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Sample records for twin pregnancy conceived

  1. [Perinatal outcomes of twin pregnancies conceived through in vitro fertilization versus spontaneous].

    Science.gov (United States)

    Rubio-Cid, Paula; Alvarez-Silvares, E; Aves-Pérez, María Teresa; García-Lavandeira, Sandra; Pérez-Adán, Marta

    2015-10-01

    Determine maternal and fetal characteristics of in vitro fertilization twin pregnancies in comparison with spontaneous twin pregnancies. Retrospective historical cohort study between 2011 and 2013. Statistical analysis was performed with SPSS 15.0 program and Epidat 3.0. A value of p<0.05 was considered statistically significant. 96 twin pregnancies met inclusive criteria with an incidence of 2.01%, of which 54.16% were spontaneous twin pregnancies and 45.83% in vitro fertilization twin pregnancies. Mean maternal age at delivery was higher in vitro fertilization twin pregnancies (p=0.004). The primigravidae were more frequent in vitro fertilization twin pregnancies group (p<0.001). Monochorionic pregnancies percentage was superior in spontaneous pregnancies (p=0.009). Amenorrhea at delivery was not a significant difference between cohorts (p=.9). Preterm rate was superior in spontaneous twin pregnancies group (p=0.003). However, "great preterm deliveries" were higher in in vitro fertilization twin pregnancies (p<0.001). Significant differences were not observed in fetal presentation at delivery, first-born child birth-weight or intrauterine growth retardation between the two groups. Nevertheless, the mean birth-weight of second-born spontaneously conceived twins was higher than second-born twins of the in vitro fertilization conceived group (p=0.027). Gestational pathology presented the same distribution in both cohorts. There was no significant difference in the mode of delivery between the two groups. Total perinatal mortality rate was 20,83%o and comprised 2 first born twins and 2 second born twins. Three of the stillbirths came from the spontaneous pregnancies group and one from the in vitro fertilization group. Perinatal death was secondary to stillbirths, which we found higher in spontaneously conceived twin pregnancies due to higher number of monochorionic pregnancies.

  2. Perinatal complications and neonatal outcomes of twin pregnancies conceived by assisted reproductive techniques and those conceived spontaneously: A retrospective analysis of 811 cases

    Directory of Open Access Journals (Sweden)

    Jin YU

    2017-11-01

    Full Text Available Objective To investigate the general situations of gravida, pregnancy complications, childbirth and neonatal outcomes of twin pregnancies conceived by assisted reproductive techniques (ART and those conceived spontaneously. Methods A retrospective analysis was carried out on the basic information, perinatal complications, delivery information and neonatal outcomes of twin pregnancies received by ART (ART group, n=518 and those conceived spontaneously (SC group, n=293. Results Gravida age was older in ART group than in SC group (P0.05. Conclusion Twin pregnancy conceived by ART may lead to higher incidences of gestational diabetes mellitus and abnormal placenta and more postpartum hemorrhage, but no significant difference existed in the neonatal outcomes between twin pregnancies conceived by ART and those conceived spontaneously. DOI: 10.11855/j.issn.0577-7402.2017.11.12

  3. Fetal cardiac remodeling in twin pregnancy conceived by assisted reproductive technology.

    Science.gov (United States)

    Valenzuela-Alcaraz, B; Cruz-Lemini, M; Rodríguez-López, M; Goncé, A; García-Otero, L; Ayuso, H; Sitges, M; Bijnens, B; Balasch, J; Gratacós, E; Crispi, F

    2018-01-01

    Recent data suggest that singleton fetuses conceived by assisted reproductive technology (ART) present cardiovascular remodeling that may persist postnatally. Twin pregnancies are more frequent in the ART population and are associated with increased adverse perinatal outcomes, such as hypertensive disorders, gestational diabetes and preterm birth. However, it is unknown whether cardiac remodeling is also present in twin pregnancies conceived by ART. Our aim was to assess the presence of fetal cardiac remodeling and dysfunction in twin pregnancies conceived by ART as compared with those conceived spontaneously (SC). This was a prospective cohort study including 50 dichorionic twin fetuses conceived by ART and 50 SC twin fetuses. The study protocol included collection of baseline/perinatal data and a fetal ultrasound examination at 28-30 weeks' gestation, including assessment of estimated fetal weight, fetoplacental Doppler and fetal echocardiography. Measurements of atrial area, atrial/heart ratio, ventricular sphericity index, free wall thickness, mitral and tricuspid annular plane systolic excursions, and systolic and early diastolic peak velocities were assessed. Multilevel analyses were used to compare perinatal and ultrasonographic parameters. Comparisons of echocardiographic variables were adjusted for parental age, paternal body mass index and incidence of pre-eclampsia. Compared with SC twins, ART twin fetuses showed significant cardiac changes, predominantly affecting the right heart, such as dilated atria (right atrial/heart area: 15.7 ± 3.1 vs 18.4 ± 3.2, P fetal cardiac programing in ART. These results open opportunities for early detection and intervention in infants conceived by ART. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

  4. Comparison of perinatal outcomes of vanishing twin and twin pregnancies conceived following assisted reproductive technology: A retrospective analysis

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    Sujata Pradhan

    2016-12-01

    Full Text Available Objective: The purpose of this study was to compare the perinatal outcomes of vanishing twin (VT pregnancies with twin pregnancies following assisted reproductive technology treatment (ART. Design: Retrospective analysis. Setting: Infertility unit of a university level hospital. Materials and methods: We included all the women with dichorionic diamniotic twin pregnancies conceived following ART from Jan 2010 to Dec 2014 in our unit. We matched the VT group and twin group for maternal age and body mass index. Results: A total of 63 vanishing twin and 135 twin pregnancies were followed up. The vanishing twin rate was 31.8%. The live birth rate at term was significantly higher in VT group compared to twin group (69.8% vs. 16.3%, P 2500 g in VT group than in twin group (77.8% vs. 25.4%, P < 0.001. The miscarriage, Cesarean and congenital anomaly rates were similar in both the groups. Conclusion: Our study finding suggests better perinatal outcomes for ART pregnancies undergoing spontaneous reduction in first trimester compared to those pregnancies which continue as twins.

  5. First-trimester inter- and intrafetal size discrepancies in bichorionic twins conceived by in vitro fertilization: can it predict pregnancy outcome?

    Science.gov (United States)

    Bardin, Ron; Oron, Galia; Levy, Yael; Sapir, Onit; Meizner, Israel; Fisch, Benjamin; Wiznitzer, Arnon; Hadar, Eran

    2017-08-01

    To evaluate the association between first-trimester inter- and intrafetal size discrepancies and pregnancy outcome, among bichorionic-biamniotic twins conceived by IVF. A retrospective study design was used. Tertiary university-affiliated medical center. All women with a viable first-trimester bichorionic-biamniotic twin gestation, who conceived after IVF in 2007-2015. None. The association between fetal size differences and pregnancy outcome was analyzed. Intrafetal size discordance was defined as a difference between the actual gestational age calculated by ovum pickup (OPU) date and the evaluated gestational age by crown-rump length (CRL), for each twin. Intertwin size discrepancy was defined as a difference in CRL between the twins. The primary outcome was the number of live-born fetuses; the secondary outcome measures were gestational age at birth, birth weight percentile, and birth weight discordancy. A total of 277 women met the study criteria and were divided into three groups by outcome: 218 (78.7%) live-born twins, 41 (14.8%) live-born singleton, and 19 (6.5%) non-live-born pregnancy. Among the smaller than expected twin, the association of CRL-OPU differences with the primary outcome was significant for twin live-born delivery (-1.43 day), singleton live-born delivery (-4.12 days), and non-live-born pregnancy (-6.72 days). For the relatively larger twin, the association was significant for non-live-born pregnancy (-4.33 days) compared with any live-born delivery, either singleton (-0.95 days) or twin (-0.21 days). Among IVF conceived twin gestations, a CRL-OPU gap was associated with an increased risk of a negative pregnancy outcome. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  6. 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

    BACKGROUND: Previous studies have found that 1 in 10 in vitro fertilization (IVF) singletons originates from a twin gestation. First trimester Down's syndrome screening markers are altered in assisted reproductive techniques (ART) pregnancies compared with spontaneously conceived pregnancies...... not differ from those of other ART singleton pregnancies. In cases where the fetal demise was first diagnosed at the time of the NT scan, it is doubtful whether the serum risk assessment is as precise as it is in singleton ART pregnancies. No difference was seen for NT measurements Udgivelsesdato: 2009/1...

  7. Early fetal reduction to twin versus prophylactic cervical cerclage for triplet pregnancies conceived with assisted reproductive techniques

    Directory of Open Access Journals (Sweden)

    Mohamed Sayed Abdelhafez

    2018-02-01

    Conclusion: Early transvaginal reduction of triplets to twins leads to improved obstetric outcomes as it decreases prematurity and its related neonatal morbidities and mortality without increase in the miscarriage rate. Early fetal reduction seems to be better than continuation of triplet pregnancies with prophylactic placement of cervical cerclage.

  8. 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....

  9. 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.

  10. 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

    and zygocity determination were performed on amniotic fluid and showed the twins to be dizygotic with normal female and male karyotypes. There were clinical and sonographic signs of twin-twin transfusion syndrome (TTTS), and Cesarean delivery was performed at 32 weeks' gestation. At birth the twins were...... phenotypically a normal male and a normal female. Histology of the placenta showed it to be monochorionic diamniotic. Blood chimerism was found postnatally as both infants had the karyotypes 46,XX[13]/46,XY[17]. Chimerism was not found in cells from a buccal swab at 6 months of age. This is one of only a few...

  11. Naturally conceived twins with monochorionic placentation have the highest risk of fetal loss

    DEFF Research Database (Denmark)

    Sperling, Lene; Kiil, C; Larsen, L U

    2006-01-01

    before 14 + 6 weeks' gestation in order to determine chorionicity. The fetal loss rate, the perinatal, neonatal and infant mortality rates and the frequency of very preterm labor were estimated for the different types of twin. RESULTS: Among the 495 pregnancies (421 DC and 74 MC) 229 (46%) were conceived...... the corresponding figures were 0% (0/10) and 0.4% (1/256). The odds ratio (OR) for very preterm birth-before 28 weeks' gestation-was 4.2 for MC twins compared to DC twins. The relative risk of fetal loss or death among DC twins was 20% of the risk for MC twins. CONCLUSION: The risk of fetal loss, very preterm...... delivery and neonatal/infant death is significantly higher among twins with MC compared to DC placentation. Twins conceived by AR have a much lower risk of MC placentation. The risk of losing one or both twins seems higher among naturally conceived twins compared to twins conceived by AR, despite the fact...

  12. Obstetric outcomes of monochorionic pregnancies conceived following assisted reproductive technology: A retrospective study

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    Mariano Mascarenhas

    2014-01-01

    Full Text Available Objectives : The overwhelming numbers of twins following assisted reproductive technology (ART are dichorionic twins, but monochorionic twins account for around 0.9% of post ART pregnancies. The data for post ART-monochorionic pregnancy outcomes are scarce due to the rarity of this condition. Hence, we evaluated the obstetric outcomes of monochorionic and dichorionic pregnancies conceived on ART. Settings : University teaching hospital. Study Design : A case-control study of monochorionic diamniotic (MCDA and dichorionic diamniotic (DCDA pregnancies conceived following ART treatment. Charts of all women who conceived following ART from 2008 to 2013 were screened. Among them, the monochorionic twins diagnosed in the first trimester were included and their obstetric outcome was followed-up. For comparison, an equal number of dichorionic twin pregnancies from age and body mass index matched mothers was selected. Results : The baseline clinical characteristics were similar between the two groups. MCDA group had a higher miscarriage rate (50% than the DCDA group (10%, with three seconds trimester miscarriages in the MCDA group. The live birth rates were lower in the MCDA versus DCDA group (40% vs. 90%. Among triplet pregnancies with a monochorionic component, the live birth rate was only 25%. Conclusions : Monochorionic pregnancies following ART have poorer obstetric outcomes when compared to dichorionic pregnancies. For monochorionic pregnancies following ART, intensive antenatal surveillance at a tertiary level obstetric and neonatal center may help optimize the outcome.

  13. Obstetric outcomes of monochorionic pregnancies conceived following assisted reproductive technology: A retrospective study.

    Science.gov (United States)

    Mascarenhas, Mariano; Kamath, Mohan S; Muthukumar, K; Mangalaraj, Ann M; Chandy, Achamma; Aleyamma, Tk

    2014-04-01

    The overwhelming numbers of twins following assisted reproductive technology (ART) are dichorionic twins, but monochorionic twins account for around 0.9% of post ART pregnancies. The data for post ART-monochorionic pregnancy outcomes are scarce due to the rarity of this condition. Hence, we evaluated the obstetric outcomes of monochorionic and dichorionic pregnancies conceived on ART. University teaching hospital. A case-control study of monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) pregnancies conceived following ART treatment. Charts of all women who conceived following ART from 2008 to 2013 were screened. Among them, the monochorionic twins diagnosed in the first trimester were included and their obstetric outcome was followed-up. For comparison, an equal number of dichorionic twin pregnancies from age and body mass index matched mothers was selected. The baseline clinical characteristics were similar between the two groups. MCDA group had a higher miscarriage rate (50%) than the DCDA group (10%), with three seconds trimester miscarriages in the MCDA group. The live birth rates were lower in the MCDA versus DCDA group (40% vs. 90%). Among triplet pregnancies with a monochorionic component, the live birth rate was only 25%. Monochorionic pregnancies following ART have poorer obstetric outcomes when compared to dichorionic pregnancies. For monochorionic pregnancies following ART, intensive antenatal surveillance at a tertiary level obstetric and neonatal center may help optimize the outcome.

  14. Intact twin tubal pregnancy

    Directory of Open Access Journals (Sweden)

    Nina Hodžić

    2010-08-01

    Full Text Available A case of a unilateral eight-week twin ectopic pregnancy diagnosed with transvaginal sonography is presented here. This ectopic pregnancy was found in the right Fallopian tube of a 35-year old woman. After the surgical procedure conducted by the method of transversal laparotomy, we removed the right Fallopian tube with two gestational sacs. So far only a hundred of such cases of ectopic twinpregnancy have been described worldwide.

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

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    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.

  16. 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

  17. First trimester biochemistry in pregnancies conceived using assisted reproduction techniques

    DEFF Research Database (Denmark)

    Tabor, Ann; Ekelund, Charlotte; Nørgaard, Pernille

    Objective: To examine the effects of method of conception on first trimester PAPP-A and free beta-hCG and the dependency of gestational age at the time of sampling on these effects Methods: Data on more than 100 000 spontaneously conceived and on 6 859 pregnancies conceived by assisted reproducti...

  18. 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

  19. [Incidence and management of monozygotic twin conceived by assisted reproductive techniques].

    Science.gov (United States)

    Mo, Lijing; Jin, Congcong; Wu, Yonggen; Wang, Peiyu; Lin, Jia; Zhao, Junzhao

    2015-08-01

    To analysis the incidence and management of monozygotic twin (MZT) conceived by assisted reproductive techniques (ART). A retrospective analysis of clinical pregnancies and MZT that resulted from ART was performed in Reproductive Medical Center, the First Affiliated Hospital, Wenzhou Medical University between January 2011 and January 2014. A total of 5 908 pregnancies were diagnosed: 2 012 twins, 157 high-order multiple pregnancy (HOMP), including 4 quadruplets. Overall, 51 MZT pregnancies were identified of them including 32 cases HOMP and 19 cases MZT. The incidence of MZT resulting from cleavage-stage embryo transfer was similar to blastocyst transfer (P = 0.960). The percent of MZT resulting from in vitro fertilization [0.93% (28/3 022)], frozen-thawed embryo transfer [0.87% (13/1 502)] and intracytoplamic sperm injection [0.72% (10/1 384)] did not show statistical significance (P = 0.794). The expectantly managed MZT was associated with a significantly greater likelihood of miscarriage [6/19 vs 5.11% (101/1 976)], and low birth weight infant [73.91% (17/23) vs 42.89% (1 453/3 388), P < 0.01], when compared with dizygotic twin (DZT) did not undergo selective embryo reduction (SER). In monozygotic (MZ)-triplets with SER to 2 fetuses or to 1 fetus, there was no cases of preterm birth or low birth weight infant observed in MZ-triplets with SER to 1 fetus; when compared with MZ-triplets with SER to 2 fetuses, the low birth weight infant [56.00% (14/25), P = 0.021] has statistical significance. The likelihood of the survival of two babies was lower in MZ-triplets with SER to 2 fetuses when compared with non-MZ triplets with SER to 2 fetuses [42.86% (9/21) vs 75.21% (91/121), P = 0.003]. The incidence of MZT pregnancies following ART is high. It plays a significant role in the occurrence of HOMP. MZT pregnancies are at an increased risk of adverse outcomes, it should transform to a single embryo thansfer (SET) program to reduce them incideuce. Reduction of MZT

  20. Obstetric and neonatal outcomes of IVF versus spontaneously conceived dichorionic twins

    OpenAIRE

    Abdel-Baset F. Mohammed; Mohammed Abdel-Maaboud

    2012-01-01

    Objective: To evaluate the obstetric and neonatal outcomes of dichorionic twin (DD) pregnancies after IVF in comparison to spontaneous conception (SC). Design: Retrospective cohort study. Setting: Women Hospital – Hamad Medical Corporation, Doha, Qatar. Material and methods: All cases of DD twin pregnancies during the period from January 2002 to December 2011 were included. Demographic and clinical data, obstetric and neonatal outcomes of DD twin pregnancies after IVF and SC were com...

  1. Obstetric and neonatal complications in pregnancies conceived after oocyte donation

    DEFF Research Database (Denmark)

    Storgaard, M.; Loft, A.; Bergh, C.

    2017-01-01

    mellitus, postpartum haemorrhage, caesarean section, preterm birth, low birthweight and small for gestational age. Selection criteria: Inclusion criteria were original studies including at least five OD pregnancies with a control group of pregnancies conceived by conventional IVF/ICSI or spontaneous...... conception, and case series with >500 cases reporting one or more of the selected complications. Studies not adjusting for plurality were excluded. Data collection and analysis: Thirty-five studies met the inclusion criteria. A random-effects model was used for the meta-analyses. Main results: For OD...

  2. Monochorionic twin pregnancies: a systematic approach to ...

    African Journals Online (AJOL)

    Complications unique to these pregnancies include Twin-To-Twin Transfusion Syndrome (TTTS), Twin Polycythaemia Anaemia Sequence (TAPS), Selective Intrauterine Growth Restriction (sIUGR) and death of the co-twin. Adhering to a systematic and objective approach of management, can lead to early recognition and ...

