blood volume, blood pressures, net fetofetal transfusion, and blood and amniotic fluid osmolality. However, the circulatory imbalance between the monoamniotic twins deteriorates similar to that of diamniotic twins. The pathophysiological differences tend to disappear for milder TTTS. In conclusion, our model suggests that the uncommon finding of TTTS in monoamniotic twins is not due to the presence of a single amniotic sac. Rather, clinically significant differences in anastomotic patterns and the delayed or lack of identification of manifestations in monoamniotic twins account for the reduced rate of TTTS diagnosis. Based on these results we expect the clinical disruption of the amnion septum in diamniotic-monochorionic TTTS pregnancies to have only minimal benefits. (note)

  10. Prediction of spontaneous preterm delivery in asymptomatic twin pregnancies using cervical length and granulocyte elastase.

    Science.gov (United States)

    Tanaka, Kei; Yamada, Kenji; Matsushima, Miho; Izawa, Tomoko; Furukawa, Seishi; Kobayashi, Yoichi; Iwashita, Mitsutoshi

    2017-04-01

    The purpose of this study was to evaluate sonographic cervical length (CL) and granulocyte elastase (GE) in cervical secretion as predictors of preterm delivery in asymptomatic twin pregnancies. This study prospectively enrolled asymptomatic twin pregnancies with CL preterm labor, and the cervical secretion was obtained for GE testing on admission. The results of CL measurement and GE testing were reviewed, and the relationship between each variables and preterm delivery prior to 34 weeks of gestation was assessed. Overall, we included 54 women with twin pregnancies, of which 12 (22.2%) had preterm deliveries prior to 34 weeks of gestation. A CL of preterm delivery with an odds ratio of 4.88 (95% confidence limit, 1.15-20.73). GE was not an independent predictive marker for preterm delivery. We also performed a subgroup analysis on the combination of CL and GE for predicting preterm delivery. Among the patients with GE(-), CL preterm delivery with an odds ratio of 10.89 (95% confidence limit, 1.40-77.10). CL was not associated with preterm delivery among those with GE(+). Those with negative GE and shorter CL demonstrated the shortest duration of pregnancy after admission. The combination of sonographic CL and GE of cervical secretion is useful to predict the risk of preterm delivery in asymptomatic twin pregnancies. Copyright © 2017. Published by Elsevier B.V.

  11. Congenital varicella syndrome in a monochorionic diamniotic twin pregnancy

    Directory of Open Access Journals (Sweden)

    Vania A Villota

    2014-01-01

    Full Text Available Congenital varicella syndrome encompasses a broad spectrum of malformations present in children of mothers who developed chickenpox during the first 20 weeks of gestation. We report a case of a monochorionic diamniotic twin pregnancy, with maternal exposure to chickenpox during the thirteenth week of gestation, which produced one symptomatic and one healthy child.

  12. Abdominal cerclage in twin pregnancy after radical surgical conization

    NARCIS (Netherlands)

    Kyvernitakis, I.; Lotgering, F.K.; Arabin, B.

    2014-01-01

    Radical and repeated cone biopsies are associated with a high risk of spontaneous preterm birth. A 30-year-old gravida 1 presented with a spontaneous dichorionic twin pregnancy. She had a history of two radical surgical conizations. By speculum examination, no cervical tissue was detected. A history

  13. Outcome of twin pregnancies conceived after assisted reproductive techniques

    Directory of Open Access Journals (Sweden)

    A Baxi

    2008-01-01

    Full Text Available Context : There is a continuous controversy regarding the obstetric perinatal outcome of twin pregnancies conceived after assisted reproductive techniques (ART. There is an ongoing discussion whether theses parameters may show poorer results as compared to spontaneous conception. Aims: To evaluate the outcome of multifetal pregnancies and to compare maternal and neonatal complications between spontaneously conceived and assisted reproductive therapy. Settings and Design : Prospective case-control study. Materials and Methods :In this prospective case-control study of 2-year duration, obstetric and perinatal outcomes were compared in 36 ART twin pregnancies (Group A with 138 twins who conceived naturally (Group B. The outcomes were analyzed and used for a comparison between spontaneous and assisted multifetal pregnancies. Statistical Analysis : The continuous variables were analyzed by Student′s t -test and categorical variables were analyzed with Fisher′s exact test. Results : Pregnancy-related complications like pregnancy-induced hypertension, antepartum hemorrhage, were similar in both groups. Incidence of cesarean section, preterm delivery, and hospital stay was significantly more in Group A vs. Group B, P < 0.001. The newborns in the assisted group had more complications than the spontaneous group; most notable were respiratory distress syndrome, newborn intensive care admission, sepsis, and longer hospital stay (4.8 days vs. 1.6 days, P < 0.001. Conclusions : Increased rates of cesarean section and preterm delivery are the main reasons for increased obstetric risk in pregnancies conceived through ART. Preterm birth and neonatal prematurity-related complications were the main cause for longer stay in hospital in ART-conceived twins.

  14. Twin anemia polycythemia sequence: a single center experience and literature review.

    Science.gov (United States)

    Moaddab, Amirhossein; Nassr, Ahmed A; Espinoza, Jimmy; Ruano, Rodrigo; Bateni, Zhoobin H; Shamshirsaz, Amir A; Mandy, George T; Welty, Stephen E; Erfani, Hadi; Popek, Edwina J; Belfort, Michael A; Shamshirsaz, Alireza A

    2016-10-01

    Twin anemia polycythemia sequence (TAPS) is defined by significant intertwin hemoglobin discordance without the amniotic fluid discordance that characterizes twin-twin-transfusion syndrome (TTTS) in monochorionic twin pregnancies. TAPS is an uncommon condition which can either occur spontaneously, or following fetoscopic laser ablation for TTTS. This complication is thought to result from chronic transfusion through very small placental anastomoses; however, the pathogenesis of TAPS remains unknown. Consequently, there is no consensus in the management of TAPS. In this article, three cases of TAPS are described and we review the literature on this uncommon pregnancy complication.

  15. Spontaneous Rupture of Uterine Vein in Twin Pregnancy

    Directory of Open Access Journals (Sweden)

    Emek Doger

    2013-01-01

    Full Text Available Objective. Aim of our study is to present a case of a twin pregnancy following invitro fertilization cycle complicated with hemoperitoneum at third trimester. Case. A 26-year-old nulliparous pregnant woman at 32 weeks of gestation with twin pregnancy following invitro fertilization cycle complained of abdominal pain. After 48 hours of admission, laparotomy was performed with indications of aggravated abdominal pain and decreased hemoglobin levels. Utero-ovarian vein branch rupture was detected on the right posterior side of uterus and bleeding was stopped by suturing the vein. Etiopathogenesis of the present case still remains unclear. Conclusion. Spontaneous rupture of the uterine vessels during pregnancy is a rare complication and may lead to maternal and fetal morbidity and mortality. Diagnosis and treatment are based on the clinical symptoms of acute abdominal pain and laboratory tests of hypovolemic shock signs.

  16. The importance of plasma volume expansion and nutrition in twin pregnancy.

    Science.gov (United States)

    Campbell, D M; MacGillivray, I

    1984-01-01

    Physiological adaptation including expansion in plasma volume is exaggerated in women with twin pregnancies. In singleton pregnancy and multiparous twin pregnancies there is an association between plasma volume expansion and birth weight, but this is not so in primigravid twin pregnancies. Women with twin pregnancies have a similar dietary intake to singleton pregnancies, but it is not known whether there are differences with parity or zygosity. Absorption and utilisation of nutrients may be increased to meet demands for extra fetal growth. Nutrient supply and plasma volume expansion will be further discussed and their association with birth weight presented.

  17. Infant mortality in twin pregnancies following in-utero demise of the co-twin

    Institute of Scientific and Technical Information of China (English)

    Boubakari Ibrahimou; Hamisu M Salihu; Muktar H Aliyu; Gary English; Getachew Dagne

    2015-01-01

    Objective:To assess whether conversion from twin to singleton pregnancy following the demise of a co-twin influences survival.Methods:This retrospective study compared the risk for neonatal, post-neonatal and infant death for converted co-twins versus unconverted co-twins using the US matched multiple file dataset for the period 1995-2000. We also examined the same risks for converted versus same-quantile co-twins, hazard ratios (HR) and 95% confidence intervals (CI) were computed using Cox Proportional Hazards models.Results:The risk for neonatal (HR=0.18, 95%CI: 0.09-0.34 andHR=0.69, 95%CI: 0.50- 0.96) and infant death (HR=0.22, 95%CI: 0.12-0.42 andHR=0.57, 95%CI: 0.42-0.77) were significantly lower for converted twins than for unconverted twins and same-quantile twins, respectively. For black compared to white, the risk for post-neonatal death increased by 89% (HR=1.89, 95%CI= 1.03, 3.48), and 79% (HR=1.79, 95%CI=1.53, 2.09) for convertedvs. unconverted and convertedvs. same-quantile, respectively. For converted black, the risk for neonatal death decreased by 17% (HR=0.83, 95%CI=0.73-0.93) as compared to unconverted.Conclusions: Risks for all mortality types were lower among converted co-twins than their unconverted or same-quantile counterparts. The lower neonatal and higher post-neonatal mortality among black require future research.

  18. Twin pregnancy in a Fontan-palliated patient.

    Science.gov (United States)

    Nair, Anupama; Radhakrishnan, Sitaraman; Iyer, Krishna S

    2016-08-01

    The Fontan connection, originally described in 1971, is used to provide palliation for patients with many forms of CHDs that cannot support a biventricular circulation. An increasing number of females who have undergone these connections in childhood are now surviving into adulthood and some are becoming pregnant. We report a case of a 29-year-old woman who presented with a twin pregnancy at 33 weeks of gestation. She had significant deterioration of her cardiovascular status before the twin babies were delivered by emergency caesarean section owing to associated obstetric complications. This report also highlights the various maternal and fetal complications occurring in pregnancy of Fontan-palliated patients and suggests the need for meticulous pre-conception counselling and strict perinatal care.

  19. Fetal blood sampling in twin pregnancies. Prenatal diagnosis and management of 19 cases.

    Science.gov (United States)

    Cox, W L; Forestier, F; Capella-Pavlovsky, M; Daffos, F

    1987-01-01

    Twin pregnancies pose particular problems in both prenatal diagnosis and obstetric management. We present 19 twin pregnancies that underwent fetal blood sampling (FBS). The indications were mostly similar to those for singleton pregnancies, with both fetuses being sampled. There was one indication specific to twin pregnancies; disseminated intravascular coagulation in the retained twin after the death-in-utero (DIU) of the other. In 5 cases, only 1 twin was sampled; in 2 because the second twin was female in the diagnosis of an X-linked disorder; in 1 because of technical failure, and in 2 the other twin had predeceased. Eight pregnancies continued after the FBS delivering 2 live, healthy infants, though 5 were delivered before 37 weeks of gestation. In 7 cases there was a discordance in the diagnosis between the twins. In 3 of these cases the affected fetus underwent selective termination by air embolism; in 2 cases the pregnancies were continued and the affected twin not resuscitated; 1 pregnancy is still in progress, and 1 patient had a non-medically supervised termination of both twins in another country. Two patients miscarried within a week of the FBS. Two patients had only 1 living twin at the time of FBS; 1 had a second DIU a month after the FBS and the other a neonatal death at 11 days of age in an infant with severe porencephaly. FBS is technically feasible for similar indications as for singleton pregnancies though discordance in diagnosis raises specific management problems.

  20. Study of obstetric and fetal outcome of twin pregnancy in a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Gurpreet Kaur Nandmer

    2015-12-01

    Conclusions: Twin pregnancies are high risk pregnancies with more maternal and fetal complications. The use of antenatal care services, identification and anticipation of complications, intrapartum management and good NICU facilities will help to improve maternal and neonatal outcome in twin pregnancies. [Int J Reprod Contracept Obstet Gynecol 2015; 4(6.000: 1789-1792

  1. Optimal timing for term delivery of twin pregnancies: a population-based study.

    Science.gov (United States)

    Vilchez, Gustavo A; Dai, Jing; Hoyos, Luis R; Chelliah, Anushka; Bahado-Singh, Ray; Sokol, Robert J

    2015-04-01

    The objective of this study was to examine the risk of adverse neonatal outcomes after twin delivery according to gestational age. The U.S. Natality Database from 2007 to 2010 was reviewed. Inclusion criteria were twin deliveries and gestational age of 37 to 42 weeks. Exclusion criteria were congenital anomalies and missing/incomplete data. Cases were subdivided by gestational age into early term, term, and late term. Singleton pregnancies matched by delivery time and location were selected as controls. Outcome variables included were low Apgar score, assisted ventilation, neonatal intensive care unit admission, surfactant/antibiotic use, seizures, and birth injury. Logistic regression analysis was used to calculate adjusted odds ratios according to gestational age and plurality, using singleton term as reference. A total of 220,169 twin and 270,540 singleton deliveries were identified. The risk of adverse neonatal outcomes for twins was higher than for singletons. For twins, the distribution of the risks of the composite of adverse neonatal outcomes was linear, being the lowest at early term and the highest at late term, whereas the distribution for singletons was u-shaped being lowest at term compared with early and late term. Twins are at higher risk of suboptimal neonatal outcomes than singletons, but do better when delivered at early term rather than term or late term. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Monozygotic Twin Pregnancy Associated with In Vitro Fertilization: Report and Revision of Three Cases Presented in a Clinic at 10,925 Feet Above Sea Level.

    Science.gov (United States)

    Tominaga, Luis Vargas; Cáceres, Ricardo Pella; Lechuga, Alberto Vargas; Durán, Livia Bartolo; Vargas, Mariela Serrano

    2015-08-01

    3 cases of monozygotic twin pregnancies associated with IVF presented at Centro de Fertilidad y Ginecología del Sur. In this study, we describe the cases and review the literature, noting possible related factors.

  3. Obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART compared with spontaneous pregnancy

    Directory of Open Access Journals (Sweden)

    Leila Pourali

    2016-05-01

    Full Text Available Introduction: Regarding to the recent advances in assisted reproductive techniques (ART, twin and multiple pregnancies have increased during past years. Objective: This study was performed to compare obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART with spontaneous pregnancy. Materials and Methods: In this cross-sectional study which was performed in Ghaem Hospital, Mashhad University of Medical Sciences, 107 dichorionic twin pregnancy were enrolled in two groups: spontaneous group (n=96 and ART group (n=31. Basic criteria and obstetrics and neonatal outcomes information including demographic data, gestational age, mode of delivery, pregnancy complications (preeclampsia, gestational diabetes, preterm labor, and intrauterine growth retardation (IUGR, postpartum hemorrhage, neonatal outcomes (weight, first and fifth minuteP PApgar score, Neonatal Intensive Care Unit (NICU admission, mortality, respiratory distress, and icterus were recorded using a questionnaire. Results: Preterm labor, gestational diabetes, and preeclampsia were significantly higher in ART group compared to spontaneous pregnancy group. However, other factors such as anemia, IUGR, postpartum hemorrhage, and intrauterine fetal death (IUFD were not significantly different between groups. There were no significant differences between groups in terms of neonatal outcomes (weight, 1PstP and 5PthP min Apgar score <7, NICU hospitalization, mortality, respiratory distress, and icterus. Conclusion: With regard of significantly higher poor outcomes such as preeclampsia, gestational diabetes and preterm labor in ART group, the couples should be aware of these potential risks before choosing ART.

  4. Ultrasound estimation of birth weight in twin pregnancy: comparison of biometry algorithms in the STORK multiple pregnancy cohort.

    Science.gov (United States)

    Khalil, A; D'Antonio, F; Dias, T; Cooper, D; Thilaganathan, B

    2014-08-01

    The aims of this study were first, to ascertain the accuracy of formulae for ultrasonographic birth-weight estimation in twin compared with singleton pregnancies and second, to assess the accuracy of sonographic examination in the prediction of birth-weight discordance in twin pregnancies. This was a retrospective cohort study including both singleton and twin pregnancies. Routine biometry was recorded and estimated fetal weight (EFW) calculated using 33 different formulae. Only pregnancies that delivered within 48 h of the ultrasound scan were included (4280 singleton and 586 twin fetuses). Differences between the EFW and actual birth weight (ABW) were assessed by percentage error, accuracy in predictions within ± 10% and ± 15% of error and use of the Bland-Altman method. The accuracy of prediction of the different cut-offs of birth-weight discordance in twin pregnancies was also assessed using the area under the receiver-operating characteristics curve (AUC). The overall mean absolute percentage error was ≤ 10% for 25 formulae in singleton pregnancies compared with three formulae in twin pregnancies. The overall predictions within ± 10% and ± 15% of the ABW were 62.2% and 81.5% in singleton and 49.7% and 68.5% in twin pregnancies, respectively. When t e formulae were categorized according to the biometric parameters included, those based on a combination of head, abdomen and femur measurements showed the lowest mean absolute percentage error, in both singleton and twin pregnancies. The predictive accuracy for 25% birth-weight discordance using the Hadlock 2 formula, as assessed by the AUC, was 0.87. Ultrasound estimation of birth weight is less accurate in twin than in singleton pregnancies. Formulae that include a combination of head, abdomen and femur measurements perform best in both singleton and twin pregnancies. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

  5. 单绒毛膜单羊膜囊双胎妊娠17例临床分析%Monochorionic monoamniotic twin pregnancy: a review of 17 cases

    Institute of Scientific and Technical Information of China (English)

    邵长香; 孙路明; 邹刚; 孙琦; 周奋翮; 周艳

    2014-01-01

    Objective To review the diagnosis,monitoring,management and perinatal outcomes of monochorionic monoamniotic (MCMA) twin pregnancy.Methods From July 2010 to August 2013,there were 17 MCMA twin pregnancies diagnosed and delivered in Shanghai First Maternity and Infant Hospital.According to the MCMA management protocol,induced abortion,elective fetal reduction,and anticipant pregnancy were optional.For those anticipant pregnancies,fetal lung underwent maturation promotion at gestational weeks 28; hospitalization with 40 min/day continual fetal electronic monitoring and umbilical blood monitoring twice weekly at gestational weeks 28-30; 40 min continual fetal electronic monitoring twice daily and umbilical blood monitoring once every other day at gestational weeks 30-32; and 40 min continual fetal electronic monitoring three times daily and umbilical blood monitoring once daily at gestational weeks 32-34; and pregnancy ended on time.The presence of umbilical cord entanglement,congenital malformation,intrauterine fetal death,complications exclusive to monochorionic twins (e.g.selective fetal growth restriction,twin reversed arterial perfusion sequence and twin-twin transfusion syndrome) and the perinatal outcomes were retrospectively analyzed.Results Average maternal age of women with 17 MCMA twins was (29.0±2.7) years,and all were primiparas.They were diagnosed at (18.6± 5.5) weeks on average (11 +5-28+1 weeks).Umbilical cord entanglements were detected in all cases by ultrasonography and confirmed postnatally.There were three cases of complications specific to monochorionic twins,including two with selective fetal growth restriction and one with twin reversed arterial perfusion sequence.There were seven women with fetal congenital malformation; four of whom chose induced abortion; one case of anencephaly chose radiofrequency ablation fetal reduction,and the remaining two cases with congenital malformation and ten cases without chose anticipant pregnancy,and there

  6. Successful term delivery of spontaneous twin pregnancy in a woman with bicorporeal septate uterus: A case report.

    Science.gov (United States)

    Li, Yanfang; Yang, Lilin; Tian, Yuanyuan; Li, Daocheng; Luo, Songping

    2016-08-01

    Herein, we report the first case of successful term delivery of twins in a patient with bicorporeal septate uterus via natural conception. The patient had been diagnosed with complete septate, didelphys and bicornuate uterus during different phases of her three pregnancies. Based on follow-up data at six weeks and then six months post-partum of the last pregnancy, we found that the abnormalities presented in our case did not fit the criteria of any categories following American Fertility Society and European Society of Human Reproduction and Embryology-European Society for Gynaecological Endoscopy classification systems. After comprehensive review of the uterine morphologic characteristics, embryology and pregnancy outcome, we considered 'bicorporeal septate uterus' the most appropriate diagnosis. This case emphasized the atypical changes of uterine shape as twin pregnancy advances and its influence on productive performance and pregnancy outcome in uterine malformation. It also raised concern regarding the usability and comprehensiveness of the two most popular classification systems.

  7. Spontaneous intra-abdominal bleeding in twin pregnancy: Case report

    Directory of Open Access Journals (Sweden)

    Berisavac Milica

    2008-01-01

    Full Text Available INTRODUCTION Spontaneous rupture of utero-ovarian vessels is a rare cause of haemoperitoneum in pregnancy, leading to significant maternal and foetal morbidity and mortality. Aetiopathogenesis of this condition is still unclear. Establishing clinical diagnosis of this condition is difficult, but very important. Clinical symptoms are nonspecific, and the diagnosis is usually made at laparotomy. CASE OUTLINE We report a case of spontaneous haematoperitoneum in the third trimester of twin pregnancy. Differential diagnosis included uterine rupture and placental abruption. Due to the deteriorated condition of the patient, it was decided to perform laparotomy which established the diagnosis of ruptured venous varices on the posterior uterine wall. Delivery was performed by caesarean section. The postoperative period was uneventful. CONCLUSION The clinical presentation of spontaneous rupture of utero-ovarian blood vessels is not specific and clinical examination and ultrasonographic scanning may be insufficient for diagnosis. Once the diagnosis of spontaneous haematoperitoneum in pregnancy is established, emergency laparotomy is indicated. Following caesarean delivery, it is necessary to establish surgical haemostasis. There are some authors who suggest leaving the pregnancy intact in cases when the fetus is not viable, although one must have in mind the possibility of recurrent bleeding. The safety of this procedure requires further investigation. It is necessary to have in mind the possibility of blood vessel rupture in all cases of abdominal pain and hypotension of unknown origin during pregnancy.

  8. Dizygotic monochorionic twin pregnancy conceived following intracytoplasmic sperm injection treatment and complicated by twin-twin transfusion syndrome and blood chimerism

    DEFF Research Database (Denmark)

    Ekelund, C K; Skibsted, L; Søgaard, K

    2008-01-01

    We report a case of a dizygotic monochorionic twin pregnancy preceded by intracytoplasmic sperm injection treatment including assisted hatching. On ultrasound examination at 25 weeks' gestation the twins, which had been assumed to be monochorionic, were found to be of different sexes. Karyotyping...

  9. Prenatal diagnosis of lethal osteogenesis imperfecta in twin pregnancy.

    Science.gov (United States)

    Morin, L R; Herlicoviez, M; Loisel, J C; Jacob, B; Feuilly, C; Stanescu, V

    1991-06-01

    Lethal osteogenesis imperfecta was diagnosed at 27 weeks amenorrea in one fetus of a bichorial twin pregnancy. Sonographic findings included: short-limb dwarfism, hypotrophy and hypoechoic bones. The affected fetus was so translucent that only the normal fetus could be seen on plain in utero radiography. The affected fetus died immediately after birth. Postmortem radiography and histology were typical of lethal osteogenesis imperfecta of type IIA. Aids to the etiological diagnosis of in utero dwarfism are presented. Sonographic features correlated with neonatal death are described.

  10. A Rare Case of Antepartum Spontaneous Septostomy in a Monochorionic Diamniotic Twin Pregnancy

    Directory of Open Access Journals (Sweden)

    Rati Chadha

    2012-01-01

    Full Text Available Spontaneous septostomy in a monochorionic diamniotic twin pregnancy is a rare phenomenon. We present a case of monochorionic diamniotic twin pregnancy with an intact dividing membrane seen in the 1st half of the pregnancy. At 26 weeks, when she was assessed for preterm contractions, the dividing membrane was not documented, which suggested spontaneous septostomy. There had been no invasive procedures during the pregnancy. She subsequently delivered at 29 weeks, secondary to preterm labor. No dividing membrane was noticed at the time of caesarian section. Spontaneous septostomy can complicate the management of monochorionic diamniotic twins by creating a pseudomonoamniotic environment resulting in cord entanglement, and difficulty in the diagnosis and management of twin-twin transfusion syndrome. We believe that such a case should be managed as monochorionic monoamniotic twin gestation.

  11. The influence of maternal body mass index on fetal weight estimation in twin pregnancy.

    LENUS (Irish Health Repository)

    Ryan, Helen M

    2013-11-08

    Sonographic estimation of fetal weight (EFW) is important in the management of high-risk pregnancies. The possibility that increased maternal body mass index (BMI) adversely affects EFW assessments in twin pregnancies is controversial. The aim of this study was to investigate the effect of maternal BMI on the accuracy of EFW assessments in twin gestations prospectively recruited for the ESPRiT (Evaluation of Sonographic Predictors of Restricted growth in Twins) study.

  12. Dramatically different dizygotic twins: will we include them in Research? Twin research reviews: congenital anomalies, mirror-image effects in conjoined twins, older mothers of twins; Twin statistics: 'Massachusetts, land of twins'; Tribute: Dr Victor A. McKusick.

    Science.gov (United States)

    Segal, Nancy L

    2008-10-01

    The increased frequency of interracial marriage is a likely source of unusual-looking dizygotic (DZ) twins. Some members of DZ twin pairs born to mixed-race couples inherit very different physical features from their parents. This raises several questions, such as: Will researchers wish to include such twins in their ongoing studies? Next, new twin research concerned with congenital anomalies, mirror-image effects in conjoined twins and older mothers of twins will be reviewed. New statistics on twinning rates in Massachusetts will also be summarized, followed by a tribute to the late medical geneticist Dr. Victor A. McKusick.

  13. Delayed interval delivery after intrauterine infection and immature birth of twin 1--a case report and literature review.

    Science.gov (United States)

    de Jong, M W; Pinas, I M; van Eijck, J

    1995-11-01

    We report a case of delayed interval delivery in a twin pregnancy complicated by rupture of membranes, intrauterine infection and birth of one twin at 21 weeks gestation. Tocolysis combined with antibiotics and corticosteroids successfully prolonged pregnancy for 73 days, allowing the second twin to mature and reach viability. At 31.5 weeks gestation, a 1890 g healthy male neonate was born with good Apgar scores. His postnatal course was uneventful. A literature review of several other cases of delayed interval delivery is presented. When multifetal pregnancies are complicated by immature birth of one fetus, delayed interval delivery may offer survival chances and favourable outcome for the remaining fetus(es).

  14. Transvaginal cervical length measurement at 22- to 26-week pregnancy in prediction of preterm births in twin pregnancies.

    Science.gov (United States)

    El-Gharib, Mohamed Nabih; Albehoty, Sherin Barakat

    2017-03-01

    To investigate the predictive role of transvaginal ultrasonographic measurement of cervical length (CL) at 22-26 weeks of gestation in determining preterm deliveries in twin pregnancies. The study included 150 twin pregnancies. CL was measured by transvaginal ultrasonography at 22-26 weeks. Signs of preterm labor, ruptured membranes, vaginal bleeding, patients with systemic disease, and cervical incompetencies were excluded. The patients had monthly digital cervical examinations but no routine TVCL ultrasound examinations. The primary outcome was spontaneous preterm birth at before 37 weeks of gestation. Ninety-two percent of twin pregnancies delivered by cesarean section and 16% babies had a neonatal intensive care unit requisitioned. Ninety-two patients were delivered in smaller than 37 gestational weeks and the mean CL measurement (CLM) was twin pregnancy, the risk of preterm birth can be evaluated using the ultrasonographic measurement of CL at 22-26 weeks of gestation.

  15. Cervical pessary placement for prevention of preterm birth in unselected twin pregnancies: a randomized controlled trial.

    Science.gov (United States)

    Nicolaides, Kypros H; Syngelaki, Argyro; Poon, Liona C; de Paco Matallana, Catalina; Plasencia, Walter; Molina, Francisca S; Picciarelli, Gemma; Tul, Natasa; Celik, Ebru; Lau, Tze Kin; Conturso, Roberto

    2016-01-01

    Preterm birth is the leading cause of neonatal death and handicap in survivors. Although twins are found in 1.5% of pregnancies they account for about 25% of preterm births. Randomized controlled trials in singleton pregnancies reported that the prophylactic use of progestogens, cervical cerclage and cervical pessary reduce significantly the rate of early preterm birth. In twin pregnancies, progestogens and cervical cerclage have been shown to be ineffective in reducing preterm birth. The objective of this study was to test the hypothesis that the insertion of a cervical pessary in twin pregnancies would reduce the rate of spontaneous early preterm birth. This was a multicenter, randomized controlled trial in unselected twin pregnancies of cervical pessary placement from 20(+0)-24(+6) weeks' gestation until elective removal or delivery vs. expectant management. Primary outcome was spontaneous birth control groups in rates of spontaneous birth birth. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Stolen twin: fascination and curiosity/twin research reports: evolution of sleep length; dental treatment of craniopagus twins; cryopreserved double embryo transfer; gender options in multiple pregnancy/current events: appendectomy in one twin; autistic twin marathon runners; 3D facial recognition; twin biathletes.

    Science.gov (United States)

    Segal, Nancy L

    2014-02-01

    The story of her allegedly stolen twin brother in Armenia is recounted by a 'singleton twin' living in the United States. The behavioral consequences and societal implications of this loss are considered. This case is followed by twin research reports on the evolution of sleep length, dental treatment of craniopagus conjoined twins, cryopreserved double embryo transfer (DET), and gender options in multiple pregnancy. Current events include the diagnosis of appendectomy in one identical twin, the accomplishments of autistic twin marathon runners, the power of three-dimensional (3D) facial recognition, and the goals of twin biathletes heading to the 2014 Sochi Olympics in Russia.

  17. Presenting Twins Are Exposed to Higher Levels of Inflammatory Mediators than Nonpresenting Twins as Early as the Midtrimester of Pregnancy.

    Directory of Open Access Journals (Sweden)

    Seung Mi Lee

    Full Text Available Presenting twins are less likely to develop respiratory complications than non-presenting twins. The precise reason for this difference is not well understood, although it is known that the presence of inflammation reduces the risk of respiratory morbidity at birth. To further investigate this association, we compared the concentrations of inflammatory biomarkers in mid-trimester amniotic fluid (AF of asymptomatic twin pairs.The study population consisted of women with twin pregnancies who underwent mid-trimester amniocentesis (15-20 weeks for routine clinical indications and delivered at term. AF was analyzed for pro-inflammatory cytokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, IL-15, IFN-γ, TNF-α, matrix metalloproteinases (MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, MMP-12, and chemokines (Complement Factor D/Adipsin, Serpin E1/PAI-1, Adiponectin/Acrp30, CRP, CCL2/MCP-1, Leptin, Resistin using Luminex Performance Assay multiplex kits. Data were analyzed using Wilcoxon signed rank test.A total of 82 twin pairs were enrolled. Mid-trimester AF concentrations of IL-8, MMP-8, CRP, MCP-1, leptin, and resistin were significantly higher in the presenting twin compared with the non-presenting twin (p<0.05 for each. Differences in AF concentrations of IL-8, MMP-8, and CRP persisted after adjustment for the fetal growth restriction at the time of birth and chorionicity.These data suggest that, as early as the mid-trimester, the presenting fetus in an otherwise uncomplicated twin pregnancy is exposed to higher levels of pro-inflammatory mediators (especially IL-8, MMP-8, and CRP than its non-presenting co-twin. Whether this pro-inflammatory milieu reduces the risk of neonatal respiratory morbidity at birth or has other functional implications needs to be further evaluated.

  18. Delayed Interval Delivery of a Second Twin after the Preterm Labor of the First One in Twin Pregnancies: Delayed Delivery in Twin Pregnancies

    Directory of Open Access Journals (Sweden)

    Yunus Aydin

    2012-01-01

    Full Text Available A diamnionic dichorionic twin pregnant women (due to in vitro fertilization admitted to emergency department at the 21st week of gestation because of regular contractions. By gynecological examination, we observed 8 cm dilated cervix with 80% effacement. Amniotic membrane was also bulging through the cervix. After evaluation delivery of the presenting fetus occurred quickly. The baby’s weight was 610 gr and no heart activity was detected. Placenta of the first fetus expulsed immediately. We decided to retain the second fetus to allow the improvement in the outcome. McDonald cerclage was performed and the patient treated with tocolytics and antibiotics, and she was continuously monitored up to the 28th week of pregnancy. After she was discharged in the 28th week, she was controlled weekly in obstetrics clinic. At the 36th gestational week which was 101 days after the cerclage procedure, 3639 g male fetus was delivered with cesarean section and had an uneventful neonatal course. Delayed-interval delivery is useful and acceptable therapeutic option for the management of the remaining fetus in twin pregnancies even after the expulsion of the placenta. Antibiotic and tocolytic administration with cervical cerclage application can be associated with longer interdelivery interval.

  19. Serum mineral levels at pregnancy and postpartum in single and twin pregnant sheep.

    Science.gov (United States)

    Yildiz, Atilla; Balikci, Engin; Gurdogan, Fuat

    2005-12-01

    This study was performed to investigate calcium (Ca), inorganic phosphorus (P), potassium (K), magnesium (Mg), and chlorine (Cl) levels in blood serum at d 60, 100, and 150 of gestation and at d 45 after parturition and to find out the significance of differences for macromineral levels during these stages of single or twin gestation in Akkaraman sheep. Blood samples of 30 apparently healthy pregnant Akkaraman sheep (15 single pregnancies, 15 twin pregnancies) were used. The samples were analyzed using a biochemical analyzer for Ca, P, Na, K, and Mg concentrations and using the Schales method for Cl levels. A statistically significant decrease (p pregnancy for Ca levels and for serum inorganic P levels in both groups. Twin pregnant sheep were found to have lower (p 0.05, p pregnancy. There were significant increases (p < 0.01) in serum Cl levels on d 100 in single and twin pregnant sheep.

  20. Double trouble: the importance of reporting chorionicity and amnionicity in twin pregnancy ultrasound reports.

    Science.gov (United States)

    Constantine, Sarah; Wilkinson, Chris

    2015-02-01

    An obstetric ultrasound report in a twin pregnancy that does not unambiguously determine chorionicity and amnionicity in the first trimester is substandard. This article will assist radiologists to understand the importance of reporting the chorionicity and amnionicity in all twin obstetric scans.

  1. Comparison of perinatal outcome in twin pregnancy with and without cervical cerclage

    Directory of Open Access Journals (Sweden)

    Mitesh Suresh Chavan

    2016-11-01

    Conclusions: In spite of close vigilance, preterm birth in twin gestation is common and unpredictable. It is difficult to predict those who may require cervical cerclage although all multiple pregnancies are at high risk. Cerclage should be considered an option for patients with twin pregnancies in the second trimester to prolong the duration of gestation as close to term as possible. [Int J Reprod Contracept Obstet Gynecol 2016; 5(11.000: 3924-3930

  2. Twin screw granulation - review of current progress.

    Science.gov (United States)

    Thompson, M R

    2015-01-01

    Twin screw granulation (TSG) is a new process of interest to the pharmaceutical community that can continuously wet granulate powders, doing so at lower liquid concentrations and with better product consistency than found by a high shear batch mixer. A considerable body of research has evolved over the short time since this process was introduced but generally with little comparison of results. A certain degree of confidence has been developed through these studies related to how process variables and many attributes of machinery configuration will affect granulation but some major challenges still lay ahead related to scalability, variations in the processing regimes related to degree of channel fill and the impact of wetting and granulation of complex powder formulations. This review examines the current literature for wet granulation processes studied in twin screw extrusion machinery, summarizing the influences of operational and system parameters affecting granule properties as well as strives to provide some practical observations to newly interested users of the technique.

  3. Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries.

    Directory of Open Access Journals (Sweden)

    Joshua P Vogel

    Full Text Available BACKGROUND: Twin pregnancies in low- and middle-income countries (LMICs pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources. We conducted a secondary analysis of the WHO Global Survey dataset to analyze maternal and perinatal outcomes in twin pregnancies and factors associated with perinatal morbidity and mortality in twins. METHODS: We examined maternal and neonatal characteristics in twin deliveries in 23 LMICs and conducted multi-level logistic regression to determine the association between twins and adverse maternal and perinatal outcomes. RESULTS: 279,425 mothers gave birth to 276,187 (98.8% singletons and 6,476 (1.2% twins. Odds of severe adverse maternal outcomes (death, blood transfusion, ICU admission or hysterectomy (AOR 1.85, 95% CI 1.60-2.14 and perinatal mortality (AOR 2.46, 95% CI 1.40-4.35 in twin pregnancies were higher, however early neonatal death (AOR 2.50, 95% CI 0.95-6.62 and stillbirth (AOR 1.22, 95% CI 0.58-2.57 did not reach significance. Amongst twins alone, maternal age 15%, born second, preterm birth and low birthweight were associated with perinatal mortality. Marriage and caesarean section were protective. CONCLUSIONS: Twin pregnancy is a significant risk factor for maternal and perinatal morbidity and mortality in low-resource settings; maternal risk and access to safe caesarean section may determine safest mode of delivery in LMICs. Improving obstetric care in twin pregnancies, particularly timely access to safe caesarean section, is required to reduce risk to mother and baby.

  4. Validity of lamellar body count as a fetal lung maturity assessment in twin pregnancy.

    Science.gov (United States)

    Tsuda, Hiroyuki; Kotani, Tomomi; Sumigama, Seiji; Kawabata, Ichiro; Takahashi, Yuichiro; Iwagaki, Shigenori; Kigoshi, Kaori; Kikkawa, Fumitaka

    2012-08-01

    Fetal lung maturity assessment in twin pregnancy has been discussed, but is still controversial. The purpose of this study is to predict the occurrence of respiratory distress syndrome (RDS) using lamellar body count (LBC) and analyze the validity of LBC for fetal lung maturity assessment in twin pregnancy. Three-hundred two amniotic fluid samples were obtained at cesarean section from 29 to 38 weeks of gestation. Samples were analyzed immediately with no centrifugation and the number of lamellar bodies was counted using a platelet channel on the Sysmex SF-3000. There were 18 neonates (6.0%) suffering from RDS. An LBC cut-off value of 2.95×10⁴/μL resulted in 91.5% sensitivity and 83.3% specificity for predicting RDS. This cut-off value for predicting RDS was the same as that in singleton pregnancy. Moreover, the median LBC value in RDS cases was significantly lower than in non-RDS cases (1.50±1.1×10⁴/μL vs. 10.6±7.5×10⁴/μL; ptwin pregnancy and also the largest study on fetal lung maturity assessment in twin pregnancy. An LBC value of >2.95×10⁴/μL means reassuring findings for RDS even in twin pregnancy. We believe the data in this study provide valuable, new information for the management of twin pregnancies.

  5. Reducing twin pregnancy rates after IVF--elective single embryo transfer (eSET).

    LENUS (Irish Health Repository)

    Milne, P

    2010-01-01

    Multiple pregnancy is a major complication of IVF and is associated with increased maternal, fetal and neonatal morbidity. Elective single embryo transfer (eSET) during IVF, rather than the more standard transfer of two embryos (double embryo transfer or DET), has been shown to significantly reduce the multiple pregnancy rate associated with IVF, while maintaining acceptable pregnancy rates. Couples undergoing IVF in 2008 who met good prognostic criteria had eSET performed. Pregnancy and twinning rates were compared with those for similar couples in 2007 who had DET. Couples unsuccessful with a fresh cycle of treatment had subsequent frozen embryo transfer cycles with DET. The cumulative pregnancy rate was similar for each group. However there were no multiple pregnancies in the eSET group, compared to 4 twins of 5 pregnancies in the DET group. 96% of eligible couples agreed to eSET. ESET is successful in and acceptable to good prognosis Irish couples undergoing IVF.

  6. Confined blood chimerism in a monochorionic dizygotic sex discordant twin pregnancy conceived after induced ovulation.

    Science.gov (United States)

    Mayeur Le Bras, Anne; Petit, François; Benachi, Alexandra; Bedel, Bettina; Oucherif, Salima; Martinovic, Jelena; Armanet, Narjes; Tosca, Lucie; Gautier, Valérie; Parisot, Frédéric; Labrune, Philippe; Tachdjian, Gérard; Brisset, Sophie

    2016-04-01

    Monochorionic twins are generally considered as a monozygotic twin pregnancy. However, several cases of monochorial dizygotic twin pregnancies have been reported. We report on a rare case of monochorionic dizygotic twin pregnancy conceived after induced ovulation in a 32-year-old woman. The diagnosis was made on morphological ultrasound examination at 18+4 weeks of gestation, showing two fetuses with discordant sex. The amniocentesis was declined by the patient. The monochorionic status was confirmed after a histopathalogical study of the placenta. At delivery, both a phenotypically normal boy and a phenotypically normal girl without sexual abnormality were observed. This analysis also revealed the presence of vascular anastomoses between both fetal circulations. Postnatal cytogenetic analyses indicated the presence of a chimerism in peripheral blood lymphocytes. This chimerism was not observed in cells obtained from a buccal swab. Molecular determination of zygosity confirmed the existence of the confined peripheral blood chimerism with the presence of four parental alleles. We report on a case of monochorionic dizygotic twin pregnancy. This observation underlies the need to carefully assess twin pregnancies, especially when obtained after assisted reproductive technology. © 2016 Wiley Periodicals, Inc.

  7. Art for twins: Yorùbá artists and their statues/twin research studies: twins' education and conceptions; diurnal preference; inherited eye diseases; ultrasound counseling when twins are conjoined/popular twin reports: twin sisters (the film); rare pregnancy; diet test; French twins reared apart and reunited.

    Science.gov (United States)

    Segal, Nancy L

    2014-06-01

    The Yorùbá of Nigeria are well known for their high twinning rate and the statues they create to commemorate deceased twins. An impressive collection of this artwork was displayed at the University of California's Fowler Museum in Los Angeles between October 13, 2013 and March 2, 2014. An overview of this exhibit is provided. Next, twin research on maternal education and conception, diurnal preference, inherited eye diseases, and ultrasound counseling for couples with conjoined twins are briefly summarized. This article concludes with a discussion of media-based items related to twins. The topics include an award-winning twin film, a rare pregnancy, a diet test, and the separation and chance reunion of monozygotic female twins.

  8. Transient early preeclampsia in twin pregnancy with a triploid fetus : a case report

    NARCIS (Netherlands)

    van der Houwen, C.; Schukken, T.; van Pampus, M.

    2009-01-01

    INTRODUCTION: Triploid pregnancies have an increased risk of early preeclampsia. Twin pregnancies consisting of one healthy fetus and one complete or partial molar, with or without a triploid fetus, are rare and management is complex. CASE PRESENTATION: A 33-year-old Caucasian woman presented with a

  9. Transient early preeclampsia in twin pregnancy with a triploid fetus : a case report

    NARCIS (Netherlands)

    van der Houwen, C.; Schukken, T.; van Pampus, M.

    2009-01-01

    INTRODUCTION: Triploid pregnancies have an increased risk of early preeclampsia. Twin pregnancies consisting of one healthy fetus and one complete or partial molar, with or without a triploid fetus, are rare and management is complex. CASE PRESENTATION: A 33-year-old Caucasian woman presented with a

  10. Successful Singleton and Twin Pregnancies With the Nuss Bars in Place.

    Science.gov (United States)

    Jaroszewski, Dawn E; Ewais, MennatAllah M; Gotway, Michael B; McMahon, Lisa E; Notrica, David M

    2015-11-01

    Pectus excavatum (PE) occurs less commonly in women, and the implications on a pregnancy after repair during the period when support bars are in place are unknown. We present 2 cases: 1 with a successful twin gestation and another with a successful singleton gestation. These women carried the pregnancies to term and delivered their infants with the Nuss bars in place.

  11. Dichorionic triamniotic triplet pregnancy complicated by twin anemia polycythemia sequence: the place of fetal therapy.

    Science.gov (United States)

    Griersmith, Thérèse H; Fung, Alison M; Walker, Susan P

    2014-12-01

    Monochorionic twins as part of a high order multiple pregnancy can be an unintended consequence of the increasingly common practice of blastocyst transfer for couples requiring in vitro fertilisation (IVF) for infertility. Dichorionic triamniotic (DCTA) triplets is the most common presentation, and these pregnancies are particularly high risk because of the additional risks associated with monochorionicity. Surveillance for twin-to-twin transfusion syndrome, including twin anemia polycythemia sequence, may be more difficult, and any intervention to treat the monochorionic pair needs to balance the proposed benefits against the risks posed to the unaffected singleton. Counseling of families with DCTA triplets is therefore complex. Here, we report a case of DCTA triplets, where the pregnancy was complicated by threatened preterm labour, and twin anemia polycythemia sequence (TAPS) was later diagnosed at 28 weeks. The TAPS was managed with a single intraperitoneal transfusion, enabling safe prolongation of the pregnancy for over 2 weeks until recurrence of TAPS and preterm labour supervened. Postnatal TAPS was confirmed, and all three infants were later discharged home at term corrected age, and were normal at follow-up. This case highlights that in utero therapy has an important role in multiple pregnancies of mixed chorionicity, and can achieve safe prolongation of pregnancy at critical gestations.

  12. Twin pregnancy in a patient of chronic myeloid leukemia on imatinib therapy.

    Science.gov (United States)

    Meera, V; Jijina, Farah; Shrikande, Mitu; Madkaikar, Manisha; Ghosh, K

    2008-10-01

    Imatinib is a tyrosine kinase inhibitor and is now used regularly in chronic myeloid leukaemia therapy in chronic phase with great success. This drug due its very nature of action is suspected to be teratogenic hence the patients are counseled not to get pregnant while on this drug. However in world literature few normal pregnancies have been reported in patients on Imatinib therapy, though no twin pregnancy has been reported on this medication. We report here the birth of normal mono-ovular mono-chorionic twin while the patient is on imatinib during conception and early pregnancy for chronic myeloid leukaemia.

  13. Assessing Weight Gain by the 2009 Institute of Medicine Guidelines and Perinatal Outcomes in Twin Pregnancy.

    Science.gov (United States)

    Ozcan, Tulin; Bacak, Stephen J; Zozzaro-Smith, Paula; Li, Dongmei; Sagcan, Seyhan; Seligman, Neil; Glantz, Christopher J

    2016-07-23

    Objective The objective is to estimate the impact of maternal weight gain outside the 2009 Institute of Medicine recommendations on perinatal outcomes in twin pregnancies. Study Design Twin pregnancies with two live births between January 1, 2004 and December 31, 2014 delivered after 23 weeks Finger Lakes Region Perinatal Data System (FLRPDS) and Central New York Region Perinatal Data System were included. Women were classified into three groups using pre-pregnancy body mass index (BMI). Perinatal outcomes in women with low or excessive weekly maternal weight gain were assessed using normal weekly weight gain as the referent in each BMI group. Results Low weight gain increased the risk of preterm delivery, birth weight less than the 10th percentile for one or both twins and decreased risk of macrosomia across all BMI groups. There was a decreased risk of hypertensive disorders in women with normal pre-pregnancy weight and an increased risk of gestational diabetes with low weight gain in obese women. Excessive weight gain increased the risk of hypertensive disorders and macrosomia across all BMI groups and decreased the risk of birth weight less than 10th percentile one twin in normal pre-pregnancy BMI group. Conclusion Among twin pregnancies, low weight gain is associated with low birth weight and preterm delivery in all BMI groups and increased risk of gestational diabetes in obese women. Our study did not reveal any benefit from excessive weekly weight gain with potential harm of an increase in risk of hypertensive disorders of pregnancy. Normal weight gain per 2009 IOM guidelines should be encouraged to improve pregnancy outcome in all pre-pregnancy BMI groups.

  14. Outcome following selective fetal reduction in monochorionic and dichorionic twin pregnancies discordant for structural, chromosomal and genetic disorders.

    Science.gov (United States)

    Nobili, Elena; Paramasivam, Gowrishankar; Kumar, Sailesh

    2013-04-01

    To investigate the indications for offering selective fetal reduction in monochorionic (MC) and dichorionic (DC) twins and to correlate obstetric outcome with the antenatal procedure. All cases of MC and DC twins discordant for structural anomalies and for chromosomal/genetic abnormalities were included. Selective reductions performed for twin-to-twin transfusion syndrome or growth restriction were excluded. For DC twins, feticide was achieved using intracardiac injection of potassium chloride (KCl). For MC twins, bipolar cord occlusion (BCO), interstitial laser or radiofrequency ablation (RFA) was used. There were 121 twin pregnancies discordant for structural and chromosomal abnormalities. Only 88 (56 were MC twins and 32 were DC twins) had selective reduction. For both MC and DC twins, the leading indication for selective reduction was structural anomalies with CNS malformations the most common. For all MC fetal reduction techniques, the overall pregnancy loss rate (twins were >87% and 100% for DC twins. Selective reduction in MC pregnancies carries an increased procedure-related and preterm delivery rate compared with DC pregnancies. The main indication for selective reduction was structural malformations, with a predominance of CNS anomalies. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  15. Loop electrosurgical excision of the cervix and risk for spontaneous preterm delivery in twin pregnancies

    DEFF Research Database (Denmark)

    Noehr, Bugge; Jensen, Allan; Frederiksen, Kirsten;

    2009-01-01

    OBJECTIVE: To investigate the association between three cervical procedures (biopsy with no treatment, ablation, and loop electrosurgical excision procedure [LEEP]) and subsequent spontaneous preterm delivery in twin pregnancies using population-based data from various nationwide registries...... spontaneously preterm (32.7%). Preterm delivery was defined as gestational age between 21 weeks and 37 weeks. Logistic regression analyses were used to evaluate the association between cervical procedures and preterm delivery. RESULTS: Twin pregnancies subsequent to LEEP had a significantly increased risk...... preterm groups. We found no increase in risk of preterm delivery subsequent to biopsy without treatment or ablation. CONCLUSION: Our study showed an overall significant increase in risk of preterm delivery in twin pregnancies subsequent to LEEP treatment, even after adjustment for several potential risk...

  16. Perinatal outcome after first-trimester risk assessment in monochorionic and dichorionic twin pregnancies

    DEFF Research Database (Denmark)

    Kristiansen, Mona Kjærbøl; Joensen, BS; Ekelund, CK

    2015-01-01

    .8% for DC, MCDA and MCMA twins, respectively (P death of one fetus after week 22 was higher in MCDA twins than DC twins 1.7% versus 0.6% (P neonatal death. CONCLUSIONS: The risk of spontaneous loss of both fetuses......) pregnancies and 15.7% monochorionic (MC) pregnancies (15% diamniotic [MCDA] and 0.7% monoamniotic [MCMA]). METHODS: A cohort study based on data collected from the Danish Fetal Medicine Database from July 2008 to July 2011. MAIN OUTCOME MEASURES: Fetal loss rate before week 22, intrauterine death rate from...... week 22 to birth, and neonatal mortality. RESULTS: Significantly more DC than MC pregnancies resulted in at least one live born infant-98.2% versus 92.3% in MCDA (P

  17. Acardiac twin pregnancy: successful intrauterine ablative treatment with alcohol at 14 weeks of gestation.

    Science.gov (United States)

    Guven, M A; Koc, O; Bodur, H; Erkanli, S; Bagis, T; Usal, D

    2016-01-01

    Twin reversed arterial perfusion (TRAP) sequence is a serious condition of monochorionic twin pregnancy, occurring in approximately one in 35,000 cases. First trimester treatment of TRAP sequence is controversial with higher incidence of procedure related complications. Present case demonstrates a TRAP sequence that was managed by intrauterine treatment with one-ml 100% pure alcohol injection into the abdominal part of the umbilical artery and obliteration of the acardiac twin at 14 weeks of gestation. Antenatal follow-up was uneventful and elective cesarean section was performed at 39 weeks' gestation. Postnatal outcome of the pump twin was excellent at 30 months after birth. Early second trimester elective ablation by alcohol injection can be an inexpensive, alternative, and reasonable minimal invasive treatment option to prevent fetal loss of pump twin before mid and late second trimester in perinatology centers where intrafetal cord occlusive methods are not available.

  18. Effectiveness of progestogens to improve perinatal outcome in twin pregnancies : an individual participant data meta-analysis

    NARCIS (Netherlands)

    Schuit, E; Stock, S; Rode, L; Rouse, D J; Lim, A C; Norman, J E; Nassar, A H; Serra, V; Combs, C A; Vayssiere, C; Aboulghar, M M; Wood, S; Çetingöz, E; Briery, C M; Fonseca, E B; Worda, K; Tabor, A; Thom, E A; Caritis, S N; Awwad, J; Usta, I M; Perales, A; Meseguer, J; Maurel, K; Garite, T; Aboulghar, M A; Amin, Y M; Ross, S; Cam, C; Karateke, A; Morrison, J C; Magann, E F; Nicolaides, K H; Zuithoff, N P A; Groenwold, R H H; Moons, K G M; Kwee, A; Mol, B W J

    2015-01-01

    BACKGROUND: In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). OBJECTIVES: To assess the effectiveness of progestogen treatment in the prevention of neonatal morbidity or PTB in twin pregnancies

  19. Can prematurity risk in twin pregnancies after in vitro fertilization be predicted? A retrospective study

    Directory of Open Access Journals (Sweden)

    Barad David

    2009-01-01

    Full Text Available Abstract Background Assisted reproduction (ART contributes to world-wide increases of twin pregnancies, in turn raising prematurity risks. Whether characteristics of ART cycles, resulting in twin gestations, can predict prematurity risks was the subject of this study. Methods One-hundred-and-six women, ages 20 to 39 years, with consecutive dichorionic-diamniotic (DC/DA twin gestations were retrospectively investigated. All pregnancies investigated followed fresh ART cycles, with use of autologous gamets, and were delivered at a university-based high-risk, maternal-fetal medicine unit. Only premature deliveries (i.e., <37.0 weeks gestational age, with viable neonate(s of ≥ 500 grams, were considered for analysis. Results After 1.8 +/- 1.2 ART cycles, 11.0 +/- 5.4 oocytes were retrieved and 2.4 +/- 0.9 embryos transferred in 106 women aged 31.6 +/- 4.2 years. Indications for ART treatment were male factor in 51.9%, female infertility in 27.4% and combined infertility in 20.8%. Though maternal age significantly influenced prematurity risk (p < 0.05, paternal age, maternal body mass index, indications for fertility treatment, number of previous ART attempts, oocytes retrieved or embryos transferred, as well as stimulation protocols and previous ART pregnancies, were not associated with gestational duration in twin pregnancies. Summary Except for female age, baseline and ART cycle characteristics do not allow for prediction of prematurity risk in dichorionic twin gestations after assisted reproduction.

  20. A comparison of the contractile properties of myometrium from singleton and twin pregnancies.

    Directory of Open Access Journals (Sweden)

    Peter Turton

    Full Text Available OBJECTIVE: Over half of twin pregnancies in US and UK deliver prematurely but the reasons for this are unclear. The contractility of myometrium from twin pregnancies has not been directly investigated. The objective of this research was to determine if there are differences in the contractile activity and response to oxytocin, between myometrium from singleton and twin pregnancies, across a range of gestational ages. Furthermore, we wished to determine if contractile activity correlates with increasing level of stretch, using neonatal birth weights as a marker of uterine stretch. METHODS: This was an in vitro, laboratory based study of myometrial contractility in women pregnant with one or two babies, using biopsies obtained from non-labouring women undergoing Caesarean section. Spontaneous, oxytocin-stimulated and depolarization induced contractile activity was compared. RESULTS: Direct measurements of myometrial contractility under controlled conditions show that the frequency of contractions and responses to oxytocin are significantly increased in twins compared to singletons. The duration of contraction however was significantly reduced. We find that contractile activity correlates with increasing levels of stretch, using neonatal birth weights as a surrogate for uterine stretch, with response to oxytocin being significantly positively correlated with birth weight. CONCLUSIONS: We have found significant differences in contractile properties between myometrium from singleton and twin pregnancies and that increasing uterine stretch can alter the contractile properties of myometrium. We discuss the implication of these findings to preterm delivery and future studies.

  1. Successful outcome in a patient with glioma of brain with twin pregnancy

    Directory of Open Access Journals (Sweden)

    Anjali Rani

    2014-06-01

    Full Text Available We present a case of glioma in pregnant female with twin pregnancy. Gliomas during pregnancy are rare. Gliomas during pregnancy pose a risk to maternal and fetal life. The benefit-to-risk ratio should be carefully evaluated and discussed prior to get marriage and pregnancy. In present case, patient had non-specific symptom like seizure and no any focal neurological deficit, Caesarean Section (CS was done at term with multidisciplinary group, including a neurosurgeon, obstetrician, anesthesiologist and neonatologist. She has been followed up to the present date and remains in good health. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 827-830

  2. Isolated pregnancy-induced anti-thrombin deficiency in a woman with twin pregnancy.

    Science.gov (United States)

    Kawabata, Kosuke; Morikawa, Mamoru; Yamada, Takahiro; Minakami, Hisanori

    2016-06-01

    A woman with twin pregnancy had a gradual decline in anti-thrombin (AT) activity from 72% at gestational week (GW) 29(-3/7) , to 53% at GW31(-2/7) , and to 41% at GW32(-2/7) , at which time hypertension (148/90 mmHg) and proteinuria (protein-to-creatinine ratio [P/Cr], 0.79 mg/mg) developed in the presence of normal platelet count (159 × 10(9) /L) and serum aspartate aminotransferase/lactate dehydrogenase (22/164 IU/L). AT product was given three times to maintain AT activity >50% and blood pressure was maintained below 155/95 mmHg with no treatment, but generalized edema with a weekly weight gain of 4.9 kg and increased proteinuria (to P/Cr, 7.6 mg/mg) required cesarean section at GW33(-3/7) . This case highlights the occurrence of pregnancy-induced AT deficiency alone in the absence of any other abnormality, including hypertension, proteinuria, or thrombocytopenia. Measurement of AT activity was considered helpful for determination of the appropriate time for delivery in this patient.

  3. Is Cesarean Delivery Preferable in Twin Pregnancies at >=36 Weeks Gestation?

    Science.gov (United States)

    Dong, Yu; Luo, Zhong-Cheng; Yang, Zu-Jing; Chen, Lu; Guo, Yu-Na; Branch, Ware; Zhang, Jun; Huang, Hong

    2016-01-01

    Background The optimal mode of delivery in twin pregnancies remains controversial. A recent randomized trial did not find any benefit of planned cesarean vs. vaginal delivery at 32–38 weeks gestation, but the trial was not powered to detect a moderate effect. We aimed to evaluate the impact of cesarean delivery on perinatal mortality and severe neonatal morbidity in twin pregnancies at ≥32 weeks through a large database exploration approach with the power to detect moderate risk differences. Methods In a retrospective birth cohort study using the U.S. matched multiple births, 1995–2000 (the available largest multiple birth dataset), we compared perinatal outcomes in twins (n = 181,810 pregnancies) delivered at 32–41 weeks gestation without congenital anomalies. The primary outcome was a composite of perinatal death and severe neonatal morbidity. Cox regression was used to estimate the adjusted hazard ratio (aHR) controlling for the propensity to cesarean delivery, fetal characteristics (sex, birth weight, birth weight discordance, same-sex twin or not) and twin-cluster level dependence. Prospective risks were calculated using the fetuses-at-risk denominators. Results The overall rates of the primary outcome were slightly lower in intended cesarean (6.20%) vs. vaginal (6.45%) deliveries. The aHRs of the primary outcome were in favor of vaginal delivery at 32 (aHR = 1.06, p = 0.03) or 33 (aHR = 1.22, pcesarean delivery at 36 (aHR = 0.94, p = 0.004), 37, 38 and 39+ weeks (aHR: 0.72 to 0.78, all pcesarean vs. vaginal deliveries at 36+ weeks of gestation remained when the analyses were restricted to different-sex (dichorionic) twins (aHR = 0.84, 95% CI 0.80–0.88). Conclusion Cesarean delivery may be beneficial for perinatal outcomes overall in twin pregnancies at ≥36 weeks gestation. PMID:27227678

  4. Ductus venosus Doppler at 11 to 13 weeks of gestation in the prediction of outcome in twin pregnancies.

    Science.gov (United States)

    Maiz, Nerea; Staboulidou, Ismini; Leal, Antonio M; Minekawa, Ryoko; Nicolaides, Kypros H

    2009-04-01

    To examine the independent contribution of abnormal flow in the ductus venosus at 11 to 13 weeks of gestation in the prediction of adverse pregnancy outcome in relation to chorionicity. This was a prospective study in 516 dichorionic and 179 monochorionic twin pregnancies in which the fetal ductus venosus flow was assessed at 11 0/7 to 13 6/7 weeks of gestation. The prevalence of reversed a-wave in the fetal ductus venosus was compared between monochorionic and dichorionic pregnancies and between those with and without pregnancy complications. Comparisons between each of the pregnancy outcomes and the normal outcome group and between monochorionic and dichorionic pregnancies were made using the Mann-Whitney U-test for continuous variables and the chi2 test and Fisher exact test for categorical variables. The prevalence of reversed a-wave in at least one of the fetuses was significantly higher in monochorionic than in dichorionic pregnancies (18.4% compared with 8.3%, P<.001) and in pregnancies complicated by miscarriage (28.6%, P=.005), fetal aneuploidy (70.0%, P<.001), and twin-twin transfusion syndrome (38.5%, P<.001) compared with the pregnancies with two healthy live births (7.7%). Pregnancy outcome was normal in 33 of the 43 (76.7%) dichorionic and in 14 of the 33 (42.4%) monochorionic twins with reversed a-wave in at least one of the fetuses. In twins, reversed a-wave in the ductus venosus at 11 to 13 weeks of gestation is associated with increased risk for aneuploidies, miscarriage, and development of severe twin-twin transfusion syndrome. However, in about 75% of dichorionic twins and 40% of monochorionic twins with reversed a-wave, the pregnancy outcome is normal. II.