  3. Perinatal outcomes of pregnancies conceived by assisted reproductive technologies

    Directory of Open Access Journals (Sweden)

    Šljivančanin Tamara

    2015-01-01

    Full Text Available Introduction. Recent epidemiological studies showed significantly higher incidence of perinatal complications in newborns and women after the use of assisted reproductive technologies (ART. Multiple pregnancies are more frequent after the use of ART. Singleton pregnancies following ART are more prone to preterm birth, low and very low birth weight (LBW and VLBW, small for gestational age (SGA and perinatal mortality. Objective. The aim of this study was to summarize the results of relevant articles and to evaluate whether the mode of conception is the determining factor for different pregnancy outcomes after assisted and natural conceptions. Methods. Eleven studies were included in this review. The following outcomes were observed: preterm and very preterm birth, SGA, LBW, VLBW, perinatal mortality, admission to neonatal intensive care unit (NICU, and Apgar score (As ≤7 at fifth minute. Qualitative analysis and quantitative assessment were performed. Results. For singletons, odds ratios were 1.794 (95% confidence interval 1.660-1.939 for preterm birth, 1.649 (1.301-2.089 for LBW, 1.265 (1.048-1.527 for SGA. Admission to NICU, As≤7 at fifth minute and perinatal mortality showed significantly different frequency after assisted conception. Summary of results for twin gestations showed no significant difference between ART and spontaneous conception for preterm birth (32-36 weeks, very preterm birth (<32 weeks, LBW and VLBW. Conclusion. Analyzed studies showed that infants from ART have significantly worse perinatal outcome compared with natural conception. More observational studies should be conducted in order to establish the exact mechanism leading to more frequent perinatal morbidity and mortality after the use of ART.

  4. Successful twin pregnancy after orthotopic liver transplantation

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    Coelho Júlio Cezar Uili

    2002-01-01

    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 twins

  5. Complications Arising in Twin Pregnancy: Findings of Prenatal Ultrasonography

    Science.gov (United States)

    Kim, Jeong-Ah; Lee, Young Ho; Song, Mi Jin; Min, Jee-Yeon; Lee, Hak Jong; Han, Byoung Hee; Lee, Kyung-Sang; Cho, Byung Jae; Chun, Yi-Kyeong

    2003-01-01

    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. PMID:12679635

  6. 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.

  7. Interstitial heterotopic pregnancy in a woman conceiving by in vitro fertilization after bilateral salpingectomy.

    Science.gov (United States)

    Dumesic, D A; Damario, M A; Session, D R

    2001-01-01

    Heterotopic pregnancy, defined as the coexistence of an intrauterine pregnancy and an ectopic pregnancy, occurs in approximately 1 in 100 pregnancies conceived by in vitro fertilization (IVF), particularly when multiple embryos are transferred into the uterus. The ectopic gestation of the combined pregnancy usually occurs within the ampulla of the fallopian tube. If it implants within the interstitial portion of the fallopian tube, however, the resulting interstitial pregnancy eventually can rupture through the uterus, leading to sudden, severe hemorrhage and maternal death. This article describes the rupture of an interstitial heterotopic pregnancy in a 37-year-old woman conceiving by IVF after bilateral salpingectomy. The interstitial pregnancy was removed by laparotomy to protect the intrauterine pregnancy from damage. Physicians should consider interstitial ectopic pregnancy as a cause of abdominal pain, even when a viable pregnancy occurs by IVF after salpingectomy.

  8. 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...

  9. 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

  10. 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...... 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....

  11. Managing a Live Advanced Abdominal Twin Pregnancy

    African Journals Online (AJOL)

    examination revealed a closed, uneffaced, firm and posterior ... Advanced abdominal pregnancies with live twin fetuses are extremely rare and are misdiagnosed ... operating room. Leaving the placenta in situ is the best way to deal with abdominal pregnancy, based on previous experience and review of the literature.

  12. pregnancy metabolism In . tWIn

    African Journals Online (AJOL)

    .ficant differences in venous blood sugar values or insulin responses were found between singleton and twin pregnancies. S Atr Med J 1983; 63: 53&-540. It is well known that pregnancy is associated with alterations in carbohydrate metabolism. These changes are best reflected by blood glucose and insulin patterns.

  13. Challenges in the management of twin pregnancy discordant for ...

    African Journals Online (AJOL)

    Challenges in the management of twin pregnancy discordant for abnormality. CJM Stewart. Abstract. Prenatal diagnosis in the setting of a twin pregnancy is challenging. The frequency of abnormalities is higher in twin than in singleton pregnancies, particularly in monozygotic pregnancies. The finding of an abnormality in ...

  14. Obstetric and neonatal outcomes of pregnancies conceived after preimplantation genetic diagnosis: cohort study and meta-analysis.

    Science.gov (United States)

    Hasson, Joseph; Limoni, Dana; Malcov, Mira; Frumkin, Tsvia; Amir, Hadar; Shavit, Tal; Bay, BjØrn; Many, Ariel; Almog, Benjamin

    2017-08-01

    Preimplantation genetic diagnosis (PGD) may pose risks to pregnancy outcome owing to the invasiveness of the biopsy procedure. This study compares outcome of singleton and twin clinical pregnancies conceived after fresh embryo transfers of PGD (n = 89) and matched intracytoplasmic sperm injection (ICSI) pregnancies (n = 166). The study was carried out in a single university affiliated centre. Because of the paucity of available data, a literature-based meta-analysis of studies comparing neonatal outcome of PGD and ICSI pregnancies was also conducted. In the retrospective cohort study, obstetric and neonatal outcome were available in 67 PGD and 118 ICSI pregnancies. Perinatal outcomes were comparable between PGD and ICSI pregnancies. Meta-analysis revealed similar outcomes, except for higher rate of low birth weight (obstetrical outcomes compared with ICSI pregnancies. Hence, blastomere biopsy for PGD does not seem to increase the risk for adverse perinatal outcome compared with ICSI pregnancies. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  15. [Impact of prepregnancy body mass index on pregnancy outcome in women with a singleton conceived by assisted reproductive technology and spontaneously conceived pregnancy: a case-control study].

    Science.gov (United States)

    Kim, Ju Hee; Shin, Hye Sook; Park, Bo Kyung; Yang, Kwang Moon; Lee, Young Ho; Ryu, Hyun Mee

    2012-08-01

    To compare and confirm the impact of prepregnancy body mass index on pregnancy outcome in women with a singleton conceived by assisted reproductive technology and spontaneously conceived pregnancy. A sample of 165 and 247 pregnant women with and without assisted reproductive technology were retrospectively recruited from electronic medical charts of C hospital. There were significant differences between the two groups for maternal age, paternal age, length of marriage, prepregnancy body mass index, parity, spontaneous abortion experience, and preterm delivery. A prepregnancy body mass index of ≥25 was associated with higher risk for maternal and neonatal complication in the assisted reproductive technology group. The results indicate that a higher prepregnancy body mass index is associated with increased risks for adverse pregnancy outcomes for women using assisted reproductive technology. So these women need appropriate care to compensate for the risk.

  16. 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.

  17. Prevalences and pregnancy outcome of vanishing twin pregnancies achieved by in vitro fertilization versus natural conception.

    Science.gov (United States)

    Márton, Virág; Zádori, János; Kozinszky, Zoltan; Keresztúri, Attila

    2016-11-01

    To evaluate whether vanishing twin (VT) pregnancies achieved by in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) had a more adverse perinatal outcome than those after natural conception. Longitudinal, retrospective cohort study. Tertiary university hospital. Three hundred and six (78 after IVF-ICSI and 228 after natural conception) VT pregnancies over a 22-year period, with VT cases matched to primarily singleton controls. None. Obstetric and neonatal outcome data. The incidence of VT was statistically significantly higher after natural conception (18.2% of twins) than after IVF-ICSI (12.6% of twins). The odds of VT in pregnancies complicated with pregestational or gestational diabetes were disproportionally higher in IVF-ICSI cases than in spontaneously conceived VT pregnancies (adjusted odds ratio [AOR]: 0.80 vs. 3.10 and 1.00 vs. 1.07, respectively). Previous induced abortion (AOR 1.34) or second-trimester fetal loss (AOR 3.3) increased the risk of VT pregnancies after spontaneous conception. Gestational diabetes mellitus in both the previous (AOR 5.41) and the present (AOR 2.3) pregnancy as well as chronic maternal diseases (AOR 3.5) and placentation anomalies all represented independent risk factors for VT after IVF-ICSI. Vanishing twin pregnancies had a lower prevalence and a worse perinatal outcome after IVF-ICSI as compared with those of their spontaneously conceived counterparts. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

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

    International Nuclear Information System (INIS)

    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

    2001-01-01

    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.

  19. Urinary Concentrations of Phthalate Metabolites and Pregnancy Loss Among Women Conceiving with Medically Assisted Reproduction.

    Science.gov (United States)

    Messerlian, Carmen; Wylie, Blair J; Mínguez-Alarcón, Lidia; Williams, Paige L; Ford, Jennifer B; Souter, Irene C; Calafat, Antonia M; Hauser, Russ

    2016-11-01

    Animal studies demonstrate that several phthalates are embryofetotoxic and are associated with increased pregnancy loss and malformations. Results from human studies on phthalates and pregnancy loss are inconsistent. We examined pregnancy loss prospectively in relation to urinary phthalate metabolite concentrations among women undergoing medically assisted reproduction. We used data from 256 women conceiving 303 pregnancies recruited between 2004 and 2012 from the Massachusetts General Hospital Fertility Center. We quantified 11 phthalate metabolite concentrations and calculated the molar sum of four di(2-ethylhexyl) phthalate (DEHP) metabolites (ΣDEHP). We estimated risk ratios (RRs) and 95% confidence intervals for biochemical loss and total pregnancy loss (assisted reproduction.

  20. Mortality following unilateral twin interstitial ectopic pregnancy. A case report.

    Science.gov (United States)

    Jackson, G M; Rubin, S M; Sondheimer, S J

    1992-10-01

    Twin ectopic pregnancy is an uncommon event, usually occurring as simultaneous intrauterine and tubal gestations. Interstitial implantation of an ectopic pregnancy is also a rare event, associated with a high mortality rate. Twin interstitial pregnancy has been previously reported only three times in the English literature. We report a recent case of unilateral twin interstitial ectopic pregnancy that resulted in maternal death and review the literature with regard to both ectopic pregnancy and factors associated with mortality from interstitial implantation.

  1. [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. Copyright © 2013. Published by Elsevier SAS.

  2. 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......). Umbilical cord occlusion was undertaken in 49 TTTS cases, in four cases with fetal abnormality and TTTS and in 12 cases because of fetal anomaly only. Main outcome measures. Overall survival per fetus, survival per pregnancy of at least one fetus and further survival according to the Quintero stages. Infant...

  3. Case of twin pregnancy complicated by idiopathic thrombocytopenic ...

    African Journals Online (AJOL)

    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 ...

  4. 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...... 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....

  5. 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.

  6. Dicephalus dibrachius dipus conjoined twins in a triplet pregnancy ...

    African Journals Online (AJOL)

    Conjoined twins occurring in a triplet pregnancy is a rare occurrence. We present a case of undiagnosed dicephalic conjoined twins occurring in a multigravida with triple pregnancy delivered by caesarian section. The anatomical and pathologic findings in these twins after their demise are described with a brief review of ...

  7. Case of twin pregnancy complicated by idiopathic thrombocytopenic ...

    African Journals Online (AJOL)

    2016-05-09

    May 9, 2016 ... 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 ...

  8. 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......: Databases were searched without language restrictions for studies of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal outcomes at various gestational ages. Pregnancies with unclear chorionicity, monoamnionicity, and twin to twin transfusion syndrome were excluded...... differences in risk were estimated for stillbirths and neonatal deaths in monochorionic and dichorionic twin pregnancies after 34 weeks' gestation. RESULTS: 32 studies (29 685 dichorionic, 5486 monochorionic pregnancies) were included. In dichorionic twin pregnancies beyond 34 weeks (15 studies, 17 830...

  9. 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

    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

  10. 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.

    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

  11. 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

    What are the pregnancy outcomes for women with a twin pregnancy that is reduced to a singleton pregnancy? Fetal reduction of a twin pregnancy significantly improves gestational age at birth and neonatal birthweight, however at an increased risk of pregnancy loss and preterm delivery. Women with a

  12. 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

  13. [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.

  14. Pregnancy outcome of monochorionic twins: does amnionicity matter?

    Science.gov (United States)

    Dias, Thiran; Contro, Elena; Thilaganathan, Basky; Khan, Hina; Zanardini, Cristina; Mahsud-Dornan, Samina; Bhide, Amar

    2011-12-01

    To compare the fetal loss rate of monochorionic (MC) twin pregnancies according to their amnionicity. A retrospective review of all MC pregnancy outcomes in a tertiary centre. Pregnancy outcomes were compared for monochorionic monoamniotic (MCMA) versus monochorionic diamniotic (MCDA) pregnancies. 29 MCMA and 117 MCDA twin pregnancies were identified. The overall fetal loss rate was significantly higher in MCMA (23/52, 44.2%) compared to MCDA pregnancies (28/233, 12%, Chi squared = 30.03, p fetal survival rate in MCDA twins were significantly higher than in MCMA twins (Log-rank Chi-squared = 27.9, p fetal losses in some MCMA twins. After exclusion of identifiable causes, the difference in fetal survival was not significant in the two groups (Log-rank chi-squared = 0.373, p = .54). The loss rate for MCMA twins is high and occurs mainly due to discordant congenital abnormality, conjoint twins or twin reversed arterial perfusion (TRAP) sequence. Although the fetal loss rate in MCDA is lower than in MCMA pregnancies, the majority of fetal loss in MCDA pregnancies cannot be predicted at the first scan at presentation. The data of this study questions the widespread policy of a difference in the scheduling of elective delivery for MCMA and MCDA twins.

  15. Monozygotic triplets: concordance and discordance for cleft lip and palate / twin research reviews: depression in mothers of multiples; depression in mothers and fathers of ART conceived multiples; epigenetic differences in monozygotic twins; congenital anomalies in surviving twins / headlines x two: twin Chefs; the world's largest twin registry; twin table tennis champions.

    Science.gov (United States)

    Segal, Nancy L

    2009-08-01

    A review of twin research on cleft lip and palate is presented. This information is accompanied by a look at the lives of young monozygotic (MZ) male triplets concordant for cleft lip, but discordant for the type and placement of the cleft and for the presence of cleft palate. Research on depression in mothers and fathers of twins conceived naturally and by artificial reproductive techniques follows. Current findings and implications of epigenetic differences in MZ twins are also summarized. Interesting life history events surrounding MZ twin chefs and table tennis players, as well as plans to construct the world's largest twin registry, are presented in the final section.

  16. First-trimester screening markers are altered in pregnancies conceived after IVF/ICSI

    DEFF Research Database (Denmark)

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

    2009-01-01

    or not to correct risk calculation for mode of conception. METHODS: A national prospective cohort study of 1000 pregnancies achieved after ART was compared with a control group of 2543 pregnancies conceived spontaneously. All women completed a first-trimester combined screening program. Risk calculation...... between groups. The median nuchal translucency thickness was smaller in the overall ART group compared with controls. The false-positive rate of first-trimester combined screening in the overall ART group, adjusted for maternal age, was significantly higher when compared with controls (9.0% vs. 6...

  17. 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

  18. Twin pregnancy possibly associated with high semen quality

    DEFF Research Database (Denmark)

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

    2007-01-01

    BACKGROUND: Recent studies found an association between a long waiting time to pregnancy (TTP) and reduced probability of twinning and a reduced dizygotic (DZ) twinning rate in subfertile men. However, it remains unsolved whether semen quality is associated with twin offspring. We therefore studied...

  19. Obstetric outcome of twin pregnancies in Jos, Nigeria | Mutihir ...

    African Journals Online (AJOL)

    Obstetric outcome of twin pregnancies in Jos, Nigeria. JT Mutihir, VC Pam. Abstract. Objectives: The objectives of the study were to determine the incidence, maternal and foetal outcome of twin delivery in Jos, Nigeria. Methodology: All consecutive twin deliveries between August 2003 and November 2004 were studied.

  20. Vanishing twin syndrome among ART singletons and pregnancy outcomes.

    Science.gov (United States)

    Magnus, Maria C; Ghaderi, Sara; Morken, Nils-Halvdan; Magnus, Per; Bente Romundstad, Liv; Skjærven, Rolv; Wilcox, Allen J; Eldevik Håberg, Siri

    2017-11-01

    VTS were also more likely to be born preterm, although this difference did not reach statistical significance. We did not have information on maternal socio-economic status, but this factor is accounted for in the sibship analyses. We also had no information on whether fresh or frozen embryos were replaced. The reduction in birth weight and increased risk of SGA in ART singletons with VTS may suggest the presence of harmful intrauterine factors with long-term health impact. While vanishing twins are not routinely observed in naturally conceived pregnancies, loss of a twin is potentially a risk factor for the surviving foetus in any pregnancy. This could be further explored in large samples of naturally conceived pregnancies with the necessary information. The authors of this study are supported in part by the UK Medical Research Council, US National Institute of Environmental Health Sciences and the Norwegian Research Council. The authors have no conflicts of interest. N/A. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.

  1. Pregnancy outcome and factors affecting vaginal delivery of twins at ...

    African Journals Online (AJOL)

    Objective: The study aims to determine the differences in maternal and perinatal outcomes between caesarean and vaginal deliveries and the factors affecting vaginal delivery in twin pregnancy. Materials and Methods: An observational study to audit twin pregnancies delivered at the University of Nigeria Teaching Hospital ...

  2. 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....

  3. Twins conceived using assisted reproduction: parent mental health, family relationships and child adjustment at middle childhood.

    Science.gov (United States)

    Anderson, Kayla N; Koh, Bibiana D; Connor, Jennifer J; Koerner, Ascan F; Damario, Mark; Rueter, Martha A

    2014-10-10

    Compared with singletons, what is the parent mental health, parent-child and couple relationship satisfaction, and child adjustment of 6- to 12-year-old assisted reproduction technology (ART) twins and their families? There are no differences between 6- and 12-year-old ART twin and singleton families in parent mental health or family relationships; however, twins had significantly fewer behavior and attention problems than singletons in middle childhood. When ART twins are younger than 5 years old, parents have more mental health difficulties and poorer parent-child relationship quality, and no differences have been found in ART twin and singletons' psychosocial adjustment. However, studies have only examined the implications of ART twin status in families with infant and toddler aged children. A cross-sectional study of 300 6-12-year-old ART children (n = 124 twins and n = 176 singletons) from 206 families at a reproductive endocrinology clinic in the USA. Patients from one clinic with a child born between 1998 and 2004 were invited to participate in an online survey (82% recruitment rate). Participants provided information on each 6- to 12-year-old ART child in the family, and responded to questions on parent mental health, family relationships and child adjustment. There were no differences in parent mental health or family relationships in families with 6- to 12-year-old ART twins versus singletons. However, twins (M = 2.40, SE = 0.35) had significantly fewer behavior problems than singletons (M = 3.47, SE = 0.36; F(1, 201) = 4.54, b = 1.08, P family demographics are representative of US ART patients, patients are from one US clinic. Responses also are from one family member and may be subject to social desirability biases. Additionally, our data did not include identification of monozygotic and dizygotic twins. Studies on infant and toddler ART twins suggest these families have parents with more mental health difficulties and lower parent-child relationship

  4. Demographic and Obstetric Outcomes of Pregnancies conceived by Assisted Reproductive Technology (ART) compared to Non-ART Pregnancies.

    Science.gov (United States)

    Johnston, Robert; Fong, Alex; Lovell, Sarah; Sobolewski, Paul S; Rad, Steve; Turner, Aaron

    2015-02-01

    Use of assisted reproductive technology has increased steadily, yet multiple socioeconomic and demographic disparities remain between the general population and those with infertility. Additionally, both mothers and infants experience higher rates of adverse outcomes compared to their non-ART counterparts. Using International Classification of Diseases, Ninth Revision (ICD-9) coding, we performed a retrospective review of all ART-conceived deliveries in California in 2009. A total of 551 ART pregnancies were compared to Non-ART pregnancies (n=406,885). The majority of ART deliveries belonged to women of advanced maternal age (AMA) and Caucasian or Asian race. Nearly half of all ART deliveries were multiple gestations. Compared to non-ART deliveries, ART pregnancies were associated with placenta previa, placental abruption, mild preeclampsia, and fetal growth restriction. While not powered to detect all outcomes, our study highlights significant racial and ethnic disparities between ART and Non-ART pregnancies.

  5. Acardiac twin pregnancies part III : Model simulations

    NARCIS (Netherlands)

    van Gemert, Martin J C; Ross, Michael G.; Nikkels, Peter G J; Wijngaard, Jeroen P H M van den

    2016-01-01

    Background: Acardiac monochorionic twins lack cardiac function but grow by passive perfusion of the pump twin's deoxygenated arterial blood through placental arterioarterial (AA) and venovenous (VV) anastomoses and by hypoxia-mediated neovascularization. Pump twins therefore must continuously

  6. 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)

  7. NOTE: Haemodynamic resistance model of monochorionic twin pregnancies complicated by acardiac twinning

    Science.gov (United States)

    Umur, Asli; van Gemert, Martin J. C.; van den Wijngaard, Jeroen P. H. M.; Ross, Michael G.; Nikkels, Peter G. J.

    2004-07-01

    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.

  8. Spontaneous unilateral Twin Ectopic Pregnancy: A case report

    Directory of Open Access Journals (Sweden)

    هادی اریا منش

    2017-03-01

    Full Text Available Abstract Aim & Objective: Twin pregnancy in the tube is a few and due to more frequent use of ovulatory medicine and increased maternal mortality rate. In this article, we report a case of  untitled twin ectopic pregnancy. Case study: The pregnant women was a 28 year-old  to had  a  history infertility, PCOD, Abortion and cortege,   too have one 5 years girl by CS and  Mild cramp pain in both abdominal lower quadrants and metroreghia . That have not treatment by projection. The ultra-sonography showed a twin pregnancy uterus with a moderate amount of fluid in pelvic cavity was seen. And do salpanjectimy surgery. Conclusion:  We report one Untitled Spontaneous Twin Ectopic Pregnancy,  is necessary any pregnant woman with  positive BhCG and metrorhoghia must be considered for Ectopic pregnancy. To decrease maternal mortality rate. Key words:

  9. 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.

  10. Outcomes of preterm premature rupture of membranes in twin pregnancies.

    Science.gov (United States)

    Trentacoste, Stephanie V; Jean-Pierre, Claudel; Baergen, Rebecca; Chasen, Stephen T

    2008-08-01

    To describe outcomes in twin pregnancies with preterm premature rupture of membranes (PPROM). Dichorionic twin pregnancies complicated by PPROM at premature rupture of membranes (PROM), latency from PROM to delivery, and infection were examined. In 49 twin pregnancies, the median gestational age at PROM was 31 weeks with a median latency between PROM and delivery of 0 days (interquartile range 0-6). Latency intervals of >or=2 and >or=7 days were achieved by 40.8% and 22.4%, respectively. PPROM at or= 2 days (70.6% vs. 25.0%) and >or=7 days (47.1% vs. 9.4%). There was a significant relationship between latency and clinical and histologic signs of infection. After 30 weeks, most twin pregnancies with PPROM delivered within 2 days. Infection appears to be a consequence rather than a cause of PPROM in most cases.

  11. Twin pregnancies: risks and complications: review article | Patel ...

    African Journals Online (AJOL)

    ... structural anomalies can be excluded and growth monitored, while Doppler velocimetry of the umbilical artery can detect placental insufficiency. Monochorionic pregnancies are at highest risk of adverse outcome due to specific complications, such as twin-to-twin transfusion syndrome. O & B Forum Vol.14(2) 2004: 13-19 ...

  12. Antenatal Surveillance in Twin Pregnancies Using the Biophysical Profile.

    Science.gov (United States)

    Booker, Whitney; Fox, Nathan S; Gupta, Simi; Carroll, Rachel; Saltzman, Daniel H; Klauser, Chad K; Rebarber, Andrei

    2015-11-01

    Objectives-The nonstress test is currently the most widely used modality for antenatal surveillance in twin pregnancies, with a quoted false-positive rate of 11%-12%. Our objective was to report our experience with the sonographic portion of the biophysical profile in twin pregnancies as the primary screening modality.Methods-Women with twin pregnancies delivered by a single maternal-fetal medicine practice from 2005 to 2013 were included. We excluded monoamniotic twins. Twin pregnancies began weekly sonography for the biophysical profile starting at 32 to 33 weeks, or earlier if indicated. The nonstress test was performed if the sonographic biophysical profile score was less than 8 of 8. We reviewed biophysical profile scores and outcomes for all patients who delivered at 33 weeks or later to assess the false-positive rate for the biophysical profile, as well as the incidence of intrauterine fetal death (IUFD) after initiation of antenatal surveillance.Results-A total of 539 twin pregnancies were included. The incidence of IUFD per patient was 2 per 539 (0.4%; 95% confidence interval [CI], 0.1%-1.3%), and the incidence of IUFD per fetus was 2 per 1078 (0.19%; 95% CI, 0.05%-0.7%). The overall positive screen rate was 24 per 539 (4.45%; 95% CI, 3.0%-6.5%). The false-positive screen rate, defined as an abnormal biophysical profile that did not diagnose an IUFD or lead to delivery, was 10 per 539 (1.9%; 95% CI, 1.0%-3.4%).Conclusions-In twin pregnancies the use of the sonographic biophysical profile for routine antenatal surveillance has a low false-positive rate, with a very low incidence of IUFD. The sonographic biophysical profile should be considered as a primary mode for antenatal surveillance in twin pregnancies, with a reflex nonstress test for an abnormal score. © 2015 by the American Institute of Ultrasound in Medicine.

  13. Twin versus singleton pregnancies: the incidence, pregnancy complications, and obstetric outcomes in a Nigerian tertiary hospital.

    Science.gov (United States)

    Obiechina, Nj; Okolie, Ve; Eleje, Gu; Okechukwu, Zc; Anemeje, Oa

    2011-01-01

    Twin pregnancy is associated with more pregnancy complications and poorer pregnancy outcome than singleton pregnancy. Hence periodic review is necessary to improve on the pregnancy outcome. To determine the incidence and compare pregnancy complications and obstetric outcomes of twin pregnancies and singleton pregnancies. The twin pregnancies (study group) that were delivered at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South-East Nigeria from 1st February 2005 to 31st January 2010 were compared with singleton deliveries (control group) that occurred in the same hospital during the same period. A total of 3351 deliveries were conducted during the study period, of which 113 were twin deliveries, giving an incidence of 1:29.6 deliveries. Only 100 case files could be retrieved for analysis. The mean parities for the twins and singletons were 2.7 ± 2.33 weeks and 1.96 ± 1.87 weeks whereas the mean gestational age at delivery for twin and singleton deliveries were 34 ± 5.2 weeks and 38.7 ± 2.4 weeks respectively (P < 0.05). The mean birth weights were 3.14 ± 0.73 kg and 2.3 ± 1.0 kg for singletons and twins respectively (P < 0.05). Hypertensive disorders of pregnancy, cord prolapse, malpresentation, premature rupture of membranes, low Apgar scores, cesarean section rate, and perinatal death were significantly higher in twin pregnancies than in singleton. The incidence of twin pregnancy over the study period was high and was significantly associated with more pregnancy complications and poorer obstetric outcomes. Close antenatal and intrapartum care are needed in order to improve outcome and decrease complications.

  14. Women's perspectives towards traditional and complementary medicine used to conceive, during pregnancy and the postpartum period.

    Science.gov (United States)

    Shaukat Ali, R; Gnanasan, S; Farooqui, M

    2018-02-01

    This study aims to explore pregnant and postpartum women's understanding of the meaning of traditional and complementary medicine (T&CM) and how that may affect their T&CM use. A cross-sectional study was conducted using self-administered questionnaires. Data collected from 374 women were analysed and represented via descriptive statistics. Out of the 374 participants, 285 (76.2%) reported using at least one type of T&CM to conceive, during pregnancy or in the postpartum period. The majority of the participants identified that T&CM is all about plants or natural products without chemicals or drugs (n = 267, 71.4%, p traditional Malay massage (n = 170, 59.6%). The main sources of information and recommendations for using T&CM came from their family members or friends (n = 199, 69.8%). Almost half of the participants incurred minimum expenditures of MYR100 and below on the T&CM used (n = 137, 48.1%) and there was no significant difference between pregnant and postpartum women (p = .056). This study reveals that many women are practising T&CM when trying to conceive and during pregnancy and the postpartum period even though they are aware that there is insufficient evidence on its safety and efficacy. Therefore, further studies are needed in order to gain sufficient clinical evidence that could be used to structure better guidelines for T&CM practices and services in Malaysia. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. 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....

  16. Unilateral spontaneous tubal twin ectopic pregnancy: A rare ...

    African Journals Online (AJOL)

    Unilateral tubal twin pregnancy remains rare despite a rise in the incidence of singleton ectopic pregnancies. A 27-year-old Gravida 1 Para 0+0 at 12 weeks gestation, presented to our institution with a 1-month history of lower abdominal pain, that progressively worsened and became very severe. An abdominal ultrasound ...

  17. Managing a Live Advanced Abdominal Twin Pregnancy | Mpogoro ...

    African Journals Online (AJOL)

    Advanced abdominal pregnancies with live twin fetuses are extremely rare and are misdiagnosed in up to 60% of the cases. Such a case is presented here, highlighting the diagnostic and management challenges encountered. A high index of suspicion in making the diagnosis of this rare variety of ectopic pregnancy, ...

  18. Unilateral twin interstitial ectopic pregnancy. A case report.

    Science.gov (United States)

    Starks, G C

    1980-08-01

    An unusual case of twin unilateral interstitial pregnancy with premature rupture of membranes and leiomyomata uteri is described. A review of the literature reveals only two previous cases of this type. On admission, the patient was diagnosed as having an intrauterine pregnancy of 27 weeks' gestation, with documented premature rupture of the membranes having occurred. An ultrasound was performed revealing a fibroid uterus, an anterior placenta and an gestation. Septicemia ensued, and antibiotics plus pitocin was begun; however, no uterine response occurred. A culdocentesis revealed free intraabdominal blood. Laparotomy followed, revealing a ruptured twin interstitial pregnancy with placenta accreta and leiomyomata of the uterus.

  19. Trial of labour in twin pregnancies: a retrospective cohort study.

    Science.gov (United States)

    de Castro, H; Haas, J; Schiff, E; Sivan, E; Yinon, Y; Barzilay, E

    2016-05-01

    To assess the success rate of vaginal delivery among women with twin pregnancies; the Twin Birth Study has shown that vaginal delivery and caesarean section are equally safe for twin delivery but >40% of the planned vaginal delivery group delivered by caesarean section. A retrospective cohort study. A tertiary medical centre. A total of 2194 women with twin pregnancies not complicated with very low birthweight. Planned mode of delivery was documented in the woman's electronic record upon entering the delivery room. Information regarding maternal age at delivery, parity, gestational age, presentation, previous history of caesarean delivery, birthweight and Apgar score was collected from the obstetric electronic charts. Rate of vaginal twin delivery. Of the 2194 women included, 1311 twin pregnancies had planned caesarean delivery and 883 underwent a trial of labour. Of the 883 women who underwent a trial of labour, the rate of vaginal delivery was 86.9%, whereas the rates of caesarean delivery and combined vaginal-caesarean delivery were 11.1% and 2.0%, respectively. Presentation of second twin, gestational age and maternal age did affect the chances of success. Nulliparity [odds ratio (OR) 2.38, 95% confidence interval (95% CI) 1.4-4.05], Foley induction of labour (OR 2.33, 95% CI 1.38-3.91) and body mass index >30 kg/m(2) (OR 1.76, 95% CI 1.03-3) were independent risk factors for caesarean delivery. The rate of vaginal delivery among women with twin pregnancies who undergo labour can be high, especially in women who laboured spontaneously and have delivered before. The rate of vaginal delivery of twins can be high, especially in women who have delivered before. © 2015 Royal College of Obstetricians and Gynaecologists.

  20. Dizygotic twin pregnancies after medically assisted reproduction and after natural conception: maternal and perinatal outcomes.

    Science.gov (United States)

    Bensdorp, Alexandra J; Hukkelhoven, Chantal W; van der Veen, Fulco; Mol, Ben W J; Lambalk, Cornelis B; van Wely, Madelon

    2016-08-01

    To compare maternal and perinatal outcomes in dizygotic twin pregnancies conceived after medically assisted reproduction (MAR) with outcomes after natural conception (NC). Nationwide registry based study. Academic medical center. Primiparous women who delivered opposite sex twins between January 2000 and December 2012 in the Netherlands, comprising dizygotic twin pregnancies: 6,694 women, 470 after ovulation induction (OI), 511 after intrauterine insemination with controlled ovarian hyperstimulation (IUI-COH), 2,437 after in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI), and 3,276 after NC. None. Multivariable logistic regression and generalized linear mixed models to evaluate differences in outcomes: maternal outcomes of hypertension, preeclampsia, preterm delivery, hemorrhage, and delivery mode, perinatal outcomes including small for gestational age (SGA) with birth weight <10th percentile, birth weight <1,500 g, 5-minute Apgar score <7, admission to neonatal intensive care unit, congenital anomalies, and perinatal mortality. We found no statistically significant differences in maternal or perinatal outcomes after OI compared with NC. Women pregnant after IVF-ICSI had a lower risk for hypertension (adjusted odds ratio [aOR] 0.74; 95% confidence interval [CI], 0.66-0.83) compared with women pregnant after NC. After IUI-COH more children had Apgar scores <7 (adjusted odds ratio (aOR) 1.38; 95% confidence interval (CI) 1.05-1.81) and perinatal mortality rates were higher (aOR 1.56; 95% CI, 1.04-2.33) compared with NC. We found no differences in perinatal outcomes after IVF-ICSI compared with NC. Overall, maternal and perinatal risks other than those due to multiplicity are similar for twin pregnancies conceived after MAR and after NC. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Unilateral twin interstitial ectopic pregnancy. Report of a case.

    Science.gov (United States)

    Twiggs, L B; Stumpf, P G; Davajan, V

    1977-01-01

    An unusual case of twin unilateral interstitial pregnancy is described. On admission the patient was thought to have an intrauterine pregnancy of 14 weeks' gestation. Because of an irregularity in the right cornual region of the uterus, a culdocentesis was performed which returned unclotted blood. Because of this finding the patient underwent laparoscopy which revealed an unruptured right cornual pregnancy. An early diagnosis before rupture allowed for conservative surgical management and uterine conservation.

  2. 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:

  3. [Twin pregnancy as the risk factor for neonatal intraventricular hemorrhage].

    Science.gov (United States)

    Wieczorek, Aleksandra I; Krasomski, Grzegorz

    2015-02-01

    The aim of this study was to find the perinatal risk factors of intravenricular hemorrhage in twin neonates. A retrospective analysis of 203 twin pregnancies and deliveries between 2003 and 2009 was performed. Then data according birth state and neonatal complications in 406 twins were analyzed. Twin outcome was compared with the outcome of 105 singletons born at the same time and at the same gestational age as twins. Intraventricular hemorrhage was diagnosed in 116/406 (29%) of twins. IVH was found two times more often in the analyzed group than in singletons born at the same gestational age (29% vs. 18%, p = 0,03). In 96% I and II grade hemorrhage was diagnosed and in 4% III and IV grade hemorrhage in the Papille scale was found. 1) Intraventricular hemorrhage is found more often in twins than in singleton neonates born at the same gestational age. 2) IVH in twins correlate with preterm birth and low birth weight. IVH occur more often in twins with birth weight discordance and with too small maternal weight gain.

  4. Gestational diabetes mellitus: glycemic control during pregnancy and neonatal outcomes of twin and singleton pregnancies.