  5. Twin births

    DEFF Research Database (Denmark)

    Hoffmann, Elise; Oldenburg, Anna; Rode, Line;

    2012-01-01

    To assess morbidity and mortality in twin pregnancy deliveries, according to chorionicity and mode of delivery.......To assess morbidity and mortality in twin pregnancy deliveries, according to chorionicity and mode of delivery....

  6. Infant mortality in twin pregnancies following in-utero demise of the co-twin

    Directory of Open Access Journals (Sweden)

    Boubakari Ibrahimou

    2015-09-01

    Conclusions: Risks for all mortality types were lower among converted co-twins than their unconverted or same-quantile counterparts. The lower neonatal and higher post-neonatal mortality among black require future research.

  7. First trimester β-hCG and estradiol levels in singleton and twin pregnancies after assisted reproduction.

    Science.gov (United States)

    Póvoa, Ana; Xavier, Pedro; Matias, Alexandra; Blicksttein, Isaac

    2017-07-28

    To compare levels of β-hCG and estradiol collected during the first trimester in singleton and twin pregnancies following assisted reproduction technologies (ART). We prospectively evaluated 50 singleton and 47 dichorionic twin pregnancies that eventually ended in live births. Patients were recruited from a single ART center with standard treatment protocols followed by fresh embryo transfers. Hormone measurements were performed within a narrow gestational age range and analyzed in a single laboratory thus minimizing inter- and intra-assay variability. We measured serum β-hCG at 13 days after embryo transfer as well as samples of β-hCG and estradiol at 8-9 weeks+6 days. No significant differences existed between singletons and twins in respect to demographic and cycle characteristics. β-hCG and estradiol were all significantly higher in twins (PhCG and estradiol in twins, pointing to the potential role of these placental hormones in early support of a twin pregnancy.

  8. Genetic amniocentesis in twin pregnancies: results of a multicenter study of 529 cases

    NARCIS (Netherlands)

    Pruggmayer, M.R.K.; M.G. Jahoda (M.); Van der Pol, J.G.; Baumann, P.; Holzgreve, W.; Karkut, G.; Lettau, R.; Eiben, B.; Osmers, R.; Gola, H.W.; Duda, V.; Polak, P.; Körner, H.; Schulte‐Valentin, M.; Schütte, H.

    1992-01-01

    textabstractTo evaluate the risk of abortion after genetic amniocentesis in twin pregnancies, a retrospective study of 15 centers was performed. The spontaneous abortion rate up to 20 completed weeks of gestation was 2.3%; the abortion rate up to 28 completed weeks, as defined by WHO, was 3.7%. The

  9. Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy

    NARCIS (Netherlands)

    van de Mheen, L; Schuit, E; Liem, S M S; Lim, A C; Bekedam, D J; Goossens, S M T A; Franssen, M T M; Porath, M M; Oudijk, M A; Bloemenkamp, K W M; Duvekot, J J; Woiski, M D; de Graaf, I; Sikkema, J M; Scheepers, H C J; van Eijk, J; de Groot, C J M; van Pampus, M G; Mol, B W J

    2015-01-01

    OBJECTIVE: To determine whether second-trimester cervical length (CL) in women with a twin pregnancy is associated with the risk of emergency Cesarean section. METHODS: This was a secondary analysis of two randomized trials conducted in 57 hospitals in The Netherlands. We assessed the univariable as

  10. Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy

    NARCIS (Netherlands)

    Van de Mheen, L.; Schuit, E.; Liem, S. M. S.; Lim, A. C.; Bekedam, D. J.; Goossens, S. M. T. A.; Franssen, M. T. M.; Porath, M. M.; Oudijk, M. A.; Bloemenkamp, K. W. M.; Duvekot, J. J.; Woiski, M. D.; De Graaf, I.; Sikkema, J. M.; Scheepers, H. C. J.; Van Eijk, J.; De Groot, C. J. M.; Van Pampus, M. G.; Mol, B. W. J.

    2015-01-01

    Objective To determine whether second-trimester cervical length (CL) in women with a twin pregnancy is associated with the risk of emergency Cesarean section. Methods This was a secondary analysis of two randomized trials conducted in 57 hospitals in The Netherlands. We assessed the univariable asso

  11. Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy

    NARCIS (Netherlands)

    Mheen, L. van de; Schuit, E.; Liem, S.M.; Lim, A.C.; Bekedam, D.J.; Goossens, S.M.; Franssen, M.T.; Porath, M.M.; Oudijk, M.A.; Bloemenkamp, K.W.; Duvekot, J.J.; Woiski, M.D.; Graaf, I. de; Sikkema, J.M.; Scheepers, H.C.; Eijk, J. van; Groot, C.J. de; Pampus, M.G. van; Mol, B.W.

    2015-01-01

    OBJECTIVE: To determine whether second-trimester cervical length (CL) in women with a twin pregnancy is associated with the risk of emergency Cesarean section. METHODS: This was a secondary analysis of two randomized trials conducted in 57 hospitals in The Netherlands. We assessed the univariable

  12. Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy

    NARCIS (Netherlands)

    Van de Mheen, L.; Schuit, E.; Liem, S. M. S.; Lim, A. C.; Bekedam, D. J.; Goossens, S. M. T. A.; Franssen, M. T. M.; Porath, M. M.; Oudijk, M. A.; Bloemenkamp, K. W. M.; Duvekot, J. J.; Woiski, M. D.; De Graaf, I.; Sikkema, J. M.; Scheepers, H. C. J.; Van Eijk, J.; De Groot, C. J. M.; Van Pampus, M. G.; Mol, B. W. J.

    2015-01-01

    Objective To determine whether second-trimester cervical length (CL) in women with a twin pregnancy is associated with the risk of emergency Cesarean section. Methods This was a secondary analysis of two randomized trials conducted in 57 hospitals in The Netherlands. We assessed the univariable

  13. Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy

    NARCIS (Netherlands)

    van de Mheen, L; Schuit, E; Liem, S M S; Lim, A C; Bekedam, D J; Goossens, S M T A; Franssen, M T M; Porath, M M; Oudijk, M A; Bloemenkamp, K W M; Duvekot, J J; Woiski, M D; de Graaf, I; Sikkema, J M; Scheepers, H C J; van Eijk, J; de Groot, C J M; van Pampus, M G; Mol, B W J

    OBJECTIVE: To determine whether second-trimester cervical length (CL) in women with a twin pregnancy is associated with the risk of emergency Cesarean section. METHODS: This was a secondary analysis of two randomized trials conducted in 57 hospitals in The Netherlands. We assessed the univariable

  14. Gestational diabetes insipidus, HELLP syndrome and eclampsia in a twin pregnancy: a case report.

    Science.gov (United States)

    Woelk, J L; Dombroski, R A; Brezina, P R

    2010-02-01

    We report a case of eclampsia in a twin pregnancy complicated by HELLP syndrome and diabetes insipidus. This confluence of disease processes suggests that a modification of common magnesium sulfate treatment protocols may be appropriate in a certain subset of patients.

  15. Genetic amniocentesis in twin pregnancies: results of a multicenter study of 529 cases

    NARCIS (Netherlands)

    Pruggmayer, M.R.K.; M.G. Jahoda (M.); Van der Pol, J.G.; Baumann, P.; Holzgreve, W.; Karkut, G.; Lettau, R.; Eiben, B.; Osmers, R.; Gola, H.W.; Duda, V.; Polak, P.; Körner, H.; Schulte‐Valentin, M.; Schütte, H.

    1992-01-01

    textabstractTo evaluate the risk of abortion after genetic amniocentesis in twin pregnancies, a retrospective study of 15 centers was performed. The spontaneous abortion rate up to 20 completed weeks of gestation was 2.3%; the abortion rate up to 28 completed weeks, as defined by WHO, was 3.7%. The

  16. Successful twin pregnancy in a patient with parkin-associated autosomal recessive juvenile parkinsonism

    Directory of Open Access Journals (Sweden)

    Takakuwa Koichi

    2011-06-01

    Full Text Available Abstract Background Pregnancy in patients with Parkinson disease is a rare occurrence. To the best of our knowledge, the effect of pregnancy as well as treatment in genetically confirmed autosomal recessive juvenile parkinsonism (ARJP has never been reported. Here, we report the first case of pregnancy in a patient with ARJP associated with a parkin gene mutation, ARJP/PARK2. Case presentation A 27-year-old woman with ARJP/PARK2 was diagnosed as having a spontaneous dichorionic/diamniotic twin pregnancy. Exacerbation of motor disability was noted between ovulation and menstruation before pregnancy as well as during late pregnancy, suggesting that her parkinsonism might have been influenced by fluctuations in the levels of endogenous sex hormones. During the organogenesis period, she was only treated with levodopa/carbidopa, although she continued to receive inpatient hospital care for assistance in the activities of daily living. After the organogenesis period, she was administered sufficient amounts of antiparkinsonian drugs. She delivered healthy male twins, and psychomotor development of both the babies was normal at the age of 2 years. Conclusion Pregnancy may worsen the symptoms of ARJP/PARK2, although appropriate treatments with antiparkinsonian drugs and adequate assistance in the activities of daily living might enable successful pregnancy and birth of healthy children.

  17. Assessment and specific nutritional recommendations for women during and after pregnancy of twins

    Directory of Open Access Journals (Sweden)

    Natalia Mira de Assumpção Werutsky

    2008-03-01

    Full Text Available Objective: To update and adjust nutritional recommendations for twin pregnancy during prenatal and postpartum periods in order to improve care provided to these women and ensure their quality of life, as well as to assess the practices adopted by the Institution and referral hospitals, in view of what was learned in specialized literature. Methods: This literature review was conducted by searching scientific papers in  databases (SciELO, Pubmed, Sibi, Medline, Lilacs, published from 1964 through 2006, as well as by surveying some authors directly by e-mail. Results: In studies selected, the age of pregnant women with twins was > 27, and the subjects were divided into three gestational periods ( 28 weeks gestational age. The nutritional program recommends: the intake of 3.000 to 4.000 kcal/day according to the pregnant body mass index (BMI, distributed as: proteins (20%, carbohydrates (40%, and fat (40%; in addition to the supplemental intake of 3 g of calcium, 1.2 g of magnesium, and 45 mg of zinc, with the prescription of two tablets of multivitamin per day after week 20. The daily diet must be divided into three meals and three snacks. The few studies found about these puerperal women recommended the addition of 500 to 600 calories/day per  child to ensure the production of the appropriate volume of milk to meet the necessary demand. Discussion: Research demonstrates that this program increases the gestational period and  newborns weight, and reduces the risk of prenatal and postpartum complications for mothers and children. The appropriate weight gain during pregnancy benefits the mother and their newborns, facilitating breast-feeding and milk volume production according to the demand. Comparing twin and single pregnant women there are differences related to weekly and total weight gain, recommendations for macro and micronutrients intake, number of portions, and nutritional status classification according to BMI. Conclusions: Nutritional

  18. Twin pregnancy possibly associated with high semen quality

    DEFF Research Database (Denmark)

    Asklund, Camilla; Jensen, Tina Kold; Jørgensen, Niels

    2007-01-01

    a questionnaire. RESULTS: After adjustment, fathers of DZ and MZ twins had 3.6 (95% CI 1.7; 5.4) and 4.6 (95% CI 2.0; 7.2) percentage points higher percentage of sperm cells with normal morphologic features and percentages of motile sperm cells were 11.5 (95% CI 7.2; 15.9) and 12.5 (95% CI 6.3; 18.6) percentage...... points higher than the reference group (P sperm concentration than the reference group. CONCLUSIONS: Fathers of DZ twins had a better semen quality than the reference group, which supports...

  19. Timing of birth for women with a twin pregnancy at term: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Haslam Ross R

    2010-10-01

    Full Text Available Abstract Background There is a well recognized risk of complications for both women and infants of a twin pregnancy, increasing beyond 37 weeks gestation. Preterm birth prior to 37 weeks gestation is a recognized complication of a twin pregnancy, however, up to 50% of twins will be born after this time. The aims of this randomised trial are to assess whether elective birth at 37 weeks gestation compared with standard care in women with a twin pregnancy affects the risk of perinatal death, and serious infant complications. Methods/Design Design: Multicentred randomised trial. Inclusion Criteria: women with a twin pregnancy at 366 weeks or more without contraindication to continuation of pregnancy. Trial Entry & Randomisation: Following written informed consent, eligible women will be randomised from 36+6 weeks gestation. The randomisation schedule uses balanced variable blocks, with stratification for centre of birth and planned mode of birth. Women will be randomised to either elective birth or standard care. Treatment Schedules: Women allocated to the elective birth group will be planned for elective birth from 37 weeks gestation. Where the plan is for vaginal birth, this will involve induction of labour. Where the plan is for caesarean birth, this will involve elective caesarean section. For women allocated to standard care, birth will be planned for 38 weeks gestation or later. Where the plan is for vaginal birth, this will involve either awaiting the spontaneous onset of labour, or induction of labour if required. Where the plan is for caesarean birth, this will involve elective caesarean section (after 38 and as close to 39 weeks as possible. Primary Study Outcome: A composite of perinatal mortality or serious neonatal morbidity. Sample Size: 460 women with a twin pregnancy to show a reduction in the composite outcome from 16.3% to 6.7% with adjustment for the clustering of twin infants within mothers (p = 0.05, 80% power. Discussion This

  20. Transient osteoporosis of pregnancy of the bilateral hips in twin gestation: a case series.

    Science.gov (United States)

    Reese, Maria E; Fitzgerald, Colleen; Hynes, Christina

    2015-01-01

    Transient osteoporosis of pregnancy has been described as a rare, self-limiting disease of unclear etiology that presents as severe pain, which typically affects pregnant women in their third trimester. We describe 3 cases of primigravid pregnant women with twin gestation who reported unilateral hip pain and who were diagnosed with transient osteoporosis of pregnancy of the hip by magnetic resonance imaging. These women were advised to undergo limited weight bearing and activity modification to minimize the risk of fracture. Each patient was able to proceed through her pregnancy, delivery, and postpartum course without complication, with symptom resolution, and return to unrestricted activity.

  1. Twin pregnancy with both complete hydatiform mole and coexistent alive fetus:case report

    Institute of Scientific and Technical Information of China (English)

    Achour Radhouane; Ben Aissa Imen; NEJI Khaled

    2015-01-01

    Twin pregnancy consisting of a complete hydatidiform mole coexisting with a live fetus is a rare condition with an incidence of 1 in 22 000 to 1 in 1 00 000 pregnancies. Clinical information is limited and management is difficult due to the risk of pregnancy complications such as fetal death, vaginal bleeding, preeclampsia, hyperthyroidism, and the risk of persistent gestational trophoblastic disease. Thus, the report described about the change of size and implantation site of the molar mass coexisting with a live fetus is rare especially about sonographic findings such as echo patterns. Recently we experienced a case of complete hydatidiform mole with a healthy infant delivered at term.

  2. Twin pregnancy with both complete hydatiform mole and coexistent alive fetus: Case report

    Directory of Open Access Journals (Sweden)

    Achour Radhouane

    2015-12-01

    Full Text Available Twin pregnancy consisting of a complete hydatidiform mole coexisting with a live fetus is a rare condition with an incidence of 1 in 22000 to 1 in 100000 pregnancies. Clinical information is limited and management is difficult due to the risk of pregnancy complications such as fetal death, vaginal bleeding, preeclampsia, hyperthyroidism, and the risk of persistent gestational trophoblastic disease. Thus, the report described about the change of size and implantation site of the molar mass coexisting with a live fetus is rare especially about sonographic findings such as echo patterns. Recently we experienced a case of complete hydatidiform mole with a healthy infant delivered at term.

  3. Unilateral twin tubal ectopic pregnancy in a patient following tubal surgery

    Directory of Open Access Journals (Sweden)

    Nahid Ghanbarzadeh

    2015-01-01

    Full Text Available We report a spontaneous unilateral live tubal twin pregnancy in a patient with a history of previous ectopic pregnancy (EP and tubal surgery. Transvaginal ultrasound showed one pregnancy sac containing two fetal poles with cardiac activity, which appeared to be sited within the right adnexum. The right tubal EP was removed by salpingectomy. Ultrasound findings of suspected adnexal mass and free liquid in the Douglas pouch along with an increased a beta-human chorionic gonadotrophin levels, especially in association of risk factors, can help the early diagnosis of EP and reduce the related mortality and morbidity.

  4. [Twin pregnancy with complete mole and coexisting fetus: Reach fetal viability is possible].

    Science.gov (United States)

    Arsène, E; Clouqueur, E; Stichelbout, M; Devisme, L; Vaast, P; Subtil, D

    2015-11-01

    Twin pregnancies combining complete hydatidiform mole and coexistent fetus are a rare situation (incidence in 1/20,000 in 1/100,000 pregnancies) and a challenge for diagnosis. Their complications can be important - bleeding, preeclampsia, miscarriage - and their management remains complex and controversial. In case of continuing the pregnancy, nearly 40% of women have lives babies. Three quarters of fetal loss occur before 24weeks gestation. We report here three new cases; only one of these cases had a favorable outcome.

  5. A re-assessment of biochemical marker distributions in T21 affected and unaffected twin pregnancies in the first trimester

    DEFF Research Database (Denmark)

    Madsen, Helen Nordahl; Tørring, Niels

    unaffected and 47 trisomy 21 affected twin pregnancies were included in the study. Chorionicity specific medians were generated for PAPP-A and free β-hCG from gestational age 8 to 14 weeks. Multiple of the median for each of the markers were calculated. Detection rates (DR) and false-positive rates (FPR....... Allowing for gestation and chorionicity, twin pregnancies affected with trisomy 21 had higher levels of free β-hCG and lower levels of PAPP-A. Adding biochemistry into the risk assessment increased the DR for fetal trisomy 21 in dizygotic twin pregnancies from 78% to 90%, and decreased the FPR from 8......INTRODUCTION Serum biochemical marker concentrations in twin pregnancies reflect the presence of two fetuses rather than one. In general, the concentrations are approximately double those found in singleton pregnancies. The objective was to estimate the difference between levels of the two...

  6. [Anti-D isoimmunization severe in a twin pregnancy. Case report].

    Science.gov (United States)

    Calomarde Rees, María Consuelo; Iglesias Sánchez, Carlos; Martín Boado, Elena; Vegas, Gabriel; Omeñaca, Félix; González González, Antonio

    2012-03-01

    Perinatal hemolytic disease occurs secondary to a hemolytic phenomenon of immune origin resulting in fetal or neonatal anemia. A 38-year-old pregnant woman was referred to the Department of high risk Obstetrics, Hospital Universitario La Paz Madrid because of presenting a dichorionic diamniotic twin pregnancy spontaneously, pre-pregnancy diabetes poorly controlled and severe alloinmunization anti-D. Her first pregnancy ended in a normal delivery at term; in the period of 4 years, she has three newborn with 36, 34 and 40 weeks respectively, who die with a week of life. After that, two intrauterine fetal death occur at 26 weeks of gestation. The patient who is RhD negative, suffers anti-D inmunization with a antibody titration of 1/1024 with 14 weeks of gestation. Twelve plasmapheresis, eight doses of anti-D inmunoglobulins and intrauterine transfusions has been the treatment received. A severe anemia is found during the ultrasound control of the middLe cerebral artery peak systolic velocity in both twins since the 16th week. It remains stable thanks to the treatment. Finally at the 28th week of gestation, pregnancy is terminated with a cesarean section. The twins are born alive and premature, but with good general state. The measurement of the middle cerebral artery peak systolic velocity predicts moderate-severe fetal anemia cases, which are the most important in the clinical management because of the need of active treatment or finish the pregnancy.

  7. Evidence for No Significant Impact of Müllerian Anomalies on Reproductive Outcomes of Twin Pregnancy in Korean Women.

    Science.gov (United States)

    Shim, Sohyun; Hur, Yoon-Mi; Kim, Da Hee; Seong, Seok Ju; Kim, Mi-La; Shin, Joong Sik

    2016-04-01

    The present article aimed to evaluate the impact of congenital Müllerian anomalies (MA) on twin pregnancy after 24 gestational weeks in Korean women. All records of twin pregnancies in a large maternity hospital in Korea between January 2005 and July 2013 were analyzed. Patients with monochorionic monoamniotic (MCMA) twins, non-Korean patients, patients with twins delivered prior to 24 gestational weeks, and patients with miscarriage of one fetus or intrauterine fetal death (IUFD) before 24 gestational weeks were excluded from data analysis. In total, 1,422 women with twin pregnancy were eligible for data analysis, including 17 (1.2%) who had a known congenital MA (septate uterus, bicornuate uterus, arcuate uterus, and unicornuate uterus). Except for the mode of conception, baseline demographics were similar between women with MA and those without MA. No significant differences were found in pregnancy outcomes of gestational age at delivery (p = .86), birth weight of smaller and larger twins (p = .54 and p = .65), and number of twins with birth weight <5th percentile for gestational age (p = .43).The rates of obstetrical complications such as pre-eclampsia, gestational diabetes mellitus (GDM), placenta previa, cerclage, IUFD, and postpartum hemorrhage were not significantly different between the two groups either. We concluded that the presence of congenital MA may not increase obstetrical risks in outcomes of pregnancy of twins delivered after 24 gestational weeks.

  8. The effect of maternal anemia on maternal and neonatal outcomes in twin pregnancies.

    Science.gov (United States)

    Kosto, Amit; Okby, Rania; Levy, Maya; Sergienko, Ruslan; Sheiner, Eyal

    2016-01-01

    The objective of this study is to investigate the effect of second trimester anemia on maternal and perinatal outcomes in twin pregnancies. A retrospective population-based study was conducted, comparing maternal and neonatal outcomes in women carrying twins, with second trimester anemia (defined as hemoglobin anemia (defined as hemoglobin > or equal to 10 g/dl). Deliveries occurred in a tertiary medical center in 2013. During the study period, there were 307 twin deliveries. Hemoglobin levels were available for 247 (80.4%) twins; 66 (26.7%) of these had anemia (anemia had a higher parity (p=0.03), and needed more blood transfusions than those with hemoglobin level > or equal to 10 g/dl (OR = 1.6; 95% CI 1.11-2.43, p anemia in women carrying twins is associated with a high parity and increases the risk for blood transfusions. However, in our population, maternal anemia in twin gestations does not increase the risk for adverse perinatal outcome.

  9. Induction of twin pregnancy and the risk of caesarean delivery: a cohort study.

    Science.gov (United States)

    Jonsson, Maria

    2015-06-16

    Complications are common in twin pregnancies and induction of labour is often indicated. Most methods for induction are used but data on risks related to induction methods are sparse. The aim of this study was to investigate the association between induction of labour and caesarean delivery in twin pregnancies, and to assess the influence of induction method. Cohort study of twin pregnancies ≥ 34 weeks, planned for vaginal delivery, from two University Hospitals in Sweden. Data were collected from medical records during the periods 1994 (Örebro) and 2004 (Uppsala) to 2013. During the study period there were 78,180 live born births and 1,282 were twin births. Women with previous caesarean section were excluded. Induction methods were categorized into amniotomy, oxytocin and cervical ripening (intra cervical Foley catheter or prostaglandin). Adjusted odds ratios (AOR) with 95 % confidence interval (CI) for caesarean section were calculated by logistic regression and were adjusted for parity, maternal age, gestational length, complications to the pregnancy, infant birth weight and year of birth. Spontaneous labour onsets were used as the reference group. The main outcome measure was caesarean section. In 462 twin pregnancies, 220 (48 %) had induction of labour and 242 (52 %) a spontaneous labour onset. Amniotomy was performed in 149 (68 %) of these inductions, oxytocin was administered in 11 (5 %) and cervical ripening was used in 60 (27 %). The rate of caesarean sections was 21 % in induced and 12 % in spontaneous labours (p 0.01). The absolute risk of caesarean section following induction was: 15 % with amniotomy; 36 % with oxytocin and 37 % with Foley/prostaglandin. Induction of labour increased the risk of caesarean section by 90 % compared with spontaneous labour onset (AOR 1.9, 95 % CI 1.1-3.5) and, when cervical ripening was used, the risk increased more than two fold (AOR 2.5, 95 % CI 1.2-5.3). Induction of labour in twin pregnancies increases the risk of

  10. Crown-rump length discordance in the first trimester: a predictor of adverse outcome in twin pregnancies?

    DEFF Research Database (Denmark)

    Johansen, Mathias; Oldenburg, A.; Rosthøj, Susanne;

    2014-01-01

    OBJECTIVES: To evaluate the usefulness of first-trimester crown-rump length (CRL) discordance in predicting adverse outcome in twin pregnancies. METHODS: This retrospective study included a large cohort retrieved from local ultrasound databases at 14 obstetric departments in Denmark, comprising all...... twin pregnancies with two live fetuses scanned between 11 and 14 weeks' gestation during the period 1 January 2004 to 31 December 2006. The association between CRL discordance ≥ 10 % and adverse outcome was evaluated. RESULTS: Among 1993 twin pregnancies, 1733 were dichorionic (156 (9%) discordant......; 1577 (91%) concordant) and 260 were monochorionic (32 (12%) discordant; 228 (88%) concordant). In dichorionic twin pregnancies we found an association between CRL discordance ≥ 10% and preterm delivery before 34 weeks' gestation (P=0.007), birth weight discordance (P=0.001) and mean birth weight (P=0...

  11. Prenatal Diagnosis of Cantrell's Pentalogy Associated with Agenesis of Left Limb in a Twin Pregnancy

    Science.gov (United States)

    Cakiroglu, Yigit; Doger, Emek; Babaoglu, Kadir; Caliskan, Eray; Yucesoy, Gulseren

    2014-01-01

    Pentalogy of Cantrell is a rare malformation described in the literature. We report a case of pentalogy of Cantrell associated with left limb deficiency in a twin pregnancy. The fetus with multiple anomalies revealed kyphosis, ectopia cordis, and a large defect with protruding liver and bowel loops at 12 weeks and 3 days of gestational age on ultrasound scan. The other fetus was ultrasonographically normal. We diagnosed a case of pentalogy of Cantrell in a twin pregnancy after exclusion of limb body wall complex, body stalk anomaly, and amniotic band syndrome and after delivery of the fetuses. Macroscopic examinations were ectopia cordis, extrusion of the abdominal organs without membranes surrounding, and agenesis of the left limb. PMID:24782934

  12. A reassessment of biochemical marker distributions in trisomy 21-affected and unaffected twin pregnancies in the first trimester.

    Science.gov (United States)

    Madsen, H N; Ball, S; Wright, D; Tørring, N; Petersen, O B; Nicolaides, K H; Spencer, K

    2011-01-01

    To estimate the difference between levels of the two biochemical markers pregnancy-associated plasma protein-A (PAPP-A) and maternal serum free β-human chorionic gonadotropin (free β-hCG) in twin pregnancies relative to singleton pregnancies and establish an improved screening procedure for chromosomal abnormalities such as trisomy 21 in twin pregnancies. 4843 unaffected and 47 trisomy 21-affected twin pregnancies were included in the study. Chorionicity-specific medians were generated for PAPP-A and free β-hCG from gestational ages 8 to 14 weeks. Multiple of the median values for each of the biochemical markers were calculated. Detection rates and false-positive rates were estimated for screening tests incorporating nuchal translucency and maternal age, with and without biochemistry. Medians for the two biochemical markers for monochorionic and dichorionic twins in unaffected pregnancies show a gestational age-specific increase relative to singleton medians. Allowing for gestation and chorionicity, twin pregnancies affected with trisomy 21 had higher levels of free β-hCG and lower levels of PAPP-A. Adding biochemistry into the risk assessment using a fixed risk cut-off of 1 in 100 increased the detection rate for fetal trisomy 21 in dizygotic twin pregnancies from 78 to 90%, and decreased the false-positive rate from 8.0 to 5.9%. Generation of chorionicity-specific medians for the biochemical markers and their use in risk assessment can improve the performance of first-trimester screening for chromosomal abnormalities in twins to a level comparable with that in singleton pregnancies.

  13. Photoperiod length and the estrus synchronization protocol used before AI affect the twin pregnancy rate in dairy cattle.

    Science.gov (United States)

    Andreu-Vázquez, C; Garcia-Ispierto, I; López-Gatius, F

    2012-10-01

    This study addresses potential management risk factors affecting the incidence of twin pregnancies in high-producing dairy cows. Special attention was paid to the estrus synchronization protocol used before the AI resulting in pregnancy. Possible factors affecting the twin pregnancy rate were analyzed through binary logistic regression procedures on 2015 pregnant cows from July 2010 to July 2011. Twin pregnancy was recorded in 361 of the 2015 pregnancy diagnoses made (17.9%). Twin pregnancy rates differed among herds (P twin pregnancy was reduced by factors of 0.65 or 0.71 when AI was performed during the warm season or an increasing photoperiod, respectively and increased by a factor of 1.11 for each unit increase in lactation number; by factors of 4.57 or 6.33 in cows that received a progesterone-releasing intravaginal device (PRID) plus 500 or 750 IU of equine chorionic gonadotropin (eCG) 28 days before the pregnancy AI, respectively; by a factor of 2.39 in cows with an ovarian cyst diagnosed in the 14 days prior to AI and treated with prostaglandins (PG); by factors of 1.94 or 3.91 in cows that received two PG doses during the 14 days prior to AI or cows that following failed PRID treatment had received PG started over the 28 days prior to AI, respectively; and by a factor of 2.58 in cows that had previously delivered twins compared to cows delivering singletons. Our results indicate that cow factors, such as lactation number and previous twining, as well as environmental factors, such as photoperiod and season and management related to synchronization protocols affect significantly the incidence of twin pregnancies.

  14. Successful Non-fluoroscopic Radiofrequency Ablation of Incessant Atrial Tachycardia in a High Risk Twin Pregnancy.

    Science.gov (United States)

    Zuberi, Zia; Silberbauer, John; Murgatroyd, Francis

    2014-01-01

    We describe a patient presenting with incessant ectopic atrial tachycardia during a high risk twin pregnancy. Tachycardia was resistant to escalating doses of beta-blockade with digoxin. Because of increasing left ventricular dysfunction early in the third trimester, catheter ablation was performed successfully at 30 weeks gestation. Electro-anatomic mapping permitted the entire procedure to be conducted without the use of ionizing radiation. The pregnancy proceeded to successful delivery near term and after three years the patient remains recurrence free with normal left ventricular function, off all medication.

  15. A case of a surviving co-twin diagnosed with porencephaly and renal hypoplasia after a single intrauterine fetal death at 21 weeks of gestation in a monochorionic monoamniotic twin pregnancy.

    Science.gov (United States)

    Machino, Hidenori; Iriyama, Takayuki; Nakayama, Toshio; Komatsu, Atsushi; Nagamatsu, Takeshi; Osuga, Yutaka; Fujii, Tomoyuki

    2017-01-01

    Monochorionic monoamniotic (MM) twin pregnancy carries a high risk of intrauterine fetal death (IUFD). Single IUFD in an MM twin pregnancy prior to 22 weeks of gestation has been reported to be strongly correlated with double twin demise. To our knowledge, there are no case reports on the natural course of a surviving co-twin in an MM twin pregnancy resulting in live birth after a single IUFD prior to 22 weeks of gestation. Here, we report a case of a surviving co-twin, after a single IUFD at 21 weeks of gestation in a MM twin pregnancy, with an antenatal diagnosis of renal hypoplasia and severe neurological damage leading to porencephaly, and live birth at 36 weeks of gestation.

  16. Coincidence of Incomplete Pentalogy of Cantrell and Meningomyelocele in a Dizygotic Twin Pregnancy

    Science.gov (United States)

    Timur, Hakan; Tokmak, Aytekin; Bayram, Hatice; Şükran Çakar, Esra; Danışman, Nuri

    2015-01-01

    Pentalogy of Cantrell is an extremely rare and lethal syndrome. Ectopia cordis is frequently found in fetuses with POC but not required for incomplete forms. Likewise, meningomyelocele is a relatively uncommon neural tube defect affecting central nervous system and associated with neurological problems. Herein, we presented a woman with dizygotic twin pregnancy having coincidence of incomplete POC and MMC in each individual fetus, which has never been reported previously. PMID:26421202

  17. Coincidence of Incomplete Pentalogy of Cantrell and Meningomyelocele in a Dizygotic Twin Pregnancy

    Directory of Open Access Journals (Sweden)

    Hakan Timur

    2015-01-01

    Full Text Available Pentalogy of Cantrell is an extremely rare and lethal syndrome. Ectopia cordis is frequently found in fetuses with POC but not required for incomplete forms. Likewise, meningomyelocele is a relatively uncommon neural tube defect affecting central nervous system and associated with neurological problems. Herein, we presented a woman with dizygotic twin pregnancy having coincidence of incomplete POC and MMC in each individual fetus, which has never been reported previously.

  18. Goldenhar syndrome with right circumflex aortic arch, severe coarctation and vascular ring in a twin pregnancy

    Directory of Open Access Journals (Sweden)

    Elaheh Malakan Rad

    2014-01-01

    Full Text Available Goldenhar syndrome (GS or oculo-auriculo-vertebral dysplasia (OAVD, involves a wide variety of organ systems. Cardiovascular anomalies are among the frequent malformations. The purpose of this report is to introduce a male case of a dizygotic twin pregnancy with GS and right circumflex aortic arch (RCAA, severe coarctation, hypoplastic aortic arch, aberrant right subclavian artery, vascular ring, bilateral renal artery stenosis, and mild Dandy-Walker syndrome. The embryology of RCAA and coarctation is revisited.

  19. Goldenhar syndrome with right circumflex aortic arch, severe coarctation and vascular ring in a twin pregnancy

    OpenAIRE

    Elaheh Malakan Rad

    2014-01-01

    Goldenhar syndrome (GS) or oculo-auriculo-vertebral dysplasia (OAVD), involves a wide variety of organ systems. Cardiovascular anomalies are among the frequent malformations. The purpose of this report is to introduce a male case of a dizygotic twin pregnancy with GS and right circumflex aortic arch (RCAA), severe coarctation, hypoplastic aortic arch, aberrant right subclavian artery, vascular ring, bilateral renal artery stenosis, and mild Dandy-Walker syndrome. The embryology of RCAA and co...

  20. Goldenhar syndrome with right circumflex aortic arch, severe coarctation and vascular ring in a twin pregnancy.

    Science.gov (United States)

    Rad, Elaheh Malakan

    2014-09-01

    Goldenhar syndrome (GS) or oculo-auriculo-vertebral dysplasia (OAVD), involves a wide variety of organ systems. Cardiovascular anomalies are among the frequent malformations. The purpose of this report is to introduce a male case of a dizygotic twin pregnancy with GS and right circumflex aortic arch (RCAA), severe coarctation, hypoplastic aortic arch, aberrant right subclavian artery, vascular ring, bilateral renal artery stenosis, and mild Dandy-Walker syndrome. The embryology of RCAA and coarctation is revisited.

  1. Goldenhar syndrome with right circumflex aortic arch, severe coarctation and vascular ring in a twin pregnancy

    Science.gov (United States)

    Rad, Elaheh Malakan

    2014-01-01

    Goldenhar syndrome (GS) or oculo-auriculo-vertebral dysplasia (OAVD), involves a wide variety of organ systems. Cardiovascular anomalies are among the frequent malformations. The purpose of this report is to introduce a male case of a dizygotic twin pregnancy with GS and right circumflex aortic arch (RCAA), severe coarctation, hypoplastic aortic arch, aberrant right subclavian artery, vascular ring, bilateral renal artery stenosis, and mild Dandy-Walker syndrome. The embryology of RCAA and coarctation is revisited. PMID:25298700

  2. 双胎妊娠的超声监测%Ultrasound Surveillance in Twin Pregnancy

    Institute of Scientific and Technical Information of China (English)

    景柏华; 陈倩

    2014-01-01

    双胎妊娠属于高危妊娠范畴,无论对母亲或者胎儿,都会增加围生期相关疾病的发病率和死亡率。近年来随着双胎妊娠的发生率逐年提高,所带来的一系列临床问题引起越来越多产科医生的重视。因此加强产前监测,对异常胎儿早期诊断、早期处理,可改善妊娠结局、降低母儿相关并发症。产前超声检查可确定双胎类型、胎盘位置、羊膜情况,并有助于胎儿生长发育监测及诊断胎儿畸形和并发症等。合理规范地应用产前超声检查可监测胎儿宫内情况,为临床处理提供依据。%As high risk pregnancy,twin pregnancy increases the morbidity and mortality of maternal-fetal complications. Recently,more and more obstetricians paid attention to the problems caused by the increased incidence of twin pregnancy. Therefore,antenatal surveillance can help to reduce the maternal-fetal complications and improve mother and child outcome through early diagnosis of abnormal fetals. Ultrasound contributes to determination of chorionicity ,amnionicity and placentas, assessment of fetal growth and screening for anomalies in twin pregnancy. Rational prenatal ultrasonography is reliable method for the diagnosis and assessment of twins and provide evidence for clinical treatment.

  3. Asthma affects time to pregnancy and fertility: a register-based twin study.

    Science.gov (United States)

    Gade, Elisabeth J; Thomsen, Simon F; Lindenberg, Svend; Kyvik, Kirsten O; Lieberoth, Sofie; Backer, Vibeke

    2014-04-01

    Coexistence of infertility and asthma has been observed clinically. Therefore, we investigated the association between asthma and delayed pregnancy in a nationwide population-based cohort of twins. A cohort of 15 250 twins living in Denmark (aged 12-41 years) participated in a questionnaire study including questions about the presence of asthma and fertility. Differences in time to pregnancy and pregnancy outcome were analysed in subjects with asthma, allergy and in healthy individuals using multiple regression analysis. Asthma was associated with an increased time to pregnancy, the percentage of asthmatics with a time to pregnancy >1 year was 27% versus 21.6% for non-asthmatics (OR (95% CI) 1.31 (1.1-1.6); p=0.009). The association remained significant after adjustment for age, age at menarche, body mass index and socioeconomic status (OR (95% CI) 1.25 (1.0-1.6); p=0.05), and was more pronounced in those >30 years of age (32.2% versus 24.9%, OR (95% CI) 1.44 (1.1-1.9); p=0.04). Untreated asthmatics had a significant increased risk of prolonged time to pregnancy compared to healthy individuals (OR (95% CI) 1.79 (1.20-2.66); p=0.004), while asthmatics receiving any kind of treatment for asthma tended to have a shorter time to pregnancy than untreated asthmatics (OR 1.40; p=0.134). Asthma prolongs time to pregnancy. The negative effect of asthma on fertility increases with age and with disease intensity, indicating that a systemic disease characterised by systemic inflammation also can involve reproductive processes.

  4. A re-assessment of biochemical marker distributions in T21 affected and unaffected twin pregnancies in the first trimester

    DEFF Research Database (Denmark)

    Madsen, Helen Nordahl; Ball, Susan; Wright, Dave

    2011-01-01

    increased the detection rate for fetal trisomy 21 in dizygotic twin pregnancies from 78 to 90%, and decreased the false-positive rate from 8.0 to 5.9%. CONCLUSION: Generation of chorionicity-specific medians for the biochemical markers and their use in risk assessment can improve the performance of first...... of the biochemical markers were calculated. Detection rates and false-positive rates were estimated for screening tests incorporating nuchal translucency and maternal age, with and without biochemistry. RESULTS: Medians for the two biochemical markers for monochorionic and dichorionic twins in unaffected pregnancies......OBJECTIVE: To estimate the difference between levels of the two biochemical markers pregnancy-associated plasma protein-A (PAPP-A) and maternal serum free β-human chorionic gonadotropin (free β-hCG) in twin pregnancies relative to singleton pregnancies and establish an improved screening procedure...

  5. Twin pregnancy: the impact of the Higgins Nutrition Intervention Program on maternal and neonatal outcomes.

    LENUS (Irish Health Repository)

    Dubois, S

    1991-06-01

    Perinatal outcomes were compared between 354 twins treated with the Higgins Nutrition Intervention Program and 686 untreated twins. After differing distributions of key confounding variables were adjusted for, the twins in the intervention group weighed an average of 80 g more (P less than 0.06) than the nonintervention twins; their low-birth-weight rate was 25% lower (P less than 0.05) and their very-low-birth-weight rate was almost 50% lower (P less than 0.05). Although the rate of preterm delivery was 30% lower in the intervention group (P less than 0.05), the rates of intrauterine growth retardation were similar in the two groups. Fetal mortality was slightly higher (14 vs 12 per 1000, NS), but early neonatal mortality was fivefold lower (3 vs 19 per 1000, P less than 0.06) in the intervention group. Maternal morbidity was significantly lower (P less than 0.05) in the intervention group. There was a trend towards lower infant morbidity in the intervention group. These results suggest that nutritional intervention can significantly improve twin-pregnancy outcome.

  6. Clinical characteristics of fetal and neonatal outcomes in twin pregnancy with preeclampsia in a retrospective case–control study

    Science.gov (United States)

    Yuan, Ting; Wang, Wei; Li, Xue-Lan; Li, Chun-Fang; Li, Chao; Gou, Wen-Li; Han, Zhen

    2016-01-01

    Abstract The aim of our study was to compare the clinical characteristics of fetal and neonatal outcomes in twin pregnancies between women with preeclampsia (PE) and those with normotension in a Chinese population. There were 143 preeclamptic women and 367 normotensive women with twin pregnancies included in this retrospective case–control study. The baseline characteristics and perinatal outcomes were collected and compared between the groups. Multiple logistic regression and linear regression were used to assess the correlations between PE and the outcomes. Significant increases were observed in the frequencies of preterm delivery (OR = 2.75, P < 0.001), iatrogenic preterm birth (OR = 3.52, P < 0.001), and IUGR (OR = 2.94, P = 0.001) in the PE group, and the PE group had more than a 2-fold risk of adverse neonatal outcomes. Preeclamptic twin neonates had lower birth weights (β = −147.34, P = 0.005; β = −169.47, P = 0.001). The comparison on the discordance of intertwin weight was not significantly different. Twin pregnancies with PE are associated with worse perinatal outcomes. The adverse outcomes of preeclamptic twin pregnancies may be associated with lower birth weights rather than the discordance of the intertwin weight, which requires further confirmation. The results may provide helpful references for better clinical assessments, evaluations of prognosis, and a deeper understanding of preeclamptic twin pregnancies. PMID:27787375

  7. First trimester risk assessment for trisomy 21 in twin pregnancies combining nuchal translucency and first trimester biochemical markers.

    Science.gov (United States)

    Prats, Pilar; Rodríguez, Ignacio; Comas, Carmina; Puerto, Bienvenido

    2012-10-01

    The aim is to describe the performance of first-trimester combined risk assessment in twin pregnancies. Maternal serum free beta-human chorionic gonadotrophin and pregnancy-associated plasma protein A (PAPP-A) were determined at 8 to 12 weeks and fetal nuchal translucency (NT) was measured at 11 to 13+6 weeks. The individual risk was estimated for each fetus using the combined test in dichorionic twins. In monochorionic twins, the mean risk assessment of the two fetuses was used. An invasive diagnostic procedure was offered when the risk was ≥ 1 : 270 in either one of the fetuses. From February 2007 to June 2011, 447 twin pregnancies were enrolled in this study. There were 402 (89.9%) dichorionic and 45 (10.1%) monochorionic twins. In dichorionic twins, mean crown-rump length (CRL) was 63.9 mm; median NT multiples of the median (MoM) was 0.97; median Β-hCG was MoM 1.74; median PAPP-A was 1.72. In monochorionic twins, mean CRL was 61.9 mm; median NT MoM was 0. 98; median Β-hCG MoM was 1.44; and median PAPP-A was 1.51. Two pregnancies with Down syndrome were detected by first trimester screening, both in dichorionic twins. The false positive rate was 5.7% (95% confidence interval 4.1-7.3) and 4.4% (95% confidence interval 0.1-8.8%) in dichorionic and monochorionic twins, respectively. The combined test in twins appears to be a good method for Down syndrome screening with a high detection rate and an acceptable false-positive rate. © 2012 John Wiley & Sons, Ltd.

  8. [Selective termination of pregnancy for monochorionic twins: a national survey of professional practice].

    Science.gov (United States)

    Arlicot, C; Potin, J; Simon, E; Perrotin, F

    2014-06-01

    Selective Termination of Pregnancy (STOP) for discordant fetal condition in monochorionic twin pregnancy is a rarely performed procedure raising technical and ethical considerations. There are no epidemiological data available in France concerning STOP and no guideline or scientific consensus on how or when to perform has been published. We conducted a study of national practice using a declarative questionnaire sent by e-mail to each medical coordinator of every 48 Multidisciplinary Center for Prenatal Diagnosis in France. The questions focused on the issues of 2010 and 2011. Two reminders were sent in case of no answer. The response rate to the questionnaire was 56 %; 81 % of centers have experienced at least once during the two years 2010-2011 a discordant fetal anomaly in monochorionic twin pregnancy. Only 59 % of centers perform all the techniques of STOP. When interruption of the umbilical blood flow is considered, bipolar forceps coagulation is the most used (75 %). Achieving STOP during a cesarean section is a common practice (75 % of centers). Locoregional anesthesia is the preferred mode of anesthesia for STOP. STOP on monochorionic twin pregnancy is not practiced in all Multidisciplinary Center for Prenatal Diagnosis in France. The most widely practiced and most studied technique is bipolar forceps coagulation. The option of an expectant management should always be considered and its risks should be balanced with those of STOP. The practice of STOP during cesarean section is not unusual. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  9. Rhinitis and pregnancy: literature review

    Directory of Open Access Journals (Sweden)

    Fábio Azevedo Caparroz

    2016-02-01

    Full Text Available ABSTRACT INTRODUCTION: There is a controversy concerning the terminology and definition of rhinitis in pregnancy. Gestational rhinitis is a relatively common condition, which has drawn increasing interest in recent years due to a possible association with maternal obstructive sleep apnea syndrome (OSAS and unfavorable fetal outcomes. OBJECTIVE: To review the current knowledge on gestacional rhinitis, and to assess its evidence. METHODS: Structured literature search. RESULTS: Gestational rhinitis and rhinitis "during pregnancy" are somewhat similar conditions regarding their physiopathology and treatment, but differ regarding definition and prognosis. Hormonal changes have a presumed etiological role, but knowledge about the physiopathology of gestational rhinitis is still lacking. Management of rhinitis during pregnancy focuses on the minimal intervention required for symptom relief. CONCLUSION: As it has a great impact on maternal quality of life, both the otorhinolaryngologist and the obstetrician must be careful concerning the early diagnosis and treatment of gestational rhinitis, considering the safety of treatment measures and drugs and their current level of evidence.

  10. Fetal cardiac activity analysis during twin pregnancy using a multi-channel SQUID system

    Science.gov (United States)

    Costa Monteiro, E.; Schleussner, E.; Kausch, S.; Grimm, B.; Schneider, A.; Hall Barbosa, C.; Haueisen, J.

    2001-05-01

    The use of SQUID magnetometers for non-invasive in utero assessment of cardiac electrical disturbances has already been shown to be a valuable clinical tool. In this way, its applicability also for the complicated case of twin pregnancy, in which the proximity of the cardiac magnetic source of each fetus can hamper the individual analysis of cardiac electrical activity, is of clinical interest. In this paper, we present fetal magnetocardiography performed on a mother pregnant of twins with 26 weeks gestational age, measured inside a magnetically shielded room, by using two identical 31-channel low- Tc SQUID magnetometer systems. Each sensor array has been positioned over one of the fetuses, according to its heart position previously assessed with the aid of ultrasound measurements. The raw data is initially averaged in time and, afterwards, analyzed by means of time plots and isofield maps. The time recordings allow the study of the morphology of each fetus’ cardiac signal and the cardiac time intervals. The resultant equivalent dipole obtained from the isofield maps indicates the position and orientation of each fetus heart. The results agree with the ultrasound analysis performed immediately before the measurements and used to obtain the approximate location of the fetuses’ hearts. Since a distinct analysis of the cardiac electrical activity of each fetus could be achieved, the results indicate the potential of the fetal magnetocardiography in the individual antenatal diagnosis of each one of the fetuses of a twin pregnancy.

  11. Fetal abnormalities leading to termination of twin pregnancies: the 17-year experience of a single medical center.

    Science.gov (United States)

    Melcer, Yaakov; Svirsky, Ran; Vaknin, Zvi; Levinsohn-Tavor, Orna; Feldman, Noa; Maymon, Ron

    2017-02-01

    To assess fetal abnormalities leading to termination of pregnancy (TOP) performed in twin pregnancies. The current study consisted of all women with dichorionic twin pregnancies (study group) who underwent TOP due to fetal abnormalities in our institute from 1999 to 2015. The data were compared to our registry of all parturient women with a singleton pregnancy (control group) that underwent TOP due to fetal anomalies at the same period. There were 2495 cases of TOP because of fetal indications during the study period. Of them, 86 (3.4%) and 2409 (96.6%) were from the study and control group, respectively. Structural anomalies were the leading indication for TOP in twins compared with singleton pregnancies (81.4% versus 50.9%, respectively, p leading indication for TOP was central nervous system (CNS) abnormalities and it was more common compared with singleton pregnancies (26.1% versus 12.2%, respectively, p leading to TOP in twins versus singleton pregnancies. The main indication for TOP in the study group was structural malformations, with a predominance of CNS abnormalities.

  12. Recurrent twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation: a systematic review of the literature.

    LENUS (Irish Health Repository)

    Walsh, C A

    2012-11-01

    Selective fetoscopic laser photocoagulation (SFLP) is now the treatment of choice for twin-twin transfusion syndrome (TTTS). The incidence of recurrent TTTS following SFLP has been inconsistently reported across different studies. We performed a systematic review of TTTS recurrence following SFLP.

  13. A successful twin pregnancy in a patient with HbE-β-thalassemia in western India.

    Science.gov (United States)

    Merchant, R; Italia, K; Ahmed, J; Ghosh, K; Colah, R B

    2015-01-01

    Improvements in medical facilities have helped a large number of clinically severe hemoglobin E (HbE)-β-thalassemia patients reach adulthood. Consequently, there is a new challenge, that of managing women with HbE-β-thalassemia during pregnancy. In particular, they have a high risk of abortion, preterm delivery, intrauterine growth restriction, and thromboembolism. A 27-year-old HbE-β-thalassemia patient on regular transfusion, who was splenectomized and heptatitis C (HCV)-positive, conceived for the first time without any infertility treatment. However, there was incomplete abortion with heavy bleeding at 3 months of gestation, which required bilateral uterine artery angiography. The angiogram showed the left uterine artery to be moderately hypertrophied. This was embolized with 300-500 micron polyvinyl alcohol (PVA) to stop the bleeding. Soon after, she conceived again with a twin pregnancy, and at 33.3 weeks of gestation, there was a normal delivery of twin girls without any postpartum hemorrhage or perineal tear. Both babies were given prematurity care. The mother and children were both normal up till the last follow-up 18 months after delivery, and both the girls are HbE heterozygous. Thorough monitoring of endocrine functions along with proper management of transfusions and iron overload can help in reducing the complications related to pregnancy in these patients.

  14. Cervical conization doubles the risk of preterm and very preterm birth in assisted reproductive technology twin pregnancies

    DEFF Research Database (Denmark)

    Pinborg, A; Ortoft, G; Loft, A

    2015-01-01

    and cervical conization are both risk factors for PTB. STUDY DESIGN, SIZE, DURATION: In this national population-based controlled cohort study, we included all ART singletons and twin deliveries from 1995 to 2009 in Denmark by cross-linkage of maternal and child data from the National IVF register......STUDY QUESTION: Does cervical conization add an additional risk of preterm birth (PTB) in assisted reproduction technology (ART) singleton and twin pregnancies? SUMMARY ANSWER: Cervical conization doubles the risk of preterm and very PTB in ART twin pregnancies. WHAT IS KNOWN ALREADY: ART......, respectively, with an aOR 1.94 (95% CI 1.36-2.77), and the risk of VPTB was also doubled. Furthermore, previous dysplasia (without conization) increased the risk of VPTB in ART twins (aOR 1.74, 95% CI 1.04-2.94). Cervical dysplasia did not increase the risk of any of the other adverse outcomes in ART...

  15. Chorioamniotic membrane separation after fetoscopy in monochorionic twin pregnancy: incidence and impact on perinatal outcome.

    Science.gov (United States)

    Ortiz, J U; Eixarch, E; Peguero, A; Lobmaier, S M; Bennasar, M; Martinez, J M; Gratacós, E

    2016-03-01

    To evaluate the incidence of chorioamniotic membrane separation (CMS) after fetoscopy in monochorionic diamniotic (MCDA) twins and its impact on pregnancy outcome. The study group comprised a consecutive series of 338 women with an MCDA pregnancy complicated by twin-twin transfusion syndrome (TTTS) or selective intrauterine growth restriction (sIUGR) treated with selective laser photocoagulation of communicating vessels (SLPCV) or cord occlusion (CO). Data obtained included cervical length, gestational age at procedure, type and duration of surgery and placental location. The incidence of CMS, the rates of miscarriage and preterm prelabor rupture of membranes (PPROM), gestational age at delivery and neonatal survival were recorded. Of the study population of MCDA pregnancies, 270 (79.9%) had TTTS and 68 (20.1%) had sIUGR. SLPCV was performed in 252 (74.6%) cases and CO in 86 (25.4%). Postoperative CMS was observed in 70 (20.7%) cases. Patients with CMS had higher rates of miscarriage (14.3% vs 7.1%; P = 0.049), PPROM before 32 weeks (43.3% vs 13.7%; P < 0.001) and preterm delivery before 32 weeks (53.3% vs 26.1%; P < 0.001) and a lower rate of neonatal survival of at least one twin (81.7% vs 93.6%; P = 0.003). Multivariate analysis showed that gestational age at surgery was the only independent predictor, with the highest proportion of CMS occurring in cases that underwent surgery before 18 weeks' gestation (odds ratio, 2.941 (95% CI, 1.640-5.275); P < 0.001). There was no influence of cervical length, placental location, duration of surgery or type of surgery on the risk of CMS. CMS complicated one-fifth of all MCDA pregnancies that underwent fetoscopy. It appeared to be more common in those who underwent surgery before 18 weeks' gestation and was associated with poorer outcomes. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  16. Cloacal dysgenesis sequence with bilateral renal agenesis and normal pulmonary development in twin pregnancy.

    Science.gov (United States)

    Jegadeesh, Sundram; Mahajan, Jai Kumar

    2016-01-20

    Cloacal dysgenesis sequence (CDS) is a rare congenital anomaly. It is characterised by a smooth perineum with absence of anal and genitourinary orifices, with reported incidence of 1:50,000-250,000 births. Association with bilateral renal agenesis is still rarer and resultant severe oligohydramnios is associated with pulmonary hypoplasia. Only a few cases of CDS with bilateral renal agenesis have been reported in the English language literature, with associated pulmonary hypoplasia as a default phenomenon. We report a case of CDS and bilateral renal agenesis without associated pulmonary hypoplasia in a twin pregnancy, which, to the best of our knowledge, is the second reported case of this amalgamation.

  17. The association between Placental T2* measured by MRI in dichorionic twin pregnancies and intertwin birth weight differences

    DEFF Research Database (Denmark)

    Sørensen, Anne Nødgaard Weidemann; Sinding, Marianne Munk; Peters, David Alberg;

    ABSTRACT FINAL ID: P22.06 TITLE: The association between Placental T2* measured by MRI in dichorionic twin pregnancies and intertwin birth weight differences AUTHORS (FIRST NAME, LAST NAME): Anne Sørensen1, 2, Marianne Sinding1, David Peters3, Jens B. Frøkjær4, 2, Astrid Petersen6, Niels Uldbjerg5...... the association between the intertwin placental T2* difference and the intertwin birth weight difference Methods: A total of 21 dichorionic twin pregnancies (gestational age 20.1 – 34.1 weeks) were included in this study and placental T2* was measured using a gradient recalled echo MRI sequence with readout at 16......: Intertwin placental T2* difference is strongly related to intertwin birthweight difference, even when performed several weeks before birth. Placental T2* might be a future method to predict intertwin birthweight difference in dichorionic twin pregnancies. Further studies should be performed in order...

  18. Uterine rupture in twin pregnancy with normal fetus and complete hydatidiform mole.

    Science.gov (United States)

    Sánchez-Ferrer, María Luisa; Hernández-Martínez, Florentina; Machado-Linde, Francisco; Ferri, Belén; Carbonel, Pablo; Nieto-Diaz, Anibal

    2014-01-01

    We describe a rare case of complete hydatidiform mole with twin live fetus (CHMTF) confirmed by histopathology, flow cytometry and polymerase chain reaction techniques. No malformations were observed, fetal karyotype was normal and β-human chorionic gonadotropin levels were high (>100,000 IU/ml). The patient was informed of the risks and decided to continue with the pregnancy, but at week 15, she had to undergo hysterectomy due to uterine rupture. She subsequently developed persistent trophoblastic disease (PTD) with pulmonary metastases that required treatment with polychemotherapy. Patients with CHMTF should be informed of all known risks, including the considerable risk of PTD, which is similar to or, even higher than that associated with a singleton complete mole. The risk does not appear to be increased by continuing the pregnancy. Because so few series have been published, there is a lack of evidence-based clinical management guidelines. To our knowledge, this is the first report of uterine rupture in CHMTF.

  19. Pregnancy in a Previously Conjoined Thoracopagus Twin with a Crisscross Heart

    Directory of Open Access Journals (Sweden)

    Bassam H. Rimawi

    2015-01-01

    Full Text Available Background. Crisscross heart (CCH is a complex, rare, congenital, rotational, cardiac abnormality that accounts for <0.1% of congenital heart defects (CHD. CCH is characterized by the crossing of the inflow streams of the two ventricles due to an abnormal twisting of the heart. A case of maternal CCH has not been previously reported. Case. We report a case of a primigravida with a CCH, who was separated at birth from her thoracopagus conjoined twin. Pregnancy was managed by congenital cardiology, maternal-fetal medicine, anesthesiology, and obstetrics. She underwent a 39-week vaginal delivery without maternal or neonatal complication. Conclusion. A successful term pregnancy outcome was achieved in a patient with CCH using a multidisciplinary approach to address her cardiac condition.

  20. Situs Inversus Totalis in Twins: A Brief Review and a Life History / Twin Research: Twin Studies of Trisomy 21; Monozygotic Twin Concordance for Bilateral Coronoid Hyperplasia; Prenatal Hormonal Effects in Mixed-Sex Non-Human Primate Litters; Insurance Mandates and Twinning After In Vitro Fertilization / News Reports: First Report of Identical Twin Puppies; Twins Sisters Turn 100; Remembering an Identical Twin Production Designer; New York City Marathon Quadruplets.

    Science.gov (United States)

    Segal, Nancy L

    2017-02-01

    The presence of situs inversus totalis (full reversal of internal organs) in twins is briefly reviewed. Information gathered from 35-year-old monozygotic (MZ) female twin pair discordant for this condition is presented. This is followed by summaries of research on the frequency of trisomy 21 (Down syndrome) in twins, the first case of MZ twin concordance for bilateral coronoid hyperplasia, prenatal hormonal effects in mixed-sex non-human primate litters, and links between insurance mandates and twinning following in vitro fertilization. The final section of this article describes twin-related events reported in the news, namely, the first recorded birth of identical twin puppies; the 100th birthday celebration of a pair of fraternal female twins, the passing of an award-winning identical twin production designer, and the first running of the New York City Marathon by a set of quadruplets.

  1. Induction of Lactation in the Biological Mother After Gestational Surrogacy of Twins: A Novel Approach and Review of Literature.

    Science.gov (United States)

    Farhadi, Roya; Philip, Roy K

    One of the important challenges in surrogate pregnancies is the early bonding of genetic mother with her infant and the establishment of breastfeeding. A combination of pharmacological and nonpharmacological methods is often used for the induction of lactation. Reports of induced lactation in surrogacy are limited and scattered. In this report, we present a case of induced lactation and initiation of breastfeeding in preterm twins by the genetic mother, through her novel approach after a gestational surrogate pregnancy. Thematic approach of maternal account is summarized with context and rigor. We reviewed the reported literature of induced lactation in similar cases with an aim to address the various methods adopted.