    Science.gov (United States)

    Guillén-Sacoto, María Augusta; Barquiel, Beatriz; Hillman, Natalia; Burgos, María Ángeles; Herranz, Lucrecia

    2018-04-20

    To assess the impact of glycemic control in gestational on neonatal weight and metabolic complications of twin and singleton pregnancies. An observational, retrospective study to monitor 120 twin and 240 singleton pregnancies in women with GDM. Maternal glycemic parameters during pregnancy (oral glucose tolerance test results, treatment, insulinization rate, mean HbA1c in the third trimester), and neonatal complications and weight were recorded. A higher infant birth weight ratio (IBWR 1.02±0.12 vs. 0.88±0.12, P<.001) and a lower rate of newborns small for gestational age (severe SGA 2.5% vs. 8.3%, P=.012) were seen after singleton pregnancies as compared to twin pregnancies. The rates of newborns large for gestational age (LGA 12.6% vs. 12.5%, P=.989); macrosomic (6.7% vs. 7.5%, P=.777); or small for gestational age (SGA 6.7% vs. 10.8%, P=.175) were similar in both groups. Neonates from twin pregnancies had a higher risk of hypoglycemia (adjusted OR 4.71; 1.38-16.07, P=.013) and polycythemia (adjusted OR 10.05; 1.82-55.42, P=0.008). A linear relationship was seen between third trimester HbA1c levels and IBWR in singleton (r=.199, P=.003), but not in twin pregnancies (r=0.049, P=0.610). Risk of severe SGA, hypoglycemia, and polycythemia was significantly higher in twin pregnancies of women with GDM. Neonatal weight outcomes and metabolic complications in twin pregnancies of women with GDM were not related to glycemic control. Moreover, in our study population, fasting glucose at diagnosis and mean HbA1c in the third trimester showed a linear relationship with higher birth weights in singleton, but not in twin pregnancies. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Prenatal screening for and diagnosis of aneuploidy in twin pregnancies.

    Science.gov (United States)

    Audibert, François; Gagnon, Alain

    2011-07-01

    To provide a Canadian consensus document with recommendations on prenatal screening for and diagnosis of fetal aneuploidy (e.g., Down syndrome and trisomy 18) in twin pregnancies. The process of prenatal screening and diagnosis in twin pregnancies is complex. This document reviews the options available to pregnant women and the challenges specific to screening and diagnosis in a twin pregnancy. Clinicians will be better informed about the accuracy of different screening options in twin pregnancies and about techniques of invasive prenatal diagnosis in twins. PubMed and Cochrane Database were searched for relevant English and French language articles published between 1985 and 2010, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, prenatal screening, genetic health risk, genetic health surveillance, prenatal diagnosis, twin gestation). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding prenatal screening were also reviewed in developing this clinical practice guideline. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). There is a need for specific guidelines for prenatal screening and diagnosis in twins. These guidelines should assist health care providers in the approach to this aspect of prenatal care of women with twin pregnancies. SUMMARY STATEMENTS 1. Fetal nuchal translucency combined with maternal age is an

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

    International Nuclear Information System (INIS)

    Wijngaard, Jeroen P H M van den; Umur, Asli; Ross, Michael G; Gemert, Martin J C van

    2004-01-01

    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)

  7. Abdominal Cerclage in Twin Pregnancy after Radical Surgical Conization

    Directory of Open Access Journals (Sweden)

    Ioannis Kyvernitakis

    2014-01-01

    Full Text Available 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-indicated transabdominal cervicoisthmic cerclage was performed at 12 + 4/7 gestational weeks because of assumed cervicoisthmic insufficiency. The pregnancy continued until 34 + 3/7 weeks when the patient developed preeclampsia indicating Cesarean delivery. Transabdominal cerclage in twin pregnancy has rarely been described, but it may be considered in case of extreme cervical shortening after radical cervical surgery, as it would in singleton pregnancy.

  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...... 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. Assisted reproductive technology and risk of adverse obstetric outcomes in dichorionic twin pregnancies: a systematic review and meta-analysis.

    Science.gov (United States)

    Qin, Jiabi B; Wang, Hua; Sheng, Xiaoqi; Xie, Qiong; Gao, Shiyou

    2016-05-01

    To examine whether dichorionic twin pregnancies after assisted reproductive technology (ART) were at higher risk of adverse obstetric outcomes compared with those conceived naturally. Meta-analysis. University-affiliated teaching hospital. Dichorionic twin pregnancies conceived with ART and naturally. Studies comparing obstetric outcomes in dichorionic twin pregnancies conceived by ART and naturally were identified by searching PubMed, Google Scholar, Cochrane Libraries, and Chinese databases through July 2015 with no restrictions. Either a fixed-effects or a random-effects model was used to calculate the overall combined risk estimates. Subgroup analysis was performed to explore potential heterogeneity moderators. Maternal complications and adverse pregnancy outcomes. Fifteen cohort studies involving 6,420 dichorionic twins after ART and 13,650 dichorionic twins conceived naturally were included. Most of maternal complications were similar in both groups, but placenta previa (relative risk [RR] = 2.99, 95% confidence interval [CI] 1.51-5.92; I(2) = 0) was significantly more common in the ART group. For neonatal outcomes, the ART group experienced higher risk of preterm birth (RR = 1.13, 95% CI 1.00-1.29; I(2) = 75%), very preterm birth (RR = 1.39, 95% CI 1.07-1.82; I(2) = 71%), low birth weight (RR = 1.11, 95% CI 1.00-1.23; I(2) = 61%), and congenital malformations (RR = 1.26, 95% CI 1.09-1.46; I(2) = 26%). In addition, the ART group had a higher proportion of elective cesarean sections (RR = 1.79, 95% CI 1.49-2.16; I(2) = 60%), but had a similar proportion for emergency cesarean sections. Relevant heterogeneity moderators have been identified by subgroup analysis. No evidence of publication bias was observed. The rates of placenta previa, elective cesarean section, preterm birth, very preterm birth, low birth weight, and congenital malformations were significantly higher in dichorionic twin pregnancies after ART. Copyright © 2016 American Society for

  10. 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.

  11. Congenital varicella syndrome in a monochorionic diamniotic twin pregnancy.

    Science.gov (United States)

    Villota, Vania A; Delgado, Julián; Pachajoa, Harry

    2014-05-01

    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. delayed interval delivery in twin pregnancy without cerclage

    African Journals Online (AJOL)

    2011-11-11

    Nov 11, 2011 ... the procedure, delayed interval delivery in twin pregnancy without cerclage may be a reasonable strategy. REFERENCES. Livingston, J. C., Livingston, L. W., Ramsey, R. and Sibai,. 1. B. M. Second-Trimester Asynchronous Multifetal Delivery. Results in Poor Perinatal Outcome. Obstetrics & Gynecol. 2004 ...

  13. Associations between uterine fibroids and obstetric outcomes in twin pregnancies.

    Science.gov (United States)

    Wang, Hong-Mei; Tian, Yu-Cui; Xue, Zhi-Fang; Zhang, Yue; Dai, Yin-Mei

    2016-10-01

    To examine potential associations between the presence of fibroids and obstetric outcomes in twin pregnancies. A prospective cohort study compared obstetric outcomes between individuals with twin pregnancies who did and did not have fibroids. Patients were considered for inclusion if they underwent first-trimester ultrasonography examination, and went on to deliver at the Beijing Obstetrics and Gynecology Hospital between September 1, 2012 and December 31, 2014. Participants were grouped based on the presence or absence of fibroids and baseline demographics, fibroid characteristics, and obstetric outcomes were recorded and compared between the two groups. In total, 153 patients with twin pregnancies were recruited; 51 had fibroids and 102 did not. Patients in the fibroid group demonstrated a higher maternal age (Pobstetric outcomes, and obstetric outcomes were unaffected by the number, size, location, and type of fibroids (all P>0.05). Fibroids were not a risk factor for any adverse obstetric outcomes among patients with twin pregnancies. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  14. 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

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

    Science.gov (United States)

    Pinborg, A; Ortoft, G; Loft, A; Rasmussen, S C; Ingerslev, H J

    2015-01-01

    Does cervical conization add an additional risk of preterm birth (PTB) in assisted reproduction technology (ART) singleton and twin pregnancies? Cervical conization doubles the risk of preterm and very PTB in ART twin pregnancies. ART and cervical conization are both risk factors for PTB. 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 and the Medical Birth register. Furthermore, control groups of naturally conceived (NC) singletons and twins were extracted. Cervical diagnoses were obtained from the Danish Pathology register. Cervical conization included both cold knife cone and LEEP (loop electrosurgical excision procedure) but not cervical biopsies. The main outcomes measures were PTB (PTB ≤ 37 + 0 gestational weeks), very preterm birth (VPTB ≤ 32 + 0 gestational weeks) and preterm premature rupture of membranes (PPROM). In all 16 923 ART singletons and 4829 ART twin deliveries were included. A random sample of NC singletons, 2-fold the size of the ART singleton group matched by date and year of birth (n = 33 835) and all NC twin deliveries (n = 15 112), was also extracted. Multiple logistic regression analyses were performed to adjust for the following confounders: maternal age, parity, year of child birth and sex of child. Cervical morbidity (dysplasia and conization) was more often observed in ART pregnancies (6.2% of ART singletons and 5.4% ART twins) than in NC pregnancies (4.2% for NC singletons and 4.5% for NC twins), both for singletons and twins. In ART singleton deliveries, the PTB rate was 13.1 versus 8.2% in women with and without conization, respectively, with an adjusted odds ratio (aOR) of 1.56 [95% confidence interval (CI) 1.21-2.01]. In ART twin deliveries, the prevalence of PTB was 58.2 versus 41.3% in women with and without conization, respectively, with an aOR 1.94 (95% CI 1

  16. pregnancy metabolism In . tWIn

    African Journals Online (AJOL)

    of this insulin insensitivity in pregnancy is Unknown, but one possible explanation is the rise in the level of human placental lactogen (HPL) that accompanies gestation.2. Spellacy er aP showed that HPL levels are even higher in pregnancies with two or more placentas. Subsequently, in a study ofcarbohydrate metabolism ...

  17. Parents' anxiety and depression symptoms after successful infertility treatment and spontaneous conception: does singleton/twin pregnancy matter?

    Science.gov (United States)

    Tendais, I; Figueiredo, B

    2016-10-01

    Does mode of conception [spontaneous/after infertility treatment (IT)], type of pregnancy (singleton/twin) and parent gender have an effect on anxiety and depression levels and trajectories during pregnancy and the post-partum period? Conception after IT was associated with a transitory increase in anxiety during the perinatal period for parents of singletons, while for IT parents of twins higher levels of psychopathological symptoms tended to persist during pregnancy and the post-partum period. Most previous studies have shown that successful IT is not associated with poor psychological well-being during pregnancy and the post-partum period, but there is also some evidence for heightened pregnancy-related anxiety, lower self-esteem and lower self-efficacy. Parents of twins experience increased postnatal anxiety and depression. This prospective longitudinal study assessed 267 couples (N = 534) at each trimester of pregnancy, after childbirth and at 3 months post-partum. The sample comprised 36 couples who had conceived after IT (19 twin pairs and 17 singletons) and 231 couples who had conceived spontaneously (SC; 28 twin pairs and 203 singletons). Couples were recruited at four public hospitals in Portugal, and self-report measures of anxiety and depression symptoms were administered. IT parents reported higher anxiety after childbirth than parents who SC, regardless of pregnancy type. IT parents of twins showed higher anxiety at mid-pregnancy, as well as higher anxiety and depression at 3 months post-partum than IT parents of singletons. Among IT mothers, those who had twins exhibited higher depression after childbirth than those who had singletons. Differences according to mode of conception, pregnancy type and parents gender over time were also noted. During pregnancy, IT parents of twins showed no significant change in depression scores, while the other groups depression scores statistically significantly decreased over time. From pregnancy to the post

  18. Pregnancy Weight Gain by Gestational Age in Women with Uncomplicated Dichorionic Twin Pregnancies.

    Science.gov (United States)

    Hutcheon, Jennifer A; Platt, Robert W; Abrams, Barbara; Braxter, Betty J; Eckhardt, Cara L; Himes, Katherine P; Bodnar, Lisa M

    2018-01-29

    Twin pregnancies are at increased risk for adverse outcomes and are associated with greater gestational weight gain compared to singleton pregnancies. Studies that disentangle the relationship between gestational duration, weight gain and adverse outcomes are needed to inform weight gain guidelines. We created charts of the mean, standard deviation and select percentiles of maternal weight gain-for-gestational age in twin pregnancies and compared them to singleton curves. We abstracted serial prenatal weight measurements of women delivering uncomplicated twin pregnancies at Magee-Womens Hospital (Pittsburgh, PA, 1998-2013) and merged them with the hospital's perinatal database. Hierarchical linear regression was used to express pregnancy weight gain as a smoothed function of gestational age according to pre-pregnancy BMI category. Charts of week- and day-specific values for the mean, standard deviation, and percentiles of maternal weight gain were created. Prenatal weight measurements (median: 11 [interquartile range: 9, 13] per woman) were available for 1109 women (573 normal weight, 287 overweight, and 249 obese). The slope of weight gain was most pronounced in normal weight women and flattened with increasing pre-pregnancy BMI (e.g. 50th percentiles of 6.8, 5.7, and 3.6 kg at 20 weeks and 19.8, 18.1, and 14.4 at 37 weeks in normal weight, overweight, and obese women, respectively). Weight gain patterns in twins diverged from singletons after 17-19 weeks. Our charts provide a tool for the classification of maternal weight gain in twin pregnancies. Future work is needed to identify the range of weight gain associated with optimal pregnancy health outcomes. © 2018 John Wiley & Sons Ltd.

  19. The vanishing twin: a major determinant of infant outcome in IVF singleton births

    DEFF Research Database (Denmark)

    Pinborg, Anja; Lidegaard, Ojvind; Andersen, Anders Nyboe

    2006-01-01

    This article attempts to assess the frequency of vanishing twins in assisted reproductive and spontaneously conceived pregnancies, including in-vitro fertilization (IVF), and its impact on the live-born surviving twin....

  20. [Prevention of spontaneous preterm birth in asymptomatic twin pregnancies].

    Science.gov (United States)

    Sentilhes, L; Bouhours, A-C; Bouet, P-E; Boussion, F; Biquard, F; Gillard, P; Descamps, P

    2009-12-01

    To determine prenatal methods to predict and prevent spontaneous preterm birth in asymptomatic twin pregnancies. Articles were searched using PubMed, Embase and Cochrane library. Uterine activity monitoring and bacterial vaginosis screening are not useful to predict preterm birth (EL2 and EL3 respectively). Current literature data are contradictory and insufficient to determine whether fetal fibronectin and digital cervical assessment are predictors of preterm birth. History of preterm birth (EL4), and cervical length measurement by transvaginal ultrasonography (EL2) predict preterm birth. Nevertheless, there are no intervention studies that have evaluated cervical length measurement in the prevention of preterm birth. Hospital bedrest, prophylactic tocolytic and progesterone therapy, and prophylactic cervical cerclage in patients with or without short cervix have not been shown to be effective in preventing preterm birth. Prenatal methods to prevent spontaneous preterm birth in asymptomatic twin pregnancies are currently very limited. Copyright © 2009 Elsevier Masson SAS. All rights reserved.

  1. Fetal Growth in Pregnancies Conceived after Gastric Bypass Surgery in Relation to Surgery-to-Conception Interval

    DEFF Research Database (Denmark)

    Nørgaard, Lone Nikoline; Gjerris, Anne Cathrine Roslev; Kirkegaard, Ida

    2014-01-01

    Medicine Database). Main outcome measures were early and late fetal growth in relation to time from bariatric surgery to conception of the pregnancy. Early fetal growth was expressed as "Fetal Growth Index": the ratio between the estimated number of days from first trimester ultrasound to second trimester......OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton...... ultrasound biometries and the actual calender time elapsed in days. Late fetal growth was expressed as the observed versus expected birthweight according to gestational age (GA). RESULTS: The surgery-to-conception interval ranged from 3 to 1851 days with a mean value of 502 (SD, 351) days. The mean "fetal...

  2. Wish to conceive and concerns to develop cardiovascular complications during pregnancy in patients with Turner syndrome

    NARCIS (Netherlands)

    I.M. van Hagen (Iris); A.L. Duijnhouwer (Anthonie L.); M.J. ten Kate-Booij (Marianne); R.H.M. Dykgraaf (Ramon); J.J. Duvekot (Hans); E.M.W.J. Utens (Elisabeth); J.W. Roos-Hesselink (Jolien)

    2017-01-01

    textabstractIntroduction: Turner syndrome (TS) is associated with subfertility and infertility. Nevertheless, an increasing number of women become pregnant through oocyte donation. The wish to conceive may be negatively influenced by the fear of cardiovascular complications. The aim was to

  3. Obstetrical complications in dichorionic twin pregnancies in women with polycystic ovary syndrome

    DEFF Research Database (Denmark)

    Jonsdottir, Fjola; Nilas, Lisbeth; Andreasen, Kirsten R

    2017-01-01

    INTRODUCTION: Both women with polycystic ovary syndrome (PCOS) and women with twin pregnancies have increased risk of adverse pregnancy outcome. The aim of this study was to investigate the impact of PCOS and maternal androgen levels on the outcome of dichorionic twin pregnancy. MATERIAL...

  4. Conjoined twins in a monochorionic triplet pregnancy after in vitro fertilization: a case report

    Directory of Open Access Journals (Sweden)

    Marzieh Talebian

    2015-11-01

    Full Text Available Background: Monozygotic monochorionic triplet pregnancy with conjoined twins is a very rare condition and is associated with many complications. Case: In this study, we describe a monochorionic–diamniotic triplet pregnancy after in vitro fertilization with an intracytoplasmic sperm injection. At a gestational age of 6 weeks and 4 days of pregnancy one gestational sac was observed, and at a gestational age of 12 weeks and 2 days, triplets with conjoined twins were diagnosed. After consulting with the parents, they chose fetal reduction of the conjoined twins. Selective feticide was successfully performed by radiofrequency ablation at 16 weeks of pregnancy. Unfortunately, the day after the procedure, the membrane ruptured, and 1 week later, all fetuses and placenta were spontaneously aborted. Conclusion: Monochorionic triplet pregnancy with conjoined twins is very rare. These pregnancies are associated with very serious complications. Intra cytoplasmic sperm injection increases the rate of monozygotic twinning and conjoined twins. Counseling with parents before IVF is very important.

  5. [Outcome of triplet pregnancies managed for twin-to-twin transfusion syndrome: A single center experience].

    Science.gov (United States)

    Chalouhi, G E; Quibel, T; Benzina, N; Bernard, J-P; Essaoui, M; Ville, Y

    2016-10-01

    Study the outcomes of triplet pregnancies (GGG) complicated with twin-to-twin transfusion syndrome (TTTS) treated with laser fetoscopy. Retrospective study of interventions, outcomes and perinatal follow-up of GGG treated for TTS. Between 2002 and 2013, 25 GGG complicated by TTTS were seen in our center, 20 dichorionic and 5 monochorionic. The mean gestational age (GA) at diagnosis of TTTS was 19.7 GW (±2.4) with 2, 4, 16 and 1 pregnancies at Quintero's stage I, II, III and V, respectively. They had a fetoscopy at an average GA of 19 GW and 6 days. There were 3 (13.0%) late miscarriages. The average GA at delivery was of 29.6 GW overall (26.3 GW and 31.1 GW in monochorionic and dichorionic pregnancies respectively). The overall fetal survival rate was 57.97% (40% and 66.7% in the group of monochorionic dichorionic pregnancies, respectively). However, neonatal mortality (<28 days) is 17.5%. GGG operated by fetoscopy for TTTS have a survival rate of three, at least 2 and at least 1 fetus of 21.7%, 69.6% and 82.6% respectively. The overall fetal survival rate is 59.97%. There is a tendency for better survival rates in dichorionic GGG compared to monochorionic GGG (P=0.079). Copyright © 2016. Published by Elsevier Masson SAS.

  6. [Early sonographic diagnosis of twin pregnancy in mares and its reduction to a single pregnancy].

    Science.gov (United States)

    Kudlac, E; Grygar, J

    1992-08-01

    The frequency of double ovulation and the chances of twin pregnancy in the mare are presented with reference to the relevant literature. A novel manual technique for reducing the embryo number from two to one is introduced and illustrated by ultrasonographic images.

  7. 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.

  8. Adverse pregnancy, birth, and infant outcomes in twins: effects of maternal fertility status and infant gender combinations; the Massachusetts Outcomes Study of Assisted Reproductive Technology.

    Science.gov (United States)

    Luke, Barbara; Gopal, Daksha; Cabral, Howard; Stern, Judy E; Diop, Hafsatou

    2017-09-01

    It is unknown whether the risk of adverse outcomes in twin pregnancies among subfertile women, conceived with and without in vitro fertilization, differs from those conceived spontaneously. We sought to evaluate the effects of fertility status on adverse perinatal outcomes in twin pregnancies on a population basis. All twin live births of ≥22 weeks' gestation and ≥350 g birthweight to Massachusetts resident women in 2004 through 2010 were linked to hospital discharge records, vital records, and in vitro fertilization cycles. Women were categorized by their fertility status as in vitro fertilization, subfertile, or fertile, and by twin pair genders (all, like, unlike). Women whose births linked to in vitro fertilization cycles were classified as in vitro fertilization; those with indicators of subfertility but without in vitro fertilization treatment were classified as subfertile; all others were classified as fertile. Risks of 6 adverse pregnancy outcomes (gestational diabetes, pregnancy hypertension, uterine bleeding, placental complications [placenta abruptio, placenta previa, and vasa previa], prenatal hospitalizations, and primary cesarean) and 9 adverse infant outcomes (very low birthweight, low birthweight, small-for-gestation birthweight, large-for-gestation birthweight, very preterm [women with twin pregnancies (6090 fertile, 724 subfertile, and 3538 in vitro fertilization). Among all twins, the risks for all 6 adverse pregnancy outcomes were significantly increased for the subfertile and in vitro fertilization groups, with highest risks for uterine bleeding (adjusted relative risk ratios, 1.92 and 2.58, respectively) and placental complications (adjusted relative risk ratios, 2.07 and 1.83, respectively). Among all twins, the risks for those born to subfertile women were significantly increased for very preterm birth and neonatal and infant death (adjusted relative risk ratios, 1.36, 1.89, and 1.87, respectively). Risks were significantly

  9. Perinatal outcome of monochorionic and dichorionic twins after spontaneous and assisted conception: a retrospective cohort study.

    Science.gov (United States)

    Hack, Karien E A; Vereycken, Marijn E M S; Torrance, Helen L; Koopman-Esseboom, Corine; Derks, Jan B

    2018-02-11

    The aim of this study was to compare pregnancy outcomes in twin pregnancies after assisted conception and spontaneous conception, according to chorionicity. Retrospective cohort study of 1305 twin pregnancies between 1995 and 2015. All spontaneous (n = 731) and assisted conception conceived (n = 574) twin pregnancies with antenatal care and delivery in University Medical Center Utrecht, the Netherlands, a tertiary obstetric care center were studied according to chorionicity. Maternal age and incidence of nulliparity were higher among the assisted conception twins. Hypertensive disorders also appeared to be more frequent in assisted conception pregnancies, which could largely be explained by the higher proportion of elderly nulliparous women in this group. Spontaneously conceived twins were born earlier than twins after assisted conception, with subsequent lower birthweights and more admissions to a neonatal intensive care unit with increased neonatal morbidity. Monochorionic twins had worse pregnancy outcomes compared with dichorionic twins, irrespective of mode of conception; monochorionic twins conceived by assisted reproduction had more neonatal morbidity (mainly respiratory distress syndrome and necrotizing enterocolitis) and late neonatal deaths compared with spontaneously conceived monochorionic twins. Spontaneously conceived twins have worse pregnancy outcome compared with twins after assisted conception, probably due to a lower incidence of monochorionicity in the assisted conception group. The already increased perinatal risks in monochorionic twins are even higher in monochorionic twins conceived after infertility treatments compared with spontaneously conceived monochorionic twins, which warrants extra attention to these high-risk pregnancies. © 2018 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

  10. Recurrence risk of preterm birth in subsequent twin pregnancy after preterm singleton delivery

    NARCIS (Netherlands)

    Schaaf, J. M.; Hof, M. H. P.; Mol, B. W. J.; Abu-Hanna, A.; Ravelli, A. C. J.

    2012-01-01

    Please cite this paper as: Schaaf J, Hof M, Mol B, Abu-Hanna A, Ravelli A. Recurrence risk of preterm birth in subsequent twin pregnancy after preterm singleton delivery.BJOG 2012;119:16241629. Objective To determine the risk of preterm birth in a subsequent twin pregnancy after previous singleton

  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. Aneuploidy screening by non?invasive prenatal testing in twin pregnancy

    OpenAIRE

    Fosler, L.; Winters, P.; Jones, K. W.; Curnow, K. J.; Sehnert, A. J.; Bhatt, S.; Platt, L. D.

    2017-01-01

    Abstract Objectives To describe our experience with non?invasive prenatal testing (NIPT) in twin pregnancy. Methods Two sets of maternal blood samples from twin pregnancies were analyzed at our laboratory using NIPT: 115 stored samples from pregnancies with known outcome (Clinical Study A) and 487 prospectively collected samples for which outcomes were requested from providers (Clinical Study B). NIPT was used to screen for the presence of fetal aneuploidy on chromosomes 13, 18, 21, X and Y i...

  13. Risk factors for cesarean delivery and adverse neonatal outcome in twin pregnancies attempting vaginal delivery.

    Science.gov (United States)

    Schachter-Safrai, Natali; Karavani, Gilad; Haj-Yahya, Rani; Ofek Shlomai, Noa; Porat, Shay

    2018-02-24

    Twin vaginal delivery presents a unique clinical challenge for obstetricians. The Twin Birth Study demonstrated the safety of planned vaginal delivery regarding neonatal outcomes. However, that study lacked a description of the risk factors associated with and the outcome of unplanned cesarean section. The aim of this study is to identify potential risk factors for cesarean section and delivery related neonatal morbidity and mortality in women with twin pregnancy attempting vaginal delivery. A retrospective cohort study including 1070 women with twin pregnancy that underwent a trial of labor between 2003 and 2015. The study population was divided according to the mode of delivery: vaginal delivery, combined vaginal-cesarean and intrapartum cesarean delivery of both twins. Several risk factors and neonatal outcomes were examined by both univariate analysis and multinomial logistic regression analysis. The rate of vaginal delivery of both twins was 88.3%, whereas the rates of combined vaginal cesarean and unplanned cesarean delivery were 4.6% and 7.1%, respectively. Nulliparity and nonvertex presentation of twin B were found to be independently associated with cesarean delivery for both twins. Additionally, nonvertex presentation of twin B was independently associated with combined vaginal-cesarean delivery. The proportion of neonates with Apgar score cesarean group compared with those delivered by the vaginal route alone. Nulliparity and nonvertex presentation of twin B were found to be associated with intrapartum cesarean delivery in twin pregnancies. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  14. A twin sibling with Prader-Willi syndrome caused by uniparental disomy conceived after in vitro fertilization.

    Science.gov (United States)

    Atik, T; Aykut, A; Karaca, E; Onay, H; Ozkinay, F; Cogulu, O

    2014-01-01

    The use of assisted reproductive technologies (ART) has increased gradually in the treatment of infertility worldwide. On the other hand ART has been found to be associated with an increased risk of congenital malformations including imprinting defects as well. Although a number of imprinting syndromes have been reported to be related with ART, no case with uniparental disomy (UPD) caused Prader-Willi syndrome (PWS) [OMIM ID: 176270] has been reported in the literature. Here we present a dizygotic twin in which one of them was born with maternal UPD15 following ART. The proband was a 2-year-old boy who had feeding difficulties, generalized hypotonia, frontal bossing, broad forehead, small hands and feet. Laboratory investigations revealed minimal dilatation in 3rd and 4th ventricles and corpus callosum hypoplasia in magnetic resonance imaging, supravalvular pulmonary stenosis in echocardiography and pelvicaliectasia in the USG examinations. Methylation and microsatellite markers analyses showed maternal UPD for chromosome 15. Here we report, for the first time UPD caused PWS patient born after ART.

  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. Fetal fraction estimate in twin pregnancies using directed cell-free DNA analysis.

    Science.gov (United States)

    Struble, Craig A; Syngelaki, Argyro; Oliphant, Arnold; Song, Ken; Nicolaides, Kypros H

    2014-01-01

    To estimate fetal fraction (FF) in monozygotic and dizygotic twin pregnancies. Maternal plasma samples were obtained from 35 monochorionic twin pregnancies with male fetuses (monozygotic) and 35 dichorionic pregnancies discordant for fetal sex (dizygotic) at 11-13 weeks' gestation. Cell-free DNA was extracted and chromosome-selective sequencing with digital analysis of selected regions (DANSR™) was carried out. The fetal-fraction optimized risk of trisomy evaluation (FORTE™) algorithm was used to estimate FF using polymorphic alleles. In dizygotic twins the FORTE algorithm was modified to estimate the smallest FF contribution of the 2 fetuses. In both types of twins, FF was also determined by analysis of Y-chromosome sequences. In monozygotic twins, the median total FF was 14.0% (range 8.2-27.0%) and in dizygotic twins the median smallest FF was 7.9% (4.9-14.0%). There were significant associations in FF between the methods using polymorphic alleles and Y-chromosome sequences for both monozygotic (r=0.951, ptwins. The study demonstrates the feasibility of an approach for cfDNA testing in twin pregnancies. This involves estimation of total FF in monozygotic twins and estimation of the lower FF of the 2 fetuses in dizygotic twins. © 2013 S. Karger AG, Basel.

  17. 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.)

  18. Obstetric and perinatal outcomes of pregnancies conceived with embryos cultured in a time-lapse monitoring system.

    Science.gov (United States)

    Insua, Maria Fernanda; Cobo, Ana Cristina; Larreategui, Zaloa; Ferrando, Marcos; Serra, Vicente; Meseguer, Marcos

    2017-09-01

    To compare obstetric and perinatal outcomes of singleton pregnancies resulting from embryos incubated in a time-lapse system (TLS) with those of embryos grown in standard IVF incubators (SI). Retrospective description of a cohort of patients who conceived during a randomized, controlled trial. Private university-affiliated IVF center. Of 856 randomized patients, 378 gave birth to a live-born infant: 216 of the deliveries originated from embryos incubated in TLS, and 162 deliveries were from embryos cultured in SI. Embryo incubation and selection in TLS. Delivery and neonatal outcomes. No significant differences were observed in the baseline characteristics of the study population. The delivery rate was 49.3% (TLS) vs. 40.0% (SI), and multiple deliveries were higher in the TLS group: 31.0% (67 of 216) vs. 24.7% (40 of 162) in the SI group. When singleton pregnancies were analyzed no differences were found between the two groups in the rate of obstetric problems with respect to weeks at delivery: 38.8 (95% confidence interval [CI] 38.4-39.1) (TLS) vs. 39.5 (95% CI 38.0-39.9) (SI); preterm births (outcomes such as birth weight: 3,163 g (95% CI 3,035-3,292 g) (TLS) vs. 3,074 (95% CI 2,913-3,236) (SI); low birth weight (obstetric and perinatal outcomes when a time-lapse incubator was used rather than a more widely used conventional incubator. As far as we know this is the first report from a randomized study of the neonatal outcomes of time-lapse monitoring. Our results suggest that this technology is an effective and safe alternative for embryo incubation, though trials of larger numbers of patients are required to further confirm our conclusions. NCT01549262. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  19. 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.

  20. 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. METH...

  1. The Trend of Twin Pregnancy Over a 5-year Period in a University ...

    African Journals Online (AJOL)

    Twin pregnancy is associated with increased perinatal mortality, preterm deliveries and maternal complications, especially in developing countries. The obstetrics result of twin deliveries at the Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria between January 2002 and December 2006 were ...

  2. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

    NARCIS (Netherlands)

    Barrett, Jon F. R.; Hannah, Mary E.; Hutton, Eileen K.; Willan, Andrew R.; Allen, Alexander C.; Armson, B. Anthony; Gafni, Amiram; Joseph, K. S.; Mason, Dalah; Ohlsson, Arne; Ross, Susan; Sanchez, J. Johanna; Asztalos, Elizabeth V.; Farrell, Scott; Hanigsberg, Julia E.; Leduc, Line; Okun, Nanette; Bracken, Michael; Crowley, Patricia; Donner, Allan; Duley, Lelia; Ehrenkranz, Richard; Thorpe, Kevin; Castaldi, Jose Luis; Bertin, Marta Susana; Partida, Yamil; Galimberti, Diana; Messina, Analia; Voto, Liliana S.; Voto, Geraldine N.; Prieto, Marìa Josè; Buraschi, Fernanda; Sexer, Hèctor; Palermo, Mario; Varela, Dolores Montes; Savransky, Ricardo; Dunaievsky, Armando; Andina, Elsa; Laterra, Cristina; Susacasa, Sandra; Frailuna, Maria Alejandra; Almansa, Silvina Ramirez; Barrere, Maria Beatriz; García, Horacio; Rivero, Mabel; Gomez, Elena Elizabet; Schinini, Josefina; Ahlbom, Monica; Aguirre, Jesus Daniel; de Lourdes Martín, Raquel; Videla, Arturo; Mesas, Walter; Arias, Carlos; Castagnola, Maria Cecilia; Gorostiaga, Raul Abalos; Curioni, Miguel; Mohedano, Maria; Dip, Viviana; Roque, Alicia; Duhalde, Esteban Marcos; Dodd, Jodie; Deussen, Andrea; Crowther, Caroline; Gardener, Glenn; Chaplin, Jackie; Wilkins, Danielle; Mahomed, Kassam; Green, Anne; Baade, Robert; Haran, Mano; Hanafy, Ash; Davis, Greg; Roberts, Lynne; Tucker, Stephen; Duncan, Christine; Watson, David; Lawrence, Annemarie; Laubach, Monika; Breugelmans, Ria; Calderon, Iracema; Martins, Anice; Magalhães, Claudia; Cecatti, Jose Guilherme; Surita, Fernanda Garanhani; Rosado, Luiza; Vidal, Augusto Cortizo; de Souza, Goianice Ribeiro; Maia Filho, Nelson Lourenço; Santana, Danielly Scaranello Nunes; de Sa, Renato Augusto Moreira; Marcolino, Luciano; Marques, Caio Coelho; Zanella, Pedro Luis; Milan, Carla; Bollis, Márcia Dalmolin; Steibel, Gustavo; Ayub, Antonio C. K.; Moreira, Simone; Lima, Antonio Carlos Barbosa; Scavuzzi, Adriana; de Souza, Alex Sandro Rolland; de Moraes Filho, Olimpio Barbosa; Carvalho, Simone Angélica Leita Silva; Bornia, Rita Guerios; da Silva, Nancy Ribeiro; Spinola, Renata; Lopes, Laudelino Marques; Sass, Nelson; Korkes, Henri; Chalem, Elisa; Yokota, Eliana Junko Morita; Ribeiro, Ana J.; Wood, Stephen; Miller, Leslie; McLeod, Lynne; Fanning, Cora; Mueller, Valerie; Gregorovich, Sandra; Moore, Elaine; Gratton, Robert; Kennedy, Laura; Scheufler, Peter; Reid, Donna; Klam, Stephanie; Daitchman, Rhona; Farquharson, Duncan; Harrison, Kristy; Kulkarni, Ramesh; Scarfone, Rhonda; Laplante, Joanne; Carson, George; Williams, Suzanne; Rosman, David; Nemtean, Debbie; Olatunbosun, Femi; Pierson, Kathleen; Crane, Joan; Hutchens, Donna; Zaltz, Arthur; Brown, Melissa; Ornstein, Melanie; Visram, Soraya; Bordin, Jennifer; Siurna, Hiliary; Petruskavich, Shelly; Gagnon, Alain; Lee, Jennifer M.; Fernandez, Ariadna; Kaye, Stephen; Haslauer, Kelly-Ann; Cundiff, Geoffrey; Gomez, Ricardo; Kusanovic, Juan Pedro; Neculman, Karla Silva; Valenzuela, Luis Leighton; Leiva, Erika Madariaga; Cabrera, Juan Guillermo Romo; Ravanal, Mónica Molina; Orrego, Rodrigo Schiaffino; Matijevic, Ratko; Makhlouf, Ahmad; Saber, Osama; Abdelradey, Tarek; Kirss, Fred; Rull, Kristiina; Vaas, Pille; Hopp, Hartmut; Nonnenmacher, Andreas; Michaelis, Silke; Hasbargen, Uwe; Delius, Maria; Antsaklis, Aris; Drakakis, Peter; Major, Tamás; Bartha, Tünde; Salim, Raed; Harel, Linda; Chayen, Benny; Siev, Sima; Hallak, Mordechai; Mei-Dan, Elad; Gonen, Ron; Wolff, Leslie; Sadan, Oscar; Mansour-Schwake, Dalia; Petchinkin, Liana; Hakim, Marwan; Perlitz, Yuri; Ben-Ami, Moshe; Pansky, Samuel; Simms-Stewart, Donnette; Wilson, Monifa; El-Zibdeh, Mazen; AlFaris, Lama; Heres, Marion; Sluis, Aafje; Roumen, Frans J. M. E.; Rinkens, Jeannine; Willekes, Christine; Alleman, Sjaak; van Zandvoort, Simone Gordijn; Porath, Martina M.; Verhoeven, Corine; Mol, Ben Willem; Radfar, Forough; Khan, Sultana; Preis, Krzysztof; Swiatkowska-Freund, Malgorzata; Krasomski, Grzegorz; Kesiak, Marcin; Krekora, Michael; Zych, Katarzyna; Wilczynski, Jan; Breborowicz, Grzegorz; Dera, Anna; ur Rahman, Sajjad; Al-Jassim, Amal Abdullah; Stamatian, Florin; Caracostea, Gabriela; Gojnic, Miroslava; Fazlagic, Amira; Perovic, Milan; Vasiljevic, Brankica; Stefanovic, Toma; Gonce, Anna; Rodriguez, Sara Herrero; Massanes, Marta; Moratonas, Elena Carreras; Rodriguez, Carlota Rodo; Martinez, Silvia Arevalo; Llurba, Elisa; Franch, Anna Suy; de la Calle, Maria; Dans, Fernando; Sancha, Marta; Lopez, Sara; Palomo, Maria Luisa Canete; del Valle, María Dolores Maldonado; Martín, María Nieves Rodríguez; Delgado, Carolina Lázaro-Carrasco; Fournier, María Carmen Jiménez; Ojutiku, Dale; Masuku, Maxwell; Goodsell, Kerry; Southam, Donna; Tuffnell, Derek; Germaine, Tracey; Palethorpe, Rebecca; Farrar, Diane; Wright, Janet; Al-Taher, Hamed; Meehan, Helen; Bricker, Leanne; Dower, Michelle; Houghton, Gillian; Pascall, Angela; Longworth, Heather; Sau, Ashis; Thornton, James; Fisher, Joanne; Houda, Mohammed; Simm, Andy; Bugg, George; Deshpande, Ruta; Davis, Yvette; Holloway, Fiona; Welch, Ross; Hollands, Heidi; Young, Peter; Hinshaw, Kim; Bargh, Amanda; Edmundson, Dawn; Cameron, Helen; Alonso, Justo; Austt, Alfonso Garcia; Ortiz, Alejandra; Burgis, Judith; Brown, Stanette; Gregg, Anthony; Borowski, Kristi; Fleener, Diedre; Deaver, John; Sumersille, Melanie; Aronoff, Christine; Bland, Kimberly; Kontopoulos, Eftichia; Rivero, Yvette; Lovett, Stuart M.; Zatinsky, Shana; Diogo, Mary; Coonrod, Dean V.; Jimenez, Blanca Flor; Chan, Sunny; Hewson, Sheila A.; Hoac, Trinh; Kowal, Christine; Mangoff, Kathryn; Mergler, Sonya; Shi, Michael