  2. Progestogens to prevent preterm birth in twin pregnancies: an individual participant data meta-analysis of randomized trials

    Directory of Open Access Journals (Sweden)

    Schuit Ewoud

    2012-03-01

    Full Text Available Abstract Background Preterm birth is the principal factor contributing to adverse outcomes in multiple pregnancies. Randomized controlled trials of progestogens to prevent preterm birth in twin pregnancies have shown no clear benefits. However, individual studies have not had sufficient power to evaluate potential benefits in women at particular high risk of early delivery (for example, women with a previous preterm birth or short cervix or to determine adverse effects for rare outcomes such as intrauterine death. Methods/design We propose an individual participant data meta-analysis of high quality randomized, double-blind, placebo-controlled trials of progestogen treatment in women with a twin pregnancy. The primary outcome will be adverse perinatal outcome (a composite measure of perinatal mortality and significant neonatal morbidity. Missing data will be imputed within each original study, before data of the individual studies are pooled. The effects of 17-hydroxyprogesterone caproate or vaginal progesterone treatment in women with twin pregnancies will be estimated by means of a random effects log-binomial model. Analyses will be adjusted for variables used in stratified randomization as appropriate. Pre-specified subgroup analysis will be performed to explore the effect of progestogen treatment in high-risk groups. Discussion Combining individual patient data from different randomized trials has potential to provide valuable, clinically useful information regarding the benefits and potential harms of progestogens in women with twin pregnancy overall and in relevant subgroups.

  3. Twins reunited: scientific and personal perspectives/twin research studies: multiple birth effects on IQ and body size; life style, muscles, and metabolism; monochorionic dizygotic twin with blood chimerism; amniocentesis for twins/twins in the media: identical doctors; freedom fighter for twins; twin scholarships; Auguste and Jean-Felix Piccard; twins born apart.

    Science.gov (United States)

    Segal, Nancy L; Mulligan, Christy A

    2014-04-01

    A reunion of 38-year-old female monozygotic twins took place in Daegu, South Korea, on January 14, 2014. Scientific and personal perspectives on this extraordinary event are provided. A review of timely twin research follows, covering the effects of multiple births on IQ and body size, lifestyle and physical fitness associations, a rare case of a dizygotic twin with blood chimerism and definitional issues surrounding amniocentesis-related loss in multiple birth pregnancies. Interesting and informative mention of twins in the media includes twin doctors, a twin freedom fighter, the availability of college scholarships for twins, a new book about the Piccard family (two of whose members were twins), and co-twins born before and after the new year. A follow-up to a previous mention of identical twin biatheletes is also provided.

  4. To Explore the Clinical Features of Twin Pregnancy%双胎妊娠的临床特点分析

    Institute of Scientific and Technical Information of China (English)

    马智慧

    2015-01-01

    ObjectiveTo investigate the clinical characteristics and treatment of twin pregnancy.MethodsThe twin pregnancy in the maternity department of our hospital were selected in this study. The clinical features, complications and treatment were analyzed in gestation period and the stage of labor.Results In the 30 patients of twin pregnancies, 10 cases received vaginal delivery, 20 cases received cesarean section, without the death of perinatal infants.Conclusion The incidence of complication for the twin pregnancy is high in gestation period and the stage of labor, with high incidence of premature delivery, low birth weight and children with birth defect which increase the perinatal mortality. So twin pregnancy is high-risk pregnancy.%目的:探讨双胎妊娠的临床特点与处理。方法选取我院的30例双胎妊娠产妇,对妊娠期与分娩期的临床特点、并发症及处理方法进行分析。结果双胎妊娠患者30例,阴道分娩10例,剖宫产20例,无围生儿死亡。结论双胎妊娠孕期及分娩期并发症多,早产率、低体重儿、畸形儿发生率高,使围产儿死亡率增加,为高危妊娠范畴。

  5. Profile of peroxidative injury and antioxidant indicators in singleton, twins and multiple bearing goats throughout pregnancy

    Institute of Scientific and Technical Information of China (English)

    Abdel-Ghani MA; T.M. El-sherry TM; Hayder M; Abou-Khalil NS

    2016-01-01

    Objective:To investigate the changes in profile of the oxidant and antioxidant indicators throughout pregnancy in goats.Methods: Estrus in goats was synchronized using an intravaginal progestogen impregnated sponge and the buck was introduced in the herd during the experiment for breeding purpose. Serum nitric oxide (NO) as standard angiogenic marker, total antioxidant capacity (TAC) as a cryoprotectant indicator, total peroxide (TPX) as a pathogenetic effector were measured, followed by calculation of OSI% (TPX/TAC)×100 as a reflector of the oxidant/antioxidant status, andmalondialdhyde were estimated.Results:Compared with values in singleton and twins bearing goats, TAC values in multiple bearing goats were higher in 4thmonth and lower in 5th month (P<0.05). Values of TPX were lower in multiple bearing goats in 4th month and higher in 5th month (P<0.05) when compared with singleton and twins bearing goats.In contrary, NO values started to increase from the 2nd month until 4th month of gestation in all pregnant goats. However, the NO was lower in 5th month (P<0.05) in multiple bearing goats.Values of NO were negatively correlated with OSI % in allbearing goats.Conclusion: Knowing the relationship between the fetal number and oxidative stress indicators could be useful in the clinical management of such pregnancies and could be useful in the early detection or prediction adverse pregnancy outcome. Particularly, the 4th and 5th month of gestation increases the liability to reactive oxygen species in goats.

  6. Fatal alloimmune thrombocytopenia due to anti-HLA alloimmunization in a twin pregnancy: A very infrequent complication of assisted reproduction.

    Science.gov (United States)

    Meler, Eva; Porta, Roser; Canals, Carme; Serra, Bernat; Lozano, Miguel

    2016-11-02

    The most frequently involved antigen in severe fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the human platelet antigen 1a. Platelets express the HLA-A and B antigens on their membrane and some studies report that maternal anti-HLA class I antibody can also cause FNAIT. We report here a very unusual case of a first twin pregnancy produced in vitro by oocyte and semen donation where the mother developed markedly elevated HLA antibodies, in the absence of anti-platelet or anti-neutrophil antibodies, that provoked in one of the twins a profound thrombocytopenia and intracranial hemorrhage and a mild thrombocytopenia and neutropenia in the second twin lasting until the fourth month of life. In addition, anti-D alloimmunization provoked hemolytic disease of the newborn with intrauterus anemia detected in the first twin and post-natal anemia in the second twin that required red blood cell transfusion and phototherapy. We hypothesize that the complete HLA-incompatible twin pregnancy due to the oocyte donation might have contributed to the severity of the clinical manifestations.

  7. Successful treatment of Rh alloimmunization in a twin pregnancy: case report

    Directory of Open Access Journals (Sweden)

    Rahimi Sharbaf F

    2008-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} Background: The prevalence of Rh alloimmunization has decreased following the use of anti-D immunoglobulin. With serial amniocentesis, Doppler sonography of the middle cerebral artery and treatment of anemia with intrauterine blood transfusion, perinatal mortality has declined. However, Rh alloimmunization in twin pregnancies poses a diagnostic and therapeutic challenge."n"n Case report: We are reporting, for the first time in Iran, the successful treatment of severe Rh alloimmunization in a dichorionic- diamnionic twin pregnancy leading to the live births of both neonates. Before treatment, the fetal hemoglobin levels were 3.1g/dL and 3.9g/dL, with ascites in both fetuses. The fetuses were treated with several IUTs."n"n Results: After treatment, the neonates were delivered, weighing 2200 and 2300g, with good Apgar scores, at a gestational age of 34 weeks. "n"n Conclusion: 10% of population in Iran is Rh-negative, although Prophylaxis for Rh alloimmunization is universal, as other part of the world it cannot irrigated. For the best management of these cases, we need a well-equipped referral center."n"n Keywords: Twin, pregnancy, Rh alloimmunization, intrauterine blood transfusion, Doppler, middle cerebral

  8. The impact of loop electrosurgical excision procedure (LEEP) for CIN 2,3 on spontaneous preterm delivery in twin pregnancies by assisted reproductive technique: preliminary data.

    Science.gov (United States)

    Ciavattini, Andrea; Stortoni, Piergiorgio; Mancioli, Francesca; Puglia, Danila; Tranquilli, Andrea Luigi; Liverani, Carlo Antonio

    2014-07-01

    The objective of this study was to compare the frequency of spontaneous preterm delivery before 35 weeks in 7 dichorionic twin pregnancies obtained after loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) 2,3 with respect to 21 twin pregnancies without previous cervical treatment. All the pregnancies were obtained after assisted reproduction techniques (ART). Same age at delivery was observed between two groups (p = 0.81) and none of our twin pregnancies after LEEP had a threatened preterm labor while four controls (19%) underwent a spontaneous preterm delivery (p = 0.35). These preliminary data seem to indicate that LEEP may not be responsible of spontaneous preterm delivery in twin pregnancies subsequent to ART.

  9. Serum levels of N-terminal fragment of precursor protein brain-type natriuretic peptide (NT-proBNP) in twin pregnancy.

    Science.gov (United States)

    Yamada, Takashi; Koyama, Takahiro; Furuta, Itsuko; Takeda, Masamitsu; Nishida, Ryutaro; Yamada, Takahiro; Morikawa, Mamoru; Minakami, Hisanori

    2013-01-16

    Twin pregnancy differs considerably from singleton pregnancy in many aspects and it is unknown how serum NT-proBNP level behaves in women with twin pregnancies. Serum NT-proBNP levels were determined longitudinally at gestational weeks (GW) 24 and 35 in normotensive women with 13 twin and 99 singleton pregnancies. The effects of maternal demographic characteristics on NT-proBNP levels were also analyzed. The serum NT-proBNP levels (pg/ml) in twin pregnancies, which were not different from those in singleton pregnancies at 24 GW (26±15 vs. 40±27, respectively, P=0.0718), increased significantly (P=0.0038) and were significantly higher than those in singleton pregnancies at 35 GW (72±49 vs. 34±24, Ptwin pregnancy were likely to exhibit an increase in serum NT-proBNP levels in the late stage of pregnancy, especially in lean and nulliparous women. The relative greater blood volume expansion occurring in twin than in singleton pregnancies was considered to be responsible for this phenomenon.

  10. Arabin cervical pessary to prevent preterm birth in twin pregnancies with short cervix.

    Science.gov (United States)

    Di Tommaso, Mariarosaria; Seravalli, Viola; Arduino, Silvana; Bossotti, Carlotta; Sisti, Giovanni; Todros, Tullia

    2016-08-01

    A retrospective study was conducted to evaluate the effect of Arabin cervical pessary in twin pregnancies with cervical length (CL)  <25 mm between 21 and 31 weeks. Forty patients receiving pessary were matched with 40 controls without pessary. They were matched for gestational age (GA) at admission and CL. GA at delivery, delivery before 36, 34 and 32 weeks, latency between detection of short cervix and delivery, and duration of hospital admission were compared between groups. Women with the pessary delivered at higher GA compared to controls (35 vs. 33 weeks, p = 0.02). Cervical pessary significantly reduced the incidence of delivery  <36 and  < 34 weeks (p < 0.05), but not before 32 weeks. Interval between detection of short cervix and delivery was longer in the pessary group and duration of hospital admission was shorter (p = 0.03) compared to women without pessary.

  11. Clinical outcomes of twin pregnancies conceived by in vitro fertilization compared with spontaneous twin pregnancies%试管婴儿双胎及自然受孕双胎临床分析

    Institute of Scientific and Technical Information of China (English)

    张惠琴; 樊蕊; 田国华; 李凌; 张志红; 张月萍

    2015-01-01

    目的:分析试管婴儿双胎与自然受孕双胎产妇和新生儿的临床结局。方法收集2010年1月至2014年4月106例试管婴儿双胎妊娠(试管组)与256例自然受孕双胎妊娠(对照组)的产妇年龄、妊娠周期、分娩方式、妊娠期合并症、新生儿体格发育、新生儿出生缺陷及新生儿围生期疾病等临床资料,并进行统计学比较分析。结果试管组产妇平均年龄(32±4岁)高于对照组(28±4岁,P0.05)。结论本研究显示试管婴儿双胎与自然受孕双胎围生期结局无明显差异;试管婴儿双胎妊娠的产妇在妊娠期需密切关注血压及血糖的波动情况。%Objective To compare the maternal and perinatal outcomes of twin pregnancies conceived by in vitro fertilization (IVF) with outcomes of spontaneous twin pregnancies. Methods A retrospective analysis was conducted between January 2010 and April 2014 to investigate the maternal age, gestation length, modes of delivery, pregnancy complications and neonatal physical development, birth defects and perinatal diseases in 106 IVF-assisted twin pregnancies (IVF group) and 256 spontaneous twin pregnancies (control group). Results The mothers in the IVF group were signiifcantly older than those in the control group (32±4 years vs 28±4 years, P0.05). Conclusions Twins conceived by IVF have similar outcomes as spontaneously conceived twins in the perinatal period. However, special attention is needed to monitor the levels of blood pressure and blood glucose for pregnant women with twins conceived by IVF during prenatal checkups.

  12. Monoamniotic twins discordant for anencephaly managed conservatively with good outcomes: two case reports and a review of the literature.

    Science.gov (United States)

    Lim, K I; Dy, C; Pugash, D; Williams, K P

    2005-08-01

    Monoamniotic twin pregnancy discordant for anencephaly (MATDA) is a rare occurrence with only seven prior reported cases. Selective termination has been advocated in managing discordant monoamniotic twins. We report two cases managed expectantly with good outcomes and review other previously reported cases. The first case was a primigravid woman diagnosed with MATDA at 18 weeks. She was managed expectantly until 32 + 5 weeks when a Cesarean section was performed for preterm labor. The surviving female infant weighed 1610 g. The second case was a multigravid woman who was diagnosed with MATDA at 17 + 5 weeks and was managed as an outpatient. An emergency Cesarean section was performed at 31 weeks for non-reassuring monitoring and the surviving male infant weighed 1790 g. In both cases, the survivors were discharged home in good condition. A review of these two cases and those in the literature suggests that expectant management should be considered among management options for this rare condition.

  13. Does amniotic fluid volume affect fetofetal transfusion in monochorionic twin pregnancies? Modelling two possible mechanisms

    Science.gov (United States)

    Umur, Asli; van Gemert, Martin J. C.; Ross, Michael G.

    2002-06-01

    Clinical evidence suggests that increased amniotic fluid volume due to polyhydramnios increases placental vascular resistance. We have sought to model the possible effects of an increased amniotic fluid volume on the net fetofetal transfusion in monochorionic twin pregnancies. We wanted to compare these effects with the results of previous simulations, which aimed to explain why the twin-twin transfusion syndrome (TTTS) placentas more often include bidirectional arteriovenous (AV) rather than AV plus arterioarterial (AA) anastomoses. We extended our mathematical model of TTTS by simulating two different mechanisms that increase the placental vascular resistance as a consequence of polyhydramnios. First, there is an increase in the placental capillary resistance and hence in deep AV and opposite AV (denoted as VA) resistances due to polyhydramnios. Second, there is an increase in the resistance of chorionic veins due to polyhydramnios, assuming that these veins act as Starling resistors. We then simulated the effects of polyhydramnios on different placental anastomotic patterns. The results were as follows. In the first mechanism (polyhydramnios affects AV-VA resistances), an increased amniotic fluid volume hardly affected bidirectional AV, but slightly decreased fetofetal transfusion in AV plus AA anastomoses. However, for these effects to change the natural development of the pregnancy, polyhydramnios needed to persist for approximately 4 weeks, and by comparing the effects of polyhydramnios with the effects of amnioreduction, amnioreduction was more beneficial for normalizing the donor amniotic fluid volume. Therefore, these beneficial effects due to polyhydramnios have no practical clinical significance. In the second mechanism (Starling resistor for chorionic veins), polyhydramnios slightly increased fetofetal transfusion and hence slightly increased TTTS severity in bidirectional AV and AV plus VV, but did not affect AV plus AA anastomoses. In conclusion, we

  14. Bariatric surgery and pregnancy: literature review

    Directory of Open Access Journals (Sweden)

    Pedro Ferrand Miranda

    2014-01-01

    Full Text Available Obesity has currently reached epidemic proportions, both in Chile and in the world. This condition is associated to a variety of maternal complications in all stages of the vital cycle and during pregnancy. Medical treatment has not proved successful thus resulting in an increase in bariatric surgery in recent years, even when it is not first line treatment. This literature review aims to report updated results of surgical treatment for obesity before and during pregnancy with respect to fertility, gestational diabetes, pre-eclampsia and pregnancy-induced hypertension. It also looks into the possible effects of surgery on fetal development, and its relation to premature delivery, fetal macrosomy, low birth weight and neural tube defects, as well as effects on maternal and fetal outcomes, mainly in nutrition. Lastly, we suggest some recommendations that arise from this review on the role of contraception, nutrition and time between surgery and pregnancy.

  15. Exercise and pregnancy: a review.

    Science.gov (United States)

    Bell, R; O'Neill, M

    1994-06-01

    The effects of pregnancy on the maternal cardiorespiratory system include increases in oxygen consumption, cardiac output, heart rate, stroke volume, and plasma volume. The increase in oxygen reserve seen in early pregnancy is reduced later, suggesting that maternal exercise may present a greater physiologic stress in the third trimester. Evidence suggests that weight-bearing exercise produces a greater decrease in oxygen reserve than nonweight-bearing exercise. Furthermore, to maintain a heart rate below 140 beats per minute during pregnancy, the intensity of weight-bearing exercise must be reduced. Nonweight-bearing, water-based exercise results in smaller fetal heart rate changes and a lower maternal heart rate than the same exercise performed on land. Exercising in the supine position in late pregnancy has raised concerns because cardiac output in the supine position is lower than in the lateral position at rest, presumably because the gravid uterus partially obstructs the inferior vena cava. Sustained exercise produces a training effect on the mother, although reported associations between this effect and the experience of labor are not consistent. Short-term changes in fetal heart rate provide circumstantial evidence that physical activity can influence the fetus. Acute effects of exercise that can potentially affect the fetus include hyperthermia, changes in uteroplacental flow, reduced levels of maternal glucose, and increased uterine contractions. Moderate to high levels of sustained maternal exercise have been associated with reduced birthweight. Much research remains to be done on the effects of specific exercise regimens during pregnancy, the effects on previously sedentary women, and the long-term health consequences to the offspring of women who perform vigorous exercise during pregnancy.

  16. Managing Prolactinomas During Pregnancy: Mini Review

    Directory of Open Access Journals (Sweden)

    Mussa eAlmalki

    2015-05-01

    Full Text Available Prolactinomas are the most prevalent functional benign pituitary tumors due to a pituitary micro- or macroadenoma. The majority of patients presents with infertility and gonadal dysfunction.A dopamine agonist (DAs (bromocriptine or cabergoline is the treatment of choice that can normalize prolactin levels, reduce tumor size and restore ovulation and fertility. Cabergoline generally preferred over bromocriptine because of its higher efficacy and tolerability. Managing prolactinomas during pregnancy may be challenging. During pregnancy, the pituitary gland undergoes global hyperplasia due to a progressive increase in serum estrogens level that may lead to increase of the tumor volume with potential mass effect and visual loss.The risk of tumor enlargement may occur in 3 % of those with microadenomas, 32 % in those with macroadenomas that were not previously operated on and 4.8% of those with macroadenomas with prior ablative treatment. Though both drugs appear to be safe during pregnancy, the data on fetal exposure to DAs during pregnancy have been reported with bromocriptine far exceeds that of cabergoline with no association of increased risk of pregnancy loss and premature delivery. It is advisable to stop the use of DAs immediately once pregnancy is confirmed, except in the case of women with invasive macroprolactinomas or pressure symptoms. This review outlines the therapeutic approach to, prolactinoma during pregnancy, with emphasis on the safety of available DA therapy.

  17. Noninvasive prenatal testing (NIPT) in twin pregnancies with treatment of assisted reproductive techniques (ART) in a single center

    DEFF Research Database (Denmark)

    Tan, YueQiu; Gao, Ya; Lin, Ge

    2016-01-01

    Objective: The objective of the study is to report the performance of noninvasive prenatal testing (NIPT) in twin pregnancies after the treatment of assisted reproductive technology (ART). Method: In two years period, 565 pregnant women with ART twin pregnancies were prospectively tested by NIPT......-test counseling. Results: In total of 565 cases, NIPT had a failure rate of 0.9% (5/565). Four cases of T21 were identified by NIPT and confirmed by karyotyping, resulting in 100% (95%CI 39.8%-100%) positive predictive value. Among 556 cases with NIPT negative results, 506 cases (91.0%) were confirmed by follow......-up of postnatal phenotypes, while 33 cases (5.9%) had adverse pregnant outcomes with unconfirmed reasons because of the lack of cytogenetic samples. The remaining 17 cases (3.1%) refused follow-up. No false negative result was reported. Conclusion: With apparently high positive predictive value and low false...

  18. Prenatal Diagnosis of Cantrell’s Pentalogy Associated with Agenesis of Left Limb in a Twin Pregnancy

    Directory of Open Access Journals (Sweden)

    Yigit Cakiroglu

    2014-01-01

    Full Text Available Pentalogy of Cantrell is a rare malformation described in the literature. We report a case of pentalogy of Cantrell associated with left limb deficiency in a twin pregnancy. The fetus with multiple anomalies revealed kyphosis, ectopia cordis, and a large defect with protruding liver and bowel loops at 12 weeks and 3 days of gestational age on ultrasound scan. The other fetus was ultrasonographically normal. We diagnosed a case of pentalogy of Cantrell in a twin pregnancy after exclusion of limb body wall complex, body stalk anomaly, and amniotic band syndrome and after delivery of the fetuses. Macroscopic examinations were ectopia cordis, extrusion of the abdominal organs without membranes surrounding, and agenesis of the left limb.

  19. Postpartum posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia: case report.

    Science.gov (United States)

    Papoutsis, D; El-Attabi, N; Sizer, A

    2014-01-01

    This is the second case in literature of posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia. A 27-year-old primigravida with dichorionic diamniotic twin pregnancy was admitted at 36 weeks of gestation for induction of labour due to preeclampsia. On the second day postpartum, the patient developed severe hypertension, visual symptoms, confusion, headache, and eclamptic fits. Head computed tomography (CT) showed hypodense basal ganglia lesions. The patient was treated in the intensive treatment unit with hydralazine and labetalol infusions and anticonvulsants. Five days later, there was complete clinical improvement and follow-up magnetic resonance imaging (MRI) was normal. The patient was discharged 11 days post-delivery. Diagnosis of PRES is based on the presence of clinical features of acute neurologic compromise, abnormal neuroimaging findings, and complete reversibility of findings after prompt treatment. Early recognition and proper treatment result in complete reversibility of this condition.

  20. Ankylosing Spondylitis and Pregnancy: A Literature Review.

    Science.gov (United States)

    Giovannopoulou, Eirini; Gkasdaris, Grigorios; Kapetanakis, Stylianos; Kontomanolis, Emmanuel

    2017-03-17

    Ankylosing Spondylitis (AS) is the prototype of a group of systemic rheumatic diseases collectively referred to as Spondyloarthitides (SpA). It is has recently become clear that AS is not as rare as previously thought and, although it has an early onset in life affecting patients in their reproductive years, it has not been proved to adversely affect fertility in females. Furthermore, new pharmaceutical agents have been introduced for its therapeutical management. The interaction between systematic rheumatic diseases and pregnancy has been under investigation with the majority of studies focusing on systemic lupus erythematosus and rheumatoid arthritis (RA). AS is the most studied in relation to pregnancy, among the group of SpA. The aim of this review is to summarize all the recent data on AS and pregnancy in terms of fertility, disease course and pregnancy outcome from a clinical perspective.

  1. Prenatal ultrasonic features of twin pregnancy with fetal abnormalities%双胎妊娠胎儿异常的产前超声特征

    Institute of Scientific and Technical Information of China (English)

    张一休; 杨筱; 孟华; 欧阳云淑; 姜玉新; 戴晴; 徐钟慧; 杨萌; 袁岩; 鲁嘉

    2012-01-01

    Objective To investigate the diagnostic value of ultrasound in twin pregnancy with fetal abnormalities. Methods The ultrasonic features and clinical data of 14 twin pregnancies with fetal abnormalities found by prenatal ultrasound were analyzed retrospectively. Results Among 14 twin pregnancies, there were 5 twins with structurally anomalous in 1 fetus, 1 with structurally anomalous in both fetuses, 1 with twin-to-twin transfusion syndrome, 2 with selective intrauter-ine growth restriction, 1 with co-twin neurological abnormality following the death of 1 twin, 2 with conjoined twins, 2 with twin reverse arterial perfusion sequence. Conclusion Ultrasound can diagnose structural complications and abnormalities of twin pregnancy, and plays an important role in clinical treatment.%目的 探讨产前超声诊断双胎妊娠胎儿异常的价值.方法 回顾性分析14对双胎妊娠胎儿异常的产前声像图特征及临床资料.结果 超声诊断5对为双胎之一结构畸形,1对为双胎均结构畸形,1对为双胎输血综合征,2对为选择性胎儿宫内发育迟缓,1对为双胎之一死亡后孪生胎神经系统损伤,2对为联体双胎,2对为双胎反向动脉灌注序列症.结论 超声有助于诊断多种双胎妊娠并发症和畸形,有重要临床指导意义.

  2. Fetal Aneuploidy Detection by Cell-Free DNA Sequencing for Multiple Pregnancies and Quality Issues with Vanishing Twins

    Directory of Open Access Journals (Sweden)

    Sebastian Grömminger

    2014-06-01

    Full Text Available Non-invasive prenatal testing (NIPT by random massively parallel sequencing of maternal plasma DNA for multiple pregnancies is a promising new option for prenatal care since conventional non-invasive screening for fetal trisomies 21, 18 and 13 has limitations and invasive diagnostic methods bear a higher risk for procedure related fetal losses in the case of multiple gestations compared to singletons. In this study, in a retrospective blinded analysis of stored twin samples, all 16 samples have been determined correctly, with four trisomy 21 positive and 12 trisomy negative samples. In the prospective part of the study, 40 blood samples from women with multiple pregnancies have been analyzed (two triplets and 38 twins, with two correctly identified trisomy 21 cases, confirmed by karyotyping. The remaining 38 samples, including the two triplet pregnancies, had trisomy negative results. However, NIPT is also prone to quality issues in case of multiple gestations: the minimum total amount of cell-free fetal DNA must be higher to reach a comparable sensitivity and vanishing twins may cause results that do not represent the genetics of the living sibling, as described in two case reports.

  3. Parental Relationship with Twins from Pregnancy to Three Months: the Relation Among Parenting Stress, Infant Temperament, and Well-being

    Directory of Open Access Journals (Sweden)

    Laura Elvira Prino

    2016-10-01

    Full Text Available Objective: The transition to parenthood, from pregnancy to postpartum period, is a critical process, particularly for couples expecting twins. There is very little literature regarding the links between anxiety, depression, dyadic adjustment, parental stress, and infant temperament spanning from pregnancy to postpartum. This study has two aims: first, to examine whether mothers’ and fathers’ anxiety, depression, and dyadic adjustment, assessed at the sixth month of pregnancy and three months postpartum, are associated with infants' negative affectivity and parenting stress; second, to examine whether there is any difference between fathers’ and mothers’ levels of parenting stress and perception of the twins’ temperament, as well as to evaluate, separately for mothers and fathers, whether the levels of parenting stress and perception of child temperament differ for each twin.Method: The study participants were 58 parents (29 couples and their healthy 58 twin babies (51.7% boys, 48.3% girls. Mothers’ ages ranged from 30 to 44 years, (MAge = 36.3 years, SD = 3.2 years, and fathers’ ages ranged from 32 to 52 years, (MAge = 38.2 years, SD = 4.4 years. The parents, during the pregnancy period and three months after delivery, filled out the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory, and the Dyadic Adjustment Scale. Three months after delivery they also filled out the Parenting Stress Index—Short Form and the Infant Behavior Questionnaire Revised. Results: The analyses showed a significant correlation between parental anxiety/depression symptoms and infants’ negative affectivity and parenting stress (in both mothers and fathers. Moreover, compared to fathers, mothers reported higher scores on specific dimensions of the infants’ negative affectivity, (t (28 = -2.62 and p < .05; t (28 = 2.09 and p < .05, and parenting stress, (t (28 = 2.19 and p < .05; t (28 = 2.23 and p < .05, but only for Twin 2. Finally

  4. Analysis of pregnancy results of singleton pregnancy and twin pregnancy by assisted reproductive technology%辅助生殖技术单胎妊娠和双胎妊娠结局分析

    Institute of Scientific and Technical Information of China (English)

    诸蕾; 张丁; 蒲娇

    2016-01-01

    目的:分析辅助生殖技术助孕成功妊娠的单胎妊娠和双胎妊娠妇女的妊娠结局,旨在为患者选择单胚胎或双胚胎移植提供参考。方法对我院通过辅助生殖技术助孕成功的237例单胎妊娠(单胎妊娠组)和126例双胎妊娠(双胎妊娠组)孕妇进行回顾性分析。结果单胎妊娠组平均分娩孕周长于双胎妊娠组(P <0.05);双胎妊娠组早产率、妊娠并发症发生率、妊娠高血压疾病发生率、低体重出生儿发生率均高于单胎妊娠组(P <0.05)。结论与多胎妊娠比较,单胎妊娠能够明显降低孕期并发症的风险,降低早产率和剖宫率。%Objective To provide the advice on choosing singleton embryo transfer or multiple embryo transfer by analyzing the abortion,premature birth,and the mode of production of singleton pregnancy and twin pregnancy by assisted reproductive technolo-gy.Methods The clinical data of two hundred and thirty-seven cases of twin pregnancy (twin pregnancy group)and 126 cases of sin-gle pregnancy (single pregnancy group)by assisted reproductive technology in our hospital were retrospective analyzed.Results In twin pregnancy group,premature delivery rate,pregnancy complications occurrence rate,hypertension of pregnancy rate,low birth weight newborns rate was higher,the average birth gestational age was shorter than in single pregnancy group(P <0.05).Conclusion Com-paring with multiple pregnancy,single pregnancy could reduce the risk of pregnancy complications,the rate of preterm birth rates and cesarean section rate significantly.

  5. Dizygotic monochorionic twin pregnancy conceived following intracytoplasmic sperm injection treatment and complicated by twin-twin transfusion syndrome and blood chimerism

    DEFF Research Database (Denmark)

    Ekelund, Charlotte Kvist; Skibsted, L.; Søgaard, Kirsten

    2008-01-01

    reported cases of dizygotic monochorionic twins. Nearly all of these cases have been conceived after assisted reproductive technology procedures. It is of clinical importance to be aware of this rare phenomenon in relation to TTTS, prenatal screening and parental counseling Udgivelsesdato: 2008/11...

  6. Psoriasis in pregnancy: a review (I).

    Science.gov (United States)

    Ruiz, V; Manubens, E; Puig, L

    2014-10-01

    Psoriasis is a complex inflammatory disease, and in women the incidence is high in child-bearing years. Treatment during pregnancy presents genuine challenges since management requires adequate assessment of the extent of disease, comorbidity, and potential risk to the fetus. Scientific evidence is scarce on the effects that certain drugs have on fetal development given the ethical concerns about enrolling pregnant women in clinical trials. This review presents up-to-date information on the course of psoriasis during gestation and discusses associated conditions and the therapeutic protocols recommended for use during pregnancy. Copyright © 2013 Elsevier España, S.L.U. and AEDV. All rights reserved.

  7. Comparison of second-trimester maternal serum free-β-human chorionic gonadotropin and α-fetoprotein between normal singleton and twin pregnancies: a population-based study

    Institute of Scientific and Technical Information of China (English)

    ZHENG Ming-ming; ZHONG Xiao-ling; HU Ya-li; ZHANG Chun-yan; RU Tong; LIU Qi-lan; XU Bi-yun; CHEN Qi-guang; XU Zheng-feng; ZHANG Yin

    2010-01-01

    Background The second-trimester maternal serum screening in twin pregnancy is still controversial, as the serum marker levels in twins are not as clear as those in singletons. This study aimed to evaluate the relationship between the levels of the second-trimester maternal serum free p-human chorionic gonadotropin (free β-HCG) and a-fetoprotein (AFP) in normal twin and singleton pregnancies and to estimate feasible analysis methods for utilizing these markers in second trimester screening for twin pregnancy. Methods On the basis of a prospective population-based study of second-trimester maternal serum screening, the concentrations of maternal serum AFP and free β-HCG of 195 normal twin pregnancy and 26 512 singleton controls at gestational weeks 15 to 20 were measured by time-resolved fluoroimmunoassay in one laboratory. The levels of markers were compared between the twins and singletons using weight-correction and gestational age-specific model. Results According to the research protocol, 95 communities were randomly sampled, which covered the whole Jiangsu province, the east of China. A total of 26 803 pregnant women (98%), from the target population accepted prenatal screening for maternal serum AFP, β-HCG detection, and all babies were followed up for at least six months. There were 197 (0.73%) twin pregnancies, of which one case had fetal trisomy 18, and one case with fetal anencephaly. The others were normal twin pregnancy. From a total enrollment of 26 803 women participants, 26 512 women with normal singleton pregnancies were selected as the model controls. The other 291 pregnancies, including trisomy 21, neural tube defect (NTD), trisomy 18, and other fetal abnormalities, were excluded. No significant differences were found in the medians of gestational age-specific maternal serum free β-hCG and AFP in normal twin pregnancy comparing with twice those in model controls with the exception of the medians for free β-hCG during the 16th gestational week

  8. Complete Hydatidiform Mole Presenting as a Placenta Accreta in a Twin Pregnancy with a Coexisting Normal Fetus: Case Report

    Directory of Open Access Journals (Sweden)

    Marijo Aguilera

    2012-01-01

    Full Text Available A twin pregnancy with a complete hydatidiform mole and a coexisting normal fetus (CHMF is a rare clinical scenario, and it carries many associated pregnancy and postnatal risks. Limited numbers of case studies exist reporting an outcome of live birth, and only three prior cases report the presentation of a hydatidiform mole as a placenta previa. We report a case of CHMF with the molar component presenting antenatally as a placenta previa, which ultimately resulted in placenta accreta at the time of delivery. A live male infant was delivered at 34 weeks’ gestation via planned cesarean section, and a hysterectomy was performed following unsuccessful removal of the molar component. We additionally utilized previously described methods of placing internal iliac balloons and ureteral stents prior to delivery. In such a high-risk pregnancy with a known molar previa component, these surgical preparation measures may be of benefit.

  9. The influence of maternal undernutrition in ovine twin pregnancy on fetal growth and Doppler flow-velocity waveforms.

    Science.gov (United States)

    Newnham, J P; Kelly, R W; Patterson, L; James, I

    1991-11-01

    The effects on placental blood flow velocity of maternal undernutrition during mid pregnancy were investigated in 38 twin bearing pregnant sheep by Doppler analysis of umbilical and uteroplacental arterial waveforms. Mid pregnancy undernutrition resulted in fetal growth restriction manifest at term gestation by reduced mean birth weight. Arterial waveform systolic/diastolic ratios from the umbilical and uteroplacental arterial circulations were not influenced by maternal nutrition either during the dietary deprivation or during a subsequent period of dietary supplementation. An effect of heart rate on systolic/diastolic ratios could not be demonstrated. The results indicate that the fetus responds to mid pregnancy maternal undernutrition with restricted growth but without alterations in systolic/diastolic ratios in umbilical or uteroplacental arterial waveforms.

  10. Preliminary report of altered insulin secretion pattern in monochorionic twin pregnancies complicated with selective intrauterine growth restriction.

    Science.gov (United States)

    Chang, Yao-Lung; Wang, Tzu-Hao; Abufraijeh, Seham M; Chang, Shuenn-Dyh; Chao, An-Shine; Hsieh, Peter C C

    2017-02-01

    Fetuses with intrauterine growth restriction (IUGR) have adaptive hormonal changes including changes in insulin, which may increase their future risks for developing diabetes mellitus. This study compared cord blood insulin concentrations in IUGR and appropriate for gestational age (AGA) fetuses in a monochorionic (MC) twin model. Ten pairs were classified as selective IUGR (sIUGR) based on having one twin weight below the 10th percentile and with an intertwin birth weight discordance>20%. Fourteen pairs without IUGR were included as a comparison group. Pregnancies with twin-twin transfusion syndrome, congenital structural malformations, and genetic abnormalities were excluded. Insulin and glucose concentrations were measured in cord venous blood at the time of delivery. Cord blood insulin concentrations of sIUGR fetuses were significantly lower than those of AGA counterpart fetuses in MC twins affected by sIUGR (5.1±4.1 mU/L, range: 0.7-9.9 mU/L for sIUGR fetuses and 12.2±7.6 mU/L, range: 3.5-23.7 mU/L for AGA fetuses, p=0.019). No significant difference in insulin concentrations between larger and smaller fetuses in MC twins without IUGR was observed. Insulin concentration was inversely correlated with gestational age of delivery in all fetuses except in those with sIUGR. We did not find any difference in cord blood glucose concentrations between the two fetuses in both groups. Our data show reduced insulin secretion and loss of the physiological decline in concentration over time as gestational age increases in fetuses with sIUGR compared to AGA counterparts. Copyright © 2017 Taiwan Association of Obstetrics & Gynecology. Published by Elsevier B.V. All rights reserved.

  11. The effect of a 'vanishing twin' on biochemical and ultrasound first trimester screening markers for Down's syndrome in pregnancies conceived by assisted reproductive technology

    DEFF Research Database (Denmark)

    Gjerris, A C; Loft, A; Pinborg, Anja

    2008-01-01

    . The presence of a perished embryo may further complicate prenatal screening among women pregnant after ART. The aim of this study was to assess the impact of a 'vanishing twin' on first trimester combined biochemical and ultrasound screening in pregnancies conceived after IVF and intracytoplasmatic sperm...... injection. METHODS: From a national prospective cohort study concerning first trimester combined screening among women pregnant after ART, 56 cases of pregnancies with a vanishing twin were identified. As control group 897 cases of ART singleton pregnancies were used. All women completed a first trimester......) or late vanishing twin (gestational week 9-13, LVT) or singleton pregnancies (0.98, 1.13 and 0.95 for free beta-hCG and 0.84, 0.80 and 0.74 for PAPP-A, respectively). Likewise, no difference was seen for NT measurements. The gestational age at the time of blood sampling and NT scan was similar...

  12. Successful twin pregnancy after orthotopic liver transplantation Gravidez gemelar com sucesso após transplante hepático

    Directory of Open Access Journals (Sweden)

    Júlio Cezar Uili Coelho

    2002-10-01

    Full Text Available AIM: Report of a case of successful twin pregnancy following liver transplantation. PATIENT AND METHOD: A 42-year-old nulliparous-woman was subjected to an orthotopic liver transplantation due to Budd-Chiari syndrome. Sixteen months after the transplantation, an ultrasonography revealed twin pregnancy. Her prenatal course was uneventful, except for mild arterial hypertension. The immunosuppressive agents used during pregnancy were cyclosporine and prednisone. RESULT: The patient gave birth to two healthy girls at 37 weeks of gestation. The patient's postpartum course was uneventful with normal liver and renal function tests. CONCLUSION: Following successful pregnancy, women may become pregnant and give birth to normal children, including twinsOBJETIVO: Descrição de um caso de gravidez gemelar com sucesso após transplante hepático. PACIENTE E MÉTODO: Paciente nulípara de 42 anos de idade com síndrome de Budd-Chiari foi submetida a transplante hepático. Dezesseis meses após o transplante, uma ultra-sonografia revelou gravidez gemelar. As avaliações pré-natais foram normais, exceto por apresentar hipertensão arterial leve. Os imunossupressores utilizados durante a gravidez foram ciclosporina e prednisona. RESULTADO: Cesariana foi realizada na 37ª semana de gravidez, com nascimento de duas meninas sadias. A evolução pós-cesárea foi normal, com os exames de avaliação hepática e renal normais. CONCLUSÃO: Após o transplante hepático com sucesso, as mulheres podem engravidar e ter filhos normais, inclusive gêmeos.

  13. Thyroid hormone dysfunction during pregnancy: A review

    Science.gov (United States)

    Alemu, Aynadis; Terefe, Betelihem; Abebe, Molla; Biadgo, Belete

    2016-01-01

    Thyroid dysfunctions such as hypothyroidism, thyrotoxicosis and thyroid nodules may develop during pregnancy leading to abortion, placental abruptions, preeclampsia, preterm delivery and reduced intellectual function in the offspring. Epidemiological data have shown the significant role of maternal thyroid hormone in fetal neurologic development and maternal health. It has been suggested that the deleterious effects of thyroid dysfunction can also extend beyond pregnancy and delivery to affect neuro-intellectual development in the early life of the child. Pregnancy poses an important challenge to the maternal thyroid gland as hormone requirements are increased during gestation as a result of an increase in thyroid- binding globulin, the stimulatory effect of HCG on TSH receptors, and increased peripheral thyroid hormone requirements. Maternal thyroid dysfunction is associated with increased risk for early abortion, preterm delivery, neonatal morbidity and other obstetrical complications. Early diagnosis for thyroid dysfunction of pregnant women and treatment of thyroid dysfunction during pregnancy is important and cost effective to avoid both fetal and maternal complications secondary to thyroid dysfunction. Therefore the aim of this review was to assess the thyroid function changes occurring during pregnancy, the different disorders with their maternal and fetal implications, the laboratory diagnosis and the best ways of management of these conditions. PMID:27981252

  14. A Comprehensive Review of Hypertension in Pregnancy

    Directory of Open Access Journals (Sweden)

    Reem Mustafa

    2012-01-01

    Full Text Available Hypertension is the most common medical disorder encountered during pregnancy. Hypertensive disorders are one of the major causes of pregnancy-related maternal deaths in the United States. We will present a comprehensive update of the literature pertinent to hypertension in pregnancy. The paper begins by defining and classifying hypertensive disorders in pregnancy. The normal vascular and renal physiological changes which occur during pregnancy are detailed. We will summarize the intriguing aspects of pathophysiology of preeclampsia, emphasizing on recent advances in this field. The existing diagnostic tools and the tests which have been proposed for screening preeclampsia are comprehensively described. We also highlight the short- and long-term implications of preeclampsia. Finally, we review the current management guidelines, goals of treatment and describe the potential risks and benefits associated with various antihypertensive drug classes. Preeclampsia still remains an enigma, and the present management focuses on monitoring and treatment of its manifestations. We are hopeful that this in depth critique will stimulate the blossoming research in the field and assist practitioners to identify women at risk and more effectively treat affected individuals.

  15. Twin studies on obsessive-compulsive disorder: a review

    NARCIS (Netherlands)

    Grootheest, van D.S.; Cath, D.C.; Beekman, A.T.F.; Boomsma, D.I.

    2005-01-01

    Genetic factors have historically been thought of as important in the development of obsessive-compulsive disorder (OCD). For the estimation of the relative importance of genetic and environmental factors, twin studies are an obvious approach. Twin studies of OCD have a long history, starting in 192

  16. Twin studies on obsessive-compulsive disorder: a review

    NARCIS (Netherlands)

    Grootheest, van D.S.; Cath, D.C.; Beekman, A.T.F.; Boomsma, D.I.

    2005-01-01

    Genetic factors have historically been thought of as important in the development of obsessive-compulsive disorder (OCD). For the estimation of the relative importance of genetic and environmental factors, twin studies are an obvious approach. Twin studies of OCD have a long history, starting in

  17. Successful outcome in a twin pregnancy with hereditary motor and sensory neuropathy type –II complicated with heart disease and preclampsia superimposed on chronic hypertension

    Directory of Open Access Journals (Sweden)

    Debasmita Mondal

    2008-06-01

    Full Text Available Heridetary motor and sensory neuropathy (HMSN TYPE-2 reflects reduction in the number of primary motor and sensory neurons. The occurrence of this disease is rare in pregnancy but may be exaggerated in pregnancy leading to preeclampsia / eclampsia. Here is a 28 years old 2nd gravidae with twin pregnancy at 31 weeks hospitalized with HMSN TYPE-2 disease and was managed successfully with good feto maternal outcome

  18. Imaging of conjoined twins

    Energy Technology Data Exchange (ETDEWEB)

    McHugh, Kieran [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); Kiely, Edward M.; Spitz, Lewis [Great Ormond Street Hospital for Children, Department of Surgery, London (United Kingdom)

    2006-09-15

    The incidence of conjoined twins is estimated to be around 1 in 250,000 live births. There is a distinct female predominance. In this paper the imaging of conjoined twins both antenatally and postnatally is reviewed, in particular taking into consideration recent advances with multidetector CT. Accurate counselling of parents regarding the likely outcome of the pregnancy and the likelihood of successful separation is dependent on good prenatal imaging with ultrasound and MRI. Planning of postnatal surgical separation is aided by accurate preoperative imaging which, depending on the conjoined area, will encompass many imaging modalities, but often relies heavily on CT scanning. (orig.)

  19. The Relation of Maternal Birth Weight to African-American and Non-Latina White Twin Pregnancy Outcomes: A Population-Based Study.

    Science.gov (United States)

    McAndrew, Sarah; Chihara, Izumi; Rankin, Kristin M; Collins, James W

    2016-07-28

    Objectives The authors investigated the association between maternal birth weight and adverse birth outcome as measured by rates of low birth weight (<2500 g, LBW), preterm birth (<37 weeks, PTB), and small for gestational age (weight <10th percentile for gestational age, SGA) among African American and White twin pregnancies. Methods Stratified and multivariable regression analyses were performed on the Illinois transgenerational dataset of non-Latina African American and non-Latina White twin pairs (born 1989-1991) and their mothers (born 1956-1976). Results Former LBW (n = 104) and non-LBW (n = 742) African American mothers had LBW rates in both twins of 76 and 56 %, respectively; RR (95 % CI) = 1.4 (1.2-1.6). Former LBW (n = 105) and non-LBW (n = 2136) White mothers had LBW rates in both twins of 41 and 34 %, respectively; RR = 1.2 (0.9-1.5). In multivariable regression models, the adjusted (controlling for maternal age, education, marital status, parity, prenatal care usage, and cigarette smoking) RR of LBW in both twins among former LBW (compared to non-LBW) African American and White mothers equaled 1.4 (1.2-1.6) and 1.2 (0.9-1.5), respectively. Maternal LBW was associated with a modestly increased risk of PTB but not SGA among African American twin pregnancies: adjusted RR = 1.3 (1.1-1.4) and 1.1 (0.8-1.5), respectively. Conclusions In African American twin pregnancies, maternal LBW is a risk factor for LBW in both twins. Further research is needed to determine whether a similar generational association occurs among non-Latina White twin pregnancies.

  20. Screening for trisomy 21 in twin pregnancies in the first trimester: does chorionicity impact on maternal serum free beta-hCG or PAPP-A levels?

    Science.gov (United States)

    Spencer, K

    2001-09-01

    In a study of 180 twin pregnancies I have examined the distribution of maternal serum free beta-human chorionic gonadotrophin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A), in addition to fetal nuchal translucency thickness (NT), in twins classified as monochorionic or dichorionic, based on ultrasound appearance at 10-14 weeks of gestation. In 45 monochorionic and 135 dichorionic twin pregnancies the median MoM free beta-hCG was not significantly different (1.00 vs 1.01), whilst that for PAPP-A was lower (0.89 vs 1.01) but again with no statistical significance. Previous reports of an increased fetal NT in monochorionic twins pregnancies could not be confirmed (1.03 vs 1.00). It is concluded that the existing pseudo risk twin correction algorithm is appropriate for both monochorionic and dichorionic twins in providing accurate first trimester risks for trisomy 21. Copyright 2001 John Wiley & Sons, Ltd.

  1. Twin pregnancy and partial hydatidiform mole following in vitro fertilization and embryos transfer: a novel case of placental mosaicism

    Institute of Scientific and Technical Information of China (English)

    SUN Cheng-juan; ZHAO You-ping; YU Song; FAN Ling; WU Qing-qing; LI Guang-hui; ZHANG Wei-yuan

    2012-01-01

    Twin pregnancy with mosaic partial hydatidiform mole (PHM) and survival of two healthy fetuses following in vitro fertilization and embryos transfer (IVF-ET) is a rare situation and is considered a challenge for management.A 32-year-old Chinese woman conceived twin pregnancy following IVF-ET.At 22 weeks' gestation,an additional intrauterine echogenic mass with features of PHM were shown by successive ultrasound examinations.At 35 weeks'gestation,two live male infants and two placentas were delivered by caesarean section (CS).Histologic examination of the abnormal placenta confirmed mosaic PHM.Genetic study showed the abnormal placental mosaicism (expressed in molar-69XXY and normal vili-46XY),co-existing with a hypospadia new-born (46XY) in one amniotic sac.However,the other one was normal.Serial serum β-hCG levels showed a declining trend and serum 3-human chorionic gonadotropin (hCG) were undetectable at 6 months after delivery.The case demonstrated that it is possible to prolonged gestation by PHM under close surveillance during the entire pregnancy.

  2. Twin pregnancy and partial hydatidiform mole following in vitro fertilization and embryos transfer: a novel case of placental mosaicism.

    Science.gov (United States)

    Sun, Cheng-juan; Zhao, You-ping; Yu, Song; Fan, Ling; Wu, Qing-qing; Li, Guang-hui; Zhang, Wei-yuan

    2012-12-01

    Twin pregnancy with mosaic partial hydatidiform mole (PHM) and survival of two healthy fetuses following in vitro fertilization and embryos transfer (IVF-ET) is a rare situation and is considered a challenge for management. A 32-year-old Chinese woman conceived twin pregnancy following IVF-ET. At 22 weeks' gestation, an additional intrauterine echogenic mass with features of PHM were shown by successive ultrasound examinations. At 35 weeks' gestation, two live male infants and two placentas were delivered by caesarean section (CS). Histologic examination of the abnormal placenta confirmed mosaic PHM. Genetic study showed the abnormal placental mosaicism (expressed in molar-69XXY and normal vili-46XY), co-existing with a hypospadia new-born (46XY) in one amniotic sac. However, the other one was normal. Serial serum β-hCG levels showed a declining trend and serum β-human chorionic gonadotropin (hCG) were undetectable at 6 months after delivery. The case demonstrated that it is possible to prolonged gestation by PHM under close surveillance during the entire pregnancy.

  3. The genetic and environmental influences on childhood obesity: a systematic review of twin and adoption studies

    DEFF Research Database (Denmark)

    Silventoinen, K; Rokholm, B; Kaprio, J;

    2010-01-01

    of obesity. Except the two twin studies from the Korean population, all studies represented Caucasian populations. In a meta-analysis of these twin studies, we found that genetic factors had a strong effect on the variation of body mass index (BMI) at all ages. The common environmental factors showed...... and their biological offspring, further supporting the importance of genetic factors. In the future, more studies implementing genetic and environmental measures into twin models are needed as they allow estimation of the proportion of total genetic variation explained by candidate genes and analyses of gene......In this systematic review, we aimed to collect together all previous twin and adoption studies on childhood and adolescent obesity up to the age of 18 years. Using several sources, we identified nine twin and five adoption studies; all of these studies had used relative weight as an indicator...

  4. Maternal serum steroid levels are unrelated to fetal sex: a study in twin pregnancies.

    NARCIS (Netherlands)

    Cohen-Bendahan, C.C.; Goozen, S.H. van; Buitelaar, J.K.; Cohen-Kettenis, P.T.

    2005-01-01

    Increased prenatal exposure to testosterone (T) in females of an opposite-sex (OS) twin pair may have an effect on the development of sex-typical cognitive and behavioral patterns. The prenatal exposure to T due to hormone transfer in OS twin females may occur in two ways, one directly via the feto-

  5. Atazanavir pharmacokinetics, efficacy and safety in pregnancy: a systematic review

    NARCIS (Netherlands)

    Eley, T.; Bertz, R.; Hardy, H.; Burger, D.M.

    2013-01-01

    BACKGROUND: For some antiretroviral therapies, drug concentrations are reduced during pregnancy, potentially compromising effective virological suppression. METHODS: Data on atazanavir boosted with ritonavir in pregnancy are reviewed. RESULTS: With standard atazanavir/ritonavir 300/100 mg once-daily

  6. The Fourth International Network of Twin Registries: Overview from Osaka/Research Reviews: Familial Fraternal Twinning; Twin Study of Masculine Faces; Physical Aggression and Epigenetics; Prenatal Education for Parents of Twins/Current Events: 2016 Guinness Book of World Records; Oldest Living Male Twins; Twins Reunited at Sixty-Nine; Panda Twins; Twins.com.

    Science.gov (United States)

    Segal, Nancy L

    2015-12-01

    The 4th International Network of Twin Registries (INTR) Consortium Meeting took place in Osaka, Japan, September 28-29, 2015. The venue was the Osaka Medical Center for Medical Innovation and Translational Research. An overview of presentations and other activities is provided. Next, 1930s research on familial fraternal twinning, preference for masculine faces, physical aggression and epigenetics, and a prenatal education program for parents of multiples are described. Current twin-related events include the 2016 Guinness Book of World Records (GWR), the oldest living male twins, newly reunited twins, the birth of panda twins and a controversial twin-based website.

  7. Acute appendicitis in pregnancy: literature review

    Directory of Open Access Journals (Sweden)

    Antônio Henriques de Franca Neto

    2015-04-01

    Full Text Available Introduction: suspected appendicitis is the most common indication for surgery in non-obstetric conditions during pregnancy and occurs in about one in 500 to one in 635 pregnancies per year. This occurs more often in the second trimester of pregnancy. Acute appendicitis is the most common general surgical problem encountered during pregnancy. Methods: a literature review on research of scientific articles, under the terms “acute appendicitis” and “pregnancy”, in PubMed, Lilacs/SciELO, Scopus, Cochrane Library and Uptodate databases. Results: the clinical manifestations of appendicitis are similar to non-pregnant women, however, without a classic presentation, which often occurs, diagnosis is difficult and must be supported by imaging. Discussion: clinical diagnosis should be strongly suspected in pregnant women with classic findings such as abdominal pain that migrates to the right lower quadrant. The main purpose of imaging is to reduce delays in surgical intervention due to diagnostic uncertainty. A secondary objective is to reduce, but not eliminate, the negative appendectomy rate. Differential diagnosis of suspected acute appendicitis usually includes pathologies considered in non-pregnant people. Conclusion: the imaging study of choice is ultrasound, MRI may be used when the former is not conclusive and, as a last resort, a CT scan can be performed. The treatment remains appendectomy by laparotomy, since the feasibility of video- assisted surgery in these cases remains controversial.

  8. STOPPIT Baby Follow-up Study: the effect of prophylactic progesterone in twin pregnancy on childhood outcome.

    Directory of Open Access Journals (Sweden)

    Helen Christine McNamara

    Full Text Available To determine the long-term effects of in utero progesterone exposure in twin children.This study evaluated the health and developmental outcomes of all surviving children born to mothers who participated in a double-blind, placebo-controlled trial of progesterone given for the prevention of preterm birth in twin pregnancies (STOPPIT, ISRCTN35782581. Follow-up was performed via record linkage and two parent-completed validated questionnaires, the Child Development Inventory and the Health Utilities Index.Record linkage was successfully performed on at least one record in 759/781 (97% children eligible for follow-up. There were no differences between progesterone-exposed and placebo-exposed twins with respect to incidence of death, congenital anomalies and hospitalisation, nor on routine national child health assessments. Questionnaire responses were received for 324/738 (44% children. The mean age at questionnaire follow-up was 55.5 months. Delay in at least one developmental domain on the Child Development Inventory was observed in 107/324 (33% children, with no evidence of difference between progesterone-exposed and placebo-exposed twins. There was no evidence of difference between the progesterone and placebo groups in global health status assessed using the Health Utilities Index: 89% of children were rated as having 'excellent' health and a further 8% as having 'very good' health.In this cohort of twin children there was no evidence of a detrimental or beneficial impact on health and developmental outcomes at three to six years of age due to in utero exposure to progesterone.

  9. Human placental lactogen and unconjugated estriol concentrations in twin pregnancy: monitoring of fetal development in intrauterine growth retardation and single intrauterine fetal death.

    Science.gov (United States)

    Trapp, M; Kato, K; Bohnet, H G; Gerhard, I; Weise, H C; Leidenberger, F

    1986-11-01

    Human placental lactogen and unconjugated estriol concentrations in maternal serum were evaluated in 100 uneventful twin pregnancies, and these values were compared with those observed in 16 twin pregnancies associated with intrauterine growth retardation or single intrauterine fetal death. In pregnancies associated with intrauterine growth retardation (n = 8), human placental lactogen levels were at the lower limit of normal range for singleton pregnancies, whereas estriol levels were normal in most cases. When one of the fetuses had died before week 33 of pregnancy (n = 5), both human placental lactogen and estriol levels were low and they were almost at the levels in singleton pregnancy. When intrauterine fetal death occurred after week 36 of pregnancy (n = 3), both hormone levels remained normal until term. Thus human placental lactogen rather than estriol is a good indicator of intrauterine growth retardation in twin pregnancy. Both human placental lactogen and estriol are useful for the monitoring of the surviving fetus in the case of single intrauterine fetal death.

  10. 双(多)胎脑瘫患儿的病因学及临床特征分析%Etiology and Clinical Features of Cerebral Palsy in Twin or Multiple Pregnancies

    Institute of Scientific and Technical Information of China (English)

    孙殿荣; 候梅; 高翔

    2011-01-01

    目的 探讨双(多)胎儿童发生脑瘫的相关因素及临床特征.方法 对52例双胎或多胎脑瘫患儿进行围产期高危因素调查、临床分型、影像学检查及粗大运动功能测评(GMFCS).结果 和结论双(多)胎之一脑瘫的发生和妊娠并发症无明显相关.同性别双胎、出生体重偏重一胎发生脑瘫的机会大.双(多)胎脑瘫以痉挛型双瘫最多见,影像学改变以侧脑室周围白质软化为主.痉挛型双瘫和偏瘫患儿GMFCS多在Ⅰ~Ⅲ级,而不随意运动型、四肢瘫和混合型患儿多在Ⅳ~Ⅴ级.%Objective To analyze the related factors and clinical features of cerebral palsy in twin or multiple pregnancies. Methods 52 cerebral palsy children in twin or multiple pregnancies were reviewed with the risk factors in perinatal period, the clinical type, findings of radiology and the gross motor function (GMFCS). Results and Conclusion No significant link was found between these pregnancy complications and cerebral palsy in twins or multiple pregnancies. The prevalence of cerebral palsy was higher for the one with more birthweight in twins of the same gender. Spastic diplegia was the most type, and most of them were found with periventricular leucomalacia. The GMFCS levels was Ⅰ ~ Ⅲ in spastic hemiplegic or spastic diplegic children, while was Ⅳ ~ Ⅴ in children with spastic quadriplegia, dyskinesia or mixed CP.

  11. The association between HIV (treatment), pregnancy serum lipid concentrations and pregnancy outcomes : a systematic review

    NARCIS (Netherlands)

    Harmsen, Marissa J; Browne, Joyce L; Venter, Francois; Klipstein-Grobusch, Kerstin; Rijken, Marcus J|info:eu-repo/dai/nl/343154757

    2017-01-01

    BACKGROUND: Observed adverse effects of antiretroviral therapy (ART) on the lipid profile could be of significance in pregnancy. This systematic review aims to summarize studies that investigated the association between HIV, ART and serum lipids during pregnancy and adverse pregnancy outcomes.

  12. Lung cancer during pregnancy: A narrative review

    Directory of Open Access Journals (Sweden)

    Sotirios Mitrou

    2016-07-01

    Full Text Available Lung cancer, the leading cause of cancer deaths in males for decades, has recently become one of commonest causes for women too. As women delay the start of their family, the co-existence of cancer and pregnancy is increasingly observed. Nevertheless, lung cancer during pregnancy remains a rather uncommon condition with less than 70 cases published in recent years. Non-small cell lung carcinoma is the commonest type accounting for about 85% of all cases. Overall survival rates are low. Chemotherapy and/or targeted treatment have been used with poor outcomes. The disease has been also found to affect the products of conception with no short- or long-term consequences for the neonate. This article is referring to a narrative review of lung cancers diagnosed in pregnant women around the world.

  13. Psoriasis in pregnancy: a review (II).

    Science.gov (United States)

    Ruiz, V; Manubens, E; Puig, L

    2014-11-01

    Scarce scientific evidence is available to define the precise effects that certain drugs might have on embryonic and fetal development if taken by pregnant women with psoriasis, given the ethical concerns that preclude enrolling such women in clinical trials. The little information on the use of biologics during gestation that has been published is based on retrospective and observational studies, and experience with these drugs in this context in psoriasis is still very limited. The literature seems to suggest that biologic therapy is safe during pregnancy, but there is no certainty. This detailed review of accumulated experience with biologic therapy during pregnancy relies mainly on descriptions of the management of other types of rheumatic disease, although the use of these agents in psoriasis is growing steadily. Copyright © 2013 Elsevier España, S.L.U. y AEDV. All rights reserved.