    2013-01-01

    Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy. We randomly assigned women between 32 weeks 0 days and 38 weeks

  3. Recurrence risk of preterm birth in subsequent singleton pregnancy after preterm twin delivery

    NARCIS (Netherlands)

    Schaaf, Jelle M.; Hof, Michel H. P.; Mol, Ben Willem J.; Abu-Hanna, Ameen; Ravelli, Anita C. J.

    2012-01-01

    OBJECTIVE: The purpose of this study was to investigate the recurrence risk of preterm birth ( <37 weeks' gestation) in a subsequent singleton pregnancy after a previous nulliparous preterm twin delivery. STUDY DESIGN: We included 1957 women who delivered a twin gestation and a subsequent singleton

  4. Perinatal Outcomes of Monochorionic-Diamniotic Twin Pregnancies Uncomplicated at 28 Weeks of Gestation

    Directory of Open Access Journals (Sweden)

    Shunji Suzuki

    2016-01-01

    Full Text Available We examined the prevalence of specific perinatal complications of monochorionic-diamniotic twin pregnancies in cases without any abnormal findings until the second trimester of pregnancy. This was a retrospective cohort study performed at a tertiary perinatal center in Tokyo, Japan. There were 88 cases of uncomplicated monochorionic-diamniotic twin pregnancies at 28 weeks of gestation. In five of them (5.7%, there were serious complications associated with placental circulatory imbalance between the twins during the third trimester of pregnancy. Two cases were complicated by twin–twin transfusion syndrome, two cases were complicated by twin anemia–polycythemia sequence, and one case was complicated by acute twin–twin transfusion syndrome. In the five cases, no abnormal ultrasonographic findings or symptoms were recognized one or two weeks prior to the diagnosis. Fifty-eight cases (65.9% were delivered at term uneventfully. Serious complications due to placental circulatory imbalance between twins occurred in about 6% of cases during the third trimester of pregnancy.

  5. First-trimester screening in pregnancies conceived by assisted reproductive technology: significance of gestational dating by oocyte retrieval or sonographic measurement of crown-rump length

    DEFF Research Database (Denmark)

    Gjerris, A.C.; Loft, A.; Pinborg, A.

    2008-01-01

    OBJECTIVES: To evaluate, in pregnancies conceived by assisted reproductive technology, whether determination of gestational age (GA) by date of oocyte aspiration (DOA) or crown-rump length (CRL) at first-trimester screening influences the distribution of serum and sonographic markers or the perfo......OBJECTIVES: To evaluate, in pregnancies conceived by assisted reproductive technology, whether determination of gestational age (GA) by date of oocyte aspiration (DOA) or crown-rump length (CRL) at first-trimester screening influences the distribution of serum and sonographic markers......). Weight-corrected log multiples of the median (MoM) marker distributions specific for IVF pregnancy were established using multiple log regression and compared for DOA- and CRL-based GA calculation. RESULTS: GA determined by CRL was significantly larger, albeit slightly, than was GA determined by DOA...

  6. 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.

  7. Abnormal Biochemical Analytes Used for Aneuploidy Screening and Adverse Pregnancy Outcomes in Twin Gestations.

    Science.gov (United States)

    Rosner, Jonathan Y; Fox, Nathan S; Saltzman, Daniel; Klauser, Chad K; Rebarber, Andrei; Gupta, Simi

    2015-12-01

    The objective of this study was to determine if first- and second-trimester biochemical markers for aneuploidy have an association with adverse pregnancy outcomes in twin gestations. A retrospective cohort study of patients who presented with dichorionic diamniotic twin gestations was performed. Patients with first-trimester low pregnancy-associated plasma protein A (PAPP-A) or low free β human chorionic gonadotropin (β-hCG), or second-trimester elevated α-fetoprotein (AFP), elevated inhibin A, elevated hCG, or low unconjugated estradiol were identified. The rates of adverse pregnancy outcomes were compared between patients with or without abnormal analytes with p pregnancies were included. Patients with a low PAPP-A had an increased risk for delivery aneuploidy markers are associated with an increased risk of adverse pregnancy outcomes in twin gestations. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. 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

    ) 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.......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 death. CONCLUSIONS: The risk of spontaneous loss of both fetuses...

  9. 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.

  10. 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.

  11. Ambulatory arterial stiffness index is unchanged in uncomplicated third-trimester singleton and twin pregnancies.

    Science.gov (United States)

    Kärkkäinen, Henna; Heiskanen, Nonna; Saarelainen, Heli; Valtonen, Pirjo; Lyyra-Laitinen, Tiina; Laitinen, Tomi; Vanninen, Esko; Heinonen, Seppo

    2011-05-01

    To document the ambulatory arterial stiffness index (AASI) during pregnancy compared to three months after delivery in singleton and twin pregnancies. Descriptive study with a follow-up design. University hospital in Eastern Finland. 43 childbearing women; 32 with singleton and 11 with twin pregnancies. Ambulatory blood pressure measurements were conducted using a digital ambulatory blood pressure system. AASI was calculated as 1 minus the regression slope of diastolic on systolic blood pressures obtained from 24-hour monitoring. Arterial stiffness measured by AASI. In normotensive pregnant women, the 95th percentiles of AASI were 0.40 in singleton and 0.46 in twin pregnancies, respectively, implying arterial normality and high elasticity. There were no differences in AASI values between singleton and twin pregnancies and no changes were observed postpartum. After delivery, but not during pregnancy, AASI correlated negatively with nocturnal systolic and diastolic blood pressure reduction (dipping) (r=-0.536, p=0.001; r=-0.674, ptwin pregnancies had no detectable effects on AASI. However, pregnancy appeared to overcome the negative effects of low high-density lipoproteins, unfavorable dipping status and advanced maternal age on arterial stiffness, but not the effect caused by maternal body mass index. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  12. 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

  13. Physical examination-indicated cerclage in singleton and twin pregnancies: maternal-fetal outcomes.

    Science.gov (United States)

    Bernabeu, Andrea; Goya, Maria; Martra, Miquel; Suy, Anna; Pratcorona, Laia; Merced, Carme; Llurba, Elisa; Casellas, Manel; Carreras, Elena; Cabero, Luis

    2016-01-01

    To study maternal and perinatal outcomes after physical examination-indicated cerclage in both singleton and twin pregnancies and evaluate the possible risk factors associated. Retrospective review of all women undergoing physical examination-indicated cerclage at the Hospital Vall d'Hebro, Barcelona from January 2009 to December 2012 after being diagnosed with cervical incompetence and risk of premature birth. During the study period, 60 cases of women diagnosed with cervical incompetence who were carrying live and morphologically-normal fetuses (53 singleton and 7 twin pregnancies), and who had an imminent risk of premature birth were evaluated. Mean gestational age until birth was 35 weeks in singleton and 32 weeks in twin pregnancies. Four cases (7.5%) of immature births and one case (2.0%) of neonatal death were recorded in singleton pregnancies. No cases of immature births or neonatal deaths were recorded in twin pregnancies. Diagnostic amniocentesis was performed IN all cases to rule out possible chorioamnionitis. Physical examination-indicated cerclage for cervical incompetence in women at risk for immature or preterm birth demonstrates good perinatal prognosis without increasing maternal morbidity in either singleton or twin pregnancies. The increase in gestation time in our study may also have been due to the fact that patients with subclinical chorioamnionitis were excluded by diagnostic amniocentesis.

  14. Optimal weight gain during twin pregnancy in Japanese women with favorable perinatal outcomes.

    Science.gov (United States)

    Suzuki, Shunji

    2018-01-01

    We examined the optimal weight gain in the healthy Japanese women with favorable perinatal outcomes of (dichorionic) twin pregnancy. We calculated the average weight gain in the women whose height was 150-164 cm with favorable perinatal outcomes of dichorionic twin pregnancy set for this study. The women were categorized to underweight, normal, overweight and obese based on the pre-pregnancy body mass index (BMI) categories according to the Institute of Medicine (IOM) and the World Health Organization (WHO) body mass index (BMI) cutoffs. The average GWG in the normal-weight women with the favorable perinatal outcomes was 13.9 ± 3.6 kg. It was significantly different from that in the underweight, overweight and obese women according to the both 2 BMI cutoffs by Student's t-test (p < 0.01). There are optimal ranges of weight gain during twin pregnancy based on the BMI classification.

  15. A case of monochorionic-diamniotic twin pregnancy with polyhydramnios-polyhydramnios sequence.

    Science.gov (United States)

    Inde, Yusuke; Miyake, Hidehiko; Takaya, Akane; Ono, Shuichi; Igarashi, Miwa; Suzuki, Shunji

    2009-04-01

    We present a case of monochorionic-diamniotic (MD) twin pregnancy with polyhydramnios-polyhydramnios sequence. A 20-year-old woman, gravida 1, para 0, was referred to our hospital at 31 weeks and 6 days' gestation for consultation about a high-risk pregnancy due to the presence of discordant fetal growth pattern (26% of fetal growth discordance) with polyhydramnios in MD twin pregnancy. Ultrasound examination at admission showed a maximal vertical pocket (MVP) of 11.4 cm in twin A and an MVP of 4.7 cm in twin B. At 33 weeks' gestation, the MVPs had increased to 22.2 cm and 10.2 cm, respectively. At 33 weeks and 2 days' gestation, Cesarean section was performed because of uncontrolled uterine contractions associated with polyhydramnios. Twin A was a female weighing 2,280 g, and twin B was a female weighing 1,782 g (22% growth discordance). The estimated amniotic fluid volumes of twins A and B were 5,000 and 1,000 mL, respectively.

  16. No. 262-Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies.

    Science.gov (United States)

    Audibert, François; Gagnon, Alain

    2017-09-01

    To provide a Canadian consensus document with recommendations on prenatal screening for and diagnosis of fetal aneuploidy (e.g., Down syndrome and trisomy 18) in twin pregnancies. The process of prenatal screening and diagnosis in twin pregnancies is complex. This document reviews the options available to pregnant women and the challenges specific to screening and diagnosis in a twin pregnancy. Clinicians will be better informed about the accuracy of different screening options in twin pregnancies and about techniques of invasive prenatal diagnosis in twins. PubMed and Cochrane Database were searched for relevant English and French language articles published between 1985 and 2010, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, prenatal screening, genetic health risk, genetic health surveillance, prenatal diagnosis, twin gestation). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding prenatal screening were also reviewed in developing this clinical practice guideline. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). There is a need for specific guidelines for prenatal screening and diagnosis in twins. These guidelines should assist health care providers in the approach to this aspect of prenatal care of women with twin pregnancies. RECOMMENDATIONS. Copyright © 2017. Published by Elsevier Inc.

  17. Progesterone Blood Level For Pregnancy Diagnosis And Prediction Of Twinning In Egyptian Ewes

    International Nuclear Information System (INIS)

    NESSIM, M.Z.; KOTTB, M.K.I.; MUSTAFA, M.M.

    2009-01-01

    Twenty adult ewes were exposed to natural mating by fertile ram labelled on the chest, and marked ewes were separated from the crew. Blood samples were withdrawn from the jugular vein at the intervals 1, 10, 20,112,119,126,133,140 and 147 days after mating. Pregnancy test had been made through determination of progesterone (P4) level by radioimmunoassay. Plasma glucose, cholesterol and total lipids were determined during the last five weeks of pregnancy. Ewes were weighed on mating day and monthly until parturition and the lambs were weighed at birth. Significant difference (P<0.01) in P4 concentration was observed between day of mating and each of 10 and 20 days post-mating. Plasma P4 levels were increased with significant differences between pregnant ewes with single lamb and those with twin lambs at days 10 (P<0.05) and 20 (P<0.01) of pregnancy. The higher P4 level was detected in ewes carrying twins. Plasma P4 levels were increased during late pregnancy followed by a significant decrease (P<0.01) during the last two weeks of pregnancy, in both single and twin bearing ewes. Plasma glucose levels were found to be higher in twin pregnant ewes than single pregnant ewes at week 4 (P<0.05) and week 2 (P<0.01) before parturition. Non-significant differences were observed in plasma cholesterol and total lipids levels between pregnant ewes carrying single and twin lambs during late pregnancy. Monthly body weights were higher in twin than single pregnant ewes. Correlation between ewe and lamb body weights was observed in twin ewes only.

  18. Conceived globals

    DEFF Research Database (Denmark)

    Cheraghi, Maryam; Schøtt, Thomas

    2016-01-01

    A firm may be conceived global, in the sense that, before its birth, the founding entrepreneur has a transnational network of advisors which provides an embedding for organising the upstart that may include assembling resources and marketing abroad. The purpose is to account for the entrepreneurs......' transnational networking as it originates in the pre-birth phase of intending to start, and as it evolves through the starting and into the operating phases, in context of culture. By using sample from 61 societies with 88,628 entrepreneurs we found that entrepreneurs are networking transnationally across...... the intending, starting and operating phases, fairly constantly with only small fluctuations. The firm is conceived global in terms of the entrepreneur's transnational networking already in the pre-birth phase, when the entrepreneur is intending to start the firm. These phase effects hardly depend on attributes...

  19. Severity of prematurity risk in spontaneous and in vitro fertilization twins: does conception mode serve as a risk factor?

    Science.gov (United States)

    Weghofer, Andrea; Klein, Katharina; Stammler-Safar, Maria; Barad, David H; Worda, Christof; Husslein, Peter; Gleicher, Norbert

    2009-12-01

    Because assisted reproductive technology (ART) contributes to world-wide increases in twin pregnancies, we retrospectively evaluated whether preterm twin gestations after ART are at higher risk for delivery at earlier gestational ages compared with naturally conceived twins. The evaluation of 204 dichorial twin pregnancies, 102 after natural conception and 102 after ART, matched for maternal age, demonstrated comparable severity of prematurity risk in both groups.

  20. The natural history of preterm premature rupture of membranes in twin pregnancies.

    Science.gov (United States)

    Kibel, Mia; Barrett, Jon; Tward, Carly; Pittini, Alex; Kahn, Michael; Melamed, Nir

    2017-08-01

    To compare the characteristics of preterm premature rupture of membranes (PPROM) between twin and singleton pregnancies. This was a retrospective study of all women with twin and singleton pregnancies admitted with PPROM between 24-34 weeks of gestation. Overall 698 women with PPROM were eligible for the study: 101 (14.5%) twins and 597 (85.5%) singletons. Twins presented with PPROM at a more advanced gestational age compared with singletons (29.1 ± 2.7 vs. 28.5 ± 2.8 weeks, p = 0.03). The latency period was shorter in twins compared with singletons, especially for women presenting after 28 weeks of gestation (5.0 ± 0.8 vs. 7.0 ± 0.4 days, p = 0.01). Women with twins were more likely to deliver within 48 h (OR: 2.7; 95%CI: 1.7-4.2) and were less likely to deliver within 2-7 days (OR:  0.5; 95%CI: 0.3-0.9) following PPROM. The rate of clinical chorioamnionitis or placental abruption following PPROM was lower in twins compared with singletons (15.8% vs. 26.0%, p = 0.03). PPROM in twin pregnancies tends to occur at a more advanced gestational age, is associated with a shorter latency period and is less likely to be complicated by chorioamnionitis or placental abruption compared with singletons. This information may be useful for counseling and management decisions in cases of PPROM in women with twins.