  14. 双胎妊娠112例结局分析%Analysis of 112 cases of twin pregnancy outcome

    Institute of Scientific and Technical Information of China (English)

    马静波

    2013-01-01

    目的 探讨双胎妊娠的母儿围生结局及孕期处理对围生结局的影响.方法 对2010年1月至2012年1月期间在洛阳市妇女儿童医疗保健中心住院分娩的112例双胎妊娠病例进行回顾性分析.结果 双胎妊娠胎儿死亡率为5.36%,新生儿死亡率为4.46%,剖宫产率为77.68%,双胎妊娠母亲合并内科疾病占76%.围生期定期进行产前检查的孕妇孕期并发症及合并症及胎儿死亡率均低于不定期产检的孕妇,差异有统计学意义(P<0.05).阴道分娩组新生儿窒息率、脑瘫发生率和死亡率明显高于剖宫产组.结论 双胎妊娠母亲及围生儿合并症、并发症及死亡率均较高,因此定期产前检查,积极防治妊娠期各种并发症,选择有利的分娩时机和分娩方式对降低双胎围生儿患病率和死亡率有重要意义.%Objective To investigate the mother child perinatal outcomes and pregnancy treatment of twin pregnancy impact on perinatal outcome.Methods One hundred and twelve cases of twin pregnancy in women and children health care Center of Luoyang from 2010 to 2012 were analyzed retrospectively.Results The incidence of twin pregnancy' s fetal mortality rate was 5.36%,neonatal mortality rate was 4.46%,cesarean section rate was 77.68%.the pregnancy complications,complications and fetal mortality were significantly lower in pregnant woman with regular perinatal conduct,than those in pregnant woman with irregular perinatal conduct.the difference were statistically significant (P <0.05) Neonatal asphyxia rate,the incidence of cerebral palsy and mortality were significantly higher in vaginal delivery group,than that in cesarean section group.Conclusions Complications and mortality of mother of twin pregnancy and perinatal children are higher.Therefore regular prenatal care,active prevention and treatment of various complications,and proper choice for the time and mode of delivery are important measures to decrease the twin

  15. Discordance for Cri du Chat Syndrome in a dichorionic–diamniotic twin pregnancy

    Directory of Open Access Journals (Sweden)

    Mireia González-Comadran

    2015-07-01

    Full Text Available We report on the prenatal diagnosis through array CGH of a dichorionic–diamniotic (DC/DA twins discordant for Cri du Chat Syndrome. Structural anomalies on one of the twins lead to amniotic fluid sampling, which revealed a partial deletion on the short arm of the chromosome 5. Selective feticide of the affected twin was performed at 34 + 1 weeks' and elective Cesarean section at 37 + 2 weeks. Postnatal cytogenetic analysis confirmed pre-natal genetic findings.

  16. Acute Abdomen in the 17th Week of Twin Pregnancy due to Ovarian Torsion – A Late Complication of IVF

    Science.gov (United States)

    Habek, D.; Bauman, R.; Rukavina Kralj, L.; Hafner, T.; Turudic, T.; Vujisic, S.

    2016-01-01

    Background: A 32-year-old woman with tubal factor infertility due to bilateral laparoscopic salpingectomy conceived twins with in vitro fertilization (IVF). She developed moderate ovarian hyperstimulation syndrome which was treated with anticoagulant therapy. The subsequent course of the twin pregnancy was normal until the 17th week of gestation when she presented to hospital because of a sharp pain in the right lower abdomen which ceased after admission. Case: Except for a single incident of vomiting, patient had no other subjective symptoms. The clinical examination showed tenderness of the lower right abdominal segment on palpation. The surgeon and the urologist found no signs of an acute surgical or urologic condition, and laboratory findings were within normal reference ranges for pregnant women. Two days after admission the pain reappeared; it was now much stronger and colic-like. The pain was initially located supraumbilically but subsequently spread diffusely across the lower abdomen. Abdominal guarding was present and laboratory findings showed an increase in inflammatory parameters. An enlarged and edematous right ovary was found on transvaginal ultrasound. Conclusion: Exploratory laparotomy via a vertical midline abdominal transection revealed a torqued necrotic right ovary with elements of inflammation and inflammatory adhesions involving the entire pelvis. The patient underwent right-sided ovariectomy and adhesiolysis. Recovered was normal and the patient was delivered of healthy twins in the 37th week of gestation. PMID:28017976

  17. A unique case of successful twin pregnancy reaching term in a patient with uterus bicornis unicollis

    Directory of Open Access Journals (Sweden)

    Simran Ahluwalia

    2014-08-01

    Full Text Available Abnormal fusion of the Mullerian ducts or failure of absorption of the septum causes varying degrees of congenital uterine malformation. Twin gestation in a case of bicornuate uterus is rare. We are reporting this case because of its rare presentation, where a case of undiagnosed twins managed to reach full-term after spontaneous conception. We report here a 30 year old gravida four para one with no live issues who presented at term in labour. Per Abdomen examination suggested a twin gestation which was confirmed by ultrasonography. Both the twins were delivered by an emergency caesarean section. Intraoperatively the uterus was found to be bicornuate uterus (bicornis unicollis with both the babies in two different horns. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 1104-1106

  18. Latent Tuberculosis in Pregnancy: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Isabelle Malhamé

    Full Text Available In countries with low tuberculosis (TB incidence, immigrants from higher incidence countries represent the major pool of individuals with latent TB infection (LTBI. The antenatal period represents an opportunity for immigrant women to access the medical system, and hence for potential screening and treatment of LTBI. However, such screening and treatment during pregnancy remains controversial.In order to further understand the prevalence, natural history, screening and management of LTBI in pregnancy, we conducted a systematic literature review addressing the screening and treatment of LTBI, in pregnant women without known HIV infection.A systematic review of 4 databases (Embase, Embase Classic, Medline, Cochrane Library covering articles published from January 1st 1980 to April 30th 2014. Articles in English, French or Spanish with relevant information on prevalence, natural history, screening tools, screening strategies and treatment of LTBI during pregnancy were eligible for inclusion. Articles were excluded if (1 Full text was not available (2 they were case series or case studies (3 they focused exclusively on prevalence, diagnosis and treatment of active TB (4 the study population was exclusively HIV-infected.Of 4,193 titles initially identified, 208 abstracts were eligible for review. Of these, 30 articles qualified for full text review and 22 were retained: 3 cohort studies, 2 case-control studies, and 17 cross-sectional studies. In the USA, the estimated prevalence of LTBI ranged from 14 to 48% in women tested, and tuberculin skin test (TST positivity was associated with ethnicity. One study suggested that incidence of active TB was significantly increased during the 180 days postpartum (Incidence rate ratio, 1.95 (95% CI 1.24-3.07. There was a high level of adherence with both skin testing (between 90-100% and chest radiography (93-100%.. In three studies from low incidence settings, concordance between TST and an interferon

  19. Delivery in Twin Gestation

    Directory of Open Access Journals (Sweden)

    Mark T. Peters

    1995-01-01

    Full Text Available Objective: The objective of this study was to determine whether prophylactic treatment with oral broad-spectrum antimicrobial therapy improves pregnancy outcomes in twin gestations.

  20. Pregnancy outcomes of twin pregnancies complicated with growth discordance%双胎妊娠胎儿发育不均衡的妊娠结局

    Institute of Scientific and Technical Information of China (English)

    赫英东; 李雨利; 陈倩

    2014-01-01

    目的 探讨双胎妊娠胎儿发育不均衡的临床特点及预后.方法 回顾性分析2000年1月1日至2012年7月31日在北京大学第一医院产科分娩的576例双胎妊娠孕妇(除外双胎输血综合征病例)资料.根据胎儿腹围以及股骨长估计胎儿体重,分娩后记录新生儿出生体重,根据公式[(较大儿体重-较小儿体重)/较大儿体重×100%]计算双胎体重的差异,体重差异≥25%考虑存在胎儿发育不均衡,<25%为胎儿发育均衡.分析双胎妊娠胎儿发育不均衡的发生率;比较胎儿发育不均衡者(不均衡组,68例)与胎儿发育均衡者(均衡组,508例)的母体并发症(子痫前期、胎膜早破、妊娠期糖尿病、产后出血等)发生率、早产率、围产儿病死率、新生儿出生体重和新生儿合并症(心血管系统疾病和颅内病变)发生率.统计学分析采用t检验或卡方检验. 结果 576例双胎妊娠中,胎儿发育不均衡总体发生率为11.8%(68/576).单绒毛膜双胎胎儿发育不均衡发生率[17.6%(40/227)]高于双绒毛膜双胎[8.0%(28/349)],差异有统计学意义(x2=11.40,P<0.05).胎儿发育不均衡组分娩孕周小于均衡组[(35.6±4.1)周与(36.6±3.2)周,t=1.66,P<0.05],早产率高于均衡组[58.8%(40/68)与47.6% (242/508),x2=3.85,P<0.05].不均衡组围产儿病死率高于均衡组[9.6%(1 3/136)与4.7% (48/1 016),x2=5.84,P<0.05].胎儿发育不均衡者中,单绒毛膜双胎妊娠新生儿颅内病变的发生率明显高于双绒毛膜双胎组[20.9%(14/67)与6.8%(3/44),x2=4.06,P<0.05].结论 双胎妊娠胎儿发育不均衡孕妇较易发生不良妊娠结局.应加强产前保健,并及时评估胎儿的宫内状况,分娩后建议对新生儿进行全面检查并长期随访.%Objective To investigate clinical characteristics and outcomes of twin pregnancies complicated with growth discordance.Methods Five hundred and seventy-six twin pregnancies who delivered between January 1

  1. Two consecutive twin and a singleton pregnancy in a patient with chronic myeloid leukemia.

    Science.gov (United States)

    Halim, T A; Nabeel, N

    2014-01-01

    Consecutive multiple pregnancies with Chronic myeloid leukemia is a rare event and little is known about its prevalence and management with or without chemotherapy. We present a case of three consecutive pregnancies in a woman with CML, two of which were multiple pregnancies.

  2. Mifepristone-induced abortion in one horn and a growing fetus in another horn in a patient with a twin pregnancy in a bicornuate uterus.

    Science.gov (United States)

    Chao, Angel; Chao, An-Shine; Wang, Shih-Tíen; Wang, Tzu-Hao

    2006-12-01

    To report a case of mifepristone-induced abortion in only one horn but a growing fetus in another horn for a twin pregnancy in a bicornuate uterus. Case report. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taiwan. A 31-year-old woman who conceived spontaneously presented with 37 days' gestation. Mifepristone 600 mg orally followed by misoprostol 400 mug orally 2 days later. Termination of pregnancy. Induced abortion in only one horn but a growing fetus in another horn for a twin pregnancy in the bicornuate uterus detected by ultrasound. Surgical abortion with vacuum curettage was performed, and menstruation resumed 1 month later. As medical abortion with mifepristone and misoprostol becomes more prevalent, more studies are necessary to establish the dosage and regimens for multiple pregnancies associated with uterine anomalies.

  3. Management of Fetal Growth Arrest in One of Dichorionic Twins: Three Cases and a Literature Review

    Directory of Open Access Journals (Sweden)

    Shoji Kaku

    2015-01-01

    Full Text Available Progressive fetal growth restriction (FGR is often an indication for delivery. In dichorionic diamniotic (DD twin pregnancy with growth restriction only affecting one fetus (selective fetal growth restriction: sFGR, the normal twin is also delivered prematurely. There is still not enough evidence about the optimal timing of delivery for DD twins with sFGR in relation to discordance and gestational age. We report three sets of DD twins with sFGR (almost complete growth arrest affecting one fetus for ≥2 weeks before 30 weeks of gestation. The interval from growth arrest to delivery was 21–24 days and the discordance was 33.7–49.8%. A large-scale study showed no difference of overall mortality or the long-term outcome between immediate and delayed delivery for FGR, while many studies have identified a risk of developmental delay following delivery of the normal growth fetus before 32 weeks. Therefore, delivery of DD twins with sFGR should be delayed if the condition of the sFGR fetus permits in order to increase the gestational age of the normal growth fetus.

  4. A literature review of the twinning approach in supporting ...

    African Journals Online (AJOL)

    2004-09-16

    Sep 16, 2004 ... in order to meet the water supply and sanitation services of the present by 2008 ... and strate- gic administrative management issues before any kind of twin- ..... at the level of the institution and/or of networks. In a context of.

  5. 体外受精-胚胎移植受孕与自然受孕双胎妊娠临床结局比较%Comparison of pregnancy outcomes between twin pregnancy conceived by IVF-ET and twin pregnancy conceived naturally

    Institute of Scientific and Technical Information of China (English)

    周晶; 李博; 陈书强; 肖西峰; 黄剑磊; 孙惠君; 董杰; 王晓红

    2016-01-01

    Objective: To compare the obstetric and neonatal outcomes between the twin pregnancy conceived by IVF-ET and the twin pregnancy conceived naturally. Methods: The retrospective cohort study included 89 twin pregnancy conceived by IVF-ET and 56 twin pregnancy conceived naturally in Tangdu hospital during 2014. The maternal complications,childbirth and neonatal outcomes were compared between the two groups. Results: The women in the IVF-ET conceived group were older than the naturally conceived group [ (30. 45 ±4. 40) vs. (28. 63±5. 12)] (P Conclusions: Twin pregnancy conceived by IVF-ET is associated with adverse pregnancy outcomes. The prevention of complications and prenatal & intrapartum care after twin pregnancy conceived by IVF-ET should be strengthened.%目的:探讨体外受精-胚胎移植( IVF-ET)对双胎妊娠母胎结局的影响。方法回顾性分析2014年1~12月于我院产科分娩的双胎妊娠产妇的临床资料。按照受孕方式分为两组:IVF-ET组(89例)和自然妊娠组(56例)。比较两组的孕产妇并发症、分娩情况及新生儿结局。结果 IVF-ET组孕产妇平均年龄(30.45±4.40)岁显著高于自然妊娠组的(28.63±5.12)岁,IVF-ET组孕妇妊娠期高血压疾病发生率(25.8%)、新生儿极早产(28~31+6周)发生率(10.1%)、极低出生体重(<1500 g)发生率(10.1%)及转新生儿科比例(55.1%)均显著高于自然妊娠组(分别为12.5%、3.6%、3.6%和34.8%)(P均<0.05)。结论 IVF-ET助孕的双胎妊娠发生不良妊娠结局的风险相对较高,建议临床上应加强IVF-ET术后双胎妊娠并发症的防治及产前、产时监护。

  6. The genetic and environmental influences on childhood obesity: a systematic review of twin and adoption studies

    DEFF Research Database (Denmark)

    Silventoinen, K; Rokholm, B; Kaprio, J

    2010-01-01

    In this systematic review, we aimed to collect together all previous twin and adoption studies on childhood and adolescent obesity up to the age of 18 years. Using several sources, we identified nine twin and five adoption studies; all of these studies had used relative weight as an indicator...... a substantial effect in mid-childhood, but this effect disappeared at adolescence. Adoption studies supported the role of family environment in childhood obesity as correlations were found between adoptees and adoptive parents; however, correlations were substantially stronger between parents...... of obesity. Except the two twin studies from the Korean population, all studies represented Caucasian populations. In a meta-analysis of these twin studies, we found that genetic factors had a strong effect on the variation of body mass index (BMI) at all ages. The common environmental factors showed...

  7. Clinical features of maternal and neonatal outcomes of twin preeclampsia pregnancies%双胎妊娠并发子痫前期临床比较分析

    Institute of Scientific and Technical Information of China (English)

    梅吉; 乔东艳; 徐玉娟; 于红

    2014-01-01

    目的:探讨双胎妊娠并发子痫前期的临床特点及围产结局。方法:回顾分析江阴市人民医院妇产科及东南大学附属中大医院妇产科2009年1月至2012年12月收治的双胎妊娠并发子痫前期30例孕妇及同期双胎正常妊娠30例孕妇的临床资料。对所有纳入对象进行临床流行病学调查,分析比较两组临床资料,包括孕妇一般情况、个人史、既往史及家族史、月经及婚育史、孕期情况和分娩结局等。结果:双胎妊娠并发子痫前期组与双胎正常妊娠组孕前及分娩前BMI、孕期体重增长比较,差异有统计学意义(均P<0.05);双胎妊娠并发子痫前期组中低蛋白血症、早产、产后出血发生率显著高于双胎正常妊娠组(均P<0.05);双胎正常妊娠组胎膜早破发生率高于双胎妊娠并发子痫前期组(P<0.05);双胎妊娠并发子痫前期组中血白蛋白、血小板计数显著低于双胎正常妊娠组,而血肌酐显著高于双胎正常妊娠组(均P<0.05);双胎妊娠并发子痫前期组剖宫产率高于双胎正常妊娠组(P<0.05)。结论:临床资料分析显示,孕前BMI过高、孕期体重增长过多为双胎妊娠并发子痫前期的常见表现;早产、低蛋白血症、产后出血为双胎妊娠并发子痫前期较常见的并发症;双胎妊娠并发子痫前期可出现血小板减少、血肌酐升高、白蛋白降低等表现。%Objective: To explore clinical features of maternal and neonatal outcomes of twin preeclampsia pregnancies .Methods:Thirty twin pregnant women with preeclampsia were selected as observation group .Thirty cases of normal twin pregnant women , clinical data over the same period , were selected as a control group .All of them came from Jiangyin People's Hospital and Zhongda Hospital Affiliated to the Southeast University from January 2009 to December 2012.All of them were Chinese Han people and all

  8. Intermittent oral iron supplementation during pregnancy (Review)

    Science.gov (United States)

    Peña-Rosas, Juan Pablo; De-Regil, Luz Maria; Dowswell, Therese; Viteri, Fernando E

    2014-01-01

    Background Anaemia is a frequent condition during pregnancy, particularly among women from developing countries who have insufficient iron intake to meet increased iron needs of both the mother and the fetus. Traditionally, gestational anaemia has been prevented with the provision of daily iron supplements throughout pregnancy, but adherence to this regimen due to side effects, interrupted supply of the supplements, and concerns about safety among women with an adequate iron intake, have limited the use of this intervention. Intermittent (i.e. one, two or three times a week on non-consecutive days) supplementation with iron alone or in combination with folic acid or other vitamins and minerals has recently been proposed as an alternative to daily supplementation. Objectives To assess the benefits and harms of intermittent supplementation with iron alone or in combination with folic acid or other vitamins and minerals to pregnant women on neonatal and pregnancy outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (23 March 2012). We also searched the WHO International Clinical Trials Registry Platform (ICTRP) for ongoing studies and contacted relevant organisations for the identification of ongoing and unpublished studies (23 March 2012). Selection criteria Randomised or quasi-randomised trials. Data collection and analysis We assessed the methodological quality of trials using standard Cochrane criteria. Two review authors independently assessed trial eligibility, extracted data and conducted checks for accuracy. Main results This review includes 21 trials from 13 different countries, but only 18 trials (with 4072 women) reported on our outcomes of interest and contributed data to the review. All of these studies compared daily versus intermittent iron supplementation. Three studies provided iron alone, 12 iron+folic acid and three more iron plus multiple vitamins and minerals. Their methodological quality was mixed

  9. The effects of twin pregnancy on uterine pull tension%双胎妊娠对子宫牵张力影响的研究

    Institute of Scientific and Technical Information of China (English)

    陶志云; 张晓慧; 张英; 魏兆莲

    2016-01-01

    Objective To study the effects of the uterine contraction when the uterine pull tension of twin pregnan-cy has changed. Methods The uterine smooth muscle of single and twin pregnant women in the second trimester of pregnancy (26 ± 6) W and late pregnancy(37 ± 6) W were collected to be made into 30 strips each group, ob-served the change of uterine pull tension of single and twin pregnancy and the effects to uterine contraction, when oxytocin concentration gradient was stimulated. Results In Krebs solution, the uterine pull tension of late single pregnancy was bigger than that in the second trimester, and the uterine pull tension of late twin pregnancy was big-ger than that in the second trimester, and the uterine pull tension of the second trimester of twin pregnancy was big-ger than that of single pregnancy at the same time, and the uterine pull tension of late twin pregnancy was bigger than that of single pregnancy at the same time. There was statistical significance (P<0. 05). With the progress of pregnancy, the uterine pull tension was enlarged. Moreover, the uterine contraction of late single pregnancy caused by the change of uterine pull tension was more obvious than that of late twin pregnancy under the oxytocin concen-tration gradient. There was statistical significance (P<0. 05). Conclusion The uterine contraction begins to de-cline with the uterine pull tension of twin pregnancy increases.%目的 探讨双胎妊娠子宫牵张力变化对子宫收缩能力的影响. 方法 采集单胎妊娠及双胎妊娠孕妇中期妊娠(孕26 ± 6周)和晚期妊娠(孕37 ± 6 周)的子宫平滑肌组织,制作成肌条各30份,给予缩宫素浓度梯度刺激,观察单胎妊娠与双胎妊娠的子宫牵张力变化及对子宫收缩力的影响. 结果 在Krebs液中,单胎妊娠晚孕阶段子宫牵张力大于中孕阶段,双胎妊娠晚孕阶段子宫牵张力大于中孕阶段,中孕阶段的双胎妊娠子宫牵张力大于单胎妊娠,晚孕阶段的双

  10. 双胎妊娠与单胎妊娠的并发症及妊娠结局比较%The comparative observation of complications and pregnancy outcomes between twin pregnancy and singleton preg-nancies

    Institute of Scientific and Technical Information of China (English)

    魏景仙; 申更存; 霍强; 赵继广; 李存娟

    2014-01-01

    Objective To comparative observation the complications and pregnancy outcomes between twin pregnancy and singleton pregnancies .Methods Selected 100 patients with twin preanancy ,and 100 patients with singleton pregnancies . After treatment,compared the complications,postpartum hemorrhage,the incidence of low-weight children,neonatal asphyxia rate and the perinatal child mortality of 2 groups .Results The complication rate of twin pregnancy was higher than that of control group,the difference was statistically significant (P<0.05).The postpartum hemorrhage,the incidence of low-weight children,nenoatal asphyxia rate and the perinatal child mortality were higher than that of control group ,the difference was sta-tistically significant(P<0.05).Conclusion The twin pregnancy can improve the complication rate ,increase the adverse out-comes,Strengthen the Prenatal guidance and guardianship has an important significant .%目的:观察双胎妊娠与单胎妊娠孕产妇并发症和妊娠结局的差异。方法选择待产双胎妊娠孕产妇(双胎妊娠组)和单胎妊娠孕产妇(单胎妊娠组)各100例,比较2组孕产妇的并发症、产后出血量、低体质量儿发生率、新生儿窒息率、围生儿病死率,评价单胎妊娠与双胎妊娠并发症、妊娠结局差异。结果双胎妊娠组的并发症发生率高于单胎妊娠组(P<0.05),产后出血量、低体质量儿发生率、新生儿窒息率、围生儿病死率明显高于单胎妊娠组(P<0.05)。结论双胎妊娠使孕产妇并发症增多,增加了新生儿预后不良的出现,加强对双胎妊娠的产前指导和监护,对双胎妊娠结局具有重要意义。

  11. Micronutrients and pregnancy; effect of supplementation on pregnancy and pregnancy outcomes: a systematic review

    Directory of Open Access Journals (Sweden)

    Zerfu Taddese Alemu

    2013-01-01

    Full Text Available Abstract Introduction Every year more than 20 million infants are born with low birth weight worldwide. About 3.6 million infants die during the neonatal period. More than one third of child deaths are thought to be attributable to maternal and child under nutrition. Objectives To systematically review the effect of supplementing various combinations and types of micronutrients on the course and outcomes of pregnancy. Methods Electronic search of Medline, Pub Med, Health Internetwork access to Research Initiative, and Google Scholar databases was conducted. Outcomes of interest were birth weight, low birth weight, small size for gestational age, prenatal mortality and neonatal mortality. After exclusion of irrelevant /incomplete ones, 17 out of 115 articles were considered for the final analysis. Findings Majority of the articles reviewed favored the supplementation of micronutrients to pregnant mother. Some studies suggested calcium supplementation is associated with a significant protective benefit in the prevention of pre-eclampsia. The remaining articles reviewed, showed significant benefit of Multiple Micronutrients supplementation during pregnancy in reducing low birth weight, small for Gestational Age births as compared to the usual iron-folate supplements. Conclusions Supplying micronutrients, mainly multiple micronutrients have beneficial effect in reducing the risk of low birth weight and other complications. Further studies at various combination and doses of micronutrient supplements are recommended.

  12. Perinatal hepatic infarction in twin-twin transfusion.

    LENUS (Irish Health Repository)

    O'Sullivan, M J

    2012-02-03

    We report a case of a twin pregnancy which was complicated by a twin-twin transfusion in which the recipient twin was noted to have an intra-abdominal echogenic mass. This twin died at two days of age of hepatic infarction. The donor twin was healthy at birth, at thirty weeks\\' gestation, and did not have any subsequent problems. Fetal intra-abdominal echogenicity may be a marker of hepatic infarction.

  13. Profile of peroxidative injury and antioxidant indicators in singleton, twins and multiple bearing goats throughout pregnancy

    Directory of Open Access Journals (Sweden)

    M.A. Abdel-Ghani

    2016-09-01

    Conclusion: Knowing the relationship between the fetal number and oxidative stress indicators could be useful in the clinical management of such pregnancies and could be useful in the early detection or prediction adverse pregnancy outcome. Particularly, the 4th and 5th month of gestation increases the liability to reactive oxygen species in goats.

  14. Accuracy of diagnosing double corpora lutea and twin pregnancy by measuring serum progesterone and bovine pregnancy-associated glycoprotein 1 in the first trimester of gestation in dairy cows.

    Science.gov (United States)

    Szelényi, Zoltán; Répási, Attila; de Sousa, Noelita Melo; Beckers, Jean Francois; Szenci, Otto

    2015-07-01

    Progesterone (P4) and bovine pregnancy-associated glycoprotein 1 (bPAG-1) concentrations during gestation are dependent on the number of CL and fetuses, respectively. The objective of this present study was to measure and evaluate the usefulness of measuring the P4 and bPAG-1 concentrations in cases of single versus twin pregnancies and one versus two CL at the first 4 months of gestation. We hypothesized that both the number of the CL and the number of fetus might have an effect on P4 and pregnancy protein concentrations, and we can set up clinically useful threshold levels to predict twin gestations. Eighty-four Holstein-Friesian dairy cows were enrolled in this prospective observational clinical trial. Blood was collected at time point 1: between Days 29 and 42, time point 2: between Days 57 and 70, time point 3: between Days 85 and 98, and time point 4: between Days 113 and 126 of gestation, and bPAG-1 and P4 concentrations were measured. Binary logistic regression analyzing serum P4 concentrations differed at time point 2 compared with baseline level, but the area under the curve (AUC) had low sensitivity. The bPAG-1 concentrations were statistically different at each time point of gestation. The AUC cutoff values of serum bPAG-1 concentrations were sufficiently sensitive to differentiate between twin gestations from singleton ones. At time points 3 (cutoff value of 3.4 ng/mL) and 4 (cutoff value of 56.5 ng/mL), statistically significant differences with low sensitivity, high specificity, and a high AUC were found. On the basis of these results, the diagnosis of twin pregnancy using pregnancy protein measurements is clinically insufficient before Day 85 of gestation; however, the ability to confirm the early twin pregnancy diagnosis with bPAG-1 measurements appears to be promising. To achieve high sensitivity, further studies are required.

  15. Influence on the Childbirth Way and Pregnancy Outcome in Twin Pregnancy%双胎妊娠经阴道分娩的经验交流

    Institute of Scientific and Technical Information of China (English)

    冯秀山; 张延珍; 陈玲

    2013-01-01

    目的:探讨孕周≥34周双胎妊娠产妇的分娩方式对母亲和新生儿结局的影响。方法收集福建医科大学附属协和医院2006年6月至2013年5月60例孕周≥34周双胎妊娠产妇的临床资料,根据分娩方式的不同分为阴道分娩组(11例)和剖宫产组(49例),对其资料进行回顾性分析。结果阴道分娩组胎方位以头-头位为主,余为头-臀位,而剖宫产组胎方位多样。阴道分娩组无妊娠合并症,而剖宫产组妊娠合并症为37例(75.51%)。两组产妇的分娩孕周、产后出血发生率、输血发生率均无显著性差异(χ2=1.97,P=0.16;χ2=0.63,P=0.43;χ2=1.88,P=0.17)。活产新生儿120例。两组新生儿体重、窒息发生率、入住NICU(新生儿重症监护室)率无显著性差异(χ2=1.53,P=0.22;χ2=2.78,P=0.10;χ2=0.24,P=0.62)。但剖宫产组住院时间显著增加(t=5.46, P<0.05)。结论双胎妊娠产妇无合并症或者合并症轻微,胎方位为头/头、头/臀位,胎儿体重相对较小,可考虑经阴道分娩。%Objective To study the relationship between childbirth way and pregnancy outcome in twin pregnancy after 34 weeks. Methods Clinical data of 60 cases of twin pregnancy women, which were divided into two groups according to the delivery mode from Jan. 2006 to May. 2013 were analyzed retrospectively. Results The head-head position is the main fetal position in vaginal delivery group, and the other is head-breech. Cesarean group fetal position is diverse. Vaginal delivery group had no pregnancy complications, and there is 37cases (75.51%) in cesarean group. There was no difference in gestational weeks, postpartum hemorrhage, transfusion rate (χ2=1.97,P=0.16;χ2=0.63,P=0.43;χ2=1.88, P=0.17). There are 120 cases of live birth. There was no difference in neonatal weight, neonatal asphyxia and neonatal NICU (Neonatal Intensive Care Unit) occupancy rate of two groups (χ2=1.53,P=0.22;

  16. Exercise during pregnancy: a review of patterns and determinants.

    Science.gov (United States)

    Gaston, Anca; Cramp, Anita

    2011-07-01

    The mental and physical health benefits of exercise during pregnancy highlight the importance of understanding the determinants of pregnant women's physical activity. This paper presents a review of the existing research on pregnancy and physical activity, in order to (a) summarize the existing body of literature since 1986 examining changes in physical activity during pregnancy, (b) summarize correlates and predictors of physical activity during pregnancy, and (c) present directions for future research. A literature search yielded 25 articles published from 1986 to 2009 in English peer-reviewed journals. The major findings were categorized into the following: (a) exercise patterns, (b) demographic correlates/predictors, (c) the influence of pre-pregnancy exercise on pregnancy exercise, (d) theory-based predictors and (f) other correlates of exercise (e.g. general health and safety concerns). Results indicated that pregnant women are less active than non-pregnant women and that pregnancy leads to a decrease in physical activity. Consistent demographic predictors of higher exercise participation during pregnancy include higher education and income, not having other children in the home, being white, and being more active prior to becoming pregnancy. Only a few studies used theoretical models to understand physical activity during pregnancy with varied results. The review outlines demographic and theory-based correlates/predictors that should be taken into consideration when developing interventions to increase physical activity among pregnant women.

  17. [Abdominal ectopic pregnancy. A case report and literature review].

    Science.gov (United States)

    Puch-Ceballos, Eduardo Erik; Vázquez-Castro, Rosbel; Osorio-Pérez, Ana Isabel; Ramos-Ayala, Montserrat; Villarreal-Sosa, Conrado Otoniel; Ruvalcaba-Rivera, Everardo

    2015-07-01

    Abdominal ectopic pregnancy is an extremely rare entity, which represents 1% of all ectopic pregnancies and is associated with high maternal and fetal morbidity and mortality. The maternal mortality risk of an abdominal ectopic pregnancy is seven to eight times greater than the risk of a tubal ectopic pregnancy and is 90 times greater than the risk of intrauterine pregnancy. This is a disease of difficult diagnosis that often takes place late. We report the case of a patient with an abdominal ectopic pregnancy, which was diagnosed by abdominal ultrasound in the second trimester; the patient was suc- cessfully treated with exploratory laparotomy with complete removal of the fetus and placenta. We provide a review of the literature on the risk factors for abdominal ectopic pregnancy, diagnostic tests and therapeutic options.

  18. [Problems posed by the death of one fetus in a twin pregnancy].

    Science.gov (United States)

    Dallay, D; Soumireu-Mourat, J

    1985-12-01

    Much recent works has highlighted the problems posed by the death of one fetus in utero during multiple pregnancy. This is a rare but serious accident which exposes the mother and the surviving fetus to the transfer of placentary and fetal thromboplastins or to the direct embolization of necrosed fragments of the placenta. Only fetal death occurring during the second and third terms of pregnancy is considered.

  19. Intramural ectopic pregnancy: a case and review of the literature.

    Science.gov (United States)

    Kirk, Emma; McDonald, Katie; Rees, Julia; Govind, Abha

    2013-06-01

    An intramural ectopic is a rare type of ectopic pregnancy in which the gestational sac is implanted within the myometrium, separate from the endometrial cavity and Fallopian tubes. There are only 53 cases in the published literature. We report a case of intramural ectopic pregnancy treated surgically and review the published data on this rare type of ectopic pregnancy, with respect to aetiology, diagnosis and management. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Spontaneous Heterotopic Pregnancy: Dual Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Annika Chadee

    2016-01-01

    Full Text Available Introduction. Heterotopic pregnancy is a rare complication usually seen in populations at risk for ectopic pregnancy or those undergoing fertility treatments. It is a potentially dangerous condition occurring in only 1 in 30,000 spontaneous pregnancies. With the advent of Assisted Reproduction Techniques (ART and ovulation induction, the overall incidence of heterotopic pregnancy has risen to approximately 1 in 3,900 pregnancies. Other risk factors include a history of pelvic inflammatory disease (PID, tubal damage, pelvic surgery, uterine Mullerian abnormalities, and prior tubal surgery. Heterotopic pregnancy is a potentially fatal condition, rarely occurring in natural conception cycles. Most commonly, heterotopic pregnancy is diagnosed at the time of rupture when surgical management is required. Case. This paper represents two cases of heterotopic pregnancies as well as a literature review. Conclusion. Heterotopic pregnancy should be suspected in patients with an adnexal mass, even in the absence of risk factors. Clinicians must be alert to the fact that confirming an intrauterine pregnancy clinically or by ultrasound does not exclude the coexistence of an ectopic pregnancy. A high index of suspicion in women is needed for early and timely diagnosis, and management with laparotomy or laparoscopy can result in a favorable and successful obstetrical outcome.

  1. Heredity and Environment in Etiology of Eating Disorders. I. Review of Twin Studies

    Directory of Open Access Journals (Sweden)

    Meshkova T.A.

    2015-06-01

    Full Text Available Twin studies of eating disorders (anorexia nervosa, bulimia nervosa, and binge eating are reviewed. Historically, eating disorders (ED was viewed as a disorders primarily influenced by sociocultural factors, however, over the past decade, this perception has been challenged. Twin studies demonstrate that genetic factors significantly influence the risk for ED and substantially contribute to the observed association between ED and other disorders and personal traits (major depression, anxiety disorders, substance use disorders, perfectionism. Among environmental factors nonshared (unique environment plays the main role, except of early puberty.

  2. Massively Parallel Sequencing (MPS) of Cell-Free Fetal DNA (cffDNA) for Trisomies 21, 18, and 13 in Twin Pregnancies.

    Science.gov (United States)

    Du, Erqiu; Feng, Chun; Cao, Yuming; Yao, Yanru; Lu, Jing; Zhang, Yuanzhen

    2017-06-01

    Massively parallel sequencing (MPS) technology has become increasingly available and has been widely used to screen for trisomies 21, 18, and 13 in singleton pregnancies. This study assessed the performance of MPS testing of cell-free fetal DNA (cffDNA) from maternal plasma for trisomies 21, 18, and 13 in twin pregnancies. Ninety-two women with twin pregnancies were recruited. The results were identified through karyotypes of amniocentesis or clinical examination and follow-up of the neonates. Fluorescent in-situ hybridization was used to examine the placentas postnatally in cases of false-positive results. The fetuses with autosomal trisomy 21 (n = 2) and trisomy 15 (n = 1) were successfully detected via MPS testing of cffDNA. There was one false-positive for trisomy 13 (n = 1), and fluorescence in-situ hybridization (FISH) identified confined placental mosaicism in this case. For twin pregnancies undergoing second-trimester screening for trisomy, MPS testing of cffDNA is feasible and can enhance the diagnostic spectrum of non-invasive prenatal testing, which could effectively reduce invasive prenatal diagnostic methods. In addition to screening for trisomy 21, 18, and 13 by cffDNA, MPS can detect fetal additional autosomal trisomy. False-positive results cannot completely exclude confined placental mosaicism.

  3. Increased doses of vaginal progesterone for the prevention of preterm birth in twin pregnancies: a randomised controlled double-blind multicentre trial.

    Science.gov (United States)

    Serra, V; Perales, A; Meseguer, J; Parrilla, J J; Lara, C; Bellver, J; Grifol, R; Alcover, I; Sala, M; Martínez-Escoriza, J C; Pellicer, A

    2013-01-01

    Previous trials have shown little benefit for preventing preterm birth in twin pregnancies using 90-200 mg of daily vaginal natural progesterone. Higher doses have not been tested. Our aim was to determine the efficacy and safety of two different daily doses of vaginal natural progesterone (200 and 400 mg), compared with placebo, for preventing preterm birth in unselected twin pregnancies. Randomised controlled double-blind multicentre trial (1:1:1). The study was carried out in five university centres from Valencia, Murcia and Alicante (Spain). Women with dichorionic diamniotic twin pregnancies. The women self-inserted two vaginal pessaries daily, containing placebo (n = 96), 200 mg of natural progesterone (n = 97) or 400 mg of natural progesterone (n = 97), from 20 to 34 weeks of gestation or delivery. Randomisation was performed by an external centre. Data were analysed on an intention-to-treat basis. Preterm birth rate. The baseline characteristics for placebo and progesterone groups were similar. Comparison of the three groups and analysis of progesterone-treated versus untreated women showed similar pregnancy and neonatal outcomes. The proportion of preterm and very preterm births, low birthweight, perinatal mortality and neonatal morbidity showed no differences between the three groups. Similar results were also obtained when comparing the 200- versus 400-mg progesterone groups. No serious adverse effects were encountered. Vaginal progesterone therapy was generally well tolerated, but failed to prevent preterm births in unselected dichorionic diamniotic twin pregnancies. The 400-mg progesterone dose offered no advantages over the 200-mg regimen. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  4. Having Twins? How to Stay Healthy

    Science.gov (United States)

    ... Listen Español Text Size Email Print Share Having Twins? How to Stay Healthy Page Content Article Body ... the eyes of obstetricians. Many would call a twin pregnancy a high-risk pregnancy , but don’t ...

  5. Adolescent pregnancy: a 25-year review.

    Science.gov (United States)

    Clark, J F; Westney, L S; Lawyer, C J

    1987-04-01

    A five-year update of a previous 20-year study of adolescent pregnancy is presented. For the 25-year period, data were collected on 2,789 adolescents. Prematurity and low birth weight infants continue to have a high incidence in adolescent pregnancy. This study found that there has been a significant decrease in preeclampsia and toxemia of pregnancy and a large increase in the incidence of cesarean section.

  6. Breast cancer in pregnancy: A brief clinical review.

    Science.gov (United States)

    Becker, Sven

    2016-05-01

    As global wealth increases and demographic changes similar to Europe and North America start affecting other societies, the global breast cancer epidemic will coincide with a delayed maternal age during first and subsequent pregnancies. Breast cancer in pregnancy will continue to increase, and standardized treatment strategies are required to be developed. This study will review current diagnostic and treatment approaches.

  7. The clinical study of twin pregnancy complicated by preeclampsia%双胎妊娠并发子痫前期的临床研究

    Institute of Scientific and Technical Information of China (English)

    朱秀君

    2015-01-01

    Objective To investigate the effects of twin pregnancies complicated by pre eclampsia of pregnancy complications and neonatal outcomes,further guide clinical.Methods retrospective analysis of the clinical data of 48 patients with twin pregnancies com-plicated by pre eclampsia patients and the same period in our hospital from 201 1 January to 2014 January were 48 cases of normal sin-gleton pregnancies,the twin pregnancies complicated by pre eclampsia patients as the observation group,while the normal single preg-nancy patients as a control group,the two groups were observed and compared analysis of the influence of comorbidity and maternal and neonatal outcomes of pregnancy.Results the group of premature rupture of membranes,the rate of postpartum hemorrhage,premature delivery,cesarean section and neonatal asphyxia was significantly higher than that in the control group,the difference was significant, with statistical significance (P<0.05 ).Conclusion The twin pregnancies complicated by pre eclampsia were more prone to pregnancy induced hypertension syndrome,affects the prognosis of mother and child,clinical worth attention.%目的:探讨双胎妊娠并发子痫前期对妊娠合并症及母婴结局的影响,进一步指导临床。方法:回顾性的分析48例双胎妊娠并发子痫前期患者和同期收治的48例双胎妊娠无并发子痫前期患者的临床资料,将双胎妊娠并发子痫前期患者作为观察组,而双胎妊娠无并发子痫前期患者作为对照组,观察两组患者对妊娠合并症及母婴结局的影响进行对比分析。结果:观察组胎膜早破、产后出血率、早产、剖宫产率及新生儿窒息情况明显高于对照组,差异具有统计学意义(P<0.05)。结论:双胎妊娠并发子痫前期较易发生妊娠期合并症,影响母婴的预后,临床值得加以重视。

  8. Analysis of 328 cases of pregnancy outcome of twin%双胎妊娠328例结局分析

    Institute of Scientific and Technical Information of China (English)

    赵勇; 张敏华

    2014-01-01

    Objective To investigate the twin pregnancy mother and child during pregnancy perinatal outcome and treatment on perinatal outcome.Methods for January 2010 to December 2013 during the First Hospital of Sanming City, Fujian hospital delivery of 328 cases of twin pregnancy were retrospectively analyzed . Results twin pregnancy fetal mortality rate was 2.13%, neonatal mortality rate was 1.83%, cesarean section rate was 53.7% . Perinatal regular prenatal care for pregnant women and fetal complications of pregnancy complications and mortality rates were lower than the occasional check-ups of pregnant women, the difference was statistically signiifcant (P<0.05 ) .Conclusion twin pregnancy mother and child perinatal complications, complications and mortality rates are high, so regular prenatal care, to prevent and treat complications of pregnancy, childbirth choose favorable timing and mode of delivery to reduce perinatal twins child morbidity and mortality is important.%目的:探讨双胎妊娠的母儿围生结局及孕期处理对围生结局的影响。方法对2010年1月~2013年12月期间在福建三明市第一医院住院分娩的328例双胎妊娠病例进行回顾性分析。结果双胎妊娠胎儿死亡率为2.13%,新生儿死亡率为1.83%,剖宫产率为53.7%。围生期定期进行产前检查的孕妇孕期并发症及合并症及胎儿死亡率均低于不定期产检的孕妇,差异具有统计学意义(P<0.05)。结论双胎妊娠母亲及围生儿合并症、并发症及死亡率均较高,因此定期产前检查,积极防治妊娠期各种并发症,选择有利的分娩时机和分娩方式对降低双胎围生儿患病率和死亡率有重要意义。

  9. MANAGEMENT OF ENDOCRINE DISEASE: Acromegaly and pregnancy: a contemporary review.

    Science.gov (United States)

    Abucham, Julio; Bronstein, Marcello D; Dias, Monike L

    2017-07-01

    Although fertility is frequently impaired in women with acromegaly, pregnancy is apparently becoming more common due to improvement in acromegaly treatment as well as in fertility therapy. As a result, several studies on pregnancy in patients with acromegaly have been published in recent years adding new and relevant information to the preexisting literature. Also, new GH assays with selective specificities and the knowledge of the expression of the various GH genes have allowed a better understanding of somatotrophic axis function during pregnancy. In this review, we show that pregnancy in women with acromegaly is generally safe, usually with tumoral and hormonal stability. Although the paucity of data limits evidence-based recommendations for preconception counseling and pregnancy surveillance, controlling tumor size and hormonal activity before pregnancy is highly recommended to ensure better outcomes, and surgical control should be attempted when feasible. Treatment interruption at pregnancy confirmation has also proven to be safe, as drugs are not formally allowed to be used during pregnancy. Drug exposure (somatostatin analogs) during early or whole pregnancy might increase the chance of a lower birth weight. Aggressive disease is uncommon and may urge individual decisions such as surgery or drug treatment during pregnancy or lactation. © 2017 European Society of Endocrinology.

  10. BACTERIURIA IN PREGNANCY: A REVIEW OF LITERATURE

    Directory of Open Access Journals (Sweden)

    S. L. B. Souza

    2015-06-01

    Full Text Available The alteration Structural and functional of the urinary system appear as a predisposing factor from pregnant population to urinary tract infections. The bacteriuria in pregnancy still be one of the principal factor of morbidity and mortality, maternal and perinatal. Thus, proposing to analyze the bibliographic production around bacteriuria in pregnancy has developed this study. Proceded to the investigation of 06 national articles, published from 2003 to 2013, on the LILACS database. Were used as descriptors: Bacteriuria and Pregnancy. Defined as bacteriuria from quantitative colony forming units per mililiter of urine (CFU / ml equal to or higher than 105. With etiology is observed Escherichia coli as a major etiologic agent and urine culture the most efficient diagnostic method. The results also attach the treatment of bacteriuria during pregnancy independently of the occurrence of symptoms and tracking of the bacteriuria from the first trimester of pregnancy to prevent maternal and fetal complications.

  11. Couples Communication Skills and Anxiety of Pregnancy: A Narrative Review

    Science.gov (United States)

    Malary, Mina; Shahhosseini, Zohreh; Pourasghar, Mehdi; Hamzehgardeshi, Zeinab

    2015-01-01

    Background: physical problems during pregnancy including Anxiety disorders form a large share of health problems. On the other hand, healthy relationship and communication skills are vital to raise a family. For couples who enjoy communication skills, parenthood will be the best and most pleasant experiences in their lives. High levels of positive communication will lead to couples and their children’s mental health and couples’ good relationship can have a protective effect against stressors including anxiety of pregnancy. The current study reviewed the studies on the relationship between communication skills and the anxiety of pregnancy. Methods: The current study is a review where the researcher browsed the available databases like Google Scholar, Pubmed, Magiran, SID, and Science Direct and using key words of Communication skills, marital satisfaction, and the anxiety of pregnancy, & the researcher has searched the articles of 2000-2014 & read 150 abstracts & 93 full papers and ultimately, chose 50 to write this study. Results: By reviewing the findings literature in three general categories as Communication Skills as the Significant Component to Get Marital Satisfaction, Improving Marital Satisfaction as Pregnancy Anxiety Reducing Factor, and Communication Skills Quality as Component Influencing Pregnancy Anxiety. Conclusions: Having communication skills will lead to promotion of marital satisfaction and increased mental health in life. It is, therefore, recommended that communication skills be trained in routine programs for pre-marriage counseling, pre-pregnancy cares and pregnancy so that the mental health of community can be improved. PMID:26543425

  12. Cell-free fetal DNA analysis in maternal plasma as a screening test for trisomy 21, 18 and 13 in twin pregnancies.

    Science.gov (United States)

    Le Conte, Grégoire; Letourneau, Alexandra; Jani, Jacques; Kleinfinger, Pascale; Lohmann, Laurence; Costa, Jean-Marc; Benachi, Alexandra

    2017-08-18

    To evaluate the utility of noninvasive prenatal testing using cell-free circulating fetal DNA (cfDNA) in screening for the three main autosomal fetal trisomies in twin pregnancies. CfDNA testing was offered to 492 patients with twin pregnancies without ultrasound anomalies as a first-line screening test or after serum screening in clinical practice. Data were collected prospectively and a retrospective analysis was performed. CfDNA analysis was performed by massively parallel sequencing. The fetal fraction threshold for test evaluation was 8%. Regression analysis was performed to investigate the effect on the test failure rate of various variables. Performance of the test is also reported. The test was performed first line (after first-trimester scan) in 377 patients and following serum screening in 115. 78.8% of pregnancies were dichorionic-diamniotic. The test failed at the first attempt in 12 (2.9%) of 420 pregnancies with available outcomes, and regression analysis demonstrated that only maternal weight was a significant independent predictor of test failure. After redraw, a result was achieved in 10 cases. CfDNA identified all 3 cases of trisomy 21, and the only case of trisomy 18. For trisomy 21, the specificity was 99.8% (95% CI [98.7% - 100.0%]). When considering the spontaneous or ART origin of pregnancies, there were no significant differences in terms of maternal weight or of no-result rate for cfDNA screening in the two groups. In twin pregnancies without fetal ultrasound abnormalities, cfDNA had a high success rate and performance. Therefore, in routine practice, cfDNA could be considered as a first- or second-line screening test. This article is protected by copyright. All rights reserved.

  13. Influence of chorionicity on perinatal outcome in a large cohort of Danish twin pregnancies

    DEFF Research Database (Denmark)

    Oldenburg, Anna; Rode, Line; Bødker, Birgit

    2012-01-01

    with two live infants at 28 days after delivery was 97.5% and 95.1%, respectively. Conclusion The increased incidence of fetal loss and neonatal death in MC compared to DC pregnancies predominantly occurs before 24 weeks’ gestation. Although risk of IUFD is slightly higher in MC than DC after 24 weeks...

  14. Systematic review of pregnancy in women with inherited cardiomyopathies

    NARCIS (Netherlands)

    Krul, Sebastien P. J.; van der Smagt, Jasper J.; van den Berg, Maarten P.; Sollie, Krystyna M.; Pieper, Petronella G.; van Spaendonck-Zwarts, Karin Y.

    2011-01-01

    Pregnancy exposes women with inherited cardiomyopathies to increased risk for heart failure and arrhythmias. In this paper, we review the clinical course and management of pregnant women with the following inherited cardiomyopathies: hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogeni

  15. 超声测量晚孕期正常双胎生长参数的初步分析%Preliminary Analysis of Ultrasound Measurement of Growth Parameters of Normal Twin Pregnancy in the Last TrimesterPregnancy

    Institute of Scientific and Technical Information of China (English)

    王晶; 杨太珠

    2011-01-01

    Objective To initially establish the growth parameters of normal twin pregnancy in 28-34 gestational ages according to the ultrasound measurement, and to compare the intrauterine growth patterns between the singleton and twin pregnancy. Methods The relevant index of the twin pregnancy, including the biparietal diameter (BPD), femur length, head circumference (HO, abdominal circumference (AC), were measured. The transverse cerebellar diameter (TCD) was measured and the virtural organ computer-aided analysis was used to detect the fetal cerebellar volume (FCV). The intrauterine growth patterns between the singleton and twin pregnancy was compared. Results After the gestational age of 30 weeks, the mean values of BPD of the twins pregnancies (1. 7 mm) were lower than those of the singleton pregnancies (2. 3 mm). After the gestational age of 32 weeks, the mean value of HC of the twins pregnancies (5. 8 mm) was lower than that of the singleton pregnancies (6. 7 mm). After the gestational age of 30 weeks, the mean values of AC of the twins pregnancies (5. 3 mm) were lower than those of the singleton pregnancies (6. 9 mm). After the gestational age of 28 weeks, the mean value of FL of the twins pregnancies (1. 7 mm) was lower than the singleton pregnancies (2. 0 mm). After the gestational age of 28 weeks, the growth of twin pregnancy fetuses is more slowly. After the gestational age of 28-34 weeks, the differences in mean values of TCD and FCV between the twin pregnancy and singleton pregnancy was not significant. Conclusion The twin pregnancy and singleton pregnancy have different growth patterns in the third trimester pregnancy.%目的 拟初步建立孕28~34周的双胎胎儿生长参数超声测量值的正常范围,比较晚孕期单、双胎妊娠胎儿的宫内生长发育模式.方法 对2009年5月-2010年4月超声诊断为正常宫内双活胎、单活胎孕妇,采用超声测量胎儿相关生长发育指标,包括双顶径、头围、腹围、股骨长

  16. Insulin requirements in type 1 diabetic pregnancy

    DEFF Research Database (Denmark)

    Callesen, Nicoline; Ringholm, Lene; Stage, Edna;

    2012-01-01

    To evaluate the insulin requirements in women with type 1 diabetes during twin pregnancy compared with singleton pregnancy.......To evaluate the insulin requirements in women with type 1 diabetes during twin pregnancy compared with singleton pregnancy....

  17. 双胎妊娠98例临床分析%A Study of 98 Cases Twin Pregnancy on the Maternal and Fetal Harm

    Institute of Scientific and Technical Information of China (English)

    李林娜

    2011-01-01

    Objective: To study the harm of the twin pregnancy on the maternal and fetal harm. Method: 98 cases outpatients with the twin pregnancy for nearly 3 years was retrospectively analysed. Result: Of 98 cases with twin pregnancy, 16 cases( 16.33% ) complicated with pregnancy-induced hypertension; 29 cases pregnancy anemia( 29.59% ); 11 cases polyhydramnios (11.22% ); 12 cases of premature rupture of membranes( 12.24% ); 41 cases birth process appears hypodynamic(68.33% ); 14 cases postpartum hemorrhage ( 14.29% ); 28 cases preterm birth ( 28.57% ) and 3 cases of premature death; 29 c.ases fetal growth restriction(29.59%); 46 cases fetal azimuth(46.94%); 3 cases double twin transfusion syndrome(3. 06% ); 6 cases asphyxia(6.12% ). Conclusion: The twin pregnancy women should be closely monitored,do more missionary, strengthen antenatal, perfected health measures, timely treated the complications.%目的:了解双胎妊娠对母婴的危害.方法:对近3年收治的98例双胎妊娠进行回顾性分析.结果:98例双胎妊娠中,合并妊娠期高血压疾病16例,发生率16.33%;妊娠贫血29例,发生率29.59%;羊水过多11例,发生率11.22%;胎膜早破12例,发生率12.24%;产程中出现宫缩乏力41例,发生率68.33%;产后出血14例,发生率14.29%;早产28例,发生率28.57%,其中早产儿死亡3例;胎儿生长受限29例,发生率29.59%;胎方位异常46例,发生率46.94%;双胎输血综合征3例,发生率3.06%;新生儿窒息6例,发生率6.12%.结论:一旦双胎妊娠,必须严密监护,向孕妇做详细宣教,加强产前检查,完善保健措施,及时处理并发症.

  18. Twin Support Vector Machine: A review from 2007 to 2014

    Directory of Open Access Journals (Sweden)

    Divya Tomar

    2015-03-01

    Full Text Available Twin Support Vector Machine (TWSVM is an emerging machine learning method suitable for both classification and regression problems. It utilizes the concept of Generalized Eigen-values Proximal Support Vector Machine (GEPSVM and finds two non-parallel planes for each class by solving a pair of Quadratic Programming Problems. It enhances the computational speed as compared to the traditional Support Vector Machine (SVM. TWSVM was initially constructed to solve binary classification problems; later researchers successfully extended it for multi-class problem domain. TWSVM always gives promising empirical results, due to which it has many attractive features which enhance its applicability. This paper presents the research development of TWSVM in recent years. This study is divided into two main broad categories - variant based and multi-class based TWSVM methods. The paper primarily discusses the basic concept of TWSVM and highlights its applications in recent years. A comparative analysis of various research contributions based on TWSVM is also presented. This is helpful for researchers to effectively utilize the TWSVM as an emergent research methodology and encourage them to work further in the performance enhancement of TWSVM.

  19. [Maternal arrhythmias during pregnancy. Practical review].

    Science.gov (United States)

    Kornacewicz-Jach, Zdzisława; Peregud-Pogorzelska, Małgorzata

    2014-01-01

    Pregnancy is accompanied by a variety of cardiovascular changes in normal women, and these changes can increased incidence of maternal cardiac arrhythmias. Supraventricular and ventricular arrhythmias reguiring treatment are rarely seen during pregnancy in healthy women. Structural cardiac defects or residual defects after repair may contribute to the occurrence of clinically relevant arrhythmias. Arrhythmias during pregnancy include a wide spectrum. The most common are simple ventricular and atrial ectopy, sinusal tachycardia and supraventricular tachycardia. The foetus may suffer both haemodynamic alternations and adverse effects of the treatment (teratogenic risk, foetal growth and development). The management of arrhythmias in pregnant women is similar to that taken in patients who are not pregnant.

  20. Twin-to-twin transfusion syndrome : from placental anastomoses to long-term outcome

    NARCIS (Netherlands)

    Lopriore, Enrico

    2006-01-01

    Twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies associated with high perinatal mortality and morbidity rates. Placental vascular anastomoses, almost invariably present in monochorionic placentas, are the essential anatomical substrate for the devel

  1. Twin-to-twin transfusion syndrome : from placental anastomoses to long-term outcome

    NARCIS (Netherlands)

    Lopriore, Enrico

    2006-01-01

    Twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies associated with high perinatal mortality and morbidity rates. Placental vascular anastomoses, almost invariably present in monochorionic placentas, are the essential anatomical substrate for the

  2. Twin-to-twin transfusion syndrome : from placental anastomoses to long-term outcome

    NARCIS (Netherlands)

    Lopriore, Enrico

    2006-01-01

    Twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies associated with high perinatal mortality and morbidity rates. Placental vascular anastomoses, almost invariably present in monochorionic placentas, are the essential anatomical substrate for the devel

  3. 双胎妊娠妇女心理健康状况的调查分析%Investigation on the mental health of twin pregnancy women during pregnancy period

    Institute of Scientific and Technical Information of China (English)

    贾曼; 廖碧珍

    2016-01-01

    目的 了解双胎妊娠妇女心理健康状况及影响因素,为改善其不良心理状况的干预措施提供依据.方法 对建卡并定期产检的双胎妊娠妇女60例,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和自编问卷进行调查.结果 双胎妊娠妇女SAS得分为(52.87±10.19)分,SDS得分为(50.61±4.31)分;不同年龄、孕周及妊娠方式对双胎妊娠妇女焦虑程度构成比比较,不同孕周、妊娠方式和有过流产史、生育史的双胎妊娠妇女抑郁构成比比铰,差异均有统计学意义(F/t=12.74~ 54.93,P< 0.05或0.01);回归分析显示,孕周和妊娠方式是影响双胎妊娠妇女焦虑、抑郁的主要因素.结论 双胎妊娠妇女存在不同程度的焦虑、抑郁情绪,孕周增加和接受辅助生殖技术是加重双胎妊娠妇女焦虑、抑郁的主要因素,需从加强心理护理、建立标准化的助产模式、鼓励孕妇自我调节、发挥社会家庭支持系统作用等方面加以改进.%Objective To investigate the mental health state of twin pregnancy women and influencing factors,so as to provide reference for measures to improve their mental condition.Methods Sixty twin pregnancy women who have made regular antenatal examination received the investigation of Self-Rating Anxiety Scale (SAS),Self-Rating Depression Scale (SDS) and self-designed questionnaire.Results The score of SAS for twin pregnancy women was (52.87±10.19) points,SDS was (50.61±4.31) points.There were significant differences in twin pregnancy women degree of anxiety with different age,gestational weeks,and pregnancy way and degree of depression with different gestational weeks,pregnancy way and abortion,reproductive history (F/t=12.74-54.93,P < 0.05 or 0.01).Regression analysis showed that gestational weeks and pregnancy way were the main factors of anxiety and depression influencing twin pregnancy women.Conclusions The anxiety state of twin pregnancy women is in a moderate level,and the

  4. Neonatal status of twins

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    Božinović Dragica

    2012-01-01

    Full Text Available Multiple pregnancy is a pregnancy where more than one fetus develops simultaneously in the womb, as a result of the ovulation and fertilization of more than one egg. It is relatively rare in humans and represents the rest of the phylogenetic stages. The most common are twins and they indicate the development of two fetuses in the womb. The frequency of twin pregnancies is about 1%. Multiple pregnancies belong to a group of high-risk pregnancies because of the many complications that occur during the pregnancy: higher number of premature deliveries, bleeding, early neonatal complications and higher perinatal morbidity and mortality. Such pregnancies and infants require greater supervision and monitoring. The aim of this study was to determine the percentage of baby twins born at the maternity ward of the General Hospital in Prokuplje and their morbidity and mortality. Data on the total number of deliveries, number of twins, parity and maternal age, gestational age, body weight of twins, method of delivery, Apgar score and perinatal mortality were collected and statistically analyzed by means of retrospective analysis of operative birth and neonatal protocol for 6 years (2005 of 2010. Out of 4527 mothers who gave birth 43 were pairs of twins, or 0.95% of women gave birth to twins. These babies are more likely born by Caesarean section, but delivered with slightly lower birth weight.

  5. Rheumatoid Arthritis Treatment during Pregnancy: Review

    OpenAIRE

    Bozkurt M et al.

    2013-01-01

    Rheumatoid arthritis (RA) affects approximately 1-2% of adults, it is more common in women than men, and some of these women are in the reproductive age. In most pregnant women with RA, disease activity is reduced but, in a minority of them symptoms gets worse. Management of RA during pregnancy is difficult. Treatment of patients with RA during pregnancy and lactation should be carefully carried out. No sufficient studies are available about safety of some ...