  1. Uterine artery embolization for management of interstitial twin ectopic pregnancy: case report.

    Science.gov (United States)

    Ophir, E; Singer-Jordan, J; Oettinger, M; Odeh, M; Tendler, R; Feldman, Y; Fait, V; Bornstein, J

    2004-08-01

    Interstitial pregnancy is rare and dangerous variation of ectopic pregnancy. We describe a case of unilateral interstitial viable twin pregnancy treated by selective uterine artery embolization. A 23-year-old women with clinical and ultrasonic diagnosis of viable twin interstitial pregnancy was treated by selective uterine artery embolization after failure of systemic methotrexate treatment. Her serum beta-HCG was undetectable 2 months after the procedure and the ultrasound scan 70 days after embolization showed only multiple echogenic spots in the right uterine cornua. This therapeutic modality seems to be effective for conservative management of interstitial ectopic pregnancy, and as a prophylactic measure before surgical intervention to prevent major bleeding. Copyright 2004 European Society of Human Reproduction and Embryology

  2. Obstetric Outcomes of Twin Pregnancies in Japanese Women Aged 40 and Older.

    Science.gov (United States)

    Suzuki, Shunji

    2017-10-01

    The aim of this study was to compare the obstetric outcomes of twin pregnancies between Japanese women aged ≥ 40 years and their younger counterparts aged 25 - 29. This was a retrospective study of twin pregnancies managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2016. Women aged 40 and older at delivery (n = 117) were compared with women aged 25 - 29 at delivery (n = 536). Although the women ≥ 40 years old were more likely to have increased risks of HELLP (hemolytic, elevated liver enzymes and low platelet) syndrome and very low birth weight neonates, there were no measurable differences in obstetric outcomes such as hypertensive disorders, premature delivery and neonatal asphyxia between the two groups. Advanced maternal age did not seem to affect obstetric outcomes in twin pregnancies seriously.

  3. Fetal growth in pregnancies conceived after gastric bypass surgery in relation to surgery-to-conception interval: a Danish national cohort study.

    Directory of Open Access Journals (Sweden)

    Lone Nikoline Nørgaard

    Full Text Available OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton pregnancy in which first trimester screening was performed between January 2008 and June 2011. Data were derived from national registers (Danish National Registry of Patients and Danish National Birth Registry, Pregnancy Complications and Abortion-clinical quality database (PreCAb and the Danish Fetal Medicine Database. Main outcome measures were early and late fetal growth in relation to time from bariatric surgery to conception of the pregnancy. Early fetal growth was expressed as "Fetal Growth Index": the ratio between the estimated number of days from first trimester ultrasound to second trimester ultrasound biometries and the actual calender time elapsed in days. Late fetal growth was expressed as the observed versus expected birthweight according to gestational age (GA. RESULTS: The surgery-to-conception interval ranged from 3 to 1851 days with a mean value of 502 (SD, 351 days. The mean "fetal growth index" was 0.99 (SD, 0.02 days/day and thus significantly lower than in the background population (mean, 1.04 (SD, 0.09 days/day, p<0.0001. The proportion of infants being small for gestational age was 18.8% and the proportion of large for gestational age infants was 6.7%. The correlation coefficients between surgery-to-conception time and "fetal growth index" and birthweight according to GA were 0.01 (p = 0.8 and 0.04 (p = 0.4, respectively. CONCLUSION: Fetal growth index was lower than reported in the background population. No correlation was found between the surgery-to-conception interval and early or late fetal growth in pregnancies conceived after gastric bypass surgery.

  4. 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.

  5. 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

  6. Comparative analysis of perinatal outcome of spontaneous pregnancy reduction and multifetal pregnancy reduction in triplet pregnancies conceived after assisted reproductive technique

    Directory of Open Access Journals (Sweden)

    Shilpa Bhandari

    2016-01-01

    Full Text Available INTRODUCTION: With the advent of assisted reproductive treatment options, the incidence of multiple pregnancies has increased. Although the need for elective single embryo transfer is emphasized time and again, its uniform applicability in practice is yet a distant goal. In view of the fact that triplet and higher order pregnancies are associated with significant fetomaternal complications, the fetal reduction is a commonly used option in such cases. This retrospective study aims to compare the perinatal outcome in patients with triplet gestation who have undergone spontaneous fetal reduction (SFR as against those in whom multifetal pregnancy reduction (MFPR was done. MATERIALS AND METHODS: In the present study, eighty patients with triplet gestation at 6 weeks were considered. The patients underwent SFR or MFPR at or before 12-13 weeks and were divided into two groups (34 and 46, respectively. RESULTS: Our study found no statistical difference in perinatal outcome between the SFR and MFPR groups in terms of average gestational age at delivery, abortion rate, preterm delivery rate, and birth weight. The study shows that the risk of aborting all fetuses after SFR is three times (odds ratio [OR] = 3.600, 95% confidence interval [CI] = 0.2794-46.388 that of MFPR in subsequent 2 weeks. There were more chances of loss of extra fetus in SFR (23.5% group than MFPR group (8.7% (OR = 3.889, 95% CI = 1.030-14.680. As neither group offers any significant benefit from preterm delivery, multiple pregnancies continue to be responsible for preterm delivery despite fetal reduction. CONCLUSION: There appears to be some advantages of MFPR in perinatal outcome when compared to SFR, especially if the latter happens at advanced gestation. Therefore, although it is advisable to wait for SFR to occur, in patients with triplet gestation at 11-12 weeks, MFPR is a viable option to be considered.

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

    DEFF Research Database (Denmark)

    Oldenburg, A.; Rode, L.; Tabor, A.

    2012-01-01

    to 31 December 2006. Outcome data were retrieved from the National Board of Health. Results: Among 2038 twin pregnancies, 1757 (86.2%) were dichorionic (DC) and 281 (13.8%) were monochorionic diamniotic (MC). In MC pregnancies, the rate of spontaneous fetal loss in both second and third trimesters...... pregnancies with two live fetuses at 24 weeks, the proportion with two live infants at 28 days after delivery was 97.5% and 95.1%, respectively. Conclusions: The increased incidence of fetal loss in MC pregnancies compared with DC pregnancies predominantly occurs before 24 weeks' gestation. After this stage......, although the risk of intrauterine fetal death is still higher in MC than in DC pregnancies, if both fetuses are alive at 24 weeks, the chance of a woman having two live infants 1 month after delivery is similar in MC and DC pregnancies....

  8. 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

    biochemical markers pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (free β-hCG) in twin pregnancies relative to singleton pregnancies and establish improved screening procedure for chromosomal anomalies such as trisomy 21 in twin pregnancies. METHODS A total of 4843.......0% to 5.9%. DISCUSSION This study demonstrates that generation of chorionicity specific medians for the biochemical markers and their use in risk assessment can increase the performance of first trimester screening for chromosomal abnormalities in twins to a level comparable to that in singleton...

  9. 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.

  10. 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

    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...... for chromosomal abnormalities such as trisomy 21 in twin pregnancies. METHODS: 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...... 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...

  11. Obstetric outcomes in reduced and non-reduced twin pregnancies. A single hospital experience

    Directory of Open Access Journals (Sweden)

    UmmKulthoum E. AlShelaly

    2015-09-01

    Full Text Available Objectives: To compare pregnancy outcomes between high-order multiple pregnancies resulting from assisted reproductive technology (ART reduced to twins and non-reduced pregnancies, and to evaluate indications for using ART. Methods: This is a descriptive retrospective review of women with high-order multiple pregnancies reduced to twin carried out at the Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia between December 2010 and December 2013. The control group consisted of subjects with twin pregnancies who received their fertility treatment at the same hospital during the same period. Results: One hundred and twelve women were included in this study. Of women reaching fetal viability, significantly more women delivered before the thirtieth week in the study group (50% versus 12%, p<0.004. Miscarriage/delivery prior to fetal viability, chorioamnionitis, and preterm premature rupture of membranes were statistically higher in the study group. A total of 83% of the miscarriages in the study group were in women carrying 4 or more fetuses initially, and 50% of women in the study group were multiparous with no clear indication for fertility treatment. Conclusion: Although fetal reduction is a safe procedure, it is associated with complications. Primary prevention of high-order multiple pregnancy is recommended.

  12. 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.

  13. Infertility, infertility treatment and twinning

    DEFF Research Database (Denmark)

    Zhu, Jin Liang; Basso, Olga; Obel, Carsten

    2007-01-01

    BACKGROUND: We have previously observed that an increasing time to pregnancy (TTP) is associated with a reduced frequency of twin deliveries in couples not receiving infertility treatment. By using updated information, we assessed the frequencies of dizygotic (DZ) and monozygotic (MZ) twin...... deliveries as a function of infertility (TTP > 12 months), as well as infertility treatment. METHODS: From the Danish National Birth Cohort (1997-2003), we identified 51 730 fertile couples with TTP 12 months and 5163 infertile couples who conceived after treatment. Information on zygosity, available...... for part of the cohort (1997-2000), was based on standardized questions on the similarities between the twins at the age of 3-5 years. RESULTS: Compared with fertile couples, the frequency of DZ twin deliveries was lower for infertile couples conceiving naturally (odds ratio 0.4, 95% confidence interval 0...

  14. Vaginal micronized progesterone and risk of preterm delivery in high-risk twin pregnancies

    DEFF Research Database (Denmark)

    Klein, K; Rode, L; Nicolaides, K H

    2011-01-01

    OBJECTIVES: Progesterone treatment reduces the risk of preterm delivery in high-risk singleton pregnancies. Our aim was to evaluate the preventive effect of vaginal progesterone in high-risk twins. METHODS: This was a subanalysis of a Danish-Austrian, double-blind, placebo-controlled, randomized...

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

    NARCIS (Netherlands)

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

    2002-01-01

    Clinical evidence suggests that increased amniotic fluid volume due to polyhydrarnnios increases placental vascular resistance. We have sought to model the possible effects of an increased amniotic fluid volume oil the net fetofetal transfusion in monochorionic twin pregnancies. We wanted to compare

  17. 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...

  18. 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

  19. Neonatal and maternal outcomes comparing women undergoing two in vitro fertilization (IVF) singleton pregnancies and women undergoing one IVF twin pregnancy.

    Science.gov (United States)

    Sazonova, Antonina; Källen, Karin; Thurin-Kjellberg, Ann; Wennerholm, Ulla-Britt; Bergh, Christina

    2013-03-01

    To compare outcomes for women undergoing two in vitro fertilization (IVF) pregnancies with singletons and women undergoing one IVF twin pregnancy. The concept of single-embryo transfer in IVF has reduced the risks of both maternal and neonatal complications, but there is still a discussion of whether or not twins are a desired outcome of IVF. Registry study. Not applicable. All reported twins after IVF with double-embryo transfer (n = 1,982) and their mothers (n = 991) and all mothers (n = 921) who gave birth to two IVF singletons (n = 1,842). None. Maternal and neonatal outcomes including severe neonatal morbidity. Preterm birth, very preterm birth, low birth weight, very low birth weight, and small for gestational age were dramatically increased for IVF twins compared with two IVF singletons with the same mother, with adjusted odds ratios from 4 to 16. Significantly higher rates of respiratory complications, sepsis, and jaundice were detected among the IVF twins. Significantly higher rates of preeclampsia, preterm premature rupture of the membranes, and cesarean section were observed for IVF twin pregnancies. The neonatal and maternal outcomes were dramatically better for women undergoing two IVF singleton pregnancies compared with one IVF twin pregnancy after double-embryo transfer. These results support single-embryo transfer to minimize the risks associated with twin pregnancies. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  20. Missed Diagnosis of Twin Pregnancy and Mis-Diagnosed Fetal ...

    African Journals Online (AJOL)

    The 1st twin had spina bifida cystica. Multiple clinical and ultrasound diagnostic errors leading to wrong clinical decision taking and unnecessary intervention can occur even in experienced hands. Correct diagnosis following sequential and meticulous forward clinical reasoning serves the clinician and patients interest ...

  1. delayed interval delivery in twin pregnancy without cerclage

    African Journals Online (AJOL)

    2011-11-11

    Nov 11, 2011 ... female infant weighing 1300g at twenty nine and a half weeks gestation. After the loss of the first foetus, delayed delivery in ... (male) in cephalic presentation, and a viable second twin. (female) also in cephalic presentation (Figure 1). ... augmentation of labor with oxytocin drip was done. A female neonate ...

  2. 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

  3. Zika virus detected in amniotic fluid and umbilical cord blood in an in vitro fertilization-conceived pregnancy in Venezuela.

    Science.gov (United States)

    Benjamin, Isaac; Fernández, Gissel; Figueira, José Valentin; Parpacén, Leticia; Urbina, María Teresa; Medina, Randolfo

    2017-06-01

    To describe the consequences of Zika virus infection at 10 weeks of gestation in an IVF-conceived pregnancy in Venezuela. A case report. Private assisted reproduction unit. A 36-year-old patient who conceived her first pregnancy through IVF and became infected with Zika virus at 10 weeks' gestation in Venezuela. In vitro fertilization with fresh ET. Clinical, laboratory, and imaging Zika diagnostic methods. Zika virus detection by real-time polymerase chain reaction (PCR) in maternal plasma, PCR in amniotic fluid and umbilical cord blood. Ultrasonography findings of anatomic abnormalities. Zika infection was confirmed at 10 weeks' gestation by real-time PCR; ultrasound results appeared normal. At 19 weeks' gestation, an ultrasound revealed biometry on three SDs below the means for all parameters but with no apparent anatomic abnormality. Zika virus was positive in maternal urine and amniotic fluid by PCR at 19 weeks' gestation. Ultrasound at 21 weeks + 4 days of gestation showed fetal cerebellar hypoplasia with ventricular dysmorphia, particularly marked on the left, consistent with microcephaly and ventriculomegaly. Because of the poor prognosis, pregnancy was interrupted at 24 weeks' gestation, in France. The PCR in umbilical cord blood taken in this procedure was positive for Zika virus. Initial ultrasound findings in pregnancy may not be informative. Only at 21 weeks + 4 days of gestation did an ultrasound reveal fetal microcephaly and ventriculomegaly. Combined clinical, laboratory, and imaging findings provided a complete picture of the severe damage caused by Zika infection. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  4. Reduction of multifetal gestation to twins: is it always possible to attain natural outcomes?

    Directory of Open Access Journals (Sweden)

    Tuncay Yuce

    2016-09-01

    Material and Methods: Women with multifetal gestation whose pregnancies were reduced to twins were compared with spontaneous twins and assisted reproduction twins. The main outcome measures were the duration of pregnancy, premature labor and delivery rates, complication rates during pregnancy, birth weight, APGAR scores, neonatal intensive care unite admission rates, and delivery routes. Results: 380 twin deliveries followed up at our institution between years 2007-2014 were enrolled. All data concerning perinatal outcomes were compared among three groups. twins conceived spontaneously (group 3, n=165 and via IVF (group 1, n=117 along with IVF conceived high order pregnancies wherein embryo reduction was implemented (group 2, n=49. The duration of pregnancy, the rate of premature and the rate of overall pregnancy associated complications were all favorable in group 1 rather than group 2. As well, the mean birth weight and APGAR scores at 1st and 5th minutes were all found to be lower in group 2 than in group 1. Conclusion: The results emphasize embryo reduction should be acknowledged as a salvage procedure due to high risk of complications in embryo reduced high-order pregnancies. Embryo reduction yields results comparable to twins conceived via IVF yields poorer results compared to spontaneously conceived twins. [Cukurova Med J 2016; 41(3.000: 485-490

  5. Obstetric outcomes of twin pregnancies at advanced maternal age: A retrospective study.

    Science.gov (United States)

    Zhu, Caixia; Wang, Malie; Niu, Gang; Yang, Juan; Wang, Zilian

    2018-02-01

    To evaluate obstetric outcomes in twin pregnancies of advanced maternal age (≥35 years). A retrospective study involved 470 twin pregnancies in a single center from Sep. 1, 2012 to Mar. 31, 2015. Clinical characteristics and obstetric outcomes were recorded and compared among twin pregnancies who were classified as follows: age 20-29, 30-34, 35-39 and ≥40 years. The incidence of gestational diabetes (age 20-29 years 15.8%; 30-34 years 24.3%; 35-39 years 30.4%; ≥40 years 57.1%; p = 0.004) and premature delivery (20-29 years 58.6%; 30-34 years 69.1%; 35-39 years 72.2%; ≥40 years 85.7%; p = 0.001) significantly increased with increasing age whereas spontaneous abortion (20-29 years 27.6%; 30-34 years 11.6%; 35-39 years 11.4%; ≥40 years 0.0%; p = 0.021) decreased in twin pregnancies of advanced maternal age. In addition, the rate of postpartum hemorrhage increased almost continuously by age and advanced maternal age was described as a risk factor for postpartum hemorrhage (age 35-39, adjusted OR 3.377; 95% confidence interval 1729-6.598; p age ≥ 40, adjusted OR 10.520; 95% CI 1.147-96.492; p = 0.037). However, there was no significant difference between advanced maternal age and adverse neonatal outcomes. In twin pregnancies, advanced maternal age experienced significant higher risk of postpartum hemorrhage, gestational diabetes and premature delivery. Neither adverse neonatal outcomes nor stillbirth was significantly associated with maternal age. Copyright © 2018. Published by Elsevier B.V.

  6. Mid-pregnancy, perinatal, and neonatal reproductive endocrinology: a prospective cohort study in twins and singleton control subjects.

    Science.gov (United States)

    Kuijper, Esther A M; Twisk, Jos W R; Korsen, Ted; Caanen, Mirte R; Kushnir, Mark M; Rockwood, Alan L; Meikle, A Wayne; Hompes, Peter G; Wit, Jan M; Lambalk, Cornelis B

    2015-12-01

    To answer the questions: Are perinatal reproductive hormone profiles different in case of a twin compared with a singleton pregnancy? Are reproductive endocrine profiles of twin girls influenced by their male co-twin and vice versa? Prospective cohort study from January 2004 to October 2009. Not applicable. A total of 204 mothers of twins and 248 singleton control subjects, aged >18 years, pregnant with a twin or singleton and no endocrine disease or malignancy. Blood samples were collected at mid-gestation from the mother and at delivery from the mothers and the umbilical cords. Estrogens, androgens, sex hormone-binding globulin, progesterone, and gonadotropins were measured. Hormonal profiles were compared between singletons and twins, different types of twins, and opposite-sex and same-sex twins. Estrogen and progesterone concentrations were higher in mothers of twins compared with singletons, but twin babies had lower estrogen and progesterone concentrations at birth. Opposite-sex twin girls did not have higher androgens in cord blood compared with same-sex twin girls. Boys of an opposite-sex twin had lower luteinizing hormone concentrations compared with dizygotic twin boys with a brother as a co-twin. Children from a twin are not overexposed to sex steroids at the time of birth, despite higher concentrations in their mothers, and girls from opposite sex twins do not show androgenic influences from their male co-twin. The female co-twin may influence the hypothalamic-pituitary-testicular axis of her brother via central inhibition. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  7. Heterotopic Pregnancy with Live Twins | Eseohe | African Journal of ...

    African Journals Online (AJOL)

    Post-operative follow-up revealed continuing symptoms of pregnancy and increasing uterine size. A diagnosis of multiple pregnancy was confirmed by abdominal ... La patiente a suivi du traitement jusqu\\'à terme et elle a eu un accouchement normal des jumeaux. (Rev Afr Santé Reprod 2002; 6[3]: 117-119) KEY WORDS: ...