  6. 试管婴儿双胎与自然受孕双胎产妇和新生儿的临床结局分析%Analysis of clinical outcomes of twin pregnancy women and neonates with twin pregnancy and natural pregnancy

    Institute of Scientific and Technical Information of China (English)

    夏燕; 潘晖; 魏兆莲

    2016-01-01

    目的:探讨试管婴儿双胎与自然受孕双胎产妇和新生儿的临床结局。方法收集2014年8月至2015年6月收治的60例试管婴儿双胎妊娠(试管组)与78例自然受孕双胎妊娠(对照组)产妇的妊娠周期、妊娠期合并症、分娩方式、年龄、新生儿体重、新生儿出生缺陷等资料,对比两组产妇之间的差异性。结果与对照组对比,试管组产妇年龄显著升高,差异有统计学意义( P 0.05);与对照组对比,试管组产妇妊娠期高血压发生率显著升高,差异有统计学意义( P 0.05);与对照组对比,试管组新生儿在28~31孕周早产的发生率显著升高,极低体质量儿及转新生儿科新生儿比率显著升高,差异有统计学意义( P 0.05)。结论试管婴儿双胎较自然受孕双胎发生不良妊娠结局的危险性相对较高,应加强对试管婴儿双胎妊娠的产前及产时监护,防治并发症的发生。%Objective To explore the clinical outcome of twin pregnancy and newborn twins with twin pregnancy in vitro. Methods From August 2014 to June 2015 in our hospital 60 cases of obstetrics and gynecology IVF twin pregnancy(tube group)and 78 cases of naturally conceived twin pregnancies( control group)were collected. Maternal pregnancy cycle,pregnancy complications,mode of delivery,age,birth weight,birth defects of the two groups were collected,and compared. Results Compared with the control group,test tube group of maternal age was significantly increased,the difference was statistically significant( P 0. 05). Compared with the control group,test tube group of maternal gestational hypertension incidence increased significantly,the difference was statistically significant( P 0. 05). Compared with the control group,the premature gestational incidence in 28 ~ 31 in tube group increased significantly,basal body weight infant and newborn proportion increased significantly,the difference was statisti

  7. Restless legs syndrome and pregnancy: A review

    Science.gov (United States)

    Srivanitchapoom, Prachaya; Pandey, Sanjay; Hallett, Mark

    2014-01-01

    Restless legs syndrome (RLS) is a common sensorimotor neurological disorder that is diagnosed according to the revised criteria of the International RLS Study Group (IRLSSG). The pathophysiology of RLS is still unknown and its prevalence is influenced by ethnicity, age, and gender. RLS is divided into two types by etiology: primary or idiopathic and secondary. Primary RLS is strongly influenced by a genetic component while secondary RLS is caused by other associated conditions such as end-stage renal disease or peripheral neuropathy. Another common condition associated with RLS is pregnancy. The prevalence of RLS during pregnancy is two to three times higher than in the normal population and is influenced by the trimester and the number of parity. The main mechanisms that may contribute to the pathophysiology of RLS during pregnancy are hormonal changes and iron and folate status. Standard medications for treating RLS during pregnancy are not established. Most medications have been used according to the evidence from non-pregnant patients. Therefore, consideration of the medical treatment for treating RLS during pregnancy should be balanced between the benefit of relieving the symptoms and maternal and fetal risk. In general, the prognosis of RLS during pregnancy is good and symptoms are usually relieved after delivery. PMID:24768121

  8. Restless legs syndrome and pregnancy: a review.

    Science.gov (United States)

    Srivanitchapoom, Prachaya; Pandey, Sanjay; Hallett, Mark

    2014-07-01

    Restless legs syndrome (RLS) is a common sensorimotor neurological disorder that is diagnosed according to the revised criteria of the International RLS Study Group (IRLSSG). The pathophysiology of RLS is still unknown and its prevalence is influenced by ethnicity, age, and gender. RLS is divided into two types by etiology: primary or idiopathic and secondary. Primary RLS is strongly influenced by a genetic component while secondary RLS is caused by other associated conditions such as end-stage renal disease or peripheral neuropathy. Another common condition associated with RLS is pregnancy. The prevalence of RLS during pregnancy is two to three times higher than in the normal population and is influenced by the trimester and the number of parity. The main mechanisms that may contribute to the pathophysiology of RLS during pregnancy are hormonal changes and iron and folate status. Standard medications for treating RLS during pregnancy are not established. Most medications have been used according to the evidence from non-pregnant patients. Therefore, consideration of the medical treatment for treating RLS during pregnancy should be balanced between the benefit of relieving the symptoms and maternal and fetal risk. In general, the prognosis of RLS during pregnancy is good and symptoms are usually relieved after delivery.

  9. Aborto en una yegua debido a mellizos, ¿porque conviene reducirlos manualmente?: reporte de un caso - Abortion in a Mare caused by twins pregnancy, the convenience of the manual reduction of one of the twins. A case report

    Directory of Open Access Journals (Sweden)

    González del Pino, Francisco Javier.

    2010-12-01

    Full Text Available ResumenEl artículo describe el caso clínico de un cuadro de aborto en un yegua deraza Peruano de Paso de 10 años de edad, debido a una preñez de mellizoscon fijación bicornual. La misma fue diagnosticada en forma precozmediante ecografía transrectal, pero su desenlace final en un abortoindeseable se debió a que el propietario del animal, no quiso su resoluciónmediante la técnica de reducción manual de uno de los mellizos.SummaryThis article describes a clinical case of an abortion in a 10 year old PeruvianPaso mare, caused by twin pregnancies bilaterally fixed. It was earlydiagnosed by transrectal ultrasound, but its final outcome in an unwantedabortion because the animal's owner declined to its resolution through thetechnique of manual reduction of one of the twins.

  10. A analysis of 34 cases of twin pregnancies with single intrauterine fetal death in pregnancy outcomes%双胎之一胎死宫内34例的妊娠结局分析

    Institute of Scientific and Technical Information of China (English)

    林颖; 王蕴慧

    2015-01-01

    ObjectiveTo study the etiology, clinical management and the related factors affecting the pregnancy outcomes of twin pregnancies with single intrauterine fetal death (sIUFD). Methods Retrospective analysis was done in 34 cases of twin pregnancies with sIUFD from April 2003 to October 2012 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University.Results The incidence of twin pregnancies with sIUFD was 6.75% in the hospital. There were 18 cases of dichorionic twins, 9 cases of monochorionic twins (including monoamiotic twins 3 cases) and 7 cases of unknown chorionic twins respectively. In 8 cases, twin pregnancies with sIUFD was found in the first trimester of gestation; in 13 cases, it was found in the second trimester of gestation; and in 13 cases it was found in the third trimester of gestation. A total of 24 patients with expectant treatment, treatment of the median time of 62.5 (41-209) days, median gestational age at delivery 32.6 (16.0-38.7) weeks. The number of live births, birth gestational age and birth weight for twin pregnancies with sIUFD occurred during first trimester of gestation, were higher than in late pregnancy group. In the same way, twin pregnancies with sIUFD occurred for dichorionic twins, were higher than monochorionic twins or unknown chorionic twins group.Conclusion Chorionicity, stillbirth weeks of gestation and delivery gestational age are the significant factors affecting the pregnancy outcomes. To strengthen the monitoring of maternal complications and the survival fetal, expectant treatment is an effective way of improving the pregnancy outcomes of twin pregnancies with sIUFD.%目的 探讨双胎妊娠一胎胎死宫内的病因、临床处理及影响妊娠结局的相关因素.方法 回顾性分析2003年1月至2012年12月在中山大学孙逸仙纪念医院住院分娩的双胎妊娠一胎胎死宫内病例共34例.结果 双胎之一胎死宫内的发生率为6.8%,34例中双绒毛膜双胎18例,单绒毛膜双胎9

  11. Congenital scoliosis in monozygotic twins: case report and review of possible factors contributing to its development

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    Weiss Hans-Rudolf

    2008-11-01

    Full Text Available Abstract Background The exact etiology of congenital scoliosis remains unknown as yet. It seems that its development may be influenced by both genetic predisposition and environmental factors, at varying degrees. International bibliography features few cases of monozygotic twins with congenital scoliosis. The aim of this study is to report a case in monozygotic twins and review the literature relating to the description of similar cases as well as the pathophysiological mechanism involved in its development. Methods Clinical examination and simple X-rays revealed scoliosis of differing degrees and types in male monozygotic twins with moderate mental retardation and dyslalia. Results Congenital scoliosis identified in both twins. In the first, this was manifested as left thoracic scoliosis, with Cobb angle of 34 degrees while in the second as left thoracolumbar scoliosis with Cobb angle of 10 degrees. Both were found to suffer from incarcerated hemivertebrae. Conclusion According to both its clinical identification and severity and to its course, not only the genetic but the environmental factors seem to play a leading role in the appearance of the condition.

  12. An unanticipated cardiac arrest and unusual post-resuscitation psycho-behavioural phenomena/near death experience in a patient with pregnancy induced hypertension and twin pregnancy undergoing elective lower segment caesarean section

    Directory of Open Access Journals (Sweden)

    Mridul M Panditrao

    2010-01-01

    Full Text Available A case report of a primigravida, who was admitted with severe pregnancy induced hypertension (BP 160/122 mmHg and twin pregnancy, is presented here. Antihypertensive therapy was initiated. Elective LSCS under general anaesthesia was planned. After the birth of both the babies, intramyometrial injections of Carboprost and Pitocin were administered. Immediately, she suffered cardiac arrest. Cardio pulmonary resucitation (CPR was started and within 3 minutes, she was successfully resuscitated. The patient initially showed peculiar psychological changes and with passage of time, certain psycho-behavioural patterns emerged which could be attributed to near death experiences, as described in this case report.

  13. An unanticipated cardiac arrest and unusual post-resuscitation psycho-behavioural phenomena/near death experience in a patient with pregnancy induced hypertension and twin pregnancy undergoing elective lower segment caesarean section.

    Science.gov (United States)

    Panditrao, Mridul M; Singh, Chanchal; Panditrao, Minnu M

    2010-09-01

    A case report of a primigravida, who was admitted with severe pregnancy induced hypertension (BP 160/122 mmHg) and twin pregnancy, is presented here. Antihypertensive therapy was initiated. Elective LSCS under general anaesthesia was planned. After the birth of both the babies, intramyometrial injections of Carboprost and Pitocin were administered. Immediately, she suffered cardiac arrest. Cardio pulmonary resucitation (CPR) was started and within 3 minutes, she was successfully resuscitated. The patient initially showed peculiar psychological changes and with passage of time, certain psycho-behavioural patterns emerged which could be attributed to near death experiences, as described in this case report.

  14. Monochorionic monoamniotic twin pregnancy:a review of 2 cases%单绒毛膜单羊膜囊双胎妊娠2例临床分析

    Institute of Scientific and Technical Information of China (English)

    马腾; 丁新

    2016-01-01

    ObjectiveTo review the diagnosis, monitoring, management and perinatal outcomes of monochoriotic monoaminiotic twin pregnancy.MethodSummary clinical experience by discuss the 2 cases and review relevant literature.ResultTwo cases were terminated pregnancy by cesarean section in the late pregnancy, two fetuses in the same amniotic cavity were found intraoperatively.ConclusionEarly ultrosonography is important to diagnosis the MCMA twin pregnancy, there is controvercy in monitoring and delivery time of MCMA twin pregnancy, it is better to terminate pregnancy by cesarean section.%目的:探讨单绒毛膜单羊膜囊(monochoroinic monoaminiotic,MCMA)双胎妊娠的诊断、妊娠期监护、分娩方式以及妊娠结局的相关问题。方法通过对本院收治的2例MCMA双胎妊娠病例进行讨论,并复习相关文献,总结临床经验。结果2例患者均于孕晚期以剖宫产术结束妊娠,术中见两胎儿位于同一羊膜腔内。结论孕早期超声诊断对MCMA的确诊极为重要,但对MCMA双胎妊娠的孕期监测以及分娩时机尚有争议,分娩方式则以剖宫产术终止妊娠为宜。

  15. Glycemic index and pregnancy: a systematic literature review.

    Science.gov (United States)

    Louie, Jimmy Chun Yu; Brand-Miller, Jennie C; Markovic, Tania P; Ross, Glynis P; Moses, Robert G

    2010-01-01

    Background/Aim. Dietary glycemic index (GI) has received considerable research interest over the past 25 years although its application to pregnancy outcomes is more recent. This paper critically evaluates the current evidence regarding the effect of dietary GI on maternal and fetal nutrition. Methods. A systematic literature search using MEDLINE, EMBASE, CINAHL, Cochrane Library, SCOPUS, and ISI Web of Science, from 1980 through September 2010, was conducted. Results. Eight studies were included in the systematic review. Two interventional studies suggest that a low-GI diet can reduce the risk of large-for-gestational-age (LGA) infants in healthy pregnancies, but one epidemiological study reported an increase in small-for-gestational-age (SGA) infants. Evidence in pregnancies complicated by gestational diabetes mellitus (GDM), though limited (n = 3), consistently supports the advantages of a low-GI diet. Conclusion. There is insufficient evidence to recommend a low-GI diet during normal pregnancy. In pregnancy complicated by GDM, a low-GI diet may reduce the need for insulin without adverse effects on pregnancy outcomes. Until larger-scale intervention trials are completed, a low-GI diet should not replace the current recommended pregnancy diets from government and health agencies. Further research regarding the optimal time to start a low-GI diet for maximum protection against adverse pregnancy outcomes is warranted.

  16. Pregnancy after Bariatric Surgery: A Review

    Directory of Open Access Journals (Sweden)

    N. L. Hezelgrave

    2011-01-01

    Full Text Available Maternal obesity is a major cause of obstetric morbidity and mortality. With surgical procedures to facilitate weight loss becoming more widely available and demanded and increasing number of women becoming pregnant after undergoing bariatric surgery, it is important and timely to consider the outcome of pregnancy following bariatric surgery. This paper aims to synthesize the current evidence regarding pregnancy outcomes after bariatric surgery. It concludes that bariatric surgery appears to have positive effects on fertility and reduces the risk of gestational diabetes and preeclampsia. Moreover, there appears to be a reduced incidence of fetal macrosomia post-bariatric procedure, although there remains uncertainty about the increased rates of small-for-gestational age and intrauterine growth restricted infants, as well as premature rupture of membranes in this group. A number of case reports highlight that pregnancy following bariatric surgery is not without complications and it must be managed as high risk by the multidisciplinary team.

  17. Nutrition and multifetal pregnancy.

    Science.gov (United States)

    Brown, J E; Carlson, M

    2000-03-01

    Largely because of assisted reproduction, the rate of multifetal pregnancy is rising rapidly in the United States. Accordingly, dietitians are increasingly being called upon to provide nutrition services for these high-risk pregnancies. This article gives an overview of the incidence of and risks associated with multifetal pregnancy and reviews studies that contribute to our knowledge of nutrition and multifetal pregnancy. Practice guidelines for promoting healthy outcomes based on the best available scientific data are suggested. Guidelines for weight gain for twin and triplet pregnancy, dietary intake, and supplement use are included. Suggested practice guidelines for multifetal pregnancy include a positive rate of weight gain early in pregnancy, the use of prepregnancy weight status to determine total weight gain goals in twin pregnancy, a 50-lb weight gain goal for triplet pregnancy, and higher minimal number of servings of foods from several of the Food Guide Pyramid groups. The need for additional information on the effects of nutritional status on the course and outcome of multifetal pregnancy is critical. Preliminary evidence of the benefits of nutrition services suggests that both the incorporation of dietetics services into care programs and additional research on nutrition and multifetal gestation are warranted.

  18. Twin Pregnancy with a Complete Hydatidiform Mole and a Coexisting Live Fetus: Rare entity.

    Science.gov (United States)

    Sheik, Shahila; Al-Riyami, Nihal; Mathew, Namitha R; Al-Sukaiti, Rashid; Qureshi, Asim; Mathew, Mariam

    2015-11-01

    A hydatidiform mole with a coexisting live fetus is a rare occurrence and the optimal management for this condition is not yet known. We report the case of a 32-year-old woman (gravida 3, para 2) who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in March 2012 at 13 gestational weeks with abdominal pain and vaginal bleeding. An ultrasound examination revealed a hydatidiform mole pregnancy coexisting with a live fetus. After extensive counselling, the patient and her husband opted for a conservative management approach. Unfortunately, a hysterotomy had to be performed at 17 gestational weeks due to severe haemorrhage. The postoperative period was uneventful and histopathology results confirmed one complete mole with a coexisting fetus and normal placenta. The patient's serum β-human chorionic gonadotropin level remained normal for 18 months following her surgery.

  19. 34 Cases of Twin Pregnancies Complicated by Single Intrautterine Death%双胎妊娠一胎宫内死亡34例临床分析

    Institute of Scientific and Technical Information of China (English)

    谯小勇; 曹曦; 邢爱耘

    2011-01-01

    目的:探讨双胎妊娠一胎宫内死亡的因为、临床处理及预后.方法:回顾性分析2005年1月至2009年12月,我院双胎妊娠一胎宫内死亡34例患者的临床资料.结果:双胎妊娠一胎宫内死亡占我院双胎妊娠的5.2%,34例中单羊膜囊双胎3例,单绒毛膜双胎23例,双绒毛膜双胎8例;及时终止妊娠23例(单羊膜囊双胎均及时终止妊娠),期待治疗11例,平均期待时间单绒毛膜双胎为4.7±5.6周,双绒毛膜双胎为8.6±1.2周;单绒毛膜双胎发现死胎时的孕周、分娩孕周及存活儿的出生体重均小于双绒毛膜双胎.除引产外的30例存活儿发生围生儿死亡6例,随访24例存活新生儿中,2例失访,22例随访中发生脑瘫(四肢瘫,语言障碍)3例,存在其他脑损害(语言或运动发育延迟)4例,余健康存活.结论:单绒毛膜双胎更易发生双胎妊娠一胎宫内死亡,绒毛膜性质和孕周是影响围生儿结局和远期预后的重要因素,存活儿无胎儿窘迫,孕妇无严重妊娠并发症及合并症情况下,期待治疗是一种有效的处理方式.%Objective: To study the causes, clinical management and prognosis of twin pregnancies complicated by single intrauterine death (slUD). Methods: Retrospective analysis was done in 34 cases of twin pregnancies complicated by slUD from January 2005 to December 2009 in West China Second University Hospital of Sichuan University. Results: The incidence rate of twin pregnancies complicated by slUD was 5. 2%. There were 3 monoamnionic twins, 23 monochorionic twins and 8 dichorionic twin pregnancies complicated by slUD respectively. Termination of the pregnancy timely in 23 cases including monoamnionic twins was done. The average expectant time of monochorionic and dichorionic twins were 4. 7 ± 5. 6 weeks and 8. 6 ± 1.2 weeks respectively in 11 cases receiving expectant treatment. The average gestational weeks of fetal death and delivery, birth weight of survivals for monochorionic twins

  20. Diagnosis of umbilical cord entanglement in a monochorionic diamniotic twin pregnancy with spontaneous septostomy of the dividing membranes using dual-gate Doppler imaging.

    Science.gov (United States)

    Ito, Ayumu; Nakata, Masahiko; Oji, Ayako; Takano, Mayumi; Umemura, Nahomi; Nagasaki, Sumito; Maemura, Toshimitsu; Morita, Mineto

    2017-05-08

    Umbilical cord entanglement is the leading cause of fetal mortality in monoamniotic twin pregnancies and a pseudo monoamniotic environment. Published methods for detecting this complication include color Doppler and pulsed Doppler sonography; however, no method provides an absolute diagnosis. In this case, we report the diagnosis of umbilical cord entanglement using dual-gate Doppler imaging. A 35-year-old woman was referred to our hospital at 28 weeks of gestation for prenatal management because of diagnosis of a monochorionic diamniotic twin pregnancy with spontaneous septostomy of the dividing membranes. Each fetus displayed normal fetal growth without obvious discordance and anatomical abnormalities. However, the dividing membrane was not detected, and an entangled cord was suspected. Dual-gate Doppler examination was carried out. Two regions of interest were considered at different areas of the umbilical arteries, and when each Doppler image showed two different heart rates at the same time, we considered this to be evidence of umbilical cord entanglement. Cesarean section was performed at 32 weeks of gestation and twins were delivered. The delivered umbilical cords had sixfold entanglement. In this case, dual-gate Doppler seems to have been more accurate than conventional single-gate Doppler for the diagnosis of cord entanglement because we confirmed two different heart rates at the same time with dual-gate Doppler.

  1. Thoracopagus conjoined twin: an unusual presentation

    Directory of Open Access Journals (Sweden)

    Rajesh Kumari

    2014-02-01

    Full Text Available Conjoined twins are among rare clinical conditions observed by obstetricians. Due to rare incidence of this condition there is general lack of knowledge among obstetricians, especially at primary care level which leads to missed diagnosis during antenatal period. The management of this condition is complex especially in cases where the diagnosis is not known before onset of labour. A 30 - year old Hindu lady was referred to us from other hospital with diagnosis of twin pregnancy and prolonged second stage of labour. Clinical examination revealed findings of ruptured uterus and foetal head of one baby and feet of second baby were outside the introitus. Emergency laparotomy was done which revealed conjoined twins. This article report clinical course of a thoracopagus conjoined twin. The relevant literature is also reviewed. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 245-247

  2. The association between HIV (treatment), pregnancy serum lipid concentrations and pregnancy outcomes: a systematic review.

    Science.gov (United States)

    Harmsen, Marissa J; Browne, Joyce L; Venter, Francois; Klipstein-Grobusch, Kerstin; Rijken, Marcus J

    2017-07-11

    Observed adverse effects of antiretroviral therapy (ART) on the lipid profile could be of significance in pregnancy. This systematic review aims to summarize studies that investigated the association between HIV, ART and serum lipids during pregnancy and adverse pregnancy outcomes. A systematic search was conducted in five electronic databases to obtain articles that measured serum lipid concentrations or the incidence of dyslipidaemia in HIV-infected pregnant women. Included articles were assessed for quality according to the Cochrane Risk of Bias Tool. The extracted data was analysed through descriptive analysis. Of the 1264 articles screened, 17 articles were included in this review; eleven reported the incidence of dyslipidaemia, and twelve on maternal serum lipid concentrations under the influence of HIV-infection and ART. No articles reported pregnancy outcomes in relation to serum lipids. Articles were of acceptable quality, but heterogenic in methods and study design. Lipid levels in HIV-infected women increased 1.5-3 fold over the trimesters of pregnancy, and remained within the physiological reference range. The percentage of women with dyslipidaemia was variable between the studies [0-88.9%] and highest in the groups on first generation protease inhibitors and for women on ART at conception. This systematic review observed physiologic concentrations of serum lipids for HIV-infected women receiving ART during pregnancy. Serum lipids were increased in users of first generation protease inhibitors and for those on treatment at conception. There was no information available about pregnancy outcomes. Future studies are needed which include HIV-uninfected control groups, control for potential confounders, and overcome limitations associated with included studies.

  3. HERBS IN PREGNANCY AND LACTATION: A REVIEW APPRAISAL

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    Poonam Shinde*, Pankaj Patil and Vinod Bairagi

    2012-09-01

    Full Text Available Pregnancy can be the most paranormal and exciting time for expectant mother. Nature provides us with many tools for supporting both the mother and baby through this time of growth and renewal, to strengthen the spirits and body to promote a healthy pregnancy and birthing process. Pregnant and lacting mother need to be educated on the need for caution when using herbs during pregnancy and lactation particularly in view of lack of complete information. The women self administer herbal medicines both before and after pregnancy often without any recognition of their potential hazards. The use of herbal supplements in pregnancy and lactation is likely to be relatively high and its importance ascertains what supplements women are taking. Pregnancy and lactation care providers should be aware of common herbal supplements used by women and of evidence regarding potential benefits or harm. Midwives and obstetricians have an obligation to facilitate women’s wishes without condemnation, but this must be tempered with accurate information to ensure that use of herbal remedies in pregnancy and breastfeeding is not only appropriate but also safe if use with proper caution. The herbs listed in this review are recommended by experienced herbalist and have been used safely by women for centuries.

  4. História natural das gestações gemelares monocoriônicas diamnióticas com e sem transfusão feto-fetal Natural history of monochorionic diamniotic twin pregnancies with and without twin-twin transfusion syndrome

    Directory of Open Access Journals (Sweden)

    Cleisson Fábio Andrioli Peralta

    2009-06-01

    Full Text Available OBJETIVO: avaliar a evolução de gestações gemelares monocoriônicas diamnióticas com e sem síndrome de transfusão feto-fetal (STFF, acompanhadas de forma expectante. MÉTODOS: estudo retrospectivo no qual as gestações sem e com STFF e com as formas leve (estágio I de Quintero e grave (estágios II, III, IV e V de Quintero da doença foram comparadas quanto a parto pré-termo extremo, comprometimento neurológico e alta dos gêmeos do berçário. Os gêmeos pré-termo extremo que tiveram ou não STFF foram comparados quanto à ocorrência de comprometimento neurológico. Foram utilizados os testes do χ2 ou exato de Fisher. RESULTADOS: quinze entre 149 gestações gemelares monocoriônicas diamnióticas apresentaram STFF, 11 (11/15-73,3% na forma grave e 4 (4/15-26,7% no estágio I. O parto pré-termo extremo foi mais frequente (pPURPOSE: to evaluate the evolution of monochorionic-diamniotic twin pregnancies with and without the twin-twin transfusion syndrome (TTTS, followed up in an expectant way. METHODS: retrospective study in which the pregnancies with and without TTTS and with mild (Quintero's stage I and severe (Quintero's stages II, III, IV and V disease manifestations were compared according to extreme preterm delivery, neurological impairment and the twins' nursery discharge. The extreme preterm twins who had had TTTS, or not, were compared whether they had or not neurological impairment. The χ2 or Fisher's exact test were used. RESULTS: among 149 monochorionic-diamniotic twin pregnancies, 15 presented TTTS, 11 (11/15 - 73.3% in the severe form and 4 (4/15 - 26.7% at stage I. The extreme preterm delivery was more frequent (p<0.001 in the cases with the disease (11/15 - 73.3% than in the cases without it (25/134 - 18.7%, and more common (p=0.033 in severe (10/11 - 91.1% than in mild cases (1/4 - 25.0%. Neurological impairment in at least one twin was more frequent in cases with (5/8 - 62.5% than in cases without (9/134 - 6

  5. A review of teenage pregnancy research in Malaysia.

    Science.gov (United States)

    Mohd Azri, M S; Adibah, H I; Haliza, G

    2015-08-01

    To summarise the published research on teenage pregnancy in Malaysia, discuss the impact of the findings on clinical practice, and identify gaps in teenage pregnancy research in Malaysia. There were 31 articles related to teen pregnancy found after searching a database dedicated to indexing all original clinical research data published in Malaysia from year 2000 to 2014. Twenty-seven articles (including reports from the National Obstetrics Registry) were selected and reviewed on the basis of clinical relevance and future research implications. This literature review has been divided into eight sections: epidemiology, age at first marriage, adolescent fertility rate, unmarried childbearing, risk factors, maternal risks and neonatal outcome, future plan after delivery, and contraceptive use. More than 19,000 births to teenage mothers were recorded each year between 2009 and 2011. Adolescent fertility rates were recorded at 6 births per 1000 women ages 15-19 years in 2013. Many of these births were from unwed pregnancies, which accounted for 1.99% of total deliveries. A majority of young mothers were willing to take care of their baby, although some of them planned to put their baby up for adoption. Risk factors for teenage pregnancy were found to be similar to those published in studies worldwide. More research is needed to better understand the issue of teen pregnancy. For the best results, collaborative studies among nationwide hospitals and institutions should be the way forward.

  6. Pregnancy

    DEFF Research Database (Denmark)

    Palmer, Keith T; Bonzini, Matteo; Bonde, Jens Peter Ellekilde;

    2013-01-01

    Most pregnant women are exposed to some physical activity at work. This Concise Guidance is aimed at doctors advising healthy women with uncomplicated singleton pregnancies about the risks arising from five common workplace exposures (prolonged working hours, shift work, lifting, standing and heavy...... physical workload). The adverse outcomes considered are: miscarriage, preterm delivery, small for gestational age, low birth weight, pre-eclampsia and gestational hypertension. Systematic review of the literature indicates that these exposures are unlikely to carry much of an increased risk for any...... on pregnancy. Moreover, moderate physical exercise is thought to be healthy in pregnancy and most pregnant women undertake some physical work at home. The guidelines provide risk estimates and advice on counselling....

  7. Contemporary uses of erythropoietin in pregnancy: a literature review.

    Science.gov (United States)

    Sienas, Laura; Wong, Tienne; Collins, Rebecca; Smith, James

    2013-08-01

    The objectives of this study were to survey the current research and provide an update on the uses and benefits of erythropoietin (EPO) in pregnancy and the postpartum period. A review of MEDLINE (1947 to present) was performed. Search terms included "erythropoietin," "pregnan*," with subheadings of "administration & dosage," "pharmacokinetics," "therapeutic use," "fetus," "fertility." We reviewed relevant articles published from 2002 to 2012. Case reports, observational studies, case-control studies, randomized controlled trials, retrospective analyses, animal studies, and review articles were included. Articles were selected if they discussed a use of EPO in pregnancy or the immediate postpartum period, as well as use of EPO in the neonate. Authors independently reviewed and extracted data. Of the 65 articles reviewed, 45 were included. Erythropoietin was used in the treatment of maternal anemia. Because of the molecule's large size, recombinant EPO does not appear to cross the placenta. No fetal morbidity or mortality was noted. Therefore, this is a safe therapy that can be used in pregnancy. Use of EPO may be especially important for women who decline blood products. Neonatal uses of EPO show benefit in the treatment of anemia due to blood type incompatibility. Erythropoietin is gaining popularity as a therapeutic option during pregnancy and the postpartum period. Further investigation is needed to establish a standard dosage and dosing interval. New studies reviewing its use in the neonate for perinatal-hypoxic injury and anemia due to blood type incompatibility provide exciting opportunities for further therapeutic use. Obstetricians and gynecologists, family physicians. After completing this CME activity, physicians should be better able to treat anemia in pregnancy, including causes and interventions; assess renal disease in pregnancy, targets of hemoglobin, precautions, and treatment considerations; and evaluate erythropoietin use in neonates and fetuses

  8. Hypertension in pregnancy: a review of therapeutic options.

    Science.gov (United States)

    Kernaghan, D; Duncan, A C; McKay, G A

    2012-06-01

    Hypertensive disorders in pregnancy are common and can occur as a result of pre-existing hypertension or as new onset hypertension usually in the second half of pregnancy. In either situation there is potential for considerable perinatal and maternal morbidity and mortality. This review article aims to compare therapeutic options outlined in a selection of national guidelines and to look in more detail at the most commonly prescribed drugs - labetalol, methyldopa and nifedipine - with respect to their pharmacology and the evidence for their use in pregnancy. We will also consider the rationale for identifying and treating hypertension in pregnancy and the effect this can have on short- and long-term maternal and neonatal outcomes.

  9. Predicting adverse obstetric outcome after early pregnancy events and complications: a review

    DEFF Research Database (Denmark)

    van Oppenraaij, R H F; Jauniaux, E; Christiansen, O B

    2009-01-01

    score after detection of an intrauterine haematoma, the risk of VPTD and intrauterine growth restriction after a crown-rump length discrepancy, the risk of VPTD, LBW and VLBW after a vanishing twin phenomenon and the risk of PTD, LBW and low 5-min Apgar score in a pregnancy complicated by severe...... pregnancy with an OR > 2.0 after complications in the index pregnancy are the risk of LBW and very low birthweight (VLBW) after a threatened miscarriage, the risk of pregnancy-induced hypertension, pre-eclampsia, placental abruption, preterm delivery (PTD), small for gestational age and low 5-min Apgar...

  10. Twin Pregnancy Obtention of Patient with Nonmosaic Klinefelter’s Syndrome and His Wife with Chromosome 9 Inversion by ICSI Treatment

    Directory of Open Access Journals (Sweden)

    Yueyue Hu

    2013-01-01

    Full Text Available A 24-year-old man was diagnosed with klinefelter’s syndrome (KS and his wife wasfound to have an inversion on chromosome 9-46, XX, inv (9 (p11q21- because of infertility.Intracytoplasmic sperm injection (ICSI was performed for fertilization after fluorescencein-situ hybridization (FISH was used to analyze the aneuploidy rate of the Xand Y chromosomes of the ejaculated sperms of the patient, and 99 sperms were haploidamong 100 sperms that were to be analyzed. A twin pregnancy was achieved. The chromosomesof the two fetuses were identified as 46, XY and 46, XY, inv (9(p11q21 after aprenatal diagnosis at 18 weeks gestation. Two healthy twins were born through caesareansection at 32 weeks gestation because of premature rupture of membranes (PROM.

  11. Contemporary management of complicated monochorionic twins.

    Science.gov (United States)

    Moise, Karen Y; Kugler, Lisa; Jones, Tyra

    2012-01-01

    Monochorionic twins are at increased risk for unique complications including twin-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), and twin-reversed arterial perfusion (TRAP) sequence. Twin-twin transfusion syndrome is treated with laser photocoagulation whereas selective reduction is an option in previable sIUGR or TRAP sequence. The nurse is integral in the management, education, care and support of women with complicated pregnancies. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  12. Pregnancy outcome and ultraviolet radiation; A systematic review.

    Science.gov (United States)

    Megaw, Lauren; Clemens, Tom; Dibben, Chris; Weller, Richard; Stock, Sarah

    2017-05-01

    Season and vitamin D are indirect and direct correlates of ultraviolet (UV) radiation and are associated with pregnancy outcomes. Further to producing vitamin D, UV has positive effects on cardiovascular and immune health that may support a role for UV directly benefitting pregnancy. To investigate the effects of UV exposure on pregnancy; specifically fetal growth, preterm birth and hypertensive complications. We conducted a systematic review of Medline, EMBASE, DoPHER, Global Health, ProQuest Public Health, AustHealth Informit, SCOPUS and Google Scholar to identify 537 citations, 8 of which are included in this review. This review was registered on PROSPERO and a. narrative synthesis is presented following PRISMA guidance. All studies were observational and assessed at high risk of bias. Higher first trimester UV was associated with and improved fetal growth and increased hypertension in pregnancy. Interpretation is limited by study design and quality. Meta-analysis was precluded by the variety of outcomes and methods. The low number of studies and risk of bias limit the validity of any conclusions. Environmental health methodological issues are discussed with consideration given to design and analytical improvements to further address this reproductive environmental health question. The evidence for UV having benefits for pregnancy hypertension and fetal growth is limited by the methodological approaches utilized. Future epidemiological efforts should focus on improving the methods of modeling and linking widely available environmental data to reproductive health outcomes. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  13. Analysis of Clinical Data of 177 Patients with Preterm Twin Pregnancies%双胎妊娠早产177例临床分析

    Institute of Scientific and Technical Information of China (English)

    吴芹; 杨茵; 邱娜璇

    2011-01-01

    Objective To investigate the cause and delivery time and mode of preterm twin preg nancies. Methods Clinical data of twin pregnancies delivered in this hospital from 2000 to 2009 were col lected and analyzed, including 177 preterm twins and 208 term twins. Results Spontaneous preterm birth accounted for the most proportion of all preterm twins, Iatrogenic preterm birth was the second a mong the late preterm twins(P<0. 05) ;There was significant difference in both caesarean and vaginal de livery rates of twin pregnancy at different gestational age(P<0.05); The incidence of single intrauterine demise, discordant fetal growth and small for gestational age showed statistical difference among three groups; The lower Apgar score rates and mortality rates in twins decreased with the increase of gestational age. Conclusion Spontaneous preterm birth is the main cause of preterm delivery in twins. The deliv ery mode of twins should be considered comprehensively. Selection of appropriate delivery gestations is thne important measures to improve the neonatal outcomes.%目的 探讨双胎妊娠早产的病因、终止妊娠的方式和时机.方法 对2000年1月-2009年12月双胎妊娠病例资料进行回顾性分析.双胎早产共177例,其中早期早产组(A组)72例,晚期早产组(B组)105例;选择双胎足月产208例为对照组(C组).结果 双胎早产发生原因以自发性早产为首位,晚期早产中医源性早产比率高于早期早产组,差别有统计学意义(P<0.05);双胎妊娠剖宫产率及阴道分娩率在不同孕周组间差异有统计学意义(P<0.05);3组一胎宫内死胎率、生长不一致率和小于孕龄儿率均不同,差别有统计学意义(P<0.05);随着分娩孕周的增加,双胎儿低Apgar评分率及死亡率下降.结论 双胎早产的主要原因为自发性早产;其分娩方式应综合决定.为改善围产儿结局,应选择适宜的分娩孕周.

  14. Screening for trisomy 21 in twins using first trimester ultrasound and maternal serum biochemistry in a one-stop clinic: a review of three years experience.

    Science.gov (United States)

    Spencer, Kevin; Nicolaides, Kypros H

    2003-03-01

    To evaluate the performance of screening for fetal trisomy 21 in the first trimester of twin pregnancies by a combination of maternal serum biochemistry and ultrasonography. Three year retrospective review of screening performance. District General Hospital maternity unit. All women booked to receive routine antenatal care at Harold Wood Hospital between 1 June 1998 and 30th September 2001. The population included 13,940 women of all ages presenting with pregnancies between 10 weeks 3 days and 13 weeks 6 days gestation. Of these, 230 had a twin pregnancy. Women booked into the clinic were offered screening using a combination of maternal serum free beta-hCG and pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal translucency thickness. Women at increased risk of carrying a fetus with trisomy 21 or trisomy 13/18 (>/=1 in 300 at sampling) were offered counselling and an invasive diagnostic procedure. Follow up of the outcome of all pregnancies was carried out. For women who on examination were at 14 weeks of gestation or greater, or for women presenting as late bookers beyond 14 weeks, screening was performed in the same time frame using only maternal serum free beta-hCG and alpha-fetoprotein. The first trimester detection rate for trisomy 21 and all aneuploides, false positive rate, uptake of screening, uptake of invasive testing in women identified at increased risk and fetal loss rates after invasive testing. Overall, 97.4% of the women with twins (224/230) accepted first trimester screening. The rate of detection of trisomy 21 was 75% (3/4). Fetal death at presentation was found in 3.4% of fetuses (16/460). Of women who accepted screening, 4.3% (10/230) presented too late for fetal nuchal translucency measurement and 10.0% of women (23/230) presented too early. A risk for trisomy 21 was calculated for each fetus based on the individual fetal nuchal translucency thickness and the maternal biochemistry. The false positive rate among those eligible for

  15. Gestação múltipla com óbito de um gêmeo Twin pregnancy with one fetal beath

    Directory of Open Access Journals (Sweden)

    Diva de Amorim Novais

    1999-05-01

    Full Text Available Objetivo: avaliar retrospectivamente aspectos obstétricos e perinatais da gestação múltipla com a morte de um dos fetos. Métodos: estudo retrospectivo incluindo 26 gestantes com gestação múltipla com óbito de um gêmeo. Foi tomada conduta conservadora e acompanhamento clínico com coagulograma. Resultados: em 50% dos casos o óbito fetal ocorreu entre 20 e 32 semanas de gestação. O período entre o óbito e a resolução da gravidez variou de 6 horas até 148 horas. Em dois casos ocorreu óbito do outro gemelar. Em 15 casos o gemelar sobrevivente teve boa evolução e apenas um apresentou seqüela neurológica discreta. Em outros nove casos o outro gemelar foi a óbito após o nascimento. Nenhuma gestante desenvolveu quadro de distúrbio da coagulação. Conclusão: a conduta conservadora é vantajosa para o gêmeo sobrevivente, desde que a mãe e feto sejam mantidos sob observação.Purpose: to evaluate retrospectively the obstetrical and perinatal aspects of multiple pregnancies with the death of one fetus. Methods: a retrospective study on 26 pregnant women with multiple pregnancies and death of one twin. A conservative approach was followed and the patients were followed-up clinically with blood clotting tests. Results: in 50% of the cases fetal death occurred between 20 and 32 weeks of pregnancy. The time between death and resolution of pregnancy ranged from 6 to 148 h. Death of the other twin occurred in two cases. In 15 cases, the surviving twin had a good course, with two of them presenting slight neurological sequelae. In the other nine cases the other twin died after birth. No pregnant woman developed coagulation disorders.

  16. Risks of miscarriage or preterm delivery in trichorionic and dichorionic triplet pregnancies with embryo reduction versus expectant management: a systematic review and meta-analysis.

    Science.gov (United States)

    Anthoulakis, C; Dagklis, T; Mamopoulos, A; Athanasiadis, A

    2017-06-01

    Is pregnancy outcome in triplet pregnancies improved with embryo reduction (ER) to twins compared to expectant management? In trichorionic triplet pregnancies, ER to twins reduces the risk of preterm birth (preterm birth. ER can ameliorate these conditions in higher order multiple gestations but is still controversial in triplets. This study aimed to conduct a systematic review, following the PRISMA guidelines, and critically appraise ER at 8-14 weeks of gestation in both trichorionic triamniotic (TCTA) and dichorionic triamniotic (DCTA) pregnancies. Selective ER to twins was compared with expectant management, focusing on the risks of miscarriage and preterm birth. The computerized database search was performed on 8 January 2017. Overall, from 25 citations of relevance, eight studies with a total of 249 DCTA and 1167 TCTA pregnancies fulfilled the inclusion criteria. A comprehensive computerized systematic literature search of all English language studies between 2000 and 2016 was performed in PubMed, EMBASE, Scopus, Evidence Based Medicine Reviews (Cochrane Database and Cochrane Central Register of Controlled Trials) and Google Scholar. Relevant article reference lists were hand searched. The management options were compared for rates of miscarriage preterm birth preterm birth were 7.4 and 50.2%, respectively. Meta-analysis demonstrated that ER to twins in TCTA pregnancies (n = 666) was associated with a lower risk (17.3 versus 50.2%) of preterm birth (RR = 0.36, 95% CI: 0.28-0.48), whereas the risk of miscarriage (8.1% versus 7.4%) did not significantly increase (RR = 1.08, 95% CI: 0.58-1.98). In DCTA triplets managed expectantly (n = 200), the rates of miscarriage and preterm birth were 8.5 and 51.9%, respectively. Although the meta-analysis was inconclusive, it suggested that ER to twins in DCTA triplets, either of the foetus with a separate placenta (n = 15) or one of the monochorionic pair (n = 34), was neither significantly associated with an

  17. Personality and birth order in monozygotic twins adopted apart: a test of Sulloway's theory; Research Reviews: twin births and cancer risk in mothers, male sexual dysfunction, twin study of ultimatum game behavior; Human Interest: 'The Land of Twins', twin-like reunion-I, twin-like reunion-II.

    Science.gov (United States)

    Segal, Nancy L

    2008-02-01

    A brief overview of Sulloway's (1996) theory of birth order and personality is presented. A reared apart twin approach for testing his personality findings regarding openness to experience and conscientiousness in first borns and later borns is described. This is followed by summaries of three recent twin studies. The topics include cancer risk in mother of twins, sexual dysfunction in males and responder behavior during ultimatum games. This article concludes with a discussion of twinning rates and rituals among the Yoruba of western Nigeria, and descriptions of two unusual reunions between siblings and twins.

  18. Some Aspects of High Manganese Twinning-Induced Plasticity (TWIP) Steel, A Review

    Institute of Scientific and Technical Information of China (English)

    Liqing CHEN; Yang ZHAO; Xiaomei QIN

    2013-01-01

    High manganese twinning-induced plasticity (TWIP) steel is a new kind of structural material and possesses both high strength and superior plasticity and can meet the weight-lightening requirement for manufacturing vehicle body.The excellent formability of the TWIP steel comes from the extraordinary strain hardening effect during plastic deformation.The reduction of specific weight by aluminum alloying and strain hardening effect can lead to an effective weight reduction of the steel components,and provide a better choice for materials in vehicle body design.The TWIP effect in high Mn steels is generally associated with the successive workhardening generated by twins and influenced by some factors,such as Mn content,AI addition revealed by stacking fault energy (SFE),grain size,deformation temperature and strain rate.The present review introduces some aspects of the TWIP steels relating to their physical metallurgy,influencing factors associated with their deformation mechanisms,and a prospect for the future investigation is also described.Moreover,as a potential candidate for replacing Ni-Cr austenitic stainless steel,researches on the oxidation behavior and corrosion resistance of Fe-Mn-AI-C system steels are also reviewed.

  19. Intrahepatic cholestasis of pregnancy: a critical clinical review.

    Science.gov (United States)

    Gabzdyl, Elizabeth M; Schlaeger, Judith M

    2015-01-01

    Intrahepatic cholestasis of pregnancy is the most common liver disease of pregnancy. It is characterized by pruitus, elevated levels of maternal serum bile salts, and normal or mildly elevated liver enzymes occurring after 30 weeks of pregnancy. The primary risks associated with this condition include preterm delivery, meconium-stained amniotic fluid, and stillbirth. Management of intrahepatic cholestasis of pregnancy utilizes a 2-prong approach of oral medications and comfort measures along with active management close to term. The goal of active management has been to deliver women between 37 and 39 weeks of gestation in order to prevent the risk of stillbirth. Currently, expert opinions vary as to recommendations for fetal surveillance and induction of labor. Controversy exists as to whether there is an increased incidence of stillbirth between 37 and 39 weeks of gestation. This critical clinical review is a comprehensive overview of intrahepatic cholestasis of pregnancy, including background, controversies, and care of the pregnant woman with this condition and how to provide appropriate follow-up care later after delivery.

  20. 双胎胎儿生长不一致妊娠结局的探讨分析%Clinical observation on perinatal outcome in discordant twin pregnancies

    Institute of Scientific and Technical Information of China (English)

    王佳蓉

    2014-01-01

    ObjectiveTo analyze the perinatal outcomes of growth discordant in twins pregnancy. MethodsA retrospective analysis of clinical data was conducted in 24 cases of twin babies who were admitted in our hospital from January 2011 to January 2014, and the 24 cases were divided groups:observation group(14 cases) and control group(10 cases). Twin pairs whose birth weight difference was 20% or more were designated as discordant twins. To compare the difference between of the pairs.ResultsThe perinatal mortality in observation group was significantly higher than that in control group(P0.05). Neonatal occupancy rate in NICU and complication rate were obviously higher in observation group than that in the control group, and there was significant difference(P20%为诊断标准,分为观察组14例和对照组10例(发育一致性),比较两组间孕妇的一般情况。结果观察组并发围生儿死亡率明显高于对照组(P0.05);观察组新生儿入住NICU比率明显高于对照组,两组比较差异有统计学意义(P<0.05)。观察组并发症发生率高于对照组(P<0.05)。结论发育不一致性双胎妊娠并发症及围生儿患病率和死亡率明显高于发育一致性双胎,及早发现和处理双胎发育不一致,是改善胎儿和新生儿预后的关键。

  1. 双胎妊娠一胎宫内死亡18例临床分析%18 cases of Twin Pregnancy Complicated by Single Intrauterine Fetal Death

    Institute of Scientific and Technical Information of China (English)

    史宏; 顾玮; 刘春敏; 孟瑜; 蔡彦卿

    2012-01-01

    Objective: To investigate the cause and factors of the mother and fetus survival in single intrauterine fetal death complicated by twin pregnancy and clinical treatments. Methods: To collect 18 cases of twin pregnancy complicated by single intrauterine fefal death in our hospital from January 2001 to October 2011 and their clinical data were retrospectively analyzed. Results: Single intrauterine fetal death accounted for 1.08% in twin pregnancy, in which 11 cases (61.11%) were monochorionic-diamniotic twin (MCDA), and 7 cases dichorionic-diamniotic twin (DCDA) (38.89%). The cause of fetal death: 3 cases of Placental umbilical cord factor (16.67%),1 case of fetal malformation (5.56%), 3 cases pregnancy complications (16.67%), 3 cases twin-twin transfusion syndrome (TTTs) (16.67 %), 3 cases intrauterine infection (16.67%), and unknown causes in 5 cases (27.78%). Cesarean section was the delivery mode in 15 cases, and 3 cases vaginal delivery. Little effect was on mother's coagulation in twin pregnancy after single intrauterine fetal death (P> 0.05). Conclusions: There were differences in the maternal and fetal outcome between DCDA and MCDA. A lot of impact on the mother and survival fetus occurred after single intrauterine fetal death in twin pregnancy. Expectant therapy was an effective choice for twin pregnancy complicated by single intrauterine death before delivery because the small gestational age and immature fetus.%目的:探讨双胎妊娠中一胎宫内死亡的原因、对母亲和存活胎儿的影响及临床处理方法.方法:对2001年1月至2011年10月分娩的双胎妊娠之一胎宫内死亡的18例产妇临床资料进行回顾性分析.结果:双胎妊娠一胎宫内死胎的发生率占双胎的1.08%,其中单绒毛膜双羊膜囊双胎(monochorioniC-diamniotic twin,MCDA)11例(61.11%),双绒毛膜双羊膜囊双胎(dichorionicdiamniotic twin,DCDA)7例(38.89%).胎儿死因:胎盘脐带因素3例(16.67%),胎儿畸形1例(5.56

  2. Pregnancy Outcome of Abnormal Nuchal Translucency: A Systematic Review.

    Science.gov (United States)

    Roozbeh, Nasibeh; Azizi, Maryam; Darvish, Leili

    2017-03-01

    Nuchal Translucency (NT) is the sonographic form of subcutaneous gathering of liquid behind the foetal neck in the first trimester of pregnancy. There is association of increased NT with chromosomal and non-chromosomal abnormalities. The purpose of this systemic review was to review the pregnancy outcome of abnormal nuchal translucency. The present systematic review was conducted by searching English language articles from sources such as International Medical Sciences, Medline, Web of science, Scopus, Google Scholar, PubMed, Index Copernicus, DOAJ, EBSCO-CINAHL. Persian articles were searched from Iranmedex and SID sources. Related key words were "outcome", "pregnancy", "abnormal", and "Nuchal Translucency" (NT). All, randomized, descriptive, analytic-descriptive, case control study conducted during 1997-2015 were included. Including duplicate articles, 95 related articles were found. After reviewing article titles, 30 unrelated article and abstracts were removed, and 65 articles were evaluated of which 30 articles were duplicate. Finally 22 articles were selected for final analysis. Exclusion criteria were, case studies and reports and quasi experimental designs. This evaluation has optioned negative relationship between nuchal translucency and pregnancy result. Rate of cardiac, chromosomal and other defects are correlated with increased NT≥2.5mm. Cardiac disease which were associated to the increased NT are heart murmur, systolic organic murmur, Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), tricuspid valve insufficiency and pulmonary valve insufficiency, Inferior Vena Cava (IVC) and Patent Ductus Arteriosus (PDA). The most common problems that related with increased NT were allergic symptoms. According to this systematic review, increased NT is associated with various foetal defects. To verify the presence of malformations, birth defect consultations with a perinatologist and additional tests are required.

  3. Comparison of prenatal ultrasound screening results and fetal health status of twin pregnancy and twin pregnancy in assisted reproductive technology%辅助生殖技术受孕双胎与自然受孕双胎的产前超声筛查结果及胎儿的健康状况比较观察

    Institute of Scientific and Technical Information of China (English)

    蒋华景; 郭津含; 陈静; 林丽璇; 熊剑

    2016-01-01

    Objective To compare the prenatal ultrasound screening results and fetal health status of twin pregnancy and twin pregnancy in assisted reproductive technology (ART). Methods 90 cases of pregnant women with twin pregnancy after ART from January 2011 to June 2015 were selected as observation group, 100 cases of spontaneous twin pregnant women were selected as control group. The relevant data of prenatal ultrasound examination and fetal situation were collected, and pregnancy outcome of the two groups were compared. Results Polyhydramnios, umbilical cord around the neck, the incidence of premature rupture of membranes rate, placenta previa incidence, anemia rate and postpartum hemorrhage incidence of the two groups had no significant difference (P 0.05). Twin transfusion syndrome incidence of observation group was significantly lower than that of control group (P 0.05). The average body weight of observation group was significantly higher than that of control group (P <0.05). Conclusion ART twin pregnancy does not increase the risk of perinatal complications. Compared to natural pregnancy, it has obvious advantages on amniotic fluid abnormalities, changes in the umbilical cord and the twin transfusion syndrome.%目的:比较辅助生殖技术受孕双胎与自然受孕双胎的产前超声筛查结果及胎儿的健康状况。方法选取2011年1月~2015年6月期间在我院应用辅助生殖技术(ART)怀孕双胎90例孕妇设为观察组,及同期自然受孕双胎100例孕妇为参照组,收集产前超声检测得到的相关数据以及胎儿情况,对比分析并比较两组的妊娠结局。结果两组在羊水过多、脐带绕颈发生率、胎膜早破发生率、前置胎盘发生率、贫血发生率和产后出血发生率等方面比较无显著差异(P<0.05);观察组平均羊水量显著多于参照组,羊水过少、脐带附着位置变化发生率显著低于参照组(P<0.05)。两组患者胎儿畸形率、

  4. Lactation Biology Symposium: maternal nutrition during early and mid-to-late pregnancy: Comparative effects on milk production of twin-born ewe progeny during their first lactation.

    Science.gov (United States)

    Paten, A M; Kenyon, P R; Lopez-Villalobos, N; Peterson, S W; Jenkinson, C M C; Pain, S J; Blair, H T

    2013-02-01

    Studies using sheep models indicate that the fetal mammary gland is sensitive to maternal nutrition during gestation; however, results have been inconsistent and do not identify critical feeding periods. This study aimed to clarify previous findings by partitioning the period of maternal nutritional manipulation into 2 stages: early and mid-to-late pregnancy. Sixty-six twin-born, twin-bearing ewes, born to dams that were fed either submaintenance, maintenance, or ad libitum during early pregnancy (d 21 to 50 of pregnancy; SmP21-50, MP21-50, or AdP21-50, respectively) and then either maintenance or ad libitum during mid-to-late pregnancy (d 50 to 140 of pregnancy; MP50-140 or AdP50-140, respectively) were milked once a week, starting from d 7 ± 1 postpartum, for 7 subsequent weeks to enable estimation of daily milk yield and composition. Their lambs were weighed weekly. Ewes born to dams fed MP21-50 tended to have greater accumulated milk (P = 0.10), fat (P = 0.07), and NE (P = 0.06) yields over 50 d compared with ewes born to dams fed SmP21-50 and AdP21-50. In contrast, ewes born to dams fed AdP50-140 tended to have greater accumulated milk (P = 0.10) and lactose (P = 0.09) yields compared with ewes born to dams fed MP50-140. Grandoffspring birth weights were unaffected by granddam nutrition during pregnancy. Ewes born to dams fed AdP21-50 weaned lighter lambs (P = 0.05) than ewes born to dams fed AmP21-50 and tended to wean lighter lambs (P = 0.07) than ewes born to dams fed MP21-50 whereas there were no differences between the weaning weights of lambs (P = 0.43) from ewes born to dams fed AdP50-140 and MP50-140. Maintenance nutrition of dams during early pregnancy appears to be associated with an improved lactation performance of ewe offspring. Higher levels of nutrition during mid-to-late pregnancy also appears to improve the first-lactation performance of ewe offspring. Interestingly, although grandoffspring birth weights were unaffected, weaning weight

  5. Imperfect twinning: a clinical and ethical dilemma

    Science.gov (United States)

    Denardin, Daniela; Telles, Jorge Alberto B.; Betat, Rosilene da Silveira; Fell, Paulo Renato K.; da Cunha, André Campos; Targa, Luciano Vieira; Zen, Paulo Ricardo G.; Rosa, Rafael Fabiano M.

    2013-01-01

    OBJECTIVE To review the history, epidemiology, etiology, gestational aspects, diagnosis and prognosis of imperfect twinning. DATA SOURCES Scientific articles were searched in PubMed, SciELO and Lilacs databases, using the descriptors "conjoined twins", "multiple pregnancy", "ultrasound", "magnetic resonance imaging" and "prognosis". The research was not delimited to a specific period of time and was supplemented with bibliographic data from books. DATA SYNTHESIS: The description of conjoined twins is legendary. The estimated frequency is 1/45,000-200,000 births. These twins are monozygotic, monochorionic and usually monoamniotic. They can be classified by the most prominent fusion site, by the symmetry between the conjoined twins or by the sharing structure. The diagnosis can be performed in the prenatal period or after birth by different techniques, such as ultrasound, magnetic resonance imaging and echocardiography. These tests are of paramount importance for understanding the anatomy of both fetuses/children, as well as for prognosis and surgical plan determination. CONCLUSIONS Although imperfect twinning is a rare condition, the prenatal diagnosis is very important in order to evaluate the fusion site and its complexity. Hence, the evaluation of these children should be multidisciplinary, involving mainly obstetricians, pediatricians and pediatric surgeons. However, some decisions may constitute real ethical dilemmas, in which different points should be discussed and analyzed with the health team and the family. PMID:24142323

  6. Imperfect twinning: a clinical and ethical dilemma.

    Science.gov (United States)

    Denardin, Daniela; Telles, Jorge Alberto B; Betat, Rosilene da Silveira; Fell, Paulo Renato K; Cunha, André Campos da; Targa, Luciano Vieira; Zen, Paulo Ricardo G; Rosa, Rafael Fabiano M

    2013-09-01

    OBJECTIVE To review the history, epidemiology, etiology, gestational aspects, diagnosis and prognosis of imperfect twinning. DATA SOURCES Scientific articles were searched in PubMed, SciELO and Lilacs databases, using the descriptors "conjoined twins", "multiple pregnancy", "ultrasound", "magnetic resonance imaging" and "prognosis". The research was not delimited to a specific period of time and was supplemented with bibliographic data from books. The description of conjoined twins is legendary. The estimated frequency is 1/45,000-200,000 births. These twins are monozygotic, monochorionic and usually monoamniotic. They can be classified by the most prominent fusion site, by the symmetry between the conjoined twins or by the sharing structure. The diagnosis can be performed in the prenatal period or after birth by different techniques, such as ultrasound, magnetic resonance imaging and echocardiography. These tests are of paramount importance for understanding the anatomy of both fetuses/children, as well as for prognosis and surgical plan determination. CONCLUSIONS Although imperfect twinning is a rare condition, the prenatal diagnosis is very important in order to evaluate the fusion site and its complexity. Hence, the evaluation of these children should be multidisciplinary, involving mainly obstetricians, pediatricians and pediatric surgeons. However, some decisions may constitute real ethical dilemmas, in which different points should be discussed and analyzed with the health team and the family.

  7. Imperfect twinning: a clinical and ethical dilemma

    Directory of Open Access Journals (Sweden)

    Daniela Denardin

    2013-09-01

    Full Text Available OBJECTIVE To review the history, epidemiology, etiology, gestational aspects, diagnosis and prognosis of imperfect twinning. DATA SOURCES Scientific articles were searched in PubMed, SciELO and Lilacs databases, using the descriptors "conjoined twins", "multiple pregnancy", "ultrasound", "magnetic resonance imaging" and "prognosis". The research was not delimited to a specific period of time and was supplemented with bibliographic data from books. DATA SYNTHESIS: The description of conjoined twins is legendary. The estimated frequency is 1/45,000-200,000 births. These twins are monozygotic, monochorionic and usually monoamniotic. They can be classified by the most prominent fusion site, by the symmetry between the conjoined twins or by the sharing structure. The diagnosis can be performed in the prenatal period or after birth by different techniques, such as ultrasound, magnetic resonance imaging and echocardiography. These tests are of paramount importance for understanding the anatomy of both fetuses/children, as well as for prognosis and surgical plan determination. CONCLUSIONS Although imperfect twinning is a rare condition, the prenatal diagnosis is very important in order to evaluate the fusion site and its complexity. Hence, the evaluation of these children should be multidisciplinary, involving mainly obstetricians, pediatricians and pediatric surgeons. However, some decisions may constitute real ethical dilemmas, in which different points should be discussed and analyzed with the health team and the family.

  8. Nursing Experience of 1 Case of Twin Pregnancy Acute Fatty Liver combined with DIC%双胎妊娠期急性脂肪肝合并DIC 1例的护理体会

    Institute of Scientific and Technical Information of China (English)

    陶园; 潘爱红; 李业桂; 胡晓鸥; 满萌; 贾金丽

    2014-01-01

    To review the treatment and nursing care of acute fatty liver with DIC in 1 cases of twin pregnancy experience.the late pregnant women pay attention to AFLP,doctors with the rapid termination of pregnancy,at the same time, disseminated intravascular Coagulation (DIC) treatment and nursing and postpartum hemorrhage, strengthen the treatment of artificial liver (plasma exchange) and first aid care,can significantly improve the prognosis.%回顾1例双胎妊娠期急性脂肪肝合并弥散性血管内凝血(DIC)的抢救与护理体会。通过对妊娠晚期孕妇急性脂肪肝(AFLP)配合医生迅速终止妊娠,同时做好DIC及产后出血的抢救与护理,加强人工肝治疗(血浆置换)的急救与护理,预后可明显改善。

  9. The Application of Ultrasound Technology in Diagnosis of Abnormal Twin Pregnancy%超声技术在异常双胎妊娠诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    侯彩霞; 梅红; 黄秀英; 程广婷

    2013-01-01

    目的探讨超声技术在异常双胎妊娠诊断中的价值。方法对2009年1月~2012年12月在我院行超声检查的双胎异常妊娠孕妇的结果进行分析。结果经超声检查,30例孕妇双胎异常妊娠的详细情况均得到了确认。结论超声诊断能够检出大部分胎儿畸形,在异常双胎妊娠的筛查中起着重要作用,可为临床提供可靠信息。%Objective To explore the diagnostic value of ultrasound technology in abnormal twin pregnancy. Methods Ultrasound results of abnormal twin pregnancy of pregnant women who were examined by ultrasound technology form 2009 to 2012 in obstetrical department in our hospital were analyzed. Results The detailed information of abnormal twin pregnancy of 30 cases were conifrmed by ultrasonic diagnosis. Conclusion Ultrasonic diagnosis which can detect most of the fetal abnormalities plays an important role in the screening of abnormal twin pregnancy, and can provide reliable information for clinical results.

  10. Depression screening and patient outcomes in pregnancy or postpartum : A systematic review

    NARCIS (Netherlands)

    Thombs, Brett D.; Arthurs, Erin; Coronado-Montoya, Stephanie; Roseman, Michelle; Delisle, Vanessa C.; Leavens, Allison; Levis, Brooke; Azoulay, Laurent; Smith, Cheri; Ciofani, Luisa; Coyne, James C.; Feeley, Nancy; Gilbody, Simon; Schinazi, Joy; Stewart, Donna E.; Zelkowitz, Phyllis

    2014-01-01

    Objective: Clinical practice guidelines disagree on whether health care professionals should screen women for depression during pregnancy or postpartum. The objective of this systematic review was to determine whether depression screening improves depression outcomes among women during pregnancy or

  11. Depression screening and patient outcomes in pregnancy or postpartum : A systematic review

    NARCIS (Netherlands)

    Thombs, Brett D.; Arthurs, Erin; Coronado-Montoya, Stephanie; Roseman, Michelle; Delisle, Vanessa C.; Leavens, Allison; Levis, Brooke; Azoulay, Laurent; Smith, Cheri; Ciofani, Luisa; Coyne, James C.; Feeley, Nancy; Gilbody, Simon; Schinazi, Joy; Stewart, Donna E.; Zelkowitz, Phyllis

    2014-01-01

    Objective: Clinical practice guidelines disagree on whether health care professionals should screen women for depression during pregnancy or postpartum. The objective of this systematic review was to determine whether depression screening improves depression outcomes among women during pregnancy or

  12. Depression screening and patient outcomes in pregnancy or postpartum : A systematic review

    NARCIS (Netherlands)

    Thombs, Brett D.; Arthurs, Erin; Coronado-Montoya, Stephanie; Roseman, Michelle; Delisle, Vanessa C.; Leavens, Allison; Levis, Brooke; Azoulay, Laurent; Smith, Cheri; Ciofani, Luisa; Coyne, James C.; Feeley, Nancy; Gilbody, Simon; Schinazi, Joy; Stewart, Donna E.; Zelkowitz, Phyllis

    Objective: Clinical practice guidelines disagree on whether health care professionals should screen women for depression during pregnancy or postpartum. The objective of this systematic review was to determine whether depression screening improves depression outcomes among women during pregnancy or

  13. Pregnancy after bariatric surgery - a review of benefits and risks

    DEFF Research Database (Denmark)

    Kjær, Mette Karie Mandrup; Nilas, Lisbeth

    2013-01-01

    Background. When other weight loss attempts have failed, bariatric surgery offers a successful alternative against obesity. Since operations are performed during women´s reproductive years, the number of pregnant women with prior bariatric surgery is increasing. Bariatric surgery results in restr......Background. When other weight loss attempts have failed, bariatric surgery offers a successful alternative against obesity. Since operations are performed during women´s reproductive years, the number of pregnant women with prior bariatric surgery is increasing. Bariatric surgery results...... in restriction of food intake and/or malabsorption leading to weight loss, but may induce a risk for malnutrition and pregnancy complications. Method. Systematically conducted review addressing pregnancy after bariatric surgery using the PubMed and Cochrane databases. Main Outcome Measures. Birthweight......, gestational age, birth defects, preeclampsia, gestational diabetes mellitus, and mode of delivery. Results. We included 17 articles in English, comparing pregnancies in women with prior bariatric surgery to pregnancies in a control group without this. There was considerable heterogeneity in study design...

  14. The adverse prognostic hallmarks in identical twins with Langerhans cell histiocytosis: a clinical report and literature review.

    Science.gov (United States)

    Chai, Damin; Tao, Yisheng; Bao, Zhengqi; Yang, Li; Feng, Zhenzhong; Ma, Li; Liang, Limei; Zhou, Xinwen

    2013-01-01

    Langerhans cell histiocytosis (LCH) is characterized by uncontrolled proliferation of Langerhans cells accompanying eosinophils. It often attacks children under 10 years of age. LCH in identical twins is very rare and its prognosis is different. Here we report identical-twin sisters with LCH. Computed tomography (CT) revealed osteolytic change in each twin's skull, and the elder exhibited poor eyesight. There were massive histiocyte-like cells surrounded by eosinophils in pathologic specimen of the abnormal lesions, which is typical pathologic finding in LCH. These pathologic cells were positive for S-100 and the cell surface protein CD1 antigen (CD1α), the known markers of LCH. After treating them with surgery, no symptoms were seen in the younger until now. While the older was found another soft mass (about 2.0 cm in diameter) in the left temporal area 18 months later. The same treatment was given to the older after admission, and she is healthy to date. To explore the relationship between hallmarks and the prognosis of identical-twin patients with LCH, we retrieved the 16 literatures (16 identical-twin pairs, 31 patients) listed in PubMed during the past 60 years. The data revealed all those patients who have disseminated to the bone marrow, spleen and liver with symptoms of fever and hepatosplenomegaly exhibited worse prognosis (9 out of the 31 patients). The other identical-twin subjects without infiltration of those organs recovered well. In conclusion, this study reveals the adverse hallmarks of prognosis in identical-twin patients with LCH by reviewing relevant literatures.

  15. 双胎妊娠分娩方式与妊娠结局120例临床分析%Impact of delivery on pregnancy outcome in twin pregnancy.

    Institute of Scientific and Technical Information of China (English)

    何建风; 王彩霞

    2011-01-01

    目的 探讨双胎妊娠的不同分娩方式对妊娠结局的影响.方法 对2008-2010年于我院分娩的120例双胎妊娠资料进行回顾性分析,其中剖宫产76例,阴道产44例.结果 孕周<34周的新生儿窒息率、病死率显著高于孕周>34周者,两者差异有统计学意义(P<0.01);阴道分娩组第2胎窒息率、死亡率显著高于第1胎,且与剖宫产组比较差异亦有统计学意义(P<0.01);两组孕周、产后出血差异无统计学意义(P>0.05).结论 与阴道产相比,双胎妊娠剖宫产可减少新生儿窒息率及死亡率.%Objective To explore the influence of delivery route on pregnancy outcome in twin pregnancy.Methods The date of 120 cases of twin pregnancy from 2008 to 2010 were retrospectively analyzed, among which 76 cases performed cesarean section and 44 underwent vaginal delivery. Results The rate of neonatal asphyxia and case fatality at 34 weeks of gestation, with statistical meaning (P<0.01); the rate of neonatal asphyxia and case fatality of second fetal were higher than that of first fetal,and had significantly difference with cesarean section cases (P<0.01); the weeks of gestation and postpartum hemorrhage had no striking difference between the two groups. Conclusion Compared with vaginal delivery, cesarean section for twin pregnancy can decrease the rate of neonatal asphyxia and case fatality.

  16. Monoamniotic twins with one fetal anencephaly and cord entanglement diagnosed with three dimensional ultrasound at 14 weeks of gestation.

    Science.gov (United States)

    Jo, Yun Sung; Son, Hyun Joo; Jang, Dong Gyu; Kim, Narinay; Lee, Guisera

    2011-01-01

    A 29-year-old pregnant woman with parity 0-0-0-0 was diagnosed with monoamniotic twin pregnancy discordant for anencephaly at 14 weeks gestation. Umbilical cord entanglement, which is an important cause of fetal death in monoamniotic twins, was confirmed by three-dimensional ultrasound. Cesarean section was performed at 34 weeks of gestation, and the normal newborn infant was discharged without any complications. We report a case of monoamniotic twin pregnancy discordant for anencephaly and diagnosed with cord entanglement by three-dimensional ultrasound at 14 weeks of gestation, and now report it along with a literature review.

  17. Monoamniotic Twins with One Fetal Anencephaly and Cord Entanglement Diagnosed with Three Dimensional Ultrasound at 14 Weeks of Gestation

    Directory of Open Access Journals (Sweden)

    Yun Sung Jo, Hyun Joo Son, Dong Gyu Jang, Narinay Kim, Guisera Lee

    2011-01-01

    Full Text Available A 29-year-old pregnant woman with parity 0-0-0-0 was diagnosed with monoamniotic twin pregnancy discordant for anencephaly at 14 weeks gestation. Umbilical cord entanglement, which is an important cause of fetal death in monoamniotic twins, was confirmed by three-dimensional ultrasound. Cesarean section was performed at 34 weeks of gestation, and the normal newborn infant was discharged without any complications. We report a case of monoamniotic twin pregnancy discordant for anencephaly and diagnosed with cord entanglement by three-dimensional ultrasound at 14 weeks of gestation, and now report it along with a literature review.

  18. Monochorionic-diamniotic discordant growth in a twin pregnancy with one fetus affected by Ebstein's anomaly of tricuspid leaflets.

    Science.gov (United States)

    Fukami, Tatsuya; Goto, Maki; Matsuoka, Sakiko; Sorano, Sumire; Tohyama, Atsushi; Yamamoto, Hiroko; Nakamura, Sumie; Matsuoka, Ryoei; Tsujioka, Hiroshi; Eguchi, Fuyuki

    2016-07-01

    Our patient was diagnosed as having discordant twin growth with Ebstein's anomaly in the larger fetus. Cardiac function was deteriorated in accordance with progression of gestational age. Our observation indicated cardiac failure of the larger fetus. The most important issue in this situation is management of the timing of delivery.

  19. Preliminary preventive protocol from first trimester of pregnancy to reduce preterm birth rate for dichorionic–diamniotic twins

    Directory of Open Access Journals (Sweden)

    Masako Matsui

    2017-02-01

    Conclusion: Even though this was a preliminary study, the results are promising, and we propose custom-made management for dichorionic–diamniotic twins: (1 earlier management from before 14 weeks; (2 high-risk selection for cervicitis and a short cervix; and (3 intervention with anti-inflammatory agents and cerclage if indicated.

  20. Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

    Directory of Open Access Journals (Sweden)

    Michelle L. Matthews

    2012-01-01

    Full Text Available Given the increases in 5-year cancer survival and recent advances in fertility preserving technologies, an increasing number of women with cancer are presenting for discussion of fertility preserving options. This review will summarize the risk of infertility secondary to cancer treatment, available treatment options for fertility preservation, and techniques to reduce future risks for patients. Concerns that will be addressed include the risk of the medications and procedures, the potential delay in cancer treatment, likelihood of pregnancy complications, as well as the impact of future pregnancy on the recurrence risk of cancer. Recent advances in oocyte cryopreservation and ovarian stimulation protocols will be discussed. Healthcare providers need to be informed of available treatment options including the risks, advantages, and disadvantages of fertility preserving options to properly counsel patients.

  1. Route of delivery and pregnancy outcome in 150 cases of twin pregnancy%双胎妊娠的分娩方式与妊娠结局150例

    Institute of Scientific and Technical Information of China (English)

    李蕙琴

    2008-01-01

    目的 探讨双胎妊娠分娩方式与妊娠结局的关系.方法 将1997年1月至2006年12月,150例双胎妊娠妇女按分娩方式分为阴道分娩组及剖宫产组,对其临床资料进行回顾性分析.结果 两组产后出血率差异无统计学意义,孕周及新生儿体重,剖宫产组显著高于阴道分娩组,新生儿窒息发生率,阴道分娩组显著高于剖宫产组,尤以阴道分娩组第2胎新生儿尤为显著,两胎儿分娩出生时间间隔>15 min者新生儿窒息发生率高.结论 正确选择双胎妊娠的分娩方式,将有助于降低新生儿窒息发生率.%Objective To study the relationship between delivery rout and pregnancy outcome in twin pregnancy.Methods 150 twin pregnancy women were divided into two groups,which were cesarean section and vaginal delivery from January 1998 to December 2005.Their data were analyzed retrospectively.Results There was no difference in postpartum hemorrhage of two groups in pregnant week and neonatal.Weight of cesarean section was higher than that of vagingal detivery the incidence of neonatal asphyxia in vaginal delivery was much highter than in cesarean section that the hightest of neonatal asphyxia of second fetal in vaginal delivery.Conclusion The right route of delivery can lower the incidence of secarean section and neonatal asphyxia.

  2. Successful fetoscopic laser coagulation for twin-to-twin transfusion syndrome under local anaesthesia.

    LENUS (Irish Health Repository)

    Cooley, S

    2011-06-01

    A review of the efficacy and outcome of fifteen fetoscopic laser ablations under local anaesthesia for twin to twin transfusion syndrome (TTTS) in the National Maternity Hospital Dublin was undertaken. The mean gestation at laser was 19.7 weeks (range 16-25 weeks) with a mean gestation at delivery of 29.1 weeks (range 20-35 weeks). The overall liveborn birth rate was 79% (22 infants) and one pregnancy was still ongoing. There were four neonatal deaths secondary to complications of prematurity. The surviving eighteen infants (64%) undergo regular paediatric review. The procedure was performed successfully in all cases with local anaesthesia. In no case was there maternal discomfort that warranted the procedure to be abandoned and good visual access of the vascular anastamoses was obtained in all cases. Local anaesthesia therefore offers a safe effective anaesthetic option for fetoscopic laser coagulation in monochorionic pregnancies complicated by TTTS.

  3. 双胎妊娠中胎儿性别和分娩孕周的相关性研究%Correlation of the Fetal Sex of Twin Pregnancy and Gestational Age

    Institute of Scientific and Technical Information of China (English)

    季景环; 姚晓玲; 李莉; 杨素琴; 张曼丽

    2011-01-01

    Objective To explore the influence of fetus's sex in twin pregnancy on gestation. Methods Retrospectively analyse the 94 cases of twin pregnancy from our hospital during the period from March 2008 to July 2009, which are divided into three groups by fetus's sex of twin male, twin female, a male and a female fpr comparison and analysis of gestation and premature delivery rate. Result No statistical difference in maternal age and average twin body weight( P > 0.05 ). Twin male fetuses average gestation 256.84 day,premature delivery rate 58.06%; twin female fetus 263.65 day, 16. 13% ;one male one female 260.76 day, 24.24%. The average gestation and premature delivery rate are statistically significantly different between twin male fetuses and twin female fetus( P < 0.05 ), Conclusion fetus's sex will influence gestation and premature delivery rate in twin pregnancy, female fetus is one of the premature delivery factors.%目的 探讨双胎妊娠中胎儿性别对分娩孕周的影响.方法 回顾性分析我院2008年3月至2009年7月住院分娩的94例双胎妊娠产妇资料,按胎儿性别分为双男胎、双女胎、一男一女胎三组,对其孕周及早产率进行比较与分析.结果 三组双胎妊娠产妇年龄和双胎儿平均体质量间差异无统计学意义(P>0.05),孕周和早产例数间差异有统计学意义(P<0.05).双男胎组孕周最短,双女胎组孕周最长.三组双胎妊娠产妇双男胎组早产率最高,双女胎组早产率最低.结论 双胎妊娠中胎儿性别影响妊娠孕周,男胎是导致早产的一个因素.

  4. Fertility disorders and pregnancy complications in hairdressers - a systematic review

    Directory of Open Access Journals (Sweden)

    Peters Claudia

    2010-08-01

    Full Text Available Abstract Background Hairdressers often come into contact with various chemical substances which can be found in hair care products for washing, dyeing, bleaching, styling, spraying and perming. This exposure can impair health and may be present as skin and respiratory diseases. Effects on reproduction have long been discussed in the literature. Method A systematic review has been prepared in which publications from 1990 to 2010 were considered in order to specifically investigate the effects on fertility and pregnancy. The results of the studies were summarised separately in accordance with the type of study and the examined events. Results A total of 2 reviews and 26 original studies on fertility disorders and pregnancy complications in hairdressers were found in the relevant databases, as well as through hand searches of reference lists. Nineteen different outcomes concerning fertility and pregnancy are analysed in the 26 original studies. Most studies looked into malformation (n = 7, particularly orofacial cleft. Two of them found statistically significant increased risks compared to five that did not. Small for gestational age (SGA, low birth weight (LBW and spontaneous abortions were frequently investigated but found different results. Taken together the studies are inconsistent, so that no clear statements on an association between the exposure as a hairdresser and the effect on reproduction are possible. The different authors describe increased risks of infertility, congenital malformations, SGA, LBW, cancer in childhood, as well as effects from single substances. Conclusion On the basis of the identified epidemiological studies, fertility disorders and pregnancy complications in hairdressers cannot be excluded. Although the evidence for these risks is low, further studies on reproductive risks in hairdressers should be performed as there is a high public health interest.

  5. Stretch marks during pregnancy: a review of topical prevention.

    Science.gov (United States)

    Korgavkar, K; Wang, F

    2015-03-01

    Striae gravidarum (SG), or stretch marks developing during pregnancy, affect up to 90% of women. While not medically dangerous, SG can be disfiguring, causing emotional and psychological distress. However, studies specifically addressing the prevention of SG, especially during pregnancy, are sparse. Furthermore, the molecular pathogenesis of SG is unclear and may differ from that of striae from other causes. Considering these factors, we review topical modalities that have been used specifically for preventing SG during pregnancy. We identify two major strategies (end points) addressed by these modalities, namely (i) preventing the de novo development of SG and (ii) reducing the severity of SG that have recently developed. We also identify risk factors for the development of SG and suggest that pregnant women with these risk factors are an appropriate target population for prevention. In reviewing the literature, we find that there is limited evidence that centella, and possibly massage with bitter almond oil, may prevent SG and/or reduce their severity. There is weak evidence that hyaluronic acid prevents SG. Tretinoin holds promise for reducing the severity of new-onset SG, but its use is limited by its pregnancy category. Finally, cocoa butter and olive oil are not effective for preventing SG or reducing the severity of lesions. We conclude that reliable methods for preventing SG are scarce. Furthermore, available topical modalities generally lack strong evidence from rigorous, well-designed, randomized controlled trials with ample numbers of subjects. Thus, further research is necessary to elucidate SG pathogenesis, which may lead to effective prevention modalities.

  6. Successful Delivery of Twin Pregnancy in Class U3b/C2/V1 Uterus by Bilateral Caesarean Section after Spontaneous Conception

    Directory of Open Access Journals (Sweden)

    Yasmine El-Masry

    2015-01-01

    Full Text Available A case of a 19-year-old female with class U3b/C2/V1 uterus conceived a twin pregnancy with a fetus in each horn after spontaneous conception. She referred to our department with presentation of premature rupture of membranes, with a history of cesarean delivery of a single full term living fetus a year and a half before this delivery. Examination revealed two completely separate uterine horns with a fetus in each horn, two distinct externally rounded cervices, and a single vagina with a short nonobstructing vaginal septum in the upper part of the vagina. And as the appropriate mode of delivery is still unclear, each case should be managed as the condition requires, and in our case urgent bilateral caesarean sections were performed.

  7. 双绒毛膜及单绒毛膜双胎与妊娠期并发症及围生儿结局分析%Pregnancy Complications and Perinatal Outcomes of Monochorionic and Dichorionic Twin Pregnancy

    Institute of Scientific and Technical Information of China (English)

    周艳; 徐丽玲; 汪平; 吴琼蔚; 陈雯霞; 金皖玲

    2012-01-01

    目的:探讨双胎妊娠绒毛膜性对孕妇妊娠期并发症及围生儿预后的影响及意义.方法:对我院定期随诊并分娩的472例双胎临床资料进行回顾性分析,根据绒毛膜性分为单绒毛膜双羊膜囊组(MCDA组)和双绒毛膜双羊膜囊组(DCDA组),对两组孕妇的分娩孕周、并发症以及围生儿预后等进行比较分析.结果:两组孕产妇妊娠并发症的发生率比较,差异无统计学意义(P>0.05).MCDA组低出生体重儿、极低出生体重儿、新生儿窒息及围生儿死亡的发生率均明显高于DCDA组,其差异有统计学意义(P<0.05),MCDA组中双胎输血综合征发生率为7.32%.结论:绒毛膜性对孕妇妊娠并发症的发生无明显影响,而双胎孕妇于孕早期行B超检查诊断单绒毛膜或双绒毛膜对预测围生儿预后具有重要意义.尽早确定双胎类型,加强对单绒毛膜双胎的监护及干预,是改善胎儿和新生儿预后的关键.%Objective:To investigate the clinical diagnostic significance of chorion properties. Methods: Retrospective analysis of the clinical data including gestational weeks, complications and perinatal outcomes of 472 twin pregnancies was done in Shanghai Changning Maternity and Infant Health Hospital. All the cases were divided into monochorionic diamnionic(MCDA) group and dichorionic diamnionic( DCDA ) group. Results: There was no statistically significant differences in complications between two groups (P>0.05). The incidences of low birth weight infant,extreme low birth weight infant, neonatal asphyxia and perinatal mortality in MCDA group were significantly higher than those in DCDA group (P < 0.05). The incidence of twin-twin transfusion syndrome(TTTS) in MCDA group was 7. 32%. Conclusions:Chorion properties make no difference in twin pregnancy complications. Differentiation between monochorionic and dichorionic twin pregnancy in first trimester of pregnancy by ultrasonography is very important in forecasting the

  8. Perinatal outcome of twin pregnancies delivered in a teaching hospital Resultado perinatal de gestações gemelares com parto em hospital universitário

    Directory of Open Access Journals (Sweden)

    Renata Almeida de Assunção

    2010-01-01

    Full Text Available OBJECTIVE: This study aimed to evaluate the perinatal outcome of twin pregnancies delivered in a tertiary teaching hospital according to chorionicity. METHODS: A retrospective study involving 289 twin pregnancies delivered from January 2003 to December 2006 was carried out. Maternal and perinatal data were obtained from hospital charts and delivery logs. Chorionicity was determined by ultrasonography or histopathological study. RESULTS: Incidence of twin gestations was 3.4% and 96.4% were spontaneously conceived. 60.5% were dichorionic (DC, 30.8% of monochorionic diamniotic (MCDA, 6.6% monochorionic monoamniotic (MCMA and for 2.1% chorionicity was unknown. The mean gestation age at delivery was respectively 35.4, 33.6, 32.9 for DC, MCDA and MCMA. The mean birth weight was 2.171, 1.832 and 1.760 g respectively for DC, MC and MCMA. The proportion of fetuses delivered with less than 34 weeks in DC was of 21.7%, while in MCDA it was of 39.3% and in MCMA of 42.1%. Birth weight below the 10th centile occurred in 15.7% for DC, 22.5% for MCDA and 26.3% in MCMA. Congenital anomalies were observed in 21.3% in monochorionic and in 7.4% in the dichorionic. Lenght of hospital stay was shorter for DC when compared to MCDA and MCMA twins (13.1, 17.3 and 23.3 days, respectively. The proportion of twin pregnancies with both babies discharged alive were 85.7% in DC and 61.1% in MC. CONCLUSION: The rate of preterm deliveries and low birth weight is higher in monochorionic pregnancies when compared to dichorionic twins. However, when adjusted for complications such as fetal abnormalities and twin-twin transfusion syndrome, double survival rates were similar in the two groups.OBJETIVO: Avaliar o resultado perinatal nas gestações gemelares com partos em hospital universitário segundo a corionicidade. MÉTODOS: Estudo retrospectivo de 289 gestações gemelares com partos no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no per

  9. Hemolytic disease of the newborn associated with anti-Jra alloimmunization in a twin pregnancy: the first case report in Korea.

    Science.gov (United States)

    Kim, Hyungsuk; Park, Min-Jeong; Sung, Tae-Jung; Choi, Ji Seon; Hyun, Jungwon; Park, Kyoung Un; Han, Kyou-Sup

    2010-10-01

    Jr(a) is a high-frequency antigen found in all ethnic groups. However, the clinical significance of the anti-Jr(a) antibody has remained controversial. Most studies have reported mild hemolytic disease of the newborn and fetus (HDNF) in Jr(a)-positive patients. Recently, fatal cases of HDNF have also been reported. We report the first case of HDNF caused by anti-Jr(a) alloimmunization in twins in Korea. A 33-yr-old nulliparous woman with no history of transfusion or amniocentesis was admitted at the 32nd week of gestation because of vaginal bleeding caused by placenta previa. Anti-Jr(a) antibodies were detected in a routine laboratory examination. An emergency cesarean section was performed at the 34th week of gestation, and 2 premature infant twins were delivered. Laboratory examination showed positive direct antiglobulin test and Jr(a+) phenotype in the red blood cells and the presence of anti-Jr(a) antibodies in the serum in both neonates. The infants underwent phototherapy for neonatal jaundice; this was followed by conservative management. They showed no further complications and were discharged on the 19th postpartum day. Preparative management to ensure the availability of Jr(a-) blood, via autologous donation, and close fetal monitoring must be performed even in cases of first pregnancy in Jr(a-) women.

  10. Cervical assessment at 22 and 27 weeks for the prediction of spontaneous birth before 34 weeks in twin pregnancies: is transvaginal sonography more accurate than digital examination?

    Science.gov (United States)

    Vayssière, C; Favre, R; Audibert, F; Chauvet, M P; Gaucherand, P; Tardif, D; Grangé, G; Novoa, A; Descamps, P; Perdu, M; Andrini, E; Janse-Marec, J; Maillard, F; Nisand, I

    2005-12-01

    This study compared the accuracy of ultrasound cervical assessment (cervical length and cervical index) and digital examination (Bishop score and cervical score) in the prediction of spontaneous birth before 34 weeks in twin pregnancies. In a prospective multicenter study, digital examination and transvaginal sonography were performed consecutively in twin pregnancies attending for routine sonography at either 22 weeks (175 women) or 27 weeks (153 women). The digital examination took place first, and the Bishop score and cervical score (cervical length minus cervical dilatation) were calculated. Ultrasound measurements were then made of cervical length and funnel length to yield the cervical index (1 + funnel length/cervical length). The association between each variable and delivery before 34 weeks was tested by the Mann-Whitney U-test. The receiver-operating characteristics (ROC) curves of the ultrasound and digital indicators were determined for both gestational age periods, and the areas under the ROC curves compared. The best cut-off values for each indicator were used to determine predictive values for delivery before 34 weeks. The median gestational age at delivery among the women included in the 22-week examination period was 36.0 (range, 21-40) weeks; 10.9% (19) gave birth spontaneously before 34 weeks. The median cervical length was 40 (range, 6-65) mm. All four parameters were predictors of delivery before 34 weeks. The areas under the ROC curves for cervical index, cervical length, Bishop score and cervical score did not differ significantly. The median gestational age at delivery among the women in the 27-week examination period was 36.0 (range, 27-40) weeks; 9.2% (14) gave birth spontaneously before 34 weeks. The median cervical length was 35 (range, 1-57) mm. All parameters except the Bishop score were predictors of delivery before 34 weeks. The likelihood ratio of the positive and negative tests for cervical length digital examination at the 27-week

  11. Intracranial aneurysms in twins: case report and review of the literature.

    Science.gov (United States)

    Leung, H K; Lam, Y; Cheng, K M; Chan, C M; Cheung, Y L

    2011-04-01

    Intracranial aneurysm in twins is a rare clinical disease entity. Only 15 cases have been described in the literature. We report on a pair of identical twins with intracranial aneurysms. One presented with subarachnoid haemorrhage; digital subtraction angiography showed a left posterior communicating artery aneurysm, which was treated by coiling. The patient's twin sister was called for screening, whereupon digital subtraction angiography revealed a right ophthalmic internal carotid artery aneurysm that was treated conservatively.

  12. 双胎妊娠中第二胎延迟分娩临床分析及护理%Twin Pregnancy Second Delay Delivery Clinical Analysis and Nursing

    Institute of Scientific and Technical Information of China (English)

    陈朝霞; 杨丽君

    2015-01-01

    目的:探讨1例双胎妊娠第二胎延迟分娩14 d的临床分析、妊娠结局及护理.方法:分析笔者所在医院1例双胎妊娠第二个胎儿延迟分娩的临床资料、妊娠结局及围生期护理.结果:本例孕妇双胎妊娠中第一胎胎膜早破后分娩,第二个胎儿延迟14 d分娩,通过精心护理产妇与两个新生儿健康出院.结论:双胎妊娠中第一个胎儿娩出后,根据实际情况第二个胎儿给予保胎治疗和护理,提高第二个胎儿的生存率.%Objective:To investigate 1 case of delayed interval delivery of the twin including clinical analysis,outcome of pregnancy and nursing measures.Method:1 cases of twin pregnancy, the clinical data of second cases of twin pregnancy, pregnancy outcome and perinatal nursing were analyzed.Result:This case of pregnant woman in the first pregnancy in the first fetal membranes after delivery, second fetal delay of 14 d delivery, through careful nursing maternal and two neonatal health.Conclusion:Twin pregnancy after the first fetal childbirth, according to the actual situation of the second fetus give tocolytic therapy and nursing, and improve the survival rate of the second fetus.

  13. [Recommendations for physical exercise practice during pregnancy: a critical review].

    Science.gov (United States)

    do Nascimento, Simony Lira; Godoy, Ana Carolina; Surita, Fernanda Garanhani; Pinto e Silva, João Luiz

    2014-09-01

    Physical exercise is recommended for all healthy pregnant women. Regular practice of exercises during pregnancy can provide many physical and psychological benefits, with no evidence of adverse outcomes for the fetus or the newborn when exercise is performed at mild to moderate intensity. However, few pregnant women engage in this practice and many still have fears and doubts about the safety of exercise. The objective of the present study was to inform the professionals who provide care for Brazilian pregnant women about the current recommendations regarding physical exercise during pregnancy based on the best scientific evidence available. In view of the perception that few systematic models are available about this topic and after performing several studies in this specific area, we assembled practical information of interest to both the professionals and the pregnant women. We also provide recommendations about the indications, contraindications, modalities (aerobics, resistance training, stretching and pelvic floor training), frequency, intensity and duration indicated for each gestational trimester. The review addresses physical exercise recommendation both for low risk pregnant women and for special populations, such as athletes and obese, hypertensive and diabetic subjects. The advantages of an active and healthy lifestyle should be always reinforced during and after gestation since pregnancy is an appropriate period to introduce new habits because pregnant women are usually more motivated to adhere to recommendations. Thus, routine exams, frequent returns and supervision are recommended in order to provide new guidelines that will have long-term beneficial effects for both mother and child.

  14. Polyunsaturated fatty acids in pregnancy and metabolic syndrome: a review.

    Science.gov (United States)

    Poniedzialek-Czajkowska, Elzbieta; Mierzynski, Radzislaw; Kimber-Trojnar, Zaneta; Leszczynska-Gorzelak, Bozena; Oleszczuk, Jan

    2014-01-01

    This review presents available evidence for possible application of n-3 long chain polyunsaturated fatty acids (PUFAs) in pregnant obese women with metabolic syndrome (MS) and focuses on prophylaxis of pregnancy complications associated with MS such as gestational hypertension, preeclampsia and gestational diabetes. Dietary supplementation with n-3 PUFAs has recently become popular and their adequate intake during pregnancy and early childhood is of clinical importance. The results of experimental and epidemiological investigations reveal that n-3 PUFAs, especially α- linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), may decrease the risk of cardiovascular diseases. It is believed that n-3 PUFAs affect a multitude of molecular pathways, involving regulation of gene expression, alteration of physical and chemical properties of cellular membranes and modulation of membrane channels and proteins. A large body of evidence focuses on anti-inflammatory properties of PUFAs which seem to be fundamental in prevention and reversing of insulin resistance, atherogenic dyslipidemia, hypertension, thromboembolism and in improving vascular function. Despite the potential PUFAs benefits of decreasing insulin resistance, their application in order to prevent preeclampsia, gestational hypertension and gestational diabetes mellitus in pregnant women with MS has not yet been established. Numerous reports have revealed that appropriate fetal development, including neuronal, retinal and immune function depends on EPA and DHA which are crucial also for prevention of preterm birth. Thus the supplementation with EPA and DHA is highly recommended during pregnancy although the optimal dosing and treatment strategies still need to be determined.

  15. Reared-Apart Chinese Twins: Chance Discovery/Twin-Based Research: Twin Study of Media Use; Twin Relations Over the Life Span; Breast-Feeding Opposite-Sex Twins/Print and Online Media: Twins in Fashion; Second Twin Pair Born to Tennis Star; Twin Primes; Twin Pandas.

    Science.gov (United States)

    Segal, Nancy L

    2017-04-01

    A January 2017 reunion of 10-year-old reared-apart Chinese twin girls was captured live on ABC's morning talk show Good Morning America, and rebroadcast on their evening news program Nightline. The twins' similarities and differences, and their participation in ongoing research will be described. This story is followed by reviews of twin research concerning genetic and environmental influences on media use, twin relations across the lifespan and the breast-feeding of opposite-sex twins. Popular interest items include twins in fashion, the second twin pair born to an internationally renowned tennis star, twin primes and twin pandas.

  16. Intravenous maternal -arginine administration to twin-bearing ewes, during late pregnancy, is associated with increased fetal muscle mTOR abundance and postnatal growth in twin female lambs.

    Science.gov (United States)

    Sales, F; Sciascia, Q; van der Linden, D S; Wards, N J; Oliver, M H; McCoard, S A

    2016-06-01

    The aims of this study were to determine whether parenteral Arg administered to well-fed twin-bearing ewes from 100 to 140 d of pregnancy influences fetal skeletal muscle growth, the abundance and activation of mechanistic target of rapamycin (mTOR) protein, and postnatal muscle growth of the offspring. Ewes fed 100% of NRC-recommended nutrient requirements for twin-bearing ewes were administered an intravenous bolus of either 345 μmol Arg HCl/kg BW or saline solution (Control) 3 times per day. At 140 d of pregnancy (P140), a group of 11 Control and 9 Arg-treated ewes were euthanized and hind leg muscles and longissimus dorsi (LD) were excised and weighed. A sample of LD was snap frozen in liquid nitrogen for later analysis of free AA (FAA) concentration, mTOR abundance and phosphorylation, and biochemical indices (DNA, RNA, and protein content). For the remaining 25 ewes (Arg, = 13, and Control, = 12), Arg administration was continued until the initiation of parturition and ewes were allowed to lamb. Lambs were weaned at postnatal Day 82 and grazed on pasture until postnatal day 153 (PN153), when a subset of 20 lambs ( = 10 per group) was euthanized. At P140, only the psoas major was heavier in the Arg-administered group compared with the Control group. Female lambs from ewes supplemented with Arg (Arg-F) had increased abundance of total mTOR, RNA concentration, and RNA:DNA ratio in LD compared with female lambs from Control ewes (Con-F), whereas males did not differ. At PN153, Arg-F were heavier than Con-F and had heavier LD and plantaris and a trend for heavier psoas major muscles compared with Con-F. In contrast, BW and individual muscle weights did not differ in male lambs. Lambs from Arg-treated ewes had heavier semimembranosus and tended to have heavier biceps femoris compared with Control lambs. The RNA concentration in LD was greater in Arg-F compared with Con-F, and DNA concentration was greater in the Arg group compared with the Control group. In

  17. The Malaria in Pregnancy Library: a bibliometric review

    Directory of Open Access Journals (Sweden)

    van Eijk Anna M

    2012-10-01

    Full Text Available Abstract Background The Malaria in Pregnancy (MiP Library is a bibliographic database that was created by the MiP Consortium in 2005 and is updated every four months using a standardized search protocol. A bibliometric review was conducted of the contents of the Library to determine dynamics in the type, content and volume of literature on malaria in pregnancy over time. Methods Data on year of publication, type, language, country of first-author affiliation and content (topic were extracted from entries in the MiP Library and plotted over time. Results By January 2012, the MiP Library contained 5,346 entries, consisting of 3,721 journal articles (69.6%, 697 reports (13.0%, 219 academic theses (4.1%, 92 books or book chapters (1.7%, 487 conference proceedings (9.1%, 68 registered studies (1.3% and 62 ‘other’ (1.2%. Most of the sources were in English language (87.3%, followed by French (7.5% and Spanish (1.5%. Over 40% of source material was publicly available online (42.4% and the remaining with restricted access (35.0% or otherwise unavailable (22.7%. The number of journal articles related to malaria in pregnancy increased from 41 in the 1960s, to 708 in the 1990s, and 1,895 between 2000 and 2009, and the variety of themes has increased over time. English-language articles were sourced from 737 different journals. The top three journals were the American Journal of Tropical Medicine and Hygiene (184, Malaria Journal (158 and the Transactions of the Royal Society of Tropical Medicine and Hygiene (131. Conclusion The last decade has seen a dramatic increase in publications related to malaria in pregnancy, and an increasing proportion of these are publically available online. The MiP Library is a useful, scholarly source for literature and systematic reviews related to malaria in pregnancy.

  18. Pregnancy and genital sarcoma: a systematic review of the literature.

    Science.gov (United States)

    Matsuo, Koji; Eno, Michele L; Im, Dwight D; Rosenshein, Neil B

    2009-08-01

    We conducted a literature review to determine the clinical characteristics of genital sarcoma during pregnancy. The systematic literature search was conducted using the search engines PubMed and MEDLINE with keywords "sarcoma" and "pregnancy" and was limited to female genital organs such as ovary, uterus, cervix, vagina, vulva, and retroperitoneal sarcoma. Kaposi's sarcoma, metastatic sarcoma, history of sarcoma, bone sarcoma located in pelvis, and fetal sarcoma were excluded in this study. There were 40 cases of genital sarcoma during pregnancy between 1955 and 2007. The majority of the cases were uterine sarcoma (37.5%), followed by retroperitoneal sarcoma (27.5%), vulvar sarcoma (22.5%), and vaginal sarcoma (12.5%). Mean age of the patient was 27.8 +/- 7.0. The distribution in the onset of symptoms had two peaks: first trimester (27.5%) and third trimester (50.0%). Growing mass (42.5%), abdominal pain (30.0%), and vaginal bleeding (22.5%) were the three most common symptoms. Incidental diagnosis was made in 22.5% and included during cesarean section (12.5%) and routine pelvic exam (7.5%). The cases initially not suspicious for malignancy were 42.5%. Thirty-three (82.5%) cases had live-born infants with term delivery in 55.2%. Mean birth weight was 2843 +/- 791 g, and male infants were more common (66.7%). Intrauterine growth retardation was seen in 12.5% of cases. Preterm labor was a common complication. Median survival period was 2.5 years (95% confidence, 1.9 to 3.1). The 2-, 3-, and 5-year cumulative survival rates were 60%, 38%, and 17%, respectively. Genital sarcomas in pregnancy are rare. There is a delay in diagnosis due to low index of suspicion. A majority had live births, and the 5-year survival is similar to that of advanced-stage sarcoma in nonpregnant women.

  19. 高龄双胎妊娠的围产结局分析%Perinatal outcomes in women aged 35 and over with twin pregnancy

    Institute of Scientific and Technical Information of China (English)

    陈敏玲; 王子莲; 凌家炜; 韩振艳

    2010-01-01

    目的 探讨高龄双胎妊娠的围产结局.方法 回顾性分析我院69例高龄双胎病例,随机对照176例非高龄双胎的临床资料,比较两组在妊娠并发症、妊娠合并症、和胎儿预后等方面的差异.结果 ①高龄组接受辅助生育技术受孕比例显著高于非高龄对照组(P<0.05);②高龄组<32孕周早产发生率明显高于对照组(P<0.05),而其他并发症及合并症两组间未见显著性差异;③高龄组以极低出生体重儿(<1500 g)比例显著高于对照组(P<0.05).高龄组新生儿窒息率及胎儿窘迫发生率明显增高(P<0.05).结论 高龄双胎妊娠不良妊娠结局主要与<32孕周的严重早产、极低体重儿、新生儿窒息及胎儿窘迫密切相关,应针对性加强高龄双胎的围生期监护,警惕严重早产的发生.%Objective The aim of this study is to present perinataloutcomes of twin gestations in older women. Methods We conducted a retrospective cohort study of 69 cases of twin pregnancies maternal age 35 years and older( study group)in our department, compared with 176 twin pregnancies cases of maternal age less than 35 years( control group). Results ①Conceptions after assisted reproductive technology were significantly higher in study group(P<0.05 ). ②The rate of preterm labour lower than 32 gestational weeks was significantly higher in the study group(P<0.05). The other complications rate did not differ singnificantly from the control groups. (3) The very low birth weight ( VLBW < 1,500 g) rate was significantly higher in the study group ( P<0.05 ), the rate of neonatal asphyxia and fetal distress were statistically significant higher in study group (P<0.05). Conclusion Advanced maternal age was related with higher incidence of the severe preterm labour(<32 gestational weeks) ,the very low birth weight(<1,500 g) ,fetal distress,neonatal asphyxia. It is important to close monitoring during perinatal period in women aged 35 and

  20. 双胎妊娠并发重度子痫前期母儿结局分析%Analysis on pregnant outcomes of twin pregnancy combined with severe preeclampsia

    Institute of Scientific and Technical Information of China (English)

    方根娟; 张甦

    2009-01-01

    To explore the pregnant outcomes of twin pregnancy complicated with severe preeclampsia. Methods: The pregnant outcomes of 66 twin pregnancies complicated with severe preeclampsia and 451 singleton pregnancies complicated with severe pre-eclampsia were analysed retrospectively and compared from January 2005 to December 2007. Results: The disease time and the time of ex-pectant treatment in twin pregnancy group were shorter than those in singleton pregnancy group (P0. 05) . There was correlation between pregnant weeks of twin pregnancy and prenatal outcomes. Conclusion: Women of twin pregnancy are required to no-tice more about health care in order to decrease the incidence of severe preeclampsia. As to the affected, the measures such as controlling the development and prolonging the gestational age should be carried out to decrease the incidence of premature delivery. It is advisable to termi-nate pregnancy on the 36th pregnant weeks.%目的:探讨双胎妊娠并发重度子痫前期的母儿结局.方法:回顾总结湖州市妇幼保健院2005年1月~2007年12月收治的66例双胎妊娠和451例单胎妊娠并发重度子痫前期孕妇的妊娠结局,以单、双胎分两组比较其发病情况、母儿并发症及结局.结果:双胎妊娠比单胎妊娠发病孕周早、期待治疗时间短(P0.05);双胎妊娠胎龄不同对围生儿结局会产生不同的影响.结论:双胎妊娠孕妇须注重孕期保健,减少重度子痫前期的发生;对发生重度子痫前期者应积极控制病情、延长孕周、减少低龄早产儿出生;胎龄36周终止妊娠围生儿结局最好.

  1. Progresses of birthweight discordance in monochorionic twins%单绒毛膜双胎出生体质量不一致的研究进展

    Institute of Scientific and Technical Information of China (English)

    李阳

    2013-01-01

    双胎出生体质量(BW)不一致是双胎妊娠特有的并发症,单绒毛膜(MC)双胎BW不一致发生率高于双绒毛膜(DC)双胎,且并发症多、预后较差,因此早期预测并进行相应处理对改善胎儿及新生儿预后具有重要意义.本文就近年来国内外对MC双胎BW不一致的研究进展进行综述.%Birthweight discordance is a characteristic complication of monochorionic twin pregnancies, with higher incidence compared with dichorionic twin pregnancies. How to predict and manage twin pregnancies with birth discordance earlier is crucial to improving the prognosis. The progresses of researching for birthweight discordance of monochorionic twin pregnancies were reviewed in this article.

  2. Gestação gemelar de mola hidatiforme completa com feto vivo Twin pregnancy with complete hydatidiform mole and living fetus

    Directory of Open Access Journals (Sweden)

    Daniela Angerame Yela

    2011-04-01

    Full Text Available A gestação gemelar de uma mola hidatiforme completa coexistindo com um feto vivo é uma entidade rara. Os poucos casos descritos na literatura mostram que, em geral, esse tipo de gestação cursa com risco aumentado de aborto espontâneo, parto prematuro, morte fetal intraútero, sangramento, pré-eclâmpsia e doença trofoblástica persistente. Neste artigo, descreveremos o caso de uma primigesta de 20 anos de idade que apresentou uma gestação gemelar de feto vivo com mola completa, a qual transcorreu sem intercorrências e complicações e cujo diagnóstico diferencial com degeneração da placenta foi feito com anatomopatológico.Twin pregnancy with a complete hydatidiform mole and a living fetus is a rare entity. According to the few cases described in the literature, this kind of gestation commonly has higher risks of miscarriage, preterm delivery, intrauterine fetal death, bleeding, preeclampsia and persistent trophoblastic disease. This study reports the case of a 20 years old primiparous patient with complete hydatidiform mole and living fetus, whose pregnancy was successfully carried to term. The differential diagnosis with placental degeneration was reached through anatomopathological investigation.

  3. A step-by-step diagnosis of exclusion in a twin pregnancy with acute respiratory failure due to non-fatal amniotic fluid embolism: a case report

    Directory of Open Access Journals (Sweden)

    Papaioannou Vasilios E

    2008-05-01

    Full Text Available Abstract Introduction Respiratory failure may develop during the later stages of pregnancy and is usually associated with tocolysis or other co-existing conditions such as pneumonia, sepsis, pre-eclampsia or amniotic fluid embolism syndrome. Case presentation We present the case of a 34-year-old healthy woman with a twin pregnancy at 31 weeks and 6 days who experienced acute respiratory failure, a few hours after administration of tocolysis (ritodrine, due to preterm premature rupture of the membranes. Her chest discomfort was significantly ameliorated after the ritodrine infusion was stopped and a Cesarean section was performed 48 hours later under spinal anesthesia; however, 2 hours after surgery she developed severe hypoxemia, hypotension, fever and mild coagulopathy. The patient was intubated and transferred to the intensive care unit where she made a quick and uneventful recovery within 3 days. As there was no evidence for drug- or infection-related thromboembolic or myocardial causes of respiratory failure, we conclude that our patient experienced a rare type of non-fatal amniotic fluid embolism. Conclusion In spite of the lack of solid scientific support for our diagnosis, we conclude that our patient suffered an uncommon type of amniotic fluid embolism syndrome and we believe that this report highlights the need for extreme vigilance and a high index of suspicion for such a diagnosis in any pregnant individual.

  4. Neonatal outcomes and influencing factors of twin pregnancies in IVF/ICSI%IVF/ICSI双胎妊娠新生儿结局及双胎妊娠影响因素分析

    Institute of Scientific and Technical Information of China (English)

    刘寒艳; 龙晓林; 李磊; 陈仕萍; 刘见桥

    2016-01-01

    目的:比较IVF/ICSI中单双胎妊娠后新生儿结局,并探讨影响双胎妊娠的相关因素。方法:回顾性分析2014年1月至2015年3月在我中心行IVF/ICSI治疗,单双胎妊娠共1026例纳入研究。结果:早期流产率,早期妊娠丢失率单胎组显著高于双胎组(16% vs 5.41%;16% vs 6.98%),晚期流产率单胎组显著低于双胎组(1.93% vs 7.12%),单双胎组整个孕期的总妊娠丢失率没有显著差异。双胎组早产率显著增加(9.19% vs 41.89%),足月抱婴率显著降低(56% vs 37.89%),但是总抱婴率双胎组显著高于单胎组;出生低体重儿双胎组显著增加(1.2% vs 14.8%),出生缺陷儿单双胎组无差异。女方年龄和移植胚胎数在单双胎妊娠组有显著差异。结论:双胎妊娠显著增加晚期流产及早产儿和低体重儿风险。女方年龄和移植胚胎数目是双胎妊娠的危险因素。%Objective To compare perinatal outcomes of the singleton and twin pregnancies , and explore risk factors associated with twin pregnancies. Methods The data of 1 026 patients in single and twin pregnancies treated with IVF/ICSI between January 2014 to March 2015 were retrospectively analyzed. Results The early miscarriage rate and early pregnancy loss rate in the singleton group was significantly higher than the twin group (16% vs 5.41%; 16% vs 6.98%) and the late abortion rate in the singleton group was significantly lower than the twin group (1.93% vs 7.12%), but the total pregnancy loss rate was not significantly different between the groups. The premature delivery rate in the twin group was significantly increased (9.19% vs 41.89%), the term taking-baby-home rate was significantly lower (56% vs 37.89%), but the total taking-baby-home rate was significantly higher in the twin group than the singleton group. The low weight delivery rate in the twin group was significantly increased (1.2% vs

  5. Conjoined Twins

    Science.gov (United States)

    ... sites of conjoined twins. Abdomen. Omphalopagus (om-fuh-LOP-uh-gus) twins are joined near the bellybutton. ... brain tissue. Head and chest. Cephalopagus (sef-uh-LOP-uh-gus) twins are joined at the face ...

  6. Natal Influences and Twin Differences: Draft.

    Science.gov (United States)

    Van den Daele, Leland D.

    1972-01-01

    A classification of natal influences is proposed with a model of their operation. Natal influences affect maternal capacity, maternal load, and maternal efficiency. Since maternal load is increased in twin pregnancy, results of twin studies must be generalized with caution. The method of co-twin control is exemplified by examination of a small…

  7. 应用时间序列分析法在医院双胎妊娠情况统计中的预测研究%Prediction Research of Applied time series analysis method in twin pregnancy statistical analysis

    Institute of Scientific and Technical Information of China (English)

    莫佳琪; 朱淳; 黄艳

    2014-01-01

    目的:探索时间序列分析法ARIMA预测模型在医院双胎妊娠情况统计中的应用。方法运用时间序列分析法ARIMA模型预测医院双胎妊娠情况的发展趋势。结果建立ARIMA(3,1,1)(1,1,1)模型,预测医院未来2年在双胎妊娠情况中有向上的趋势性和季节性,预测数据在5月、8月和12月双胎妊娠情况中呈现高峰。结论 ARIMA(3,1,1)(1,1,1)模型可以较好的拟合2009-2012年湖南省妇幼保健院双胎妊娠情况统计的时间变化趋势。应用时间序列分析法ARIMA模型在医院双胎妊娠情况统计的预测研究精度较高,是一种理想的研究方法,能够为医院管理提供科学依据。%Objective To explore the application of applied time series analysis method ARIMA modeling in twin preg-nancy statistical analysis .Method To predict the development trend of twin pregnancy by using applied time series analysis method ARIMA modeling Results Predicted the rising trend and seasonal feature of the twin pregnancy in the next two years by building ARIMA (1,1,1)(0,1,1),the prediction statistic showed that the twin pregnancy situation will be at the peak time on May, Autumn and December. Conclusion ARIMA(3,1,1)(0,1,1)modeling fitted the time varia-tion trend of twin pregnancy statistic well during 2009 to 2012 in MCH hospital of Hunan province. It is proved that ap-plied time series analysis method ARIMA modeling can provide satisfied predictions of the twin pregnancy in the hospi-tal and to be thought as the ideal research method.for providing scientific support for hospital management.

  8. Vitamin D supplementation in pregnancy: a systematic review.

    Science.gov (United States)

    Harvey, Nicholas C; Holroyd, Christopher; Ntani, Georgia; Javaid, Kassim; Cooper, Philip; Moon, Rebecca; Cole, Zoe; Tinati, Tannaze; Godfrey, Keith; Dennison, Elaine; Bishop, Nicholas J; Baird, Janis; Cooper, Cyrus

    2014-07-01

    It is unclear whether or not the current evidence base allows definite conclusions to be made regarding the optimal maternal circulating concentration of 25-hydroxyvitamin D [25(OH)D] during pregnancy, and how this might best be achieved. To answer the following questions: (1) What are the clinical criteria for vitamin D deficiency in pregnant women? (2) What adverse maternal and neonatal health outcomes are associated with low maternal circulating 25(OH)D? (3) Does maternal supplementation with vitamin D in pregnancy lead to an improvement in these outcomes (including assessment of compliance and effectiveness)? (4) What is the optimal type (D2 or D3), dose, regimen and route for vitamin D supplementation in pregnancy? (5) Is supplementation with vitamin D in pregnancy likely to be cost-effective? We performed a systematic review and where possible combined study results using meta-analysis to estimate the combined effect size. Major electronic databases [including Database of Abstracts of Reviews of Effects (DARE), Centre for Reviews and Dissemination (CRD), Cochrane Database of Systematic Reviews (CDSR) and the Health Technology Assessment (HTA) database] were searched from inception up to June 2012 covering both published and grey literature. Bibliographies of selected papers were hand-searched for additional references. Relevant authors were contacted for any unpublished findings and additional data if necessary. Abstracts were reviewed by two reviewers. pregnant women or pregnant women and their offspring. either assessment of vitamin D status [dietary intake, sunlight exposure, circulating 25(OH)D concentration] or supplementation of participants with vitamin D or food containing vitamin D (e.g. oily fish). offspring - birthweight, birth length, head circumference, bone mass, anthropometry and body composition, risk of asthma and atopy, small for gestational dates, preterm birth, type 1 diabetes mellitus, low birthweight, serum calcium concentration, blood

  9. Twin-twin transfusion syndrome - diagnosis and prognosis

    Directory of Open Access Journals (Sweden)

    Hajrić-Egić Amira

    2003-01-01

    Full Text Available Twin-twin transfusion syndrome is a serious complication of monozygotic, monochorionic, diamniotic twins resulting from transplacental vascular communications. In this syndrome blood is thought to be shunted from one twin - donor,who develops anaemia,growth retardation and oligoamnios, to the other twin - recipient,who becomes plethoric,macrosomic and develops polyhydroamnios. The incidence of twin-twin transfusion syndrome ranges from 5-15% of all twin pregnancies. If this condition develops in the second trimester, it is usually associated with spontaneous abortion and death of one or both fetuses before viability. Developing the syndrome in the third trimester has better perinatal outcome. Mortality rates ranging from 56%-100%, depending on gestational age and severity of the syndrome. The ultrasound criterias for diagnosis, in this study,were the presence of twins of the same sex with discordant growth, with oligohydroamnios in one twin sac and polyhydroamnios in the other one, one placenta and thin membrane between twins. The present study shows clinical course of 14 cases and value of Doppler ultrasound to analyze the usefulness of umbilical artery blood flow velocimetry for predicting the risk of twin-twin transfusion syndrome. 14 twin pregnancies with twin-twin transfusion syndrome were diagnosed during the last four years period and prospectivelly followed. 9 cases were diagnosed before the completion od 28 weeks of gestation.The mean gestational age was 21,6_+4,2 weeks at diagnosis and 23,2+_3,6 weeks at delivery. 5 cases were diagnosed after 28 weeks of gestation. The mean gestational age in this group was 29,6+_2,1 weeks at diagnosis and 33+_3,3 weeks at delivery. The survival rate in this study was 29%(8/28.9 cases ended in spontaneous abortion between 18th and 27th weeks of pregnancy (table 1 and 5 in premature labor (table 2.There were 7 intrauterine death (5 at admission and 2 few days after admission and 13 neonatal deaths

  10. Recipient twin limb ischemia with postnatal onset.

    Science.gov (United States)

    Broadbent, Roland Spencer

    2007-02-01

    After the occurrence of 3 local cases of limb ischemia in newborn twins, we reviewed the literature to investigate this combination systematically. This review reveals a distinct condition: postnatal onset limb ischemia affecting recipient twins in twin-twin transfusion syndrome.

  11. Are children's activity levels determined by their genes or environment? A systematic review of twin studies ☆

    OpenAIRE

    Abigail Fisher; Lee Smith; van Jaarsveld, Cornelia H. M.; Alexia Sawyer; Jane Wardle

    2015-01-01

    Context: The importance of physical activity to paediatric health warrants investigation into its determinants. Objective measurement allows a robust examination of genetic and environmental influences on physical activity. Objective: To systematically review the evidence on the extent of genetic and environmental influence on children's objectively-measured activity levels from twin studies. Data sources and search terms: Medline, EMBASE, PsycINFO, Health and Psychosocial Instruments a...

  12. Tribute to dr louis keith: twin and physician extraordinaire/twin research reports: influences on asthma severity; chimerism revisited; DNA strand break repair/media reports: twins born apart; elevated twin frequencies; celebrity father of twins; conjoined twinning.

    Science.gov (United States)

    Segal, Nancy L

    2014-10-01

    The International Society for Twin Studies has lost a valued friend and colleague. Dr Louis Keith, Emeritus Professor of Obstetrics and Gynecology at Northwestern University, in Chicago, passed away on Sunday, July 6, 2014. His life and work with twins will be acknowledged at the November 2014 International Twin Congress in Budapest, Hungary. Next, twin research reports on the severity of asthma symptoms, a case of chimerism, and factors affecting DNA breakage and repair mechanisms are reviewed. Media reports cover twins born apart, elevated twin frequencies, a celebrity father of twins, and a family's decision to keep conjoined twins together.

  13. APPLICATION OF FIRST-MIDTRIMESTER PREGNANCY ULTRASOUND COMBINED WITH INVASIVE PRENATAL DIAGNOSIS IN TWIN PREGNANCY%早中孕期超声联合有创性产前诊断在双胎妊娠中的应用

    Institute of Scientific and Technical Information of China (English)

    胡矩锋; 李炳星; 高丽丽

    2015-01-01

    效降低出生缺陷,在提高人口素质方面有重要的应用价值。%Objective Evaluate application value that ultrasound of first‐midtrimester combined with in‐vasive prenatal diagnosis in linyi city .Methods Research of first‐midtrimester pregnancy ultrasound com‐bined with invasive prenatal diagnosis in twin pregnancy from Octobor 2014 to May 2015 clinic in our hos‐pital during the 11 weeks ago ,statistics of pregnant age ,first trimester ultrasound ,18 to 22 weeks ultra‐sound ,invasive prenatal diagnosis ,prenatal diagnosis ,selective reduction ,etc .summary all the data ,a‐nalysis the application value of first‐midtrimester pregnancy ultrasound combined with invasive prenatal di‐agnosis in twin pregnancy in linyi city .Results Included in the study of a total of 1437 cases of twin preg‐nancy ,anomaly detection ,with pregnancy ultrasound system is 56 cases ,ultrasonic detection of first tri‐mestr abnormalities is 7 cases ,abnormal ultrasonic detection of midtrimester is 49 cases ,invasive prenatal diagnosis to all ultrasonic detection pregnancy ,actually have invasive prenatal diagnosis ,27 cases (48 . 2% ) ,including 3 patients to CVS ,24 cases to amniocentesis .The actual number of prenatal diagnosis of fetal 47 (including twins prenatal diagnosis in 21 cases ,one of the tires to prenatal diagnosis of 5 cases) , diagnosis of five chromosome abnormality ,are one of the twins anomalies (including 1 case no abnormal sonographic findings but prenatal diagnosis) ,including 2 cases of one of twins 21 three body syndrome , chromosome abnormality rate 10 .6% (5/47) .7 cases to selective reduction (5 cases of abnormal chromo‐some abnormality and 2 cases of ultrasonic normal chromosome) ,else choose expectation .Avoided the born of abnormal karyotypes including 2 cases of 47 ,+21 (including ultrasonic no abnormality in 1 case)、2 cases of 47 ,+18 and 1 case of 47 ,+13 ,and 1 case of fetal ascites ,1 cases of tetralogy of fallot

  14. Complete mole in a dichorionic twin pregnancy after intracytoplasmic sperm injection Mola hidatiforme completa em gravidez bicoriônica após injecção intracitoplasmática de espermatozoides

    Directory of Open Access Journals (Sweden)

    Tiago José Santos de Matos Ferraz

    2013-01-01

    Full Text Available A dichorionic twin pregnancy with complete hydatidiform mole and coexistent fetus is a rare and challenging situation, whose pathogenesis has not been yet fully understood. We present a case of a 39-year-old woman who underwent intracytoplasmic sperm injection with two embryos transfer. The 12-week gestation ultrasound examination revealed normal fetus and placenta with features of hydatidiform mole, leading to pregnancy termination. Autopsy and histological examinations diagnosed a complete mole coexisting with a normal fetus, and the genetic analysis showed a diploid fetus with biparental genome and molar tissue with paternal diploidy. This case highlighted that complete molar pregnancies may still occur even though pregnancy is achieved after intracytoplasmic sperm injection. A review of the literature was performed by collecting data from the few similar reported cases and by commenting on the pathogenesis of this rare condition.Uma gravidez bicoriônica com mola hidatiforme completa e feto normal é uma situação rara e desafiadora, cuja patogênese não foi ainda totalmente compreendida. Apresenta-se o caso de uma mulher de 39 anos submetida à injeção intracitoplasmática de espermatozoides com transferência de dois embriões. Na ecografia pré-natal realizada na 12ª semana de gestação, foi identificado um embrião morfologicamente normal e uma placenta com características molares. Esta situação resultou na terminação eletiva da gravidez. A autópsia e o estudo histológico permitiram o diagnóstico definitivo de uma mola hidatiforme completa coexistindo com feto normal. A análise genética mostrou feto diploide com genoma biparental e tecido molar com diploidia paterna. Este caso ressaltou que as gestações com mola hidatiforme completa poderão ainda ocorrer, mesmo que a gravidez seja realizada após uma injeção intracitoplasmática de espermatozoides. Foram realizadas uma revisão dos raros casos descritos na literatura

  15. Culture systems: embryo culture and monozygotic twinning.

    Science.gov (United States)

    Sparks, Amy E

    2012-01-01

    The incidence of monozygotic twinning in pregnancies achieved with assisted reproductive technologies (ART) is significantly higher than spontaneously conceived pregnancies. The factors associated with ART that predispose the embryos to splitting are not well-characterized. Assisted hatching and extended embryo culture are two ART laboratory methods that have been risk factors for monozygotic twinning. The methods and strategies that may be employed to avoid monozygotic twinning are discussed in this chapter.

  16. 131例双胎妊娠并发重度子痫前期的妊娠结局%Pregnancy outcomes of 131 twin pregnancies complicated with severe pre-eclampsia

    Institute of Scientific and Technical Information of China (English)

    王姗; 罗方媛; 何国琳; 刘兴会

    2013-01-01

    新生儿HIE发生率[8.4%(22/262)与4.7%(27/572)]、新生儿NICU转入率[76.2%(205/262)与58.4%(332/572)]比较,双胎组均高于单胎组(x2=162.000、4.392和31.980,P均<0.05).结论 双胎妊娠较单胎妊娠更易发生重度子痫前期,且更易发生严重并发症,导致围产儿不良结局.临床应重视双胎妊娠的管理,一旦发生妊娠期高血压疾病应积极治疗并预防并发症,根据病情适时终止妊娠.%Objective To explore the clinical characteristics and pregnancy outcomes of twin pregnancies complicated with severe preeclampsia.Methods The pregnant outcomes of 131 twin pregnancies (twin group) and 572 singleton pregnancies (singleton group),all complicated with severe preeclampsia,were analyzed retrospectively.All patients were treated in the Department of Obstetrics and Gynecology,West China Second University Hospital,Sichuan University from June 2007 to June 2011.The patients' age,onset of disease,gestational weeks at delivery,mean duration of expectant treatment,blood pressure,laboratory parameters and incidence of pregnancy complications,including placental abruption,heart failure,pulmonary edema,postpartum hemorrhage,uteroplacental apoplexy,eclampsia,HELLP syndrome (hemolysis,elevated liver enzymes and low platelets syndrome),hypoproteinemia,retinopathy,intracranial hemorrhage and renal insufficiency,were compared between the two groups.Perinatal outcomes such as premature delivery,perinatal mortality,neonatal intensive care unit (NICU) hospitalization,fetal distress,hypoxic-ischemic encephalopathy (HIE),asphyxia neonatorum,neonatal pneumonia,hyperbilirubinemia and neonatal hypoglycemia of two groups were also compared.Chi-square test,Fisher's exact test or t-test were used for statistical analysis.Results The severe preeclampsia incidence of twin pregnancies (5.03%,131/2604) was higher than that (1.94%,572/29 452) of singleton pregnancy (x2=106.40,P<0.001).The onset time [(33.6±1.8) weeks] and gestations at delivery [(34.6

  17. Acute myocardial infarction during pregnancy and puerperium: a review.

    Science.gov (United States)

    Badui, E; Enciso, R

    1996-08-01

    The purpose of this review is to analyze the possible parameters that lead to the development of what is a rare event--acute myocardial infarction (AMI) during pregnancy and puerperium. Through the Index Médicus, 109 publications on the subject were obtained. Since the first well-documented case by Katz in 1922, 136 patients have been reported, and from these reports the following data have been gathered: the average age was 32.1 years. This event is more frequent during the third trimester and puerperium of the first and second pregnancies. In 42.6% of the patients no coronary risk factors were observed, but when present, hypertension and cigarette smoking were the most common. The anterior wall along or in combination with any other anatomic area was affected in 73% of cases. Coronary angiograms, when taken, appeared normal in 47%. The maternal mortality rate was 26/136 (19.1%) and was higher during the third trimester, labor, and puerperium. Eight patients (8/26) (30.7%) had sudden death. In 5 of these, (62.5%) coronary thrombosis was found. In 18/26 deaths, an autopsy was performed; 9/18 (50%) had coronary thrombus formation and in 7/18 (39%) variable degrees of atherosclerosis were detected. On the other hand, the fetal mortality rate was 16.9%; however, in only 52% was death coincidental with that of the mother. Coronary artery spasm associated with a probable hypercoagulability state was the most likely mechanism in the majority of these patients, followed by atherosclerotic heart disease and coronary dissection-the last being secondary most likely to hormonal changes. During the AMI these patients should be studied by a medical team composed of a cardiologist, gynecologist, and anesthesiologist. A complete cardiologic work-up should be made to decide individually about further pregnancies.

  18. 双胎之一胎儿宫内死亡51例临床分析%Clinical Analysis of 51 Cases of Single Intrauterine Fetal Demise in Twin Pregnancy

    Institute of Scientific and Technical Information of China (English)

    张奕; 王洁; 王晨虹

    2013-01-01

    Objective:To investigate the cause,clinical management and matemal-neonatal outcomes of single intrauterine fetal demise (sIUFD) in twin pregnancy.Methods:The clinical data of 51 cases of sIUFD in twin pregnancy(sIUFD group) from 2009 to 2012 were retrospectively analyzed.51 cases of normal twin pregnancy in the same period were included as controls.Results:①The incidences of fetal anomalies,fetal growth restriction (FGR),twin-twin transfusion syndrome (TTTS),torsion cord,single umbilical artery,assisted reproductive techniques (ART) in the sIUFD group were significantly higher than those in the control group(P <0.05).There were no statistically significant differences in hypertensive disorders pregnancy,gestational diabetes mellitus,intrahepatic cholestasis of pregnancy between the two groups (P > 0.05).②The average gestational age of single intrauterine fetal demise (sIUFD) in twin pregnancy was 28.7 ± 6.4 weeks,the medium of expectant time was 3.1 weeks,and the quartile intervals was 13.1 weeks.The termination of monochorionic twin pregnancy gestational age was 34.6 ±2.2 weeks on average and that of dichorionic twin was 35.9 ± 1.9 weeks.③There was no statistically significant difference in neonatal asphyxia between the two groups(P>0.05).There was no perinatal mortality in both groups.In the follow-up visit of the sIUFD group,47 survivors were normal,4 cases were lost of follow-up.Conclusions:Fetal anomalies,FGR,TTTS,torsion cord and single umbilical artery are the critical reasons for the sIUFD in twin pregnancy.There is no obvious relationship between maternal complications and sIUFD in twin pregnancy.The connection between ART and sIUFD in twin pregnancy needs to carry on deeper research.sIUFD in monochorionic twin pregnancy should be expected to 34 weeks and sIUFD in dichorionic twin pregnancy should be expected to 37 weeks to improve neonatal outcomes.%目的:探讨双胎之一胎儿宫内死亡(sIUFD)的原因、临床处理及母

  19. Clinical analysis of single or twin pregnancy complicated with preeclampsia%单、双胎妊娠并发子痫前期临床分析

    Institute of Scientific and Technical Information of China (English)

    匡丽云; 汤雯婷; 周燕媚; 孙雯; 龚景进; 李晓梅; 李秀英; 陈敦金

    2016-01-01

    Objective To explore the clinical features and pregnancy outcomes of single or twin pregnancy complicated with preeclampsia.Methods From January 2009 to April 2013, 405 pregnancies complicated with preeclampsia, who were admitted to the Obstetrics department of the Third Affiliated Hospital of Guangzhou Medical University were enrolled in this retrospective study.This study included 43 twin pregnancies in research group and 362 singleton pregnancies in the control group.The clinical features and pregnancy outcomes of the two groups were retrospectively analyzed.Results The length of hospital stay in research group and control group were ( 13.28 ±11.23 ) day and ( 9.48 ±4.97 ) day, respectively.There was significant difference in the two groups (t=2.20, P<0.05).In research group, the incidence of cesarean section, premature rupture of membranes, postpartum hemorrhage, heart failure were 97.67%, 13.95%, 11.63% and 11.63%, respectively, which were higher than that in control group ( 79.83%, 5.25%, 5.25% and 4.14%) with significant difference ( P <0.05 ) .In research group, the incidence of newborn infection and jaundice were 25.58%and 48.84%,which were higher than that in control group ( 15.19% and 32.60%) with significant difference ( P <0.05 ) .Conclusion Compared to singleton pregnancy complicated with preeclampsia, twin pregnancy complicated with preeclampsia increased the incidence of cesarean section, premature rupture of membranes, postpartum hemorrhage and heart failure, and extended maternal hospital stay.%目的探讨单、双胎妊娠并发子痫前期的临床特点及妊娠结局。方法选取2009年1月至2013年4月在广州医科大学附属第三医院产科住院分娩的43例双胎并发子痫前期的孕妇为研究组,362例单胎并发子痫前期产妇作为对照组,回顾性分析两组患者的临床特点及母婴结局的情况。结果研究组住院时间(13.28±11.23)d,较对照组(9.48±4.97)d延长,t=2.20,P<0

  20. The Clinical Analysis of Twin Pregnancy Complicated by Preeclampsia%双胎妊娠并发子痫前期的临床分析

    Institute of Scientific and Technical Information of China (English)

    沈晔; 王文娟

    2015-01-01

    目的:探讨双胎妊娠并发子痫前期在临床中的情况。方法选取2011年1月至2014年6月我院治疗的37例双胎妊娠并发子痫前期孕妇为观察组,同期37例单胎妊娠并发子痫前期孕妇为对照组,分析两组的情况。结果两组在分娩方式及胎儿情况方面相比差异不具有显著性(P>0.05),两组在子痫、HELLP综合征、产后出血、胎盘早剥、胎儿窘迫、FGR(胎儿生长发育迟缓)、妊娠期糖尿病、肺水肿等并发症方面相比差异具有显著性(P0.05), the two groups in preeclampsia and HELLP syndrome, postpartum hemorrhage, placental abruption, fetal distress, FGR (fetal growth retardation), gestational diabetes and complications such as pulmonary edema, compared with the difference is signiifcant (P<0.05). Conclusions On the twins with preeclampsia patients, to enhance prenatal guidance and supervision, the childbirth way to choose the most reasonable, improving the quality of labor, to ease the twin pregnancy outcomes and reduce the perinatal mortality is crucial.

  1. Pregnancy

    DEFF Research Database (Denmark)

    Palmer, Keith T; Bonzini, Matteo; Bonde, Jens Peter Ellekilde

    2013-01-01

    Most pregnant women are exposed to some physical activity at work. This Concise Guidance is aimed at doctors advising healthy women with uncomplicated singleton pregnancies about the risks arising from five common workplace exposures (prolonged working hours, shift work, lifting, standing and heavy...... on pregnancy. Moreover, moderate physical exercise is thought to be healthy in pregnancy and most pregnant women undertake some physical work at home. The guidelines provide risk estimates and advice on counselling....

  2. Outcome of pregnancy in women with congenital heart disease - A literature review

    NARCIS (Netherlands)

    Drenthen, Willem; Pieper, Petronella G.; Roos-Hesselink, Jolien W.; van Lottum, Willem A.; Voors, Adriaan A.; Mulder, Barbara J. M.; van Dijk, Arie P. J.; Vliegen, Hubert W.; Yap, Sing C.; Moons, Philip; Ebels, Tjark; van Veldhuisen, Dirk J.

    2007-01-01

    A search of peer-reviewed literature was conducted to identify reports that provide data on complications associated with pregnancy in women with structural congenital heart disease (CHD). This review describes the outcome of 2,491 pregnancies, including 377 miscarriages (15%) and 114 elective abort

  3. Effects of endocrine disruption during pregnancy: a systematic review

    Directory of Open Access Journals (Sweden)

    Agustin Llopis-Gonzalez

    2014-06-01

    Full Text Available Endocrine disruptors are ubiquitous natural and synthetic environmental pollutants that can mimic, block or disturb normal hormonal function. Environmental exposure to these pollutants is almost impossible to prevent due to their presence in the air, water, soil, food and in many other materials with which we come in contact daily, such as plastics. Foetuses are vulnerable during pregnancy because their organism is in a developmental stage, and any disruption may affect their health in the short and/or long term. There is some evidence that these substances disrupt tissue differentiation and growth processes, cause birth defects and affect the length of pregnancy. In this review we will focus on environmental epidemiology and related literature in order to update current knowledge based on the actual evidence of the effects of these substances on the aetiology of preterm delivery, miscarriages, low birth weight, malformations, cryptorchidism, hypospadias and micropenis. The difficulty in studying this topic is due to the high number of involved factors, which makes the available results inconclusive or even contradictory. Consequently, further research is necessary.

  4. Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Ozkan, Sebiha; Ceylan, Yasin; Ozkan, Orhan Veli; Yildirim, Sule

    2015-06-21

    Intrahepatic cholestasis of pregnancy (ICP) is a reversible pregnancy-specific cholestatic condition characterized by pruritus, elevated liver enzymes, and increased serum bile acids. It commences usually in the late second or third trimester, and quickly resolves after delivery. The incidence is higher in South American and Scandinavian countries (9.2%-15.6% and 1.5%, respectively) than in Europe (0.1%-0.2%). The etiology is multifactorial where genetic, endocrine, and environmental factors interact. Maternal outcome is usually benign, whereas fetal complications such as preterm labor, meconium staining, fetal distress, and sudden intrauterine fetal demise not infrequently lead to considerable perinatal morbidity and mortality. Ursodeoxycholic acid is shown to be the most efficient therapeutic agent with proven safety and efficacy. Management of ICP consists of careful monitoring of maternal hepatic function tests and serum bile acid levels in addition to the assessment of fetal well-being and timely delivery after completion of fetal pulmonary maturity. This review focuses on the current concepts about ICP based on recent literature data and presents an update regarding the diagnosis and management of this challenging issue.

  5. School-based teenage pregnancy prevention programs: a systematic review of randomized controlled trials.

    Science.gov (United States)

    Bennett, Sylvana E; Assefi, Nassim P

    2005-01-01

    We compared school-based abstinence-only programs with those including contraceptive information (abstinence-plus) to determine which has the greatest impact on teen pregnancy. The United States has one of the highest rates of teen pregnancy in the industrialized world. Programs aimed at reducing the rate of teen pregnancy include a myriad of approaches including encouraging abstinence, providing education about birth control, promoting community service activities, and teaching skills to cope with peer pressure. We systematically reviewed all published randomized controlled trials of secondary-school-based teen pregnancy prevention programs in the United States that used sexual behavior, contraceptive knowledge, contraceptive use, and pregnancy rates as outcomes.

  6. Magnesium in pregnancy blood pressure and pre-eclampsia - A review.

    Science.gov (United States)

    Rylander, Ragnar

    2014-04-01

    Magnesium is an important cation present in more than 300 enzymes in the body. This review evaluates the information on magnesium and pregnancy. In normal pregnancies Mg responsive genes are upregulated, suggesting Mg deficiency. Blood pressure increase is related to the urinary excretion of Mg. In pregnancies complicated by preeclampsia the Mg homeostasis is different from normal pregnancies. Supplementation with Mg has shown beneficial effects on high blood pressure and infant conditions in some studies. Although several studies show important relationships between Mg homeostasis and pregnancy, particularly those with pre-eclampsia, further studies are needed to assess the relationship and formulate requirements for intervention programmes.

  7. 胎儿纤维连接蛋白联合宫颈长度预测无症状双胎妊娠早产%Fetal Fibronectin combined with cervical length to predict preterm delivery in asymptomatic twin pregnancy

    Institute of Scientific and Technical Information of China (English)

    郭雪箐; 莫慧芬

    2015-01-01

    目的探讨无症状的双胎妊娠应用阴道分泌物胎儿纤维连接蛋白(fFN)联合经腹宫颈长度预测早产的价值。方法共纳入98例双胎妊娠孕妇,于妊娠24周~35周检测孕妇宫颈阴道分泌物fFN、经腹B超检测宫颈长度并随访妊娠结局。结果 fFN联合宫颈长度检测预测双胎妊娠早产较两项单独检测预测早产的敏感度、阴性预测值均有所提高。结论 fFN及宫颈长度联合检测可用于筛查无症状的双胎妊娠孕妇早产,具有较高的临床应用价值。%Objective To evaluate transabdominal cervical length measurements and fetal fibronectin detection in the maternal vaginal secretions as predictors of preterm delivery in asymptomatic twin pregnancy. Methods A total of 98 cases of twin pregnancy were recruited. Transabdominal ultrasound assessments of cervical length and fetal bronectin detection were performed from 24 to 35 weeks of gestation. The pregnancy outcomes were followed up. Results The sensitivity of detection of cervical length combined with fetal bronectin as predictors of preterm delivery in asymptomatic twin pregnancies was 82.0%, specificity 76.7%, positive predictive value 49.3%and negative predictive value 91.7%. The sensitivity and negative predictive value of the joint tests were higher than that of the respective detection for predicting preterm delivery. Conclusion For asymptomatic twin pregnancy, fetal bronectin detection combined with cervical length measurements can be used for screening of asymptomatic twin pregnancy.

  8. Twin pregnancy childbirth way with gestational age of pregnancy outcome%双胎妊娠分娩方式与孕龄对妊娠结局的探讨

    Institute of Scientific and Technical Information of China (English)

    陈晓妮

    2014-01-01

    Twin pregnancy childbirth way and gestational age influence on pregnancy outcome.Methods:In twin pregnancy, 240 cases of maternal childbirth obstetrics and gynecology hospital as the research object.Through self-made form col ection of maternal clinical data were retrospectively analyzed. analyze the different gestational age and birth weight, the relationship between neonatal asphyxia, and different position and the way of delivery and neonatal asphyxia. Result: This group of neonatal asphyxia in 15.83% (76/480). Gestational age 28~34 weeks and of 39 weeks or a newborn, the incidence of asphyxia were significantly higher than that of 35~38 weeks gestational age neonates (al P<0.05). First position as head of the women, the vaginal trial production success of newborns, the incidence of first and second child suffocation were significantly higher than that of elective cesarean section newborn (3.67%, 6.42%vs0.00%, 3.67%), statistical y significant difference (P<0.05). Conclusion:Cesarean section can effectively reduce the incidence of postpartum hemorrhage, twin pregnancy maternal extend gestational age can effectively improve the newborn weight, reduce the incidence of neonatal asphyxia, the cutting head first recommended palace childbirth.%探讨双胎妊娠分娩方式和孕龄对妊娠结局的影响。方法:选择在我院妇产科分娩的双胎妊娠产妇240例为研究对象。通过自制的表格收集产妇的临床资料进行回顾性分析。分析不同的孕龄和新生儿体重、新生儿窒息的关系以及不同胎位和分娩方式与新生儿窒息发生的关系。结果:本组新生儿窒息共计15.83%(76/480)。孕龄28~34周和≥39周的新生儿,窒息的发生率均显著高于孕龄35~38周的新生儿(均P<0.05)。第一胎胎位为头位的产妇中,阴道试产成功的新生儿,第一胎和第二胎窒息的发生率均显著高于择期剖宫产的新生儿(3.67%、6.42%vs0.00%、0.92%),

  9. ACARDIAC TWIN

    OpenAIRE

    Vinayachandran; Jyothi,; Bindu; Umadevi

    2014-01-01

    Acardiac twin is a very rare complication occurring in monozygotic twins in which one fetus develops normally (pump twin) and the other (recipient twin) demonstrate cardiac non development and othe r anomalies. This may represent an extreme form of TTTS, also referred to as TRAP sequence. 1,2,

  10. Ionizing radiations in pregnancy and teratogenesis: a review of literature.

    Science.gov (United States)

    De Santis, M; Di Gianantonio, E; Straface, G; Cavaliere, A F; Caruso, A; Schiavon, F; Berletti, R; Clementi, M

    2005-01-01

    The present paper is a review of the data available in the literature concerning the prenatal exposure to radiation evaluating the reported teratogenic effect. We have particularly focused on the fetal effects of maternal ionising radiation exposure, both diagnostic and occupational, particularly in terms of congenital anomalies and birth weight. Ionising radiation represents a possible teratogen for the fetus, but this risk has been found to be dependent on the dosage and the effects correlatable to the gestational age at exposure. Recently, of particularly note is the fact that maternal thyroid exposure to diagnostic radiation has been associated with a slight reduction in the birth weight. Inadvertent exposure from diagnostic procedures in pregnancy doesn't usually increase the natural risk of congenital anomalies but creates a considerable state of maternal anxiety. Diagnostic radiological procedures should be avoided in pregnant women unless the information cannot be obtained by other techniques.

  11. Twin-to-twin delivery time: neonatal outcome of the second twin.

    Science.gov (United States)

    Schneuber, Susanne; Magnet, Eva; Haas, Josef; Giuliani, Albrecht; Freidl, Thomas; Lang, Uwe; Bjelic-Radisic, Vesna

    2011-12-01

    To examine the effect of twin-to-twin delivery time (TTDT) on neonatal outcome. We evaluated twin deliveries >34 weeks of gestation. Twin pregnancies with both twins delivered by cesarean section and pregnancies with antenatal complications were excluded. We analyzed TTDT and neonatal outcomes of the second twin (umbilical arterial pH value (pH(art)), Apgar scores at 1, 5 and 10 minutes, need for intensive care). The study population was divided into two homogenous groups based on the mode of delivery: (A) vertex presentation and vaginal delivery of both twins, (B) vertex presentation and vaginal or vaginal operative delivery of twin I, breech or transverse presentation and vaginal breech delivery or cesarean section (CS) of twin II. A total of 207 twin pairs were included in our study. In Group A (n = 151) there were no significant correlations between TTDT and pH(art) or Apgar scores at 1,5 and 10 minutes of twin II (p = .156; 0.861; 0.151 and 0.384, respectively). In Group B (n = 56), the mean pH(art) of twin II was inversely correlated to TTDT, but not significantly (p = .417). TTDT was inversely related to 1-min and 5-min Apgar scores, but not significantly (p = .330; p = .138, respectively). The 10-min Apgar score showed no correlation with TTDT (p = .638). Increasing TTDT was not associated with adverse fetal outcome. Expectant management of the second twin appears possible and elapsed time alone does not appear to be an indication for intervention.

  12. Rapid onset of severe twin-twin transfusion syndrome caused by placental venous thrombosis

    NARCIS (Netherlands)

    Nikkels, PGJ; van Gemert, MJC; Sollie-Szarynska, KM; Molendijk, H; Timmer, B; Machin, GA

    2002-01-01

    We report a case of rapid onset of severe twin-twin transfusion syndrome (TTTS) at 25 weeks gestation in a monochorionic twin pregnancy that was uneventful before that time. Thrombosis of a main venous branch draining several arteriovenous (AV) anastomoses to the donor changed the previous hemodynam

  13. Glycemic Index and Pregnancy: A Systematic Literature Review

    Directory of Open Access Journals (Sweden)

    Jimmy Chun Yu Louie

    2010-01-01

    Conclusion. There is insufficient evidence to recommend a low-GI diet during normal pregnancy. In pregnancy complicated by GDM, a low-GI diet may reduce the need for insulin without adverse effects on pregnancy outcomes. Until larger-scale intervention trials are completed, a low-GI diet should not replace the current recommended pregnancy diets from government and health agencies. Further research regarding the optimal time to start a low-GI diet for maximum protection against adverse pregnancy outcomes is warranted.

  14. TWIN BIRTHS IN THE COMOROS MA ABDUL ABSTRACT Objective

    African Journals Online (AJOL)

    hi-tech

    2000-11-11

    Nov 11, 2000 ... Conclusion: Multiple pregnancy is common in the Comoros and the epidemiology and ... Of the 23 twin deliveries in Domoni, only one neonate. (a second twin) had ... including ambiguous genitalia and died in the immediate.

  15. 双胎妊娠不同分娩方式及时机对新生儿影响的探讨%Twin Pregnancy Different Mode of Delivery and Timing of Impact on Neonatal

    Institute of Scientific and Technical Information of China (English)

    赖娟娟

    2013-01-01

    Objective:To investigate the twin pregnancy, delivery methods and timing of the newborn, and to provide a theoretical basis for the choice of mode of delivery and the timing of delivery of clinical twin. Methods:The retrospective analysis of clinical data for hospital deliveries in the hospital July 2008 to July 2011, 192 cases of twin pregnancy. Results:Twin incidence of 1.10%, the preterm birth rate was 36.00%, vaginal delivery, 19.00%, vaginal assisted deliveries by 4.00%,cesarean section delivery by 77.00%. Conclusion:To strengthen the custody of the twin pregnancy, maternal pregnancy, reduce the incidence of pregnancy complications and preterm delivery, select the appropriate timing of delivery and childbirth in order to reduce the incidence of pregnant women and newborns.%  目的:探讨双胎妊娠不同分娩方式及时机对新生儿的影响,以为临床双胎分娩方式的选择及分娩时机提供理论依据。方法:回顾性分析我院2008年7月至2011年7月住院分娩的192例双胎妊娠孕妇的临床资料。结果:双胎发生率为1.10%,早产率为36.00%,经阴道分娩19.00%,阴道助产分娩4.00%,剖宫产手术分娩77.00%。结论:加强双胎妊娠产妇的孕期监护可以减少妊娠并发症及早产的发生,分娩时选择适当的时机和方式可以降低孕妇及新生儿的发病率。

  16. Perinatal outcomes of twin pregnancies among cases of spontaneous conception and assisted reproduction technology%自然妊娠和辅助生育技术妊娠双胎的母婴围产期预后

    Institute of Scientific and Technical Information of China (English)

    陈蔚琳; 宋英娜; 刘俊涛; 高劲松

    2011-01-01

    Objective The aim of this study was to evaluate and compare the perinatal and neonatal outcomes of assisted reproduction technology (ART) twin pregnancies and those of spontaneously conceived twin pregnancies (SC). Methods The medical files of ART and naturally conceived twin pregnancies were studied retrospectively.Data concerning maternal characteristics, obstetric complications and neonatal outcomes were recorded and compared. Results Mean maternal age was higher in ART group than in SC group [ (34.23±4. 13) ys vs (32. 02±4. 45) ys, P<0. 05)]. No significant differences were found in obstetric complication between the two groups. The mean gestational age and the incidence of neonatal infection were lower in ART group [ (251.87±15. 16) days,3. 7%] than in SC group [ (256. 04±12. 26) d, 9.4%] (P<0. 05). Conclusion The obstetric complications and neonatal outcomes have no significant differences in ART twin pregnancies and naturally conceived twin pregnancies.%目的 比较自然妊娠和辅助牛育技术(assisted reproduction technology,ART)妊娠双胎的母婴围产期预后.方法 选择北京协和医院定期随诊并分娩的双胎211例,其中自然妊娠142例,ART妊娠69例,回顾性分析两组孕妇一般情况、围产期并发症、分娩情况及新生儿并发症.结果 ①ART组孕妇年龄[(34.23±4.13)岁]大于自然妊娠组孕妇[(32.02±4.45)岁],P<0.05.两组孕妇围产期并发症的发生率差异无统计学意义(P>0.05);②ART组新生儿平均孕龄小于自然妊娠组,(251.87±15.16)d比(256.04±12.26)d,且新牛儿感染发牛率低,5(3.7%)比26(9.4%),P<0.05.结论 与自然妊娠双胎相比,ART双胎妊娠不增加孕妇围产期并发症的风险,而且新生儿健康状态与自然妊娠双胎相当.

  17. Ectopic pregnancy with use of progestin-only injectables and contraceptive implants: a systematic review.

    Science.gov (United States)

    Callahan, Rebecca; Yacobson, Irina; Halpern, Vera; Nanda, Kavita

    2015-12-01

    Use of contraception lowers a woman's risk of experiencing an ectopic pregnancy. In the case of method failure, however, progestin-only contraceptives may be more likely to result in ectopic pregnancies than some other methods such as combined hormonal and barrier contraceptives. To describe ectopic pregnancy risk associated with use of implants and progestin-only injectable contraceptives through a systematic review of published studies. We searched electronic databases for articles in any language published through May 2015 describing studies of progestin-only injectables and implants. We also searched bibliographies and review articles for additional studies. Studies that reported any pregnancies were included in the review. Independent data extraction was performed by two authors based on predefined data fields, and where possible, we calculated the proportion of pregnancies that were ectopic and the ectopic pregnancy incidence rate per 1000 woman-years. Fifty-three studies of implants and 28 studies of injectables were identified; 79% reported pregnancy location. The proportion of ectopic pregnancy ranged from 0 to 100% with an incidence of 0-2.9 per 1000 woman-years in studies of marketed levonorgestrel implants. Studies of etonogestrel implants and the injectables, depot-medroxyprogesterone acetate and norethisterone enanthate, reported few ectopic pregnancies. Progestin-only contraceptive implants and injectables protect against ectopic pregnancy by being highly effective in preventing pregnancy overall; however, the absolute risk of ectopic pregnancy varies by type of progestin. Risk of ectopic pregnancy should not be a deterrent for use or provision of these methods. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  18. 助孕治疗与自然妊娠双胎围产期结局的比较%Comparison of perinatal outcomes of twin pregnancy with assisted reproductive techniques and natural pregnancy

    Institute of Scientific and Technical Information of China (English)

    李洁; 杨菁; 徐望明; 程丹

    2013-01-01

    目的 比较辅助生殖技术获得的双胎妊娠与自然妊娠双胎产科合并症及新生儿不良结局的发生情况,探讨在双胎妊娠中辅助生殖技术是否会增加围产期疾病及新生儿不良结局风险.方法 回顾性分析108例经辅助生殖技术助孕的双胎妊娠病例(研究组)和144例自然受孕双胎妊娠病例(对照组)围产期疾病的发生率与产科结局.结果 研究组孕妇平均年龄为31.04±3.63岁,与对照组28.81±4.75岁比较年龄较大,差异有统计学意义(t=2.88,P0.05).其它孕期合并症如重度子痫前期、肝内胆汁淤积症、妊娠期糖尿病、贫血发病率等在研究组与对照组的差异均无统计学意义(均P>0.05).在新生儿结局中,0.05).结论 双胎妊娠围产期疾病及新生儿不良结局风险增加,其发生率与孕妇年龄有关.通过辅助生殖技术获得的双胎妊娠在0.05 ). The differences in other pregnant complications such as severe preeclampsia, intrahepatic cholestasis, gestational diabetes mellitus and anemia between study group and control group were not significant ( all P >0. 05 ). The mild asphyxia of the second neonatorum in study group and control group was 23. 53% and 12. 20% , respectively, and the difference was statistically significant(χ2 =4. 61 ,P 0. 05 ). Conclusion The risk of perinatal disease and neonatal adverse outcomes in twin pregnancy increases, and the incidence is related with maternal age. The incidence of premature rupture of membranes and that of mild asphyxia of the second neonatorum in pregnant women <35 years with twin pregnancy with ART are higher than those of natural twin pregnancy, but the risk of other perinatal diseases and neonatal adverse outcomes is not increased.

  19. A Review of the Effects of Anxiety During Pregnancy on Children’s Health

    Science.gov (United States)

    Shahhosseini, Zohreh; Pourasghar, Mehdi; Khalilian, Alireza; Salehi, Fariba

    2015-01-01

    Background: Although pregnancy is often portrayed as a time of great joy, that’s not the reality for all women. The adverse, long-term, stable, and sometimes, irreparable effects of anxiety during pregnancy can change pregnancy into an agonizing and unpleasant event of women’s life span. Aim: The aim of this study was to explore the adverse effects of anxiety in pregnancy on children’s health in order to promote child health. Methods: In this narrative review the researchers searched in public databases like Google Scholar general search engine, and then more specific: Science Direct, Scientific Information Database, Magiran, Irandoc, Pubmed, Scopus, Cochrane library, and Psych info using Medical Subject Headings (MeSH) keywords: anxiety, maternal anxiety, pregnancy, pregnancy outcome, control and prevention restricted to English / Persian language, during the 20 years ago. Then those articles written by renowned experts were selected. At first, a list of 60 papers generated from the initial search. Then reviewers studied titles and abstracts and finally, quality assessment of full text studies was performed by two independent reviewers. Researchers reviewed summary of all articles sought, ultimately used data from 25 full articles to compile this review paper. Results: The findings were classified into four groups Biological, Mental, Behavioral, and Medical effects of anxiety during pregnancy. Conclusions: The effects of anxiety during pregnancy on offspring’s health are serious and thought-provoking to which the need for identifying and screening of anxiety disorders in prenatal care is necessary. PMID:26236168

  20. Special features of high-risk pregnancies as factors in development of mental distress: a review

    Directory of Open Access Journals (Sweden)

    Paula Borba Rodrigues

    Full Text Available Abstract Introduction: Approximately 22% of all pregnant women are classified as having high-risk pregnancies, which may involve feelings of vulnerability because of having a high-risk pregnancy, resulting in greater exposure to stressful feelings. Objective: To review aspects of high-risk pregnancy that can have a negative impact on the these women's mental health status. Method: Original articles were identified by conducting searches of the PubMed/MEDLINE, LILACS and SciELO databases, followed by a manual search of references to select articles and additional bibliographic material. Articles from the last 22 years were included in the review (1992-2014. Results: Fifteen articles were found that specifically studied high-risk pregnancies and mental health outcomes. Women with high-risk pregnancies exhibited a significantly higher level of stress and reported negative emotions as they dealt with stress and had worse emotional status than women with normal pregnancies. Researchers found that hospitalized pregnant women had higher levels of anxiety than non-hospitalized women. Studies of women going through normal and high-risk pregnancies show that women with normal pregnancies had good self-perceived quality of life. Conclusion: Special features of high-risk pregnancies could be factors in development of mental distress, in addition to psychological and social factors. Therefore, only a biopsychosocial research study would be able to identify the factors that can affect the quality of mental health during high-risk pregnancy.

  1. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review.

    Science.gov (United States)

    Panelli, Danielle M; Phillips, Catherine H; Brady, Paula C

    2015-01-01

    Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar. Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.

  2. A review on thyroid cancer during pregnancy: Multitasking is required

    Directory of Open Access Journals (Sweden)

    Hussein Khaled

    2016-07-01

    Full Text Available Thyroid cancer is the second most common cancer diagnosed during pregnancy after breast cancer. The goal of management is to control malignancy and prevent maternal and fetal complications as a result of maternal hypothyroidism. The role of female sex hormones as an etiologic factor was investigated, with no clear association. Pregnancy can cause an increase in size of a previously existed thyroid nodule through the structural similarity between TSH and BHCG, and the normally expressed estrogen receptors on thyroid gland cells. Effect of pregnancy on development and prognosis of differentiated thyroid malignancies (papillary and follicular has also been studied. The prognosis of thyroid cancer is not worse in patients diagnosed during pregnancy or those who got pregnant after curative treatment. Termination of pregnancy is not indicated at all, surgery can be delayed till after delivery except in rapidly growing aggressive tumors. While radioactive iodine ablation is absolutely contra-indicated, the new systemic therapies are not well studied during pregnancy. However, almost all these new agents are classified as FDA category C or D and are better to be avoided. The effect of pregnancy on other types of thyroid cancer (medullary and anaplastic thyroid tumors is not well studied because of very low incidence with pregnancy. The endocrinological management of thyroid cancer during pregnancy is of utmost importance. The hypothyroidism after total thyroidectomy can cause fetal hypothyroidism. Therefore, the management of thyroid cancer related to pregnancy needs a multidisciplinary team.

  3. Brazilian Twin Registry: A Bright Future for Twin Studies/Twin Research: Twin Study of Alcohol Consumption and Mortality; Oxygen Uptake in Adolescent Twins/In the News: Superfecundated Twins In Vietnam; Adolescent Twin Relations; Twin and Triplet Co-Workers; A Special Twin Ultrasound; Monozygotic Twins With Different Skin Color; Identical Twin Returns from Space.

    Science.gov (United States)

    Segal, Nancy L

    2016-06-01

    The establishment of the Brazilian Twin Registry for the study of genetic, social, and cultural influences on behavior is one of eleven newly funded projects in the Department of Psychology at the University of São Paulo. These 11 interrelated projects form the core of the university's Center for Applied Research on Well-Being and Human Behavior. An overview of the planned twin research and activities to date is presented. Next, two recent twin studies are reviewed, one on the relationship between alcohol consumption and mortality, and the other on factors affecting maximal oxygen uptake. Twins cited in the media include the first identified superfecundated twins in Vietnam, adolescent twin relations, twins and triplets who work together, monozygotic twins with different skin tones and a co-twin control study that addresses the effects of space travel.

  4. Multiple Unintended Pregnancies in U.S. Women: A Systematic Review.

    Science.gov (United States)

    Aztlan-James, E Angel; McLemore, Monica; Taylor, Diana

    Each year, nearly one-half of all pregnancies in the United States are unintended. Risk factors of unintended pregnancy have been studied without attention to whether the pregnancy was the woman's first unintended pregnancy or whether she had had more than one. Little is known about the prevalence, incidence, and risk factors for multiple unintended pregnancies. The purpose of this paper is to present a systematic review of the extant literature on the risk factors for multiple unintended pregnancies in women in the United States, and whether these factors are specific to multiple unintended pregnancies. PubMed, PsychInfo, CINAHL, Web of Science, and JSTOR databases were searched for empirical research studies performed after 1979, in the United States, with a primary outcome of multiple unintended pregnancies. Articles that did not establish the intendedness of the studied pregnancies were excluded. Seven studies were identified. For multiple unintended pregnancies, incidence rates ranged from 7.4 to 30.9 per 100 person-years and prevalence rates ranged from 17% to 31.6%. Greater age; identifying as Black or Hispanic; nonvoluntary first intercourse, particularly at a young age; sex trade involvement; and previous abortion were found to be associated with multiple unintended pregnancies. Use of intrauterine devices or combined oral contraceptives were found to decrease the risk of multiple unintended pregnancies. This review suggests a small number of modifiable factors that may be used to better predict and manage multiple unintended pregnancies. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  5. Effect of uterine fibroids on fetal growths and neonatal outcomes in twin pregnancies%子宫肌瘤对双胎胎儿生长发育及新生儿结局的影响

    Institute of Scientific and Technical Information of China (English)

    王红梅; 代荫梅; 田玉翠; 薛智方

    2015-01-01

    Objective To prospectively estimate the effect of fibroids on fetal growths and neonatal outcomes in twin pregnancies. Methods Data of 46 twin pregnancies with fibroids delivered from June 2013 to December 2014 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University who have already established their records were collected. And data were also collected from 63 twin pregnancies without fibroids as matched group. The monitoring parameters of ultrasounds in their early, middle and late pregnancy and neonatal conditions and obstetric outcomes were observed and recorded. Results Twin pregnancies with fibroids were more likely to be of advanced maternal age ﹝(35.04±4.24)years vs (31.67±3.56)years, P=0.000﹞, higher pre-pregnancy body mass index ﹝(21.46± 3.69)kg/m2 vs (20.77±2.38)kg/m2, P=0.009﹞ and had lower amniotic fluid volume﹝(3.14±0.55)cm vs (3.38±0.55)cm, P=0. 001﹞ in 11-14 weeks ultrasound compared with twin pregnancies without fibroids. However, other parameters of fetal growths in early, middle and late pregnancy, neonatal conditions and obstetric outcomes had no statistical significance between twin pregnancies with fibroids and those without fibroids. Conclusion Fibroids’ effect on fetal growths and neonatal outcomes in twin pregnancies is not obvious. But twin pregnancy is a high risk factor for pregnancy and we should give more monitoring and management for twin pregnancy with fibroids, so that mothers and newborns get more reasonable and secure treatment.%目的:前瞻性评估子宫肌瘤对双胎胎儿生长发育及新生儿结局的影响。方法选取在首都医科大学附属北京妇产医院建档并于2013年6月至2014年12月分娩的双胎妊娠合并子宫肌瘤患者共46例作为研究组,以及双胎妊娠无肌瘤者63例作为对照组,观察并记录其孕早期、中期、晚期B超监测胎儿生长发育指标、新生儿出生情况及妊娠结局。结果与对照组相比,双胎妊娠合

  6. A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis

    NARCIS (Netherlands)

    Abraham, M. (Miriam); Alramadhan, S. (Salem); A. Iñiguez (Andrés); L. Duijts (Liesbeth); V.W.V. Jaddoe (Vincent); Dekker, H.T.D. (Herman T. Den); Crozier, S. (Sarah); N. Godfrey; Hindmarsh, P. (Peter); Vik, T. (Torstein); Jacobsen, G.W. (Geir W.); W. Hanke (Wojciech); Sobala, W. (Wojciech); M.P. Devereux (Michael ); S. Turner (Steve)

    2017-01-01

    textabstractBackground Maternal smoking during pregnancy is linked to reduced birth weight but the gestation at onset of this relationship is not certain. We present a systematic review of the literature describing associations between maternal smoking during pregnancy and ultrasound measurements of

  7. Biochemical Cardiovascular Risk Factors After Hypertensive Pregnancy Disorders: A Systematic Review and Meta-analysis

    NARCIS (Netherlands)

    Hermes, W.; Ket, J.C.; Pampus, M.G. van; Franx, A.; Veenendaal, M.V.; Kolster, C.; Tamsma, J.T.; Bloemenkamp, K.W.; Ponjee, G.; Hout, E. van der; Ten Horn, H.; Loix, S.; Mol, B.W.; Groot, C.J. de

    2012-01-01

    The objective of this study was to perform a systematic review and meta-analysis of studies assessing biochemical cardiovascular risk factors in women with previous hypertensive pregnancy disorders and women with previous normotensive pregnancies. Data were collected from PubMed and EMBASE (from inc

  8. Biochemical Cardiovascular Risk Factors After Hypertensive Pregnancy Disorders : A Systematic Review and Meta-analysis

    NARCIS (Netherlands)

    Hermes, Wietske; Ket, Johannes C. F.; van Pampus, Maria G.; Franx, Arie; Veenendaal, Marjolein V. E.; Kolster, Clara; Tamsma, Jouke T.; Bloemenkamp, Kitty W. M.; Ponjee, Gabrielle; van der Hout, Evelien; ten Horn, Hilde; Loix, Stephanie; Mol, Ben Willem; de Groot, Christianne J. M.

    2012-01-01

    The objective of this study was to perform a systematic review and meta-analysis of studies assessing biochemical cardiovascular risk factors in women with previous hypertensive pregnancy disorders and women with previous normotensive pregnancies. Data were collected from PubMed and EMBASE (from inc

  9. Study on the Route of Delivery and Pregnancy Outcome in Twin Pregnancy%双胎妊娠分娩方式对妊娠结局的影响

    Institute of Scientific and Technical Information of China (English)

    陈志梅

    2013-01-01

    目的:探讨双胎妊娠的分娩方式与妊娠结局之间的关系。方法:将我院273例双胎妊娠产妇按分娩方式的不同分为阴道分娩组(29例)及剖宫产组(224例),回顾性分析两组临床资料,对比两组妊娠结局。结果:剖宫产组224例,阴道分娩组29例;两组产后出血量无明显差异,P>0.05;剖宫产组平均分娩孕周大于阴道分娩组,新生儿出生平均体重显著高于阴道分娩组,P0.05,第二胎儿剖宫产组新生儿窒息率显著低于阴道分娩组,P0.05;cesarean section pregnancy week than vaginal delivery group,the average weight of newborns were significantly higher than those in the vaginal delivery group,P0.05,whereas the second tire has a significant,P<0.05.Conclusion:Cesarean section is the main mode of delivery of twin pregnancy and can reduced the.second fetal neonatal asphyxia rate.

  10. What Twin Studies Tell Us About the Heritability of Brain Development, Morphology, and Function: A Review

    NARCIS (Netherlands)

    A.G. Jansen (Arija G.); S.E. Mous (Sabine); T.J.H. White (Tonya); D. Posthuma (Danielle); T.J.C. Polderman (Tinca)

    2015-01-01

    textabstractThe development of brain structure and function shows large inter-individual variation. The extent to which this variation is due to genetic or environmental influences has been investigated in twin studies using structural and functional Magnetic Resonance Imaging (MRI). The current rev

  11. Canine and feline pregnancy loss due to viral and non-infectious causes: a review.

    Science.gov (United States)

    Verstegen, J; Dhaliwal, G; Verstegen-Onclin, K

    2008-08-01

    Among the causes for pregnancy loss, viruses and non-infectious factors are among the most important. In both dogs and cats, research and clinical evidence provide proof that there is an increasing incidence of pregnancy loss associated with infectious diseases like herpesvirus, as well as the presence of toxicants or chemicals in the animal's diet and environment. Endocrine causes must be taken into consideration when dealing with pregnancy loss. This review will cover the most recent knowledge regarding viral and non-infectious of pregnancy losses in the dog and cat.

  12. A Review of the Course and Treatment of Non-Infectious Uveitis during Pregnancy.

    Science.gov (United States)

    Grotting, Lindsay A; Papaliodis, George N

    2017-01-01

    Inflammatory conditions such as autoimmune uveitis often occur in women of childbearing age. During pregnancy, women may experience exacerbations of their disease in the first trimester. In the later stages of pregnancy, however, the uveitis tends to remain less active. The management of uveitis during pregnancy is a challenging task, forcing the physician to re-evaluate the patient's current therapy and offer alternative options that pose the least risk to the patient and fetus. This article will review treatments widely used for uveitis, including corticosteroid therapy, anti-metabolites, calcineurin inhibitors, and biologic therapy. It will evaluate the use of these medications in pregnancy and the postpartum state.

  13. Clinical Analysis of Maternal and Perinatal Outcome of 44 Patients with Twin Pregnancy%双胎妊娠44例妊娠结局临床分析

    Institute of Scientific and Technical Information of China (English)

    陈凤霞

    2014-01-01

    目的:探讨改善双胎妊娠的产妇和围产儿的预后。方法回顾分析该院2001年1月-2013年10月病案资料,包括双胎妊娠孕妇基本资料、妊娠并发症、新生儿并发症及新生儿结局,数据经统计学处理。结果双胎妊娠女性年龄相对较大,有较高的平均身高和较重平均体重。虽然没有孕产妇死亡,但妊娠并发症均显着较高,其中早产发生率(36.3%),妊娠期高血压疾病(9.1%),胎膜早破(27.2%),贫血(29.5%),产后出血(15.9%),产前出血(6.8%),妊娠糖尿病(11.3%),羊水过多(4.5%),大多数患者有一个以上并发症。只有8%的患者没有任何并发症。剖宫产与阴道分娩相比没有显著减少或增加围产儿结局。产科医生及时有效的判断行紧急剖宫产可有效降低新生儿死亡率及严重并发症的发病率。结论双胎妊娠具有较高的妊娠并发症和新生儿并发症,剖宫产与阴道分娩相比没有显著减少或增加围产儿结局。%Objective To explore the measures of improving the maternal and perinatal outcome of twin pregnancy by analyzing the treatment and outcome of 44 puerperants with twin pregnancy retrospectively. Methods The clinical data during January, 2001 to October, 2013 in our hospital, including the basic data of puerperants with twin pregnancy, pregnancy complications, neonatal complications and neonatal outcome, were analyzed retrospectively and treated statistically. Results The results showed that the women with twin pregnancy were relatively older, had a higher average height and a heavier body weight. Although there was no maternal mortality, pregnancy complications were remarkably higher, pregnancy complicated by preterm labor(36.3%), hypertensive disorders in pregnancy (9.1%), premature rupture of membrane(27.2%), anaemia(29.5%), postpartum hemorrhage (15.9%), antepar-tum hemorrhage(6.8%), gestational diabetes(11.3%), polyhydramnios(4.5%). Most of the patients had

  14. Pregnancy and oral health: a review and recommendations to reduce gaps in practice and research.

    Science.gov (United States)

    Russell, Stefanie L; Mayberry, Linda J

    2008-01-01

    This article presents a review of the research relevant to oral health during pregnancy and includes nursing practice recommendations for referral of women to a dentist for safe and effective dental care during pregnancy. In recent years, research linking periodontitis to the risk for adverse birth outcomes has resulted in increased interest in the topic of oral health during pregnancy. The achievement of optimal oral health in pregnant women as its own benefit, however, has in the past been hampered by myths surrounding the safety of dental care during pregnancy. Many women also lack access to dental care and dental insurance, which interferes with their ability to receive adequate oral care during pregnancy. Intraoral changes that occur with pregnancy because of hormonal changes, combined with lack of routine exams and delays in treatment for oral disease, place pregnant women at higher risk for dental infections.

  15. Psychological stress and adjustment in pregnancy following assisted reproductive technology and spontaneous conception: A systematic review.

    Science.gov (United States)

    Gourounti, Kleanthi

    2016-01-01

    The aim of this review was to examine studies describing the psychological stress and adjustment in pregnancy after an assisted reproductive technology (ART) treatment. A systematic search of the electronic databases was performed. This review considered only quantitative, primary studies in the English language, published during the period 2000-2014 and relevant to the objective. The population of interest was previously infertile pregnant women. Outcome variables were general anxiety, depressive symptoms, pregnancy-specific anxiety, quality of life, self-esteem, pregnancy attitudes and adjustment, and maternal-fetal attachment. Twenty studies met the inclusion and methodological criteria and were included in the review. The review revealed that compared to women who conceive naturally or to general norms, women who conceive after an in vitro fertilization treatment had greater pregnancy-specific anxiety, poorer quality of life, either the same or less depressive symptomatology, the same level of self-esteem, more positive attitudes toward pregnancy demands, and higher levels of maternal-fetal attachment. However, the evidence regarding the general anxiety levels in pregnancy after an ART treatment was inconclusive. Methodological limitations and differences across studies may explain the inconsistencies in their findings regarding the impact of ART. This review provides an insight into psychological reactions and adjustment in pregnancy after an ART treatment.

  16. 产前超声监测羊水量不均衡双胎妊娠的临床价值%Value of prenatal surveillances of ultrasonography in twin pregnancies with amniotic fluid discordance

    Institute of Scientific and Technical Information of China (English)

    刘涛; 吴瑛; 王慧芳; 谭喜平; 甘晗靖; 林琪; 焦阳; 熊奕; 姜燕; 张辉

    2010-01-01

    Objective To evaluate the values of prenatal surveillances of ultrasonography in twin pregnancies with amniotic fluid discordance. Methods Two hundred and seventy cases of diamniotic twins were included. Both postnatal outcomes and prenatal amniotic fluid discordant variations were analyzed,and the incidences of amniotic fluid discordance were compared between the monochorionic-diamniotic(MCDA)and dichorionic-diamniotic (DCDA) gruop. Results Twenty four cases of twins with amniotic fluid discordance were found in the study. The incidence of amniotic fluid discordance in MCDA group was much higher than that in DCDA group (28.9% vs 5.6%, P <0. 001 ) ,and 24 cases of twin-to-twin transfusion syndrome (TTTS) were diagnosed in the former group and none were found in the latter group. Downward tendency of amniotic fluid discordance was shown in non-TTTS cases of MCDA group. Compared with TTTS cases, the postnatal outcomes of non-TTTS cases with amniotic fluid discordance were much better in MCDA group ( P <0.001 ). Conclusions TTTS and MCDA twins with amniotic fluid discordance may overlap each other in the early stage. Serial surveillances of ultrasonography are necessary for prenatal differentiating twin pregnancies complicated by amniotic fluid discordance,and providing strong support to clinical treament.%目的 探讨产前超声监测羊水量不均衡双胎的临床价值.方法 分析270例双羊膜囊双胎中单绒毛膜双羊膜囊双胎(monochorionic-diamniotic twin,MCDA)与双绒毛膜双羊膜囊双胎(dichorionicdiamniotic twin,DCDA)羊水量不均衡的发生率,妊娠过程中羊水量变化趋势及与妊娠结局的关系.结果 共45例双胎间羊水量不均衡,MCDA组37例,其中24例为双胎输血综合征(twin-to-twin transfusion syndrome,TTTS);DCDA组8例,无TTTS发生.MCDA组羊水量不均衡的发生率明显高于DCDA组(P<0.001).MCDA组中羊水量不均衡的非TTTS双胎,羊水量的差异随孕周增加呈减少趋势,且

  17. Caesarean scar pregnancy: a review of management options.

    Science.gov (United States)

    Litwicka, Katarzyna; Greco, Ermanno

    2013-12-01

    The current review aims to provide an overview of the already available and emerging treatment modalities for caesarean scar pregnancy (CSP). CSP is a type of ectopic gestation associated with a high risk of serious complications. The cause of this condition and the best management are still unclear. However, some medical and surgical treatment modalities have been suggested. The main objectives in the clinical management of CSP should be the prevention of massive blood loss and the conservation of the uterus to maintain further fertility, women's health and quality of life. Current data suggest that expectant management should not be recommended, whereas there are accumulating data suggesting that early diagnosis offers single or combined medical and surgical treatment options avoiding uterine rupture and haemorrhage, thus preserving the uterus and fertility. No universal treatment guidelines for management of CSP have been published up to now. The lack of data on the best evidence should encourage any individual case report and further multicentre studies for recommendation establishment.

  18. Risk factors associated with twin pregnancy in double embryo transfer%移植2个胚胎发生双胎妊娠的风险因素分析

    Institute of Scientific and Technical Information of China (English)

    徐维海; 童晓嵋; 竺海燕; 林小娜; 蒋凌英; 张松英

    2011-01-01

    Objective To explore the risk factors associated with twin pregnancy in double embryo transfer.Methods A retrospective analysis was performed for 2970 double embryo transfer cycles,including 1984 cycles of fresh embryo transfer and 986 cycles of frozen-thawed embryo transfer (FET).Multiple factor Logistic regression was used.The twin pregnancy rate was studied in group of age < 35 or age ≥ 35 years old,in group of zero,single or double high-quality embryos transferred and group of fresh embryo transfer or FET cycles.Results (1) There was a significantly negative correlation between women's age and twin pregnancy according to the analysis of multiple factor Logistic regression ( P < 0.01 ).And a significantly positive correlation existed between the number of high-quality embryos transferred,FET and twin pregnancy (P <0.0l ) ; (2)the twin pregnancy rate of both fresh embryo transfer and FET cycles was higher in group of age <35 years than that in group of age ≥35 years ( 16.0% vs 8.0%,P <0.01 ; 26.9% vs 14.2%,P <0.01 ) ; (3) the twin pregnancy rate of fresh embryo transfer cycles with double high-quality embryos transferred was higher than that with zero or single high-quality embryos transferred ( 19.1% vs 5.4% ;19.1% vs 11.0%,P < 0.01 ); the twin pregnancy rate of FET cycles with double high-quality embryos transferred was also higher than that with zero or single high-quality embryos transferred (32.7% vs 10.8% ; 32.7% vs 20.7%,P <0.01 ) ; (4)the twin pregnancy rate of FET cycles was significantly higher than that of fresh embryo transfer cycles (24.7% vs 14.9%,P <0.01 ).Conclusion Women's age,the number of high quality embryos transferred and FET are risk factors associated with twin pregnancy.At reproductive centers with a mature technique of FET,we recommend performing single high-quality embryo transfer in FET cycles to reduce the occurrence of twin pregnancy.%目的 探讨1次移植2枚胚胎时发生双

  19. Management of osteogenesis imperfecta type I in pregnancy; a review of literature applied to clinical practice.

    Science.gov (United States)

    Cozzolino, Mauro; Perelli, Federica; Maggio, Luana; Coccia, Maria Elisabetta; Quaranta, Michela; Gizzo, Salvatore; Mecacci, Federico

    2016-06-01

    Osteogenesis imperfecta (OI) is a rare heritable heterogenous disorder characterized by bone fragility and susceptibility to fractures with a wide spectrum of clinical expression due to defects in collagen type I biosynthesis. The purpose of the review is to highlight the practical norms in pregnancies with osteogenesis imperfecta. We carried out a literature review in MEDLINE on OI during pregnancy, focusing on diagnosis, therapy and delivery. We reviewed 28 articles (case reports, original articles and reviews). Pregnant women affected by type I OI should be closely monitored to assess fetal well-being and detect pregnancy-related complications associated with an increased risk for osteoporosis, restrictive pulmonary disease, cephalopelvic disproportion and other problems related to connective tissue disorders. Mode of delivery remains controversial and should be determined on an individual basis. In conclusion, women affected by type I OI represent a subset of patients whose pregnancies should be considered high risk and warrant a multidisciplinary approach in a referral center.

  20. The influence of pregnancy and lactation on maternal bone health: a systematic review.

    Directory of Open Access Journals (Sweden)

    Pooneh Salari

    2014-12-01

    Full Text Available Osteoporosis is considered as an important public health problem especially in postmenopausal women. There are some hypotheses support the contributory effect of pregnancy and lactation on osteoporosis later in life. High calcium demand during pregnancy and lactation and low estrogenic state support those hypotheses. Numerous studies have investigated on the issue but there is no consensus about the contributory effect of pregnancy and lactation on osteoporosis. To explore the current state of fact, in the present study, all bibliographic databases were searched and all relevant studies on the topic of osteoporosis, lactation, and pregnancy were reviewed. The review shows that despite of controversial results, pregnancy may have protective effect on bone especially if followed by lactation.

  1. A case-control review of placentas from patients with intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Patel, Shivani; Pinheiro, Meaghan; Felix, Juan C; Opper, Neisha; Ouzounian, Joseph G; Lee, Richard H

    2014-08-01

    To compare the incidence of histopathological features in placentas from women with cholestasis of pregnancy to healthy individuals without ICP. Placentas from mothers with and without cholestasis of pregnancy were reviewed by a pathologist masked to the study group. Subjects were excluded if they had medical problems already associated with placental histopathology. Twenty-four cases and 30 controls placentas were reviewed. Seventeen placental histopathological features were found. There was no statistically significant difference between the groups. Amongst patients with cholestasis, there was a decrease in villitis of unknown etiology in those treated with ursodeoxycholic acid. There is no difference in the placental histopathology in cholestasis of pregnancy compared to normal pregnancies, but treatment of patients with cholestasis of pregnancy with ursodeoxycholic acid may decrease findings of villitis of unknown etiology.

  2. Pregnancy

    Science.gov (United States)

    ... occur between 34 and 36 weeks—these are late-preterm births. 5 Infants born in the 37th and 38th ... NICHD News and Spotlights Common tests for preterm birth not useful for ... in treating mildly low thyroid function in pregnancy, NIH Network study finds ...

  3. Dialysis for twins

    DEFF Research Database (Denmark)

    Gramkow, Ann-Maria; Aarup, Michael; Andersen, L. L. T.

    2014-01-01

    A 32-year-old woman with known stage-4 chronic kidney disease due to lupus nephritis presented with twin pregnancy after in vitro fertilization at a gestational age of 24 weeks + 3 days because of imminent preterm labour. Repeated ultrasound evaluations confirmed intrauterine growth restriction...... in both twins and polyhydramnios as the cause of imminent preterm labour. After initiation of haemodialysis treatment, ultrasound evaluation showed a significant decrease in amniotic fluids, and also reduction in blood urea nitrogen and in clinical complaints could be observed. At a gestational age of 28...... weeks + 4 days, delivery was performed by Caesarean section. This case study shows that effective treatment of elevated uraemic toxins significantly reduced the morbidity risks of the twins....

  4. Bilateral Humerus and Right Femur Fracture in a Newborn after Cesarean Section for Breech Presentation in a Twin Pregnancy: A Very Rare Case Report.

    Science.gov (United States)

    Rahul, P; Grover, Amit Rakesh; Ajoy, S M

    2017-01-01

    The most common fractures during vaginal delivery occur in the clavicle, humerus, and femur. Cesarean section reduces the chances of a child having a birth injury. However, in some difficult extractions, long bone fractures may occur. Cesarean section further reduces the incidence of birth injuries, especially in a breech delivery. Maneuvers employed during cesarean section, energetic traction, improper uterine incisions, and contracted uterus may cause these injuries. In the medical literature, there are few articles highlighting the occurrence of long bone fractures during cesarean section. There has been no case reported with a combined bilateral humerus and femur fracture in the medical literature. A 2-day-old neonate born after cesarean section for breech presentation in a twin pregnancy presented with restricted movements of both his arms and right leg. Infantogram revealed bilateral humerus and right femur fracture. Biochemical tests were normal, and there were no other findings on clinical examination. There was no evidence of child abuse or any positive family history. Child was splinted for 3 weeks. X-rays suggested good callus at the fracture site of the right femur and bilateral humerus fracture were united. To conclude, we would like to emphasize that long bone fractures can happen with cesarean section also. To prevent such untoward complications, during delivery of the baby the surgeon should be very careful, avoid energetic traction and should plan his incisions. Appropriate relaxation of the uterus must be achieved. Clavicles and other long bones should be palpated after a difficult delivery. However, it is important to note that long bone fractures in children heal rapidly without the need for any major intervention.

  5. Prospective risk of fetal death in uncomplicated monochorionic twins.

    LENUS (Irish Health Repository)

    Farah, Nadine

    2012-03-01

    A retrospective cohort study was carried out in a university teaching hospital to determine the prospective risk of unexpected fetal death in uncomplicated monochorionic diamniotic (MCDA) twin pregnancies after viability. All MCDA twins delivered at or after 24 weeks\\' gestation from July 1999 to July 2007 were included. Pregnancies with twin-twin transfusion syndrome, growth restriction, structural abnormalities, or twin reversed arterial perfusion sequence were excluded. Of the 144 MCDA twin pregnancies included in our analysis, the risk of intrauterine death was 4.9%. The prospective risk of unexpected intrauterine death was 1 in 43 after 32 weeks\\' gestation and 1 in 37 after 34 weeks\\' gestation. Our results demonstrate that despite close surveillance, the unexpected intrauterine death rate in uncomplicated MCDA twin pregnancies is high. This rate seems to increase after 34 weeks\\' gestation, suggesting that a policy of elective preterm delivery warrants evaluation.

  6. [Systemic sclerosis and pregnancy. A review of the current literature].

    Science.gov (United States)

    Németh, A; Szamosi, S; Horváth, A; Schönherr, J; Nicksch, E; Szekanecz, Z; Szűcs, G

    2014-03-01

    Pregnancy in women diagnosed with systemic sclerosis generally has a favorable outcome according to most recent studies. Women with systemic sclerosis who wish to become pregnant should achieve low disease activity for at least 6 months prior to conception. Regular follow-up of pregnant scleroderma patients by an interdisciplinary medical team including gynaecologists and rheumatologists is necessary to control disease activity and avoid possible complications. Severe organ involvement, early diffuse systemic sclerosis with rapid onset, and pulmonary hypertension ought to discourage patients from pregnancy, as these situations are at high risk of complications for both mother and fetus during pregnancy.

  7. Clinic observation on effecting of chorionic nature in twin pregnancy on pregnancy complications and perinatal outcome%双胎妊娠绒毛膜性质对孕妇妊娠期并发症及围生儿预后的影响

    Institute of Scientific and Technical Information of China (English)

    袁秀红

    2014-01-01

    Objective :To investigate the effects with chorionic nature in twin pregnancy and pregnancy complications .Methods :102 cases with twins were retrospectively analyzed .According to chorionic nature ,cases were divided into two groups :observation group (monochorionic) and control group (double chorion) .Results :There were no difference in gestational hypertension ,intrahepatic cholestasis of pregnancy ,polyhydramnios ,prema-ture rupture of membranes and preterm birth rate between Observation group and control group .But compared with observation group ,the rat of neonatal asphyxia and perinatal mortality in control group was significantly higher . Conclusions :Compared with double chorion twin pregnancies ,monochorionic twin pregnancies has a higher risk .It should be accurately determine about the chorionic nature ,to improve the level of care in monochorionic twin preg-nancies .%目的:探讨双胎妊娠绒毛膜性质对孕妇妊娠期并发症及围生儿预后的影响。方法:选取定期产检并分娩的双胎产妇102例,根据双胎绒毛膜性质分为观察组(单绒毛膜)和对照组(双绒毛膜),分析两组孕妇妊娠期并发症发生率及围生儿预后情况。结果:观察组妊娠期高血压、妊娠期肝内胆汁淤积症、羊水过多、胎膜早破、早产发生率与对照组比较无明显差异。新生儿窒息发生率、围生儿病死率均显著高于对照组。结论:单绒毛膜双胎妊娠比双绒毛膜双胎妊娠对围生儿具有更高的危险,故在孕早期应及时对双胎妊娠孕妇的绒毛膜性质进行准确判断,提高对单绒毛膜双胎妊娠孕妇和胎儿的整体监护水平。

  8. On some phenomena concerning pregnancy and parturition of the Cetacea

    NARCIS (Netherlands)

    Slijper, E.J.

    1949-01-01

    1. A review is given of some phenomena concerning pregnancy and parturition of the Cetacea, depending on data in literature and on observations made in Antarctic Blue and Fin Whales on board the f.f. “Willem Barendsz” (1946—1947). 2. In Mystacoceti the frequency of twins appears to be less than in m

  9. On some phenomena concerning pregnancy and parturition of the Cetacea

    NARCIS (Netherlands)

    Slijper, E.J.

    1949-01-01

    1. A review is given of some phenomena concerning pregnancy and parturition of the Cetacea, depending on data in literature and on observations made in Antarctic Blue and Fin Whales on board the f.f. “Willem Barendsz” (1946—1947). 2. In Mystacoceti the frequency of twins appears to be less than in m

  10. On some phenomena concerning pregnancy and parturition of the Cetacea

    NARCIS (Netherlands)

    Slijper, E.J.

    1949-01-01

    1. A review is given of some phenomena concerning pregnancy and parturition of the Cetacea, depending on data in literature and on observations made in Antarctic Blue and Fin Whales on board the f.f. “Willem Barendsz” (1946—1947). 2. In Mystacoceti the frequency of twins appears to be less than in

  11. 超声诊断双胎妊娠并单脐动脉胎儿异常分析%Analysis of Fetal Malformations of Twin Pregnancy with Single Umbilical Artery Diagnosed by Ultrasound

    Institute of Scientific and Technical Information of China (English)

    陈肖侠; 解丽梅

    2013-01-01

    Objective To investigate ultrasound diagnosis of fetal malformations of twin pregnancy combined single umbilical artery (SUA).Methods A retrospective analysis was performed,SUA prenatal ultrasonographic results,chromosome check results and the follow up fetal outcomes were found from 36 cases of twin pregnancy.Results Among the 36 cases of twin fetus with SUA,there were 23 cases of single umbilical and fetal malformations (63.9%).Chromosome examination was performed in 15 cases,and 6 cases showed chromosomal abnormalities.There were 22 cases of fetal birth,of which 8 cases were born with twin reverse arterial perfusion (including 5 cases of low birth weight infants),the other 14 cases were born with single umbilical artery fetal (including 7 cases of low birth weight infants).Conclusion It is necessary to follow up twin pregnancy with SUA fetal outcome,summarize the patterns of fetal malformations and explore the relationship with chromosome and fetal outcome,so as to provide rationalization proposal for SUA antenatal consultation.%目的 探讨超声检查双胎妊娠合并单脐动脉(SUA)的胎儿异常情况.方法 回顾36例双胎妊娠合并SUA病例的产前超声检查结果及染色体检测结果,随访胎儿妊娠结局.结果 36例双胎妊娠合并SUA胎儿中,单脐动脉合并胎儿异常23例(63.9%),15例进行胎儿染色体检查,共检查出胎儿染色体异常6例.胎儿出生22例,其中双胎反向动脉灌注序列征者出生8例,5例为低出生体质量儿.其余合并单脐动脉胎儿出生14例,7例为低出生体质量儿.结论 通过对双胎合并SUA胎儿的随访,总结合并SUA胎儿畸形类型、与染色体关系及胎儿结局,为单脐动脉产前咨询提供合理化建议.

  12. [Woman's participation in the decision process of the pregnancy and puerperal cycle: nursing care integrative review].

    Science.gov (United States)

    Busanello, Josefine; Lunardi Filho, Wilson Danilo; Kerber, Nalú Pereira da Costa; Lunardi, Valéria Lerch; dos Santos, Silvana Sidnei

    2011-12-01

    This is an integrative review that aims to identify the contribution of nursing care for woman's participation in the decision process of the pregnancy and puerperal cycle, as described in Brazilian scientific publications. The scientific productions were retrieved in May, 2010, from the Virtual Library of Health (Biblioteca Virtual em Saúde) database. From the eight articles reviewed, two themes stood out: Contributions of nursing care to the woman's participation in the decision process of the pregnancy and puerperal cycle; and Limitations of nursing care to the woman's participation in the decision process of the pregnancy and puerperal cycle. The following review supports the production of knowledge in nursing, by identifying a gap in what nurses know and do about this issue, as shown by the lack of nursing researches that concern, specifically, the participation of the woman in the decision process during the pregnancy and puerperal cycle and the possible contributions of nursing care to ensure women of this right.

  13. Pregnancy after cardiac transplantation. Report of one case and review

    Directory of Open Access Journals (Sweden)

    Solange Bordignon

    2000-12-01

    Full Text Available A 14-year-old female patient became pregnant 6 years after heart transplantation. The pregnancy evolved uneventfully, and the newborn infant was healthy. Five months after delivery, the mother was in good condition with preserved ventricular function, and the baby had normal neuro-psychomotor development. Even though the case reported here was a success, pregnancy following cardiac transplantation is considered a high-risk condition and remains contraindicated.

  14. Plasma concentrations of four pregnancy proteins in complications of pregnancy.

    Science.gov (United States)

    Lin, T M; Halbert, S P; Spellacy, W N; Berne, B H

    1977-08-01

    Toxemia of pregnancy was associated with an elevation of the pregnancy-associated plasma protein (PAPP)-A concentration, as compared to the level in normal pregnancy in the last month of gestation. The other pregnancy proteins measured were not altered in toxemia. In twin pregnancies, the PAPP-A, PAPP-C, and human placental lactogen levels were all increased, particularly PAPP-A. On the other hand, pregnancy zone protein was not affected by twinning. Pregnancy with diabetes showed normal levels of these proteins.

  15. Periodontal infection and adverse pregnancy outcomes: a systematic review of epidemiological studies

    Directory of Open Access Journals (Sweden)

    Vettore Mario Vianna

    2006-01-01

    Full Text Available The objective of this systematic review was to evaluate analytical studies on periodontal disease as a possible risk factor for adverse pregnancy outcomes. A literature search of the MEDLINE, SciELO, and LILACS bibliographic databases and CAPES thesis database was conducted up to December 2005, covering epidemiological studies of periodontal disease and adverse pregnancy outcomes. Of the 964 papers identified, 36 analytical studies met the inclusion criteria. Twenty-six epidemiological studies reported associations between periodontal disease and adverse pregnancy outcomes. There was a clear heterogeneity between studies concerning measurement of periodontal disease and selection of type of adverse pregnancy outcome. Therefore no meta-analysis was performed. Most studies did not control for confounders, thus raising serious doubts about their conclusions. The methodological limitations of most studies did not allow conclusions concerning the effects of periodontal disease on adverse pregnancy outcomes. Larger and methodologically rigorous analytical studies using reliable outcomes and exposure measures are recommended.

  16. Genetic and environmental contributions to children's prosocial behavior: brief review and new evidence from a reanalysis of experimental twin data.

    Science.gov (United States)

    Knafo-Noam, Ariel; Vertsberger, Dana; Israel, Salomon

    2017-08-12

    Children's prosocial behaviors show considerable variability. Here we discuss the genetic and environmental contributions to individual differences in children's prosocial behavior. Twin research systematically shows, at least from the age of 3 years, a genetic contribution to individual differences in prosocial behavior, both questionnaire-based and observed. This finding is demonstrated across a wide variety of cultures. We discuss the possibility that different prosocial behaviors have different genetic etiologies. A re-analysis of past twin data shows that sharing and comforting are affected by overlapping genetic factors at age 3.5 years. In contrast, the association between helping and comforting is attributed to environmental factors. The few molecular genetic studies of children's prosocial behavior are reviewed, and we point out genome-wide and polygenic methods as a key future direction. Finally, we discuss the interplay of genetic and environmental factors, focusing on both gene×environment interactions and gene-environment correlations. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. 双胎妊娠之一胎死宫内原因及处理17例临床分析%Clinical Analysis of 17 Cases of Twin Pregnancy with One Fetal Intrauterine Death

    Institute of Scientific and Technical Information of China (English)

    赵国斌; 左莉; 陈翊; 郑玲; 郭华

    2011-01-01

    Objective To study the cause, clinical treatment, and prognosis of twin pregnancy with one fetal intrauterine death. Methods 17 cases of twin pregnancy with one fetal intrauterine death from February 1995 to May 2009 in Panyu Central Hospital were analyzed. Results The rate of twin pregnancy with one fetal intrauterine death was 2.99% ( 17/568 ). Of the 17 cases, 3 patients were found one fetal death within 28 weeks of pregnancy; their pregnancy were terminated after averagely 102.8 days of expectant treatment; average termination time were 36 +5 weeks. 12 patients were found intrauterine death after 28 weeks of pregnancy deal with expectant treatment; their pregnancy were terminated after averagely 13.2 days; average termination time was 35 +1 weeks. Only 1 premature delivery cases had mild asphyxia. Of the 17 cases, no coagulation disturbance occurred. The most common complications were the premature birth and preeclampsia and premature rupture of membranes. Congenital malformation was the main reason to the intrauterine fetal death. Conclusion On condition that the intrauterine surviving fetal and maternal coagulation function were watched and maternal complications and accompanying diseases were dealt with, expectant treatment was an effective way of treating twin pregnancy with one fetal intrauterine death.%目的 探讨双胎妊娠之一胎死宫内的原因、临床处理及预后.方法 回顾性分析1995年2月-2009年5月广州番禺中心医院双胎妊娠之一胎死宫内的病例共17例临床资料.结果 双胎一胎宫内死亡的发生率为2.99%.孕28周前发现一胎宫内死亡者3例,平均期待治疗102.8 d,平均分娩孕周为36+5周;孕28周后发现一胎宫内死亡者期待治疗12例,平均期待治疗13.2 d,平均分娩孕周为35+1周.仅1例新生儿发生轻度窒息.无一例孕妇发生凝血功能障碍.早产、子痫前期和胎膜早破发生率高.胎儿畸形是胎死宫内的重要原因.结论 双胎妊娠一胎宫

  18. Long-Term Neuropsychological Outcome in Preterm Twins

    Directory of Open Access Journals (Sweden)

    Giovanni Iannone

    2006-01-01

    Full Text Available Few long-term studies have yet described neuropsychological outcome in preterm twins. Our aim was to assess, by long-term evaluation, neuropsychological outcome in preterm twins in order to define a correct follow-up program. Our study was a cohort one, with an index and a comparison group. Neonatal medical records of all preterm newborns admitted to our centre between 1991 and 1997 were reviewed and selected patients were recalled. The sample population included two matched groups of children aged 6—12 years, 86 twins and 86 singletons, submitted to paediatric, neurological, psychological, and ophthalmological examinations. Inclusion criteria were twin pregnancy and gestational age 27—36 weeks for index group; same gestational age, but single pregnancy, for the comparison group. All children underwent paediatric and neuropsychiatric examinations, cognitive assessment, and psychological evaluation by standardized tests for screening of learning specific disorders and language difficulties, and finally, ophthalmological examination. In order to study their role in predicting neuropsychological outcome, we examined some perinatal prognostic factors by statistical analysis. Unfavourable neuropsychological outcome was observed in 55/172 (32% children, with different prevalence in the two groups, 42/172 (24% in twins and 13/172 (8% in singletons. Statistical analysis performed for examined prognostic factors showed significant differences in neuropsychological outcome with regard only to gestational age < 32 weeks, low birth weight, intraventricular haemorrhage, and periventricular leukomalacia. The incidence of neuropsychological diseases in the two groups showed significant difference about language and learning difficulties. Our data suggest that preterm twins represent a particular high-risk category of premature babies, mostly regarding the risk of so-called “minimal brain dysfunction”, so a careful follow-up is recommended.

  19. Systemic lupus erythematosus and pregnancy outcomes: an update and review of the literature.

    Science.gov (United States)

    Peart, Erica; Clowse, Megan E B

    2014-03-01

    This review synthesizes new data from the studies published between 2011 and 2013, with particular focus on the different information gleaned by various study types. Population-based cohorts have demonstrated that women with systemic lupus erythematosus (SLE) have fewer live births and more pregnancy complications, but can have successful live births after having a poor outcome. A retrospective study suggests that only 4 months, not the traditional 6 months of disease quiescent SLE prior to pregnancy improves outcomes. Prospective studies identified several novel predictors of poor pregnancy outcomes, including uterine Doppler and laboratory findings. A prospective study found great success in transitioning to azathioprine from mycophenolate mofetil prior to pregnancy in patients with quiet lupus nephritis. Two retrospective analyses suggest that hydroxychloroquine may prevent congenital heart block in pregnancies exposed to SSA/Ro antibodies. Finally, the initial pregnancy data for belimumab suggest a high degree of transplacental transfer, but thus far no definitive link between belimumab and congenital abnormalities. Recent studies suggest both novel markers of poor pregnancy outcomes and new approaches to the management of lupus during pregnancy.

  20. Management of the abnormal Papanicolaou smear and colposcopy in pregnancy: an evidenced-based review.

    Science.gov (United States)

    Fleury, A C; Birsner, M L; Fader, A N

    2012-04-01

    Women diagnosed with abnormal Papanicolau smears or cervical abnormalities during pregnancy present a challenge to health care providers, as conventional management guidelines appropriate for the non-pregnant population may be contraindicated. The physiologic effects of pregnancy that may result in greater difficulty with the colposcopic examination include increased cervical mucus production that may obscure visualization, cervical hyperemia, gland prominence, and eversion of the columnar epithelium. The squamo-columnar junction may also be difficult to visualize in early pregnancy, but will often evert as the pregnancy continues. Because of these changes, cervical dysplasia may have a more prominent appearance in the gravid patient. Therefore, colposcopy should be performed by a skilled examiner with expertise in the cervical changes of pregnancy. The primary goal of colposcopy during pregnancy is to exclude the presence of invasive cancer, and thus, many cervical lesions may be followed with serial cytology and colposcopy during pregnancy or by deferring further colposcopic examination until the postpartum period. Cervical biopsy should be avoided unless a malignancy is suspected and endocervical sampling is contraindicated. Herein, we present a contemporary, evidence-based review of the colposcopic examination and guidelines for triaging and evaluating abnormal cervical cytology and lesions that are diagnosed during pregnancy.

  1. Pregnancy-associated morphea: a case report and literature review.

    Science.gov (United States)

    Pham, Anh Khoa; Srivastava, Bhaskar; Deng, April

    2017-01-15

    Morphea, also known as localized scleroderma, is arare fibrosing disorder of the skin, the pathogenesisof which is incompletely understood. It is thought,however, to involve interplay of genetic dispositionand triggering environmental factors, such asinfections and autoimmunity. Pregnancy as a potentialtrigger has only been reported in four cases. Herein,we present a patient who developed morphea of thebreasts during pregnancy, which rapidly resolvedwith a normal delivery. Our patient was distinct fromsome of the reported patients because her conditionwas tightly correlated with her pregnancy, as judgingby rapid resolution after delivery. In addition, therewas no apparent infection, history of autoimmunity,or development of autoimmunity during or afterpregnancy. Although the pathogenesis of pregnancyassociatedmorphea is largely unknown, we exploredpotential mechanisms of this condition, which mayinvolve mechanical injury, "microchimerism," andshifts in intrapartum hormones, such as TGF-β.

  2. Systematic review of progesterone for the prevention of preterm birth in singleton pregnancies

    DEFF Research Database (Denmark)

    Rode, Line; Langhoff-Roos, Jens; Andersson, Charlotte

    2009-01-01

    . SEARCH STRATEGY: A search in the PubMed, Embase, and Cochrane database was performed using the keywords: pregnancy, progesterone, preterm birth/preterm delivery, preterm labor, controlled trial, and randomized controlled trial. SELECTION CRITERIA: Studies on singleton pregnancies. DATA COLLECTION...... AND ANALYSIS: A meta-analysis was performed on randomized trials including singleton pregnancies with previous preterm birth. MAIN RESULTS: Two new randomized controlled trials of women with previous preterm birth were added to the four analyzed in the Cochrane review, and the meta-analysis of all six studies......BACKGROUND: A Cochrane review in 2006 concluded that further knowledge is required before recommendation can be made with regard to progesterone in the prevention of preterm birth. OBJECTIVE: To provide an update on the preventive effect of progesterone on preterm birth in singleton pregnancies...

  3. The prevalence of pregnancy-related acute renal failure in Asia: A systematic review.

    Science.gov (United States)

    Karimi, Zynab; Malekmakan, Leila; Farshadi, Maryam

    2017-01-01

    Acute renal failure (ARF) is a major complication during pregnancy and is associated with high mortality rate in developing countries. The aim of this study was to report the prevalence of pregnancy-related ARF in Asia. This study is a systematic review Google Scholar, PubMed, and Medline databases were searched for all papers in English on pregnancy related ARF (PR-ARF) in Asian countries that were published between 2010 and 2015 were reviewed. Of all the articles published in that period, 19 were selected - 17 were original articles and two were cases reports. We gathered information on the prevalence of PR-ARF, parity, duration of pregnancy when PR-ARF developed, etiology of PR-ARF, common clinical symptoms, and laboratory findings in PR-ARF.

  4. College-age twins: university admission policies / twin research: birth weight and neuromotor performance; transfusion syndrome markers; vanishing twins and fetal sex determination; mz twin discordance for wilson's disease / media: big at birth; planned separation of conjoined twins; x factor twins; Cinema: the identical.

    Science.gov (United States)

    Segal, Nancy L

    2014-12-01

    There is a lack of research findings addressing the unique college admissions issues faced by twins and other multiples. The advantages and disadvantage twins face, as reported by college administrators, twins and families are reviewed. Next, recent research addressing twins' birth weight and neuromotor performance, transfusion syndrome markers, the vanishing twin syndrome and monozygotic (MZ) twin discordance for Wilson's disease is described. News items concerning the birth of unusually large twins, the planned separation of conjoined twins, twin participants in the X Factor games and a film, The Identical, are also summarized.

  5. Multiaxial changes in pregnancy: mental health--a review of the literature.

    Science.gov (United States)

    Müldner-Nieckowski, Lukasz; Cyranka, Katarzyna; Smiatek-Mazgaj, Bogna; Mielimąka, Michał; Sobański, Jerzy A; Rutkowski, Krzysztof

    2014-10-01

    Pregnancy constitutes not only a challenge for the body of the woman, but also a developmental and psychological task for the mother-to-be, her partner and the entire family. Considerable amount of research has been published on the subject of the puerperal period and treatment options of various disorders emerging after pregnancy. However, data on psychiatric disorders and their treatment during that period, although available, remain insufficient. The paper reviews the literature on mental disorders occurring in pregnancy taking into account the overall emotional situation of the pregnant woman.

  6. Gorlin-Goltz syndrome in twin brothers: an unusual occurrence with review of the literature.

    Science.gov (United States)

    Anchlia, Sonal; Vyas, Siddharth; Bahl, Sumit; Nagavadiya, Vipul

    2015-08-21

    Gorlin-Goltz syndrome, also known as nevoid basal cell carcinoma syndrome, is caused by genetic alteration produced by a mutation in the 'patched' tumour suppressor gene, and is inherited in a dominant autosomal way. Although sporadic cases have been found, this syndrome has rarely been reported in twin patients. The syndrome is characterised by a wide range of developmental abnormalities and has a predisposition to neoplasms such as multiple pigmented basal cell carcinomas and keratocysts in jaws; it also has other features such as palmar and/or plantar pits and calcification of falx cerebri. Owing to the critical oral and maxillofacial manifestations of this syndrome, it is important to recognise its characteristics in order to make a diagnosis, and to plot early preventive treatment and establish the right genetic evidence. Based on a combination of imaging, clinical and histopathological findings, we present a diagnosed case of Gorlin-Goltz syndrome in 18-year-old twin brothers. All cystic lesions were enucleated and 1 year follow-up showed no recurrence.

  7. Fish Intake during Pregnancy and Foetal Neurodevelopment—A Systematic Review of the Evidence

    OpenAIRE

    2015-01-01

    Fish is a source of several nutrients that are important for healthy foetal development. Guidelines from Australia, Europe and the USA encourage fish consumption during pregnancy. The potential for contamination by heavy metals, as well as risk of listeriosis requires careful consideration of the shaping of dietary messages related to fish intake during pregnancy. This review critically evaluates literature on fish intake in pregnant women, with a focus on the association between neurodevelop...

  8. Factors associated with teenage pregnancy in South Asia: a systematic review

    OpenAIRE

    Acharya, Dev Raj; Bhattaria, Rabi; Poobalan, Amudha S.; van Teijlingen, Edwin; Chapman, Glyn N

    2010-01-01

    Background: South Asia has a large proportion of young people in the world and teenage pregnancy has emerged as one of the major public health problem among them. The objective of this study is to systematically review to identify the risk factors associated with teenage pregnancy in South Asian countries.\\ud Methods: We systematically searched MEDLINE, EMBASE and CINAHL database (1996 to April 2007) and web-based information. Inclusion criteria were the English-language papers available in t...

  9. Exploring the barriers of quitting smoking during pregnancy: a systematic review of qualitative studies.

    OpenAIRE

    Ingall, G; Cropley, M.

    2010-01-01

    Smoking during pregnancy is widely known to increase health risks to the foetus, and understanding the quitting process during pregnancy is essential in order to realise national government targets. Qualitative studies have been used in order to gain a greater understanding of the quitting process and the objective of this systematic review was to examine and evaluate qualitative studies that have investigated the psychological and social factors around women attempting to quit smoking during...

  10. [Urological problems in pregnancy, birth, and puerperium--a systematic review].

    Science.gov (United States)

    Nielsen, Rikke Vibeke; Østergaard, Jeanett; Alling-Møller, Lars

    2012-04-30

    Urological problems in pregnancy represent a diagnostic and therapeutic challenge. Urinary tract symptoms in pregnant women comprise urinary tract infections, urolithiasis, hydronephrosis, urinary retention, urinary frequency and urinary incontinence. The primary purpose of this paper was to link our current understanding of the urinary tract anatomy and physiology to urinary tract symptoms in pregnancy and puerperium and the secondary purpose was to provide a review on diagnosis and management of these.

  11. Twins' injuries: genetic and environmental risks / twin research reports / human interest stories.

    Science.gov (United States)

    Segal, Nancy L

    2011-04-01

    The relative contributions of genetic and environmental factors to unintentional injuries are of interest to families with young twins. A recent study found that childhood injuries are explained mostly by child-specific environmental factors. Next, twin research reviews of the association between periodontal disease and cancer, secular trends in gestational age and birthweight, and language development in hearing and deaf co-twins are also summarized. Interesting reports of newborn twins, twin-like relationships, twin interactions and missed twin relationships are presented.

  12. 产前超声在双胎妊娠中胎儿心脏复杂畸形中的应用%Application of Prenatal Ultrasound in Fetal Cardiac Complex Malformation in Twin Pregnancy

    Institute of Scientific and Technical Information of China (English)

    丁凤霞

    2016-01-01

    目的:分析产前超声在双胎妊娠中胎儿心脏复杂畸形中的临床价值。方法:回顾性分析我院于2012年1月~2015年1月期间经产前超声检查的双胎妊娠孕妇16例,至少有1例孕妇合并心脏复杂畸形,对孕妇产前、产后超声结果进行总结,并分析其产前漏诊原因。结果:经产后超声检查,证实本组16例孕妇均合并心脏复杂畸形的双胎,其中有11例为单绒毛膜囊双胎,有5例为双绒毛膜囊双胎。有14例孕妇经产前超声检查明确诊断,且由产后随访检查证实;有1例A型主动脉弓离断,其心脏复杂畸形多与心外畸形共存;有1例右室双出口出现漏诊,经产前诊断为室间隔缺损。结论:通过产前超声筛查,可有效诊断单绒毛膜囊双胎合并心脏复杂畸形的发生率明显高于双绒毛膜囊双胎,其具有良好的临床价值。%Objective: to analyze the clinical value of prenatal ultrasound in fetal cardiac complex malformation in twin pregnancy.Methods:a retrospective analysis of our hospital in 2012 January 2015 period in January by prenatal ultrasound examination of twin pregnancy in 16 cases, at least 1 cases of pregnant women with complex heart malformation, the prenatal and postnatal ultrasound results are summarized and and analysis of prenatal reasons for misdiagnosis.Results: multiparous after ultrasound examination, confirmed that this group of 16 cases of pregnant women were associated with cardiac malformation complex twins, of which 11 cases for sac properties of monochorionic twins, 5 cases of cystic nature of dichorionic twin pregnancy. With 14 cases pregnant women by prenatal ultrasound diagnosis and confirmed by postnatal follow-up examination;1 case of type A aortic arch interruption, the complex heart malformation with extracardiac malformations coexist; 1 case of right ventricular double outlet of missed diagnosis and prenatal diagnosis for ventricular septal defect

  13. Sigmoid volvulus in pregnancy: case report and review of literature.

    Science.gov (United States)

    Serafeimidis, Costas; Waqainabete, Ifereimi; Creaton, Anne; Vakamacawai, Esala; Kumar, Ronal

    2016-08-01

    Sigmoid volvulus in pregnancy is a very rare condition. Despite this, clinicians should have a high index of suspicion of this condition if they encounter a pregnant woman with symptoms suggestive of bowel obstruction. Incorrect diagnosis may be catastrophic, resulting in major complications, including fetal and maternal death.

  14. Inhibitors and Facilitators of Unwanted Adolescent Pregnancy in Iran and the World: A Review

    Directory of Open Access Journals (Sweden)

    Farzaneh Rashidi Fakari

    2017-07-01

    Full Text Available Background: Approximately 16 million adolescent girls aged 15 to 19 years and 1 million teenage girls less than 15 years of age become pregnant worldwide annually, and the majority of these pregnancies are unintended. Unwanted adolescent pregnancy coupled with impaired and inadequate physical and mental health can lead to slow progression of the community and the short- and long-term negative consequences. Aim: This study aimed to investigate the inhibitors and facilitators of unwanted adolescent pregnancy in Iran and across the globe. Method: The current narrative review was conducted using the keywords of "pregnancy", "unwanted", and "adolescent" in both Persian and English articles published from 2000 to 2016. The searched databases included Google Scholar, PubMed, Elsevier, Scopus, ProQuest, Irandoc, Scientific Information Database (SID, and Magiran. Results: Twenty-nine articles related to the study objectives were selected. Our investigations indicated that the inhibitors of unwanted adolescent pregnancy could be classified into four main categories of abstinence, religious beliefs, adolescent employment program, and parent-adolescent relationship. Further, the facilitators of unwanted adolescent pregnancy were categorized into eight categories of pornography on the Internet and media, peer pressure, lack of knowledge and information, drug and alcohol abuse, violence, adherence to fashion in clothing, economic and income status and family structure. Implications for Practice: The findings of this review revealed that more studies were conducted to explore the facilitators of unwanted adolescent pregnancy in comparison with inhibitors. Shortage of knowledge and information among adolescents plays a major role in unwanted adolescent pregnancy. However, a definitive judgment on the contribution of each factor to unwanted adolescent pregnancy requires further in-depth studies.

  15. Comparison of Naturally Conceived and IVF-DZ Twins in the Netherlands Twin Registry: A Developmental Study

    Directory of Open Access Journals (Sweden)

    Catharina E. M. van Beijsterveldt

    2011-01-01

    Full Text Available In a large set of twin pairs, we compared twins born after IVF to naturally conceived twins with respect to birth characteristics, growth, attainment of motor milestones, and emotional and behavioral problems. Twin families were registered with the Netherlands Twin Register. We included 1534 dizygotic (DZ twins born after IVF, 5315 naturally conceived (NC DZ twins, and 1504 control NC DZ twins who were matched to the IVF twins based on maternal age, maternal educational level, smoking during pregnancy, gestational age, and offspring sex. Data were obtained by longitudinal surveys sent to fathers, mothers, and teachers at ages 1, 2, 3, 7, 10, and 12 years. Results showed no differences in growth, in attainment of motor milestones, and in behavioral development between IVF and matched NC twins. It can be concluded that for nearly all aspects, development in IVF and NC children is similar.

  16. [The Chinese national twin cohort: an update].

    Science.gov (United States)

    Gao, W J; Li, L M

    2017-06-10

    The importance of large cohort studies in China has been increasingly emphasized. As special group in the population, twins provide excellent natural resources since they share the same birthday, maternal intrauterine environment and early family environment. Twin cohorts are unique for and benefit on controlling the confounding factors as age, gender (same-sex twins), genetic background (monozygotic twins) or early environment (being raised together) in the etiological studies on complex diseases. In this review, we briefly introduce the objectives, current situation, challenges and opportunities related to the Chinese national twin cohort, focusing on the characteristics of twins that are different from other groups in the general population.

  17. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews.

    Science.gov (United States)

    Marchi, J; Berg, M; Dencker, A; Olander, E K; Begley, C

    2015-08-01

    Maternal obesity is linked with adverse outcomes for mothers and babies. To get an overview of risks related to obesity in pregnant women, a systematic review of reviews was conducted. For inclusion, reviews had to compare pregnant women of healthy weight with women with obesity, and measure a health outcome for mother and/or baby. Authors conducted full-text screening, quality assurance using the AMSTAR tool and data extraction steps in pairs. Narrative analysis of the 22 reviews included show gestational diabetes, pre-eclampsia, gestational hypertension, depression, instrumental and caesarean birth, and surgical site infection to be more likely to occur in pregnant women with obesity compared with women with a healthy weight. Maternal obesity is also linked to greater risk of preterm birth, large-for-gestational-age babies, foetal defects, congenital anomalies and perinatal death. Furthermore, breastfeeding initiation rates are lower and there is greater risk of early breastfeeding cessation in women with obesity compared with healthy weight women. These adverse outcomes may result in longer duration of hospital stay, with concomitant resource implications. It is crucial to reduce the burden of adverse maternal and foetal/child outcomes caused by maternal obesity. Women with obesity need support to lose weight before they conceive, and to minimize their weight gain in pregnancy.

  18. Sudden twin infant death on the same day: a case report and review of the literature.

    Science.gov (United States)

    Huang, Ping; Yu, Rongjun; Li, Shiying; Qin, Zhiqiang; Liu, Ningguo; Zhang, Jianhua; Zou, Donghua; Chen, Yijiu

    2013-06-01

    Sudden infant death syndrome (SIDS) is a major contributor to infant mortality. The cause of death is unknown: suggested possibilities include cardiovascular disease, anaphylactic shock, and suffocation. The occurrence of simultaneous sudden infant death syndrome is uncommon, such cases being extremely rare in forensic pathologic practice. We report two 10-week-old male twins who appeared well at the time of their evening feeding, yet died while sleeping on their backs. Both infants had petechial hemorrhages on the visceral pleura, epicardial surface of the heart, and thymus gland. Microscopic examination revealed pulmonary edema, intra-alveolar hemorrhage, and minor lymphocytic infiltration, again in both infants. In this report, we discuss the risk factors for SIDS, which should be considered individually or in combination as possible causes of death.

  19. Twin Studies of Atopic Dermatitis

    DEFF Research Database (Denmark)

    Elmose, Camilla; Thomsen, Simon Francis

    2015-01-01

    Aim. The aim of this study was to conduct a systematic review of population-based twin studies of (a) the concordance and heritability of AD and (b) the relationship between AD and asthma and, furthermore, to reinterpret findings from previous twin studies in the light of the emerging knowledge a...

  20. Safety of sumatriptan in pregnancy: a review of the data so far.

    Science.gov (United States)

    Loder, Elizabeth

    2003-01-01

    The high prevalence of migraine in women during their reproductive years means that new drug treatments for migraine, such as the serotonin 5-HT(1B/1D) receptor agonists (the 'triptans'), are likely to be widely used by women of childbearing potential. Scrutiny of these agents in an effort to detect any signal of teratogenicity is thus important. A systematic review of the medical literature was conducted to identify information regarding the safety of sumatriptan during pregnancy. This agent was chosen to be investigated because it has been available for the longest and is the most widely used of the triptan class. Information was obtained regarding the impact of migraine on pregnancy outcome, and data on sumatriptan use in pregnancy were obtained from animal studies, preclinical drug trials, postmarketing surveillance efforts, prospective pregnancy registries, national birth registries and teratogen information services. Synthesis of information from these sources is sufficient to rule out a large increase in birth defects from sumatriptan use during pregnancy and is reassuring for cases where inadvertent exposure to sumatriptan during pregnancy has occurred. However, current information is not sufficient to rule out small increases in the risk for birth defects. For this reason, caution should be exercised in making a positive recommendation for the use of sumatriptan during pregnancy.

  1. Breast cancer and pregnancy. Literature review and case report

    Directory of Open Access Journals (Sweden)

    Lidia Torres Aja

    2011-03-01

    Full Text Available The present case is included among the so-called special forms of breast cancer. It appears during pregnancy or up to one year after childbirth. It occurs in 1 in 3,000 pregnant women. The highest incidence rates have been registered in developed or developing countries. Diagnosis is performed, in most cases, in advanced stages of the disease, which leads to a worse prognosis and survival than in non-pregnant and puerperal women. The case of a patient who had given birth 9 months ago and was pregnant at the time she attended consultation is presented. She was diagnosed with undifferentiated breast carcinoma. This is the first case of breast cancer diagnosis during pregnancy in the province of Cienfuegos in the last 30 years.

  2. Hemophagocytic lymphohistiocytosis in pregnancy: a case report and review of treatment options.

    Science.gov (United States)

    Dunn, Tamara; Cho, May; Medeiros, Bruno; Logan, Aaron; Ungewickell, Alexander; Liedtke, Michaela

    2012-11-01

    Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening inflammatory disorder characterized by uncontrolled proliferation and activation of histiocytes with phagocytosis of normal hematopoietic cells. A 41-year-old woman, 19 weeks pregnant with twins, and a history of Still's disease, presented with rash, fever, and headache. Laboratory studies revealed transaminitis, hyperbilirubinemia, and eventually severe neutropenia as well as elevations in ferritin, lactate dehydrogenase, and C-reactive protein. A bone marrow biopsy confirmed HLH. She declined standard HLH-treatment but responded well to high-dose corticosteroids. Her blood counts remained stable following corticosteroid taper, and she delivered healthy twin girls at 30-week gestation. Few cases of HLH during pregnancy have been reported. In some cases, the condition has proved fatal. Therefore recognizing signs and symptoms of HLH is essential to avoid treatment delay. In our case, high-dose corticosteroids alone were a safe and effective therapy for the mother and fetuses resulting in long-term disease control.

  3. A psychometric systematic review of self-report instruments to identify anxiety in pregnancy.

    Science.gov (United States)

    Evans, Kerry; Spiby, Helen; Morrell, C Jane

    2015-09-01

    To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument. Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed. Psychometric systematic review. A systematic literature search of the multiple databases (1990-September 2014). Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability. Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category. Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy. © 2015 John Wiley & Sons Ltd.

  4. Glycemic Index and Pregnancy: A Systematic Literature Review

    OpenAIRE

    2010-01-01

    Background/Aim. Dietary glycemic index (GI) has received considerable research interest over the past 25 years although its application to pregnancy outcomes is more recent. This paper critically evaluates the current evidence regarding the effect of dietary GI on maternal and fetal nutrition. Methods. A systematic literature search using MEDLINE, EMBASE, CINAHL, Cochrane Library, SCOPUS, and ISI Web of Science, from 1980 through September 2010, was conducted. Results. Eight studies were incl...

  5. Pregnancy-related spontaneous coronary artery dissection: Two case reports and a comprehensive review of literature

    Directory of Open Access Journals (Sweden)

    Azeem S Sheikh

    2012-01-01

    Full Text Available Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, particularly seen in women during pregnancy or in the puerperium. It has a high acute phase mortality. The etiology is uncertain. Hormonal changes during pregnancy, hemodynamic stress and changes in the autoimmune status have been considered as possible etiological factors. A timely diagnosis and institution of appropriate treatment is important for a successful outcome. There is no consensus of opinion for optimal treatment. Conservative management, coronary artery bypass graft surgery, and percutaneous coronary intervention, all have been described in the literature as possible therapeutic options. Spontaneous coronary artery dissection should be considered as a differential in any young woman presenting with chest pain associated with pregnancy. We report two cases of pregnancy-associated spontaneous coronary artery dissection, both successfully managed, along with a comprehensive review of the previously published literature.

  6. Epidemiology and pathophysiology of pregnancy-associated breast cancer: A review.

    Science.gov (United States)

    Ruiz, Rossana; Herrero, Carmen; Strasser-Weippl, Kathrin; Touya, Diego; St Louis, Jessica; Bukowski, Alexandra; Goss, Paul E

    2017-10-01

    The interactions between pregnancy and breast cancer (BC) are complex. Overall, parity is associated with long-term protective effects against BC, however in a small group of susceptible patients, pregnancy can lead to the development of a form of BC with a particularly poor prognosis. Pregnancy-associated breast cancer (PABC) remains an under-studied but important and growing clinical problem worldwide. Several aspects of PABC, including risk factors and mechanisms involved in its occurrence and aggressiveness, are incompletely understood. This review aims to summarize the epidemiology, biology, patho-physiology and clinical characteristics of PABC. We emphasize that age at first pregnancy, absence of breastfeeding and family history stand out as possible risk factors for developing PABC that ought to be incorporated into clinical tools for assessing a woman's risk of developing PABC. Also, improved methods for identifying women at risk of developing PABC in the general population are needed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Exposure to Air Pollution and Pregnancy Outcomes in the East Mediterranean Region: a Systematic Review

    Directory of Open Access Journals (Sweden)

    Yousef Khader

    2016-01-01

    Full Text Available The East Mediterranean region suffers from high levels of air pollution which has a negative impact on pregnancy outcomes. This work systematically reviews the epidemiological evidence on maternal exposure to air pollution and adverse pregnancy outcomes in the region. Relevant papers and reports published between 2000 and 2014 were searched. Combinations of search terms including countries, exposures, and pregnancy outcomes were used to search for the relevant literature. Twelve articles from 6 countries met the inclusion criteria. There was a pattern of an association between outdoor air pollution and preterm birth and spontaneous abortion; indoor wood fuel smoke and birth weight; and second-hand smoke and birth weight, preterm birth, and spontaneous abortion.The quality of evidence on the impact of air pollution on pregnancy outcomes in the EMR is inadequate to form a base for future adaptation strategies and action plans. Therefore, more quality research is needed to portrait the actual situation in the region

  8. Intra-hepatic cholestasis of pregnancy: A comprehensive review

    Directory of Open Access Journals (Sweden)

    Sangita Ghosh

    2013-01-01

    Full Text Available Intra-hepatic cholestasis of pregnancy is a cholestatic disorder characterized by i pruritus, with onset in the third trimester of pregnancy, without any primary skin lesions, ii elevated fasting serum bile acids > 10 μmol / L (and elevated serum transaminases, iii spontaneous relief of signs and symptoms within two to three weeks after delivery, and iv absence of other disease that cause pruritus and jaundice. It is believed to be a multi-factorial disease with interplay between genetic, environmental and hormonal factors. Incidence is between 0.02% to 2.4% of all pregnancies; with wide geographical variations. Maternal prognosis is usually good but can result in adverse fetal outcomes like meconium staining of amniotic fluid, fetal bradycardia and even fetal loss. Response to anti-histaminic is poor. Of all the medical therapies that have been described for the treatment for IHCP, ursodeoxycholic acid has the best response in relieving pruritus in mother, and probably has a role in preventing even the perinatal complications. Timely diagnosis and treatment is urged in order to prevent fetal complications and an early delivery between 37 to 38 weeks should be contemplated in severe cases, especially once fetal lung maturity is attained.

  9. TWIN GESTATION : A CHALLENGING TASK

    Directory of Open Access Journals (Sweden)

    Vrunda V.

    2015-03-01

    Full Text Available INTRODUCTION In the era of modern obstetrics when multiple pregnancies are on increase it is very important to know the incidence and obstetric outcomes of twin deliveries. Twin pregnancy is still associated with increased maternal and perinatal morbidity and mortality as well as healthcare costs . ( 1 , 2 , 3 MATERIALS AND METHODS : This is a r etrospective study of twin deliveries done in the rural medical college teaching hospital over a period of 3 years. RESULTS : During the study period , incidence of twin delivery was 19.37 per 1000 deliveries. Majority cases of twins were young primies in ag e group (20 - 30 years . Preterm delivery occurred in 68% cases and was therefore , the most common morbidity followed by anaemia (38% and PIH (28%. Most common presentation was vertex (66% and malpresentation were present in 44% of cases. 54% were deliver ed by caesarean section. In 88% second baby delivered within 15 minutes. Uterine inertia , PROM , fetal distress , PPH , cord prolapse and abruption were complications during labour. There was no maternal mortality in present study. Average weight of first baby was 1679.63 gms and 2 nd baby was 1586.94 gms. Perinatal mortality of 1 st baby was 27.55 for 1 st baby and 37.25% for 2 nd baby . Average gestational age for patients in whom cervical encirclage was done was 34 weeks. CONCLUSION: P reterm delivery and low birth weight babies are main challenges to the obstetrician. Incidence of LSCS is quite high with malpresentation of leading (twin A baby is a major indication for LSCS . The use of antenatal care services and good intrapartum mana gement will help improve outcome in twin pregnancies.

  10. Epigenetic Epidemiology of Complex Diseases Using Twins

    DEFF Research Database (Denmark)

    Tan, Qihua

    2013-01-01

    through multiple epigenetic mechanisms. This paper reviews the new developments in using twins to study disease-related epigenetic alterations, links them to lifetime environmental exposure with a focus on the discordant twin design and proposes novel data-analytical approaches with the aim of promoting...... a more efficient use of twins in epigenetic studies of complex human diseases....

  11. Determinants of Unintended Pregnancy among Women of Reproductive Age in Developing Countries: A Narrative Review

    Directory of Open Access Journals (Sweden)

    Sumera Aziz Ali Aziz Ali

    2016-01-01

    Full Text Available Background & aim: Thecurrent population of the world is seven billion, and developing countries account for its 97%. Approximately 210 million pregnancies annually occur worldwide and 75-80 million of them are reported to be unintended. Multiple factors can contribute to unintended pregnancy, which need to be assessed to design interventions reducing the incidence of unintended pregnancies.This study aimed to identify the determinants of unintended pregnancy among women of reproductive age in developing countries. Methods:This review of the literature was carried out by retrieving articles from various databases such as PubMed, Google scholar, and Science Direct and using mesh terms and phrases including ‘unintended pregnancy’, ‘contraception’, and ‘determinants of unintended pregnancy’. The reviewed studies included descriptive studies, population council reports, demographic and health survey reports, the United Nations Children's Fund statistics, and the World Health Organization reports. Results: The most common determinants of unintended pregnancy in the literature were reported under the headings of sociodemographic, socioeconomic, sociocultural, fertility related, contraceptive methods, and access related factors. Conclusion: Multiple factors can predict unintended pregnancy, and these findings have significant policy implications. Policymakers and healthcare providers can benefit from the evidence on determinants of unwanted pregnancy to design and implement policies and programs that can support couples to have their desired number of children, without facing unnecessary threats to their health. Furthermore, more studies are needed to be done in future to assess the available cost-effective interventions for reducing unintended pregnancy and ultimately, to improve women’s and children’s health.

  12. Effects of dietary interventions on pregnancy outcomes: a systematic review and meta-analysis.

    Science.gov (United States)

    Gresham, Ellie; Bisquera, Alessandra; Byles, Julie E; Hure, Alexis J

    2016-01-01

    Dietary intake during pregnancy influences maternal health. Poor dietary practices during pregnancy have been linked to maternal complications. The objective was to determine the effect of dietary intervention before or during pregnancy on pregnancy outcomes. A systematic review was conducted without date restrictions. Randomised controlled trials (RCTs) evaluating whole diet or dietary components and pregnancy outcomes were included. Two authors independently identified papers for inclusion and assessed methodological quality. Meta-analysis was conducted separately for each outcome using random effects models. Results were reported by type of dietary intervention: (1) counselling; (2) food and fortified food products; or (3) combination (counseling + food); and collectively for all dietary interventions. Results were further grouped by trimester when the intervention commenced, nutrient of interest, country income and body mass index. Of 2326 screened abstracts, a total of 28 RCTs were included in this review. Dietary counselling during pregnancy was effective in reducing systolic [standardised mean difference (SMD) -0.26, 95% confidence interval (CI) -0.45 to -0.07; P blood pressure (SMD -0.57, 95% CI -0.75 to -0.38; P effective in reducing the incidence of preterm delivery (SMD -0.19, 95% CI -0.34 to -0.04; P = 0.01). No effects were seen for other outcomes. Dietary interventions showed some small, but significant differences in pregnancy outcomes including a reduction in the incidence of preterm birth. Further high-quality RCTs, investigating micronutrient provision from food, and combination dietary intervention, are required to identify maternal diet intakes that optimise pregnancy outcomes.

  13. Clinical Study on the Mode of Delivery and Pregnancy Outcome in Twin Pregnancy%双胎妊娠的分娩方式与妊娠结局的临床研究分析

    Institute of Scientific and Technical Information of China (English)

    陈丽花

    2014-01-01

    目的:探讨双胎妊娠的不同分娩方式与其妊娠结局的关联。方法:将2009年3月~2013年3月我院产科收治的双胎妊娠孕妇80例随机均分为2组,各40例,其中一组行剖宫产,另一组行阴道产,观察比较两种分娩方式的妊娠结局。结果:(1)两种分娩方式孕妇产后出血机率比较无显著差异(P>0.05);剖宫产组孕周≥37周有29例(72.5%),明显高于阴道分娩组17例,42.5%(P0.05),但在第二胎儿中阴道分娩组窒息率达到27.5%,剖宫产组为7.5%,比较差异有统计学意义(P15min时第二例胎儿窒息发生率明显高于≤15min出生者(P0.05);The pregnant week and birth weight of cesarean section group was significantly greater than the vaginal delivery group. (2)There were no differences about incidence of neonatal asphyxia in first fetal between two groups (P>0.05), but the incidence of neonatal asphyxia of second fetal in vaginal delivery group was higher than that in cesarean section group (P<0.05).(3)The incidence of neonatal asphyxia of second fetal at≥15 minutes was higher than that of at<15 minutes(P<0.05). Conclusion:For twin pregnancy pregnant, making a right choice for the mode of delivery can lower the incidence of neonatal asphyxia.

  14. 双胎妊娠生长不一致对新生儿甲状腺功能的影响%Effects of growth-discordant twin pregnancies on thyroid function of neonates

    Institute of Scientific and Technical Information of China (English)

    陈怡博; 余颀; 陈志央; 庄丹燕; 潘婕文; 王飞; 卢文波

    2016-01-01

    性甲低的概率较大.%Objective To investigate the effects of growth-discordant twin pregnancies on neonatal thyroid stimulating hormone (TSH) level and congenital hypothyroidism (CH).Methods A total of 3 444 live-birth twin neonates born between January 1,2012 and December 30,2014 in Ningbo City were enrolled.Blood samples via heel puncture were collected and tested.Incidence of CH in singleton and twin neonates was compared.Deviation of birth weight larger than 25% in twin neonates was set as the criteria for discordant growth.TSH and 17 α-hydroxylase levels in CH twins and normal twins,with or without discordant growth,were compared.Chi-square and non-parametric statistics were performed for data analysis.Results The incidence of CH in twin neonates was 0.56% (19/3 444),higher than that in singleton neonates [0.09% (203/225 712),x2=76.225,P<0.01].Among nineteen CH twins,CH occurred in both twins in eight cases (four twins) and in one of the twins in eleven cases.The gestational age at birth in the eight CH twins were less than 37 weeks,with four males and four females;five were low birth weight infants;one twin were dichorionic,and three twins were monochorionic.In the eleven cases of CH occurring in one of the twins,the gestational age was less than 37 weeks in nine cases,eight were low birth weight infants,six were male and five female;seven were monochorionic and four were dichoronic twins.Five cases of temporary hypothyroidism were all low birth weight infants among the growth-discordant twins.CH cases in growth-discordant group had lower birth weight than their normal twins [M(P25-P75),2 100 (1 800-2 600) vs 2 770 (2 530-2 960) g,Z=4.369],and a higher TSH level [15.4 (11.8-18.5) vs 6.4 (4.8-7.9) mU/L,Z=6.339] (both P<0.05).In normal twins with or without discordant growth,the neonates with a lower birth weight had a higher TSH level [3.6(2.5-4.7) vs 2.4(1.8-2.9) mU/L,Z=0.962] in weight consistent group,compared with 6.0(4.4-7.8) vs 3.4(1.9-4.1) mU/L in weight inconsistent group

  15. Exercise during pregnancy. A narrative review asking: what do we know?

    Science.gov (United States)

    Barakat, Ruben; Perales, María; Garatachea, Nuria; Ruiz, Jonatan R; Lucia, Alejandro

    2015-11-01

    Although there is no consensus as to whether exercise is beneficial during pregnancy, most studies report it poses no risk to either the mother or the fetus, and many suggest it to be beneficial to both. This review, which examines the evidence available, also reveals the many differences in study design followed, the type of exercise undertaken and the variables measured, which make it difficult to compare results. Advances in our understanding of the effects of exercise during pregnancy might best be made by undertaking randomised clinical trials with standardised protocols. However, most of the studies examining the relationship between exercise and pregnancy report no complications on maternal or fetal well-being. This is also in line with recent review studies advising that the pregnant population without obstetric contraindications should be encouraged to exercise during pregnancy. Therefore, the results of the present review stimulate those responsible for the healthcare of the pregnant woman to recommend moderate exercise throughout pregnancy without risk to maternal and fetal health.

  16. Mobile Phone Apps for the Prevention of Unintended Pregnancy: A Systematic Review and Content Analysis.

    Science.gov (United States)

    Mangone, Emily Rose; Lebrun, Victoria; Muessig, Kathryn E

    2016-01-19

    Over 50% of pregnancies in the United States are unintended, meaning that the pregnancy is mistimed, unplanned, or unwanted. Unintended pregnancy increases health risks for mother and child, leads to high economic costs for society, and increases social disparities. Mobile phone ownership is rapidly increasing, providing opportunities to reach at-risk populations with reproductive health information and tailored unintended pregnancy prevention interventions through mobile phone apps. However, apps that offer support for unintended pregnancy prevention remain unevaluated. To identify, describe, and evaluate mobile phone apps that purport to help users prevent unintended pregnancy. We conducted an extensive search of the Apple iTunes and Android Google Play stores for apps that explicitly included or advertised pregnancy prevention or decision-making support in the context of fertility information/tracking, birth control reminders, contraceptive information, pregnancy decision-making, abortion information or counseling, sexual communication/negotiation, and pregnancy tests. We excluded apps that targeted medical professionals or that cost more than US $1.99. Eligible apps were downloaded and categorized by primary purpose. Data extraction was performed on a minimum of 143 attributes in 3 domains: (1) pregnancy prevention best practices, (2) contraceptive methods and clinical services, and (3) user interface. Apps were assigned points for their inclusion of features overall and for pregnancy prevention best practices and contraceptive information. Our search identified 6805 app descriptions in iTunes and Google Play. Of these, 218 unique apps met inclusion criteria and were included in the review. Apps were grouped into 9 categories: fertility trackers (n=72), centers and resources (n=38), birth control reminders (n=35), general sexual and reproductive health (SRH) information (n=17), SRH information targeted specifically to young adults (YA) (n=16), contraceptive

  17. Violence against women during pregnancy in some Asian countries: a review of the literature

    Directory of Open Access Journals (Sweden)

    Mobina Kashif

    2010-06-01

    Full Text Available

    Background: Violence against women is a recognized violation of human rights and an important public health concern. Violence during pregnancy is a risk to both the woman and her baby. Aims: The aim of this review was to identify what the literature reveals about violence during pregnancy in Asian countries.

    Methods: A systematic, integrated review was conducted of peer-reviewed literature published 1995-2009. Four databases were searched using the terms ‘intimate partner violence’, ‘domestic violence’, ‘pregnancy’, ‘Asia’, and ‘developing countries’. Reported results were compared within identified themes: prevalence, associated factors, interaction of violence and pregnancy, impact on women’s health, and the cultural role of children.

    Results: Twenty three eligible papers were found; 14 reported quantitative methods, 3 reported qualitative methods, and 6 reported both. Research was conducted in Bangladesh, Pakistan, India, China, Thailand, and Iran. The prevalence of violence during pregnancy ranged from 4.3% to 48%. Adverse effects of violence were evident on women’s physical and mental health and on their babies. Variables found to interact with violence were unintended pregnancy, woman’s age, partner’s education, social support, previous history of family violence, and the cultural value of children. The existing pattern and intensity of violence in the relationship were not found to change consistently with the woman’s pregnancy.

    Conclusions: The limited literature suggests that violence during pregnancy is a problem in at least some Asian countries as throughout the world. Further research is needed to increase knowledge of this important matter of significance both to women’s health and well-being and to social coherence.

  18. Intravitreal Anti-VEGF Injections in Pregnancy: Case Series and Review of Literature.

    Science.gov (United States)

    Polizzi, Silvio; Mahajan, Vinit B

    2015-12-01

    The use of intravitreal antivascular endothelial growth factor (anti-VEGF) injection is gaining wide acceptance as an off-label therapy for diseases that may affect pregnant women. However, these drugs may cause systemic side effects in the mother and fetal harm. This could lead specialists to not administer the drug or women to abort the fetus or to refuse treatment during pregnancy. We report the course of pregnancy in 3 women treated with intravitreal bevacizumab and provide a review of the literature on the use of intravitreal anti-VEGF in pregnancy. Our patients did not have any drug-related adverse event and delivered healthy full-term infants, although one of the women had risk factors for miscarriage. Infants reached all developmental milestones appropriately during infancy. A literature search on the use of intravitreal anti-VEGF injection in pregnancy was undertaken. Data for this review were identified by searches of PubMed and references from relevant articles using the search terms "pegaptanib," "bevacizumab," "ranibizumab," "aflibercept," "anti-VEGF," "intravitreal injection," "pregnant," "pregnancy," "abortion," "miscarriage," "preeclampsia," "embryo-fetal toxicity," "fetal malformations," "teratogenesis," "adverse events," and "maternofetal complications" in multiple combinations. We believe that intravitreal anti-VEGF can be given during pregnancy only when potential benefit to the woman justifies the potential risks to the fetus. When making a decision about whether to give drugs during pregnancy, it is important to consider the timing of exposure and its relationship to windows of developmental sensitivity. We believe that this review will be useful to specialists to inform and possibly treat their pregnant patients.

  19. Pregnancy

    DEFF Research Database (Denmark)

    Palmer, Keith T; Bonzini, Matteo; Bonde, Jens Peter Ellekilde

    2013-01-01

    physical workload). The adverse outcomes considered are: miscarriage, preterm delivery, small for gestational age, low birth weight, pre-eclampsia and gestational hypertension. Systematic review of the literature indicates that these exposures are unlikely to carry much of an increased risk for any...

  20. Early neonatal morbidity and mortality in growth-discordant twins.

    Science.gov (United States)

    Alam Machado, Rita De Cássia; Brizot, Maria De Lourdes; Liao, Adolfo Wenjaw; Krebs, Vera Lucia Jornada; Zugaib, Marcelo

    2009-01-01

    To evaluate early neonatal morbidity and mortality in twin pregnancies with growth discordance. Retrospective study. Tertiary teaching hospital, Sao Paulo, Brazil. A total of 151 twin pregnancies managed and delivered at the Multiple Pregnancy Unit at Sao Paulo University Hospital between 1998 and 2004. METHODS; Comparison between twin pregnancies with weight discordance > or =20% and pregnancies concordant for fetal weight. Cases with fetal death, abnormalities, twin-to-twin transfusion and delivery before 26 weeks or in another hospital were excluded. Early neonatal morbidity (Apgar at 5 minutes pregnancies presented discordance > or =20% and 111 (73.5%) were concordant. In the discordant group, 75% of pregnancies had at least one growth restricted fetus (pregnancies, monochorionic cases (22.5%) presented with lower gestational age (34.3 vs. 36.2 weeks), lower birthweight (2,067 vs. 2,334 g) and a longer period of hospital stay (5.5 vs. 3.0) compared to dichorionic concordant twins. No differences between monochorionic and dichorionic subgroups were observed in discordant twins. Pregnancies in which at least one baby was born with a birthweight below the 10th centile showed that discordant pregnancies had a lower gestational age at delivery (35.2 vs. 36.8 weeks) and a longer period of hospital stay (9 vs. 4 weeks) compared to concordant cases. Neonatal mortality was similar in discordant (3.7%) and concordant (4.5%) twins. Early perinatal morbidity is increased in twin pregnancies with birthweight discordance > or =20% only when associated with fetal growth restriction and low birthweight.