  8. 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.

  9. Association between perfluorinated compounds and time to pregnancy in a prospective cohort of Danish couples attempting to conceive

    DEFF Research Database (Denmark)

    Vestergaard, Sonja; Nielsen, Flemming; Andersson, Anne-Maria

    2012-01-01

    Perfluorinated chemicals (PFCs) have been widely used and have emerged as important food contaminants. A recent study on pregnant women suggested that PFC exposure was associated with a longer time to pregnancy (TTP). We examined the association between serum concentrations of PFCs in females...

  10. Prenatal screening at 11-13+6 weeks in assisted reproductive technology singleton pregnancies and those conceived naturally.

    Science.gov (United States)

    Gong, Meng; Shi, Hua; Zhang, Yu-guo; Ming, Lei

    2015-10-01

    To investigate whether assisted reproductive technology (ART) increases the risk of fetal chromosomal abnormalities. A total of 2034 singleton pregnant women were included in this retrospective study. They were divided into ART (574 fetuses) and control groups (1460 fetuses conceived naturally). All pregnant women received screening according to the Fetal Medicine Foundation, London 2004 Kypros H. Nicolaides guidelines at 11-13+6 weeks of gestation. Accordingly, women with value at risk of chromosomal abnormalities >1:250 underwent chorionic villus sampling or amniocentesis. Mean body mass index was 22.83 ± 3.27 versus 21.29 ± 2.81 kg/m(2) in the ART and control groups, respectively (P fetal chromosomal abnormalities. Additionally, fetus size in the ART group was bigger than that in the natural conception group. © 2015 Japan Society of Obstetrics and Gynecology.

  11. Delayed Interval Delivery following Early Loss of the Leading Twin

    Directory of Open Access Journals (Sweden)

    P. C. Udealor

    2015-01-01

    Full Text Available This was a case of a nulliparous woman with reduced chance of conception following unilateral salpingectomy and years of infertility. She eventually conceived following ovulation induction resulting in twin pregnancy. She had miscarriage that led to loss of one of the twins at 17 weeks of gestational age. The pregnancy was however continued for 116 days following meticulous management with eventual delivery of a live female baby with good outcome.

  12. Use of atosiban in a twin pregnancy with extremely preterm premature rupture in the membrane of one twin: a case report and literature review.

    Science.gov (United States)

    Wu, Ming-Yih; Chen, Shee-Uan; Lee, Chien-Nan; Ho, Hong-Nerng; Yang, Yu-Shih

    2010-12-01

    Pregnancies with extremely preterm premature rupture of membranes (EPPROM), especially before 20 weeks of gestation, are usually considered to be a termination of pregnancy. By improvement of obstetric and neonatal care, we can prolong the pregnancy across the threshold of survival by aggressive tocolysis. Using intrauterine insemination, a 32-year-old woman became pregnant with twins (first pregnancy). Threatened abortion occured since 9 weeks of gestation and EPPROM of the upper twin was noted at 18 weeks. Massive vaginal bleeding and vigorous uterine contractions occurred at 22 weeks. Poor control of preterm labor occurred using ritodrine and MgSO(4). Atosiban was applied to calm uterine activities. After discontinuation of atosiban at 30 weeks, the uterine contractions became severe again and an emergency cesarean section was performed to deliver two live, premature babies weighing 1,518 g and 830 g, respectively. Twin A was healthy, weighing 2,030 g at 35 days after birth and subsequently discharged. The smaller twin B was dependent on continuous positive airway pressure and died of pulmonary infection 120 days after birth. Comparing to other tocolytic agents, Atosiban has few side effects and assisted in prolonging a pregnancy involving twins that experienced EPPROM. Copyright © 2010 Taiwan Association of Obstetric & Gynecology. Published by Elsevier B.V. All rights reserved.

  13. Successful Rescue Cerclage in a Monochorionic Diamniotic Twin Pregnancy at 20 Weeks: Case Report and Overview of Literature.

    Science.gov (United States)

    Mitric, Cristina; Ponette, Vincent

    2018-03-01

    In twin pregnancies, elective cerclage placement based on obstetrical history or ultrasound findings has been shown to be ineffective and even harmful. There are currently no guidelines for the use of rescue cervical cerclage in twin pregnancies. The current report presents the case of a 33-year-old patient with monochorionic diamniotic twins (MCDA) found to have dilated cervix at 3.5cm with exposed membranes upon physical examination at 19 weeks and 3 days. An emergency McDonald cerclage was placed at 20 weeks and the patient carried the current pregnancy until 35weeks 6 days. Rescue cerclage represents an important option to consider in order to preserve twin pregnancies regardless of chorionicity. Copyright © 2017 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  14. First-trimester sonographic prediction of obstetric and neonatal outcomes in monochorionic diamniotic twin pregnancies.

    Science.gov (United States)

    Allaf, M Baraa; Vintzileos, Anthony M; Chavez, Martin R; Wax, Joseph A; Ravangard, Samadh F; Figueroa, Reinaldo; Borgida, Adam; Shamshirsaz, Amir; Markenson, Glenn; Davis, Sarah; Habenicht, Rebecca; Haeri, Sina; Ozhand, Ali; Johnson, Jeffery; Sangi-Haghpeykar, Haleh; Spiel, Melissa; Ruano, Rodrigo; Meyer, Marjorie; Belfort, Michael A; Ogburn, Paul; Campbell, Winston A; Shamshirsaz, Alireza A

    2014-01-01

    The purpose of this study was to investigate whether discordant nuchal translucency and crown-rump length measurements in monochorionic diamniotic twins are predictive of adverse obstetric and neonatal outcomes. We conducted a multicenter retrospective cohort study including all monochorionic diamniotic twin pregnancies with two live fetuses at the 11-week to 13-week 6-day sonographic examination who had serial follow-up sonography until delivery. Isolated nuchal translucency, crown-rump length, and combined discordances were correlated with adverse obstetric outcomes, individually and in composite, including the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction (IUGR), twin-twin transfusion syndrome (TTTS), intrauterine fetal death (IUFD), growth discordance (≥ 20%), and preterm birth before 28 weeks' gestation. Correlations with adverse composite neonatal outcomes were also studied. A receiver operating characteristic curve analysis and a logistic regression analysis with a generalized estimating equation were conducted. Fifty-four of the 177 pregnancies included (31%) had an adverse composite obstetric outcome, with TTTS in 19 (11%), IUGR in 21 (12%), discordant growth in 14 (8%), IUFD in 14 (8%), and preterm birth before 28 weeks in 10 (6%). Of the 254 neonates included in the study, 69 (27%) were complicated by adverse composite neonatal outcomes, with respiratory distress syndrome being the most common (n = 59 [23%]). The areas under the curve for the combined discordances to predict composite obstetric and neonatal outcomes were 0.62 (95% confidence interval, 0.52-0.72), and 0.54 (95% confidence interval, 0.46-0.61), respectively. In our population, nuchal translucency, crown-rump length, and combined discordances in monochorionic diamniotic twin pregnancies were not predictive of adverse composite obstetric and neonatal outcomes.

  15. Delayed interval delivery in twin pregnancy without cerclage: Case ...

    African Journals Online (AJOL)

    After the loss of the first foetus, delayed delivery in multiple pregnancies can be successful in selected cases as exemplified by the case presentation. In well prepared perinatal centers, with physically and psychologically balanced patients who are well informed about the risks and benefits of the procedure, delayed interval ...

  16. Twin Fetuses Papyraeci in a Spontaneous Triplet Pregnancy ...

    African Journals Online (AJOL)

    The history and general examination were unremarkable. The pulse rate was 86 beat per min and her blood pressure was 130/80 ... Department of Obstetrics and Gynecology, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria. Abstract. Fetus papyracie in a triplet pregnancy is indeed rare and can ...

  17. Aneuploidy screening by non-invasive prenatal testing in twin pregnancy.

    Science.gov (United States)

    Fosler, L; Winters, P; Jones, K W; Curnow, K J; Sehnert, A J; Bhatt, S; Platt, L D

    2017-04-01

    To describe our experience with non-invasive prenatal testing (NIPT) in twin pregnancy. Two sets of maternal blood samples from twin pregnancies were analyzed at our laboratory using NIPT: 115 stored samples from pregnancies with known outcome (Clinical Study A) and 487 prospectively collected samples for which outcomes were requested from providers (Clinical Study B). NIPT was used to screen for the presence of fetal aneuploidy on chromosomes 13, 18, 21, X and Y in all cases, and results were compared with outcomes when known. In Clinical Study A, all 115 samples were classified correctly by NIPT: three cases of trisomy 21 (one fetus affected), one of monochorionic trisomy 18 (both fetuses affected) and 111 euploid. In Clinical Study B, a NIPT result was reported for 479 (98.4%) of the 487 samples. Aneuploidy was detected or suspected in nine (1.9%) cases: seven cases of trisomy 21 detected, one case of trisomy 21 suspected and one case with trisomy 21 detected and trisomy 18 suspected. Information on aneuploidy outcome was available for 171 (35.7%) cases in Clinical Study B. Of the nine cases with aneuploidy detected or suspected, six were confirmed to be a true positive in at least one twin based on karyotype or birth outcome and two were suspected to be concordant based on ultrasound findings; the one known discordant result was for the aneuploidy suspected case. No false negatives were reported. NIPT performed well in the detection of trisomy 21 in twin pregnancy, with a combined false-positive frequency for trisomies 13, 18 and 21 of 0% for Clinical Study A and 0.2% for Clinical Study B. © 2016 Illumina. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. © 2016 Illumina. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

  18. Twin pregnancy complicated with acute appendicitis and cholecystitis in the same gestational period.

    Science.gov (United States)

    Başaran, Ahmet; Bozdağ, Gürkan; Aksu, A Tarik; Deren, Ozgür

    2007-09-01

    Acute appendicitis and symptomatic biliary stones are the most common indications for non-obstetrical surgical procedures during pregnancy. However, combination of these two clinical presentations in the same gestational period is anecdotal. A 30-year-old twin pregnant patient complicated with acute appendicitis followed by cholecystitis was reported with poor fetal outcomes. Despite appropriate management when two conditions, appendicitis and cholecystitis, occur in the same gestational period one after another complications might become inevitable.

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

    Directory of Open Access Journals (Sweden)

    Dr Zia Zuberi, BSc PhD MRCP

    2014-01-01

    Full Text Available 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.

  20. 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.

  1. Monoamniotic twin pregnancies: antenatal management and perinatal results of 19 consecutive cases.

    Science.gov (United States)

    Demaria, Fabien; Goffinet, François; Kayem, Gilles; Tsatsaris, Vassilis; Hessabi, Madieh; Cabrol, Dominique

    2004-01-01

    To describe the obstetric management and perinatal outcome of antenatally diagnosed monoamniotic twin pregnancies (MATP) in a tertiary level maternity unit. Port-Royal Maternity Hospital, Paris, France. MATP that progressed beyond 22 weeks seen from 1993 to 2001. A retrospective chart review of all twin pregnancies. Diagnosis of MATP was made by ultrasonography and confirmed by placental pathology. Perinatal mortality. Among the 1242 twins pregnancies delivered during the study period, 19 were monoamniotic. Four fetuses (10% of all births) had malformations. Perinatal mortality was high (n= 12, 32%) because of fetal deaths (nine cases) and very preterm births (three neonatal deaths). No fetal deaths occurred after 29 weeks. Of the 15 women with at least one live fetus before labour, 6 gave birth by vaginal delivery (40%). No obstetric accidents occurred during vaginal deliveries. Perinatal mortality of MATP is still very high, even with accurate, early antenatal diagnosis, intensified surveillance and delivery provided in a tertiary level hospital. The main causes of perinatal deaths are cord accidents in utero, congenital anomalies and very preterm births.

  2. Twin pregnancy complicated by esophageal atresia, duodenal atresia, gastric perforation, and hypoplastic left heart structures in one twin: a case report and review of the literature.

    Science.gov (United States)

    Abou Chaar, Mohamad K; Meyers, Mariana L; Tucker, Bethany D; Galan, Henry L; Liechty, Kenneth W; Crombleholme, Timothy M; Marwan, Ahmed I

    2017-03-18

    The antenatal diagnosis of a combined esophageal atresia without tracheoesophageal fistula and duodenal atresia with or without gastric perforation is a rare occurrence. These diagnoses are difficult and can be suspected on ultrasound by nonspecific findings including a small stomach and polyhydramnios. Fetal magnetic resonance imaging adds significant anatomical detail and can aid in the diagnosis of these complicated cases. Upon an extensive literature review, there are no reports documenting these combined findings in a twin pregnancy. Therefore we believe this is the first case report of an antenatal diagnosis of combined pure esophageal and duodenal atresia in a twin gestation. We present a case of a 30-year-old G1P0 white woman at 22-week gestation with a monochorionic-diamniotic twin pregnancy discordant for esophageal atresia, duodenal atresia with gastric perforation, hypoplastic left heart structures, and significant early gestation maternal polyhydramnios. In this case, fetal magnetic resonance imaging was able to depict additional findings including area of gastric wall rupture, hiatal hernia, dilation of the distal esophagus, and area of duodenal obstruction and thus facilitated the proper diagnosis. After extensive counseling at our multidisciplinary team meeting, the parents elected to proceed with radiofrequency ablation of the anomalous twin to maximize the survival of the normal co-twin. The procedure was performed successfully with complete cessation of flow in the umbilical artery and complete cardiac standstill in the anomalous twin with no detrimental effects on the healthy co-twin. Prenatal diagnosis of complex anomalies in twin pregnancies constitutes a multitude of ethical, religious, and cultural factors that come into play in the management of these cases. Fetal magnetic resonance imaging provides detailed valuable information that can assist in management options including possible prenatal intervention. The combination of a cystic

  3. Can early ultrasonography explain the lower miscarriage rates in twin as compared to singleton pregnancies following assisted reproduction?

    Science.gov (United States)

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

    2017-06-20

    To compare first trimester 2D conventional and 3D power Doppler angiography measures in twins and singletons following assisted reproduction. We prospectively evaluated 50 singleton and 47 twin pregnancies that eventually ended in live births. Patients were recruited from a single assisted reproductive technology (ART) center with standard treatment protocols. Obstetric ultrasound was performed at 8-9 weeks +6 days. Intervillous flow, uteroplacental circulation and uterine artery pulsatility (PI) and resistance index (RI) using two-dimensional (2D) ultrasound examination were evaluated. Using three-dimensional (3D) power Doppler angiography, placental volume and the 3D power Doppler indices from the intervillous and uteroplacental circulation were calculated. Demographic and cycle characteristics were similar in mothers of singletons and twins. Placental volume was significantly (1.6-fold) larger in twins. Vascular density and blood perfusion in the intervillous space were lower in twins. The comparison of the other parameters did not show significant differences between singletons and twins. The data confirm the larger placental volume in twins, denoting a probable higher production of placental hormones that would support an early twin pregnancy. The lower vascular density and blood perfusion in the intervillous space in twins may also confer a reproductive advantage to them.

  4. 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.

  5. Continued pregnancy and vaginal delivery after 32 weeks of gestation for monoamniotic twins.

    Science.gov (United States)

    Anselem, O; Mephon, A; Le Ray, C; Marcellin, L; Cabrol, D; Goffinet, F

    2015-11-01

    To report the outcomes of 38 monoamniotic twin pregnancies managed homogeneously to assess whether continuing the pregnancy past 32 weeks of gestation and vaginal delivery are reasonable options. Single-centre retrospective study including all monoamniotic pregnancies managed over a 20-year period at Port-Royal Obstetrics Department, Paris, France. In the study department, both continuation of the pregnancy up to 36 weeks of gestation and vaginal delivery are allowed for monoamniotic pregnancies in some conditions. Perinatal outcomes are described and then compared according to mode of delivery for patients who gave birth at or after 32 weeks of gestation. Three of the 38 pregnancies included fetal malformations; in two of these cases, both fetuses died in utero at 26 weeks of gestation. In cases without malformations, one twin died in utero in two women at 28.0 and 29.2 weeks of gestation, and both fetuses died in two other women at 24.0 and 24.5 weeks of gestation. Mean gestational age at delivery was 32.9 weeks (range 24.0-36.3). Five women gave birth between 22 and 26 weeks of gestation, six women gave birth between 27 and 31 weeks of gestation, and 27 women gave birth at or after 32 weeks of gestation (26 after excluding those with fetal malformations). No intrauterine or neonatal deaths were observed at or after 32 weeks of gestation. The 28 infants delivered vaginally did not differ significantly from the 22 infants born by caesarean section in terms of umbilical artery pH or 5-min Apgar scores. Continuation of monoamniotic pregnancies beyond 32 weeks of gestation and trial of vaginal delivery are both reasonable options if the parents agree, and optimal surveillance is provided. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. 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.

  7. [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.

  8. Is the probability of prenatal diagnosis or termination of pregnancy different for fetuses with congenital anomalies conceived following assisted reproductive techniques? A population-based evaluation of fetuses with congenital heart defects.

    Science.gov (United States)

    Tararbit, K; Lelong, N; Jouannic, J-M; Goffinet, F; Khoshnood, B

    2015-06-01

    To compare the probability of prenatal diagnosis (PND) and termination of pregnancy for fetal anomaly (TOPFA) between fetuses conceived by assisted reproductive techniques (ART) and spontaneously-conceived fetuses with congenital heart defects (CHD). Population-based observational study. Paris and surrounding suburbs. Fetuses with CHD in the Paris registry of congenital malformations and cohort of children with CHD (Epicard). Comparison of ART-conceived and spontaneously conceived fetuses taking into account potential confounders (maternal characteristics, multiplicity and year of birth or TOPFA). Probability and gestational age at PND and TOPFA for ART-conceived versus spontaneously conceived fetuses. The probability of PND (28.1% versus 34.6%, P = 0.077) and TOPFA (36.2% versus 39.2%, P = 0.677) were not statistically different between ART-conceived (n = 171) and spontaneously conceived (n = 4620) fetuses. Estimates were similar after adjustment for potential confounders. Gestational age at PND tended to be earlier for ART fetuses (23.1 versus 24.8 weeks, P = 0.05) but no statistical difference was found after adjustment for confounders. Gestational age at TOPFA was comparable between ART-conceived and spontaneously conceived fetuses. In our population, ART conception was not significantly associated with the probability of PND or TOPFA for CHD. One implication of our results is that live births may be adequate for assessing the overall risk of CHD related to ART. However, total prevalence, in particular of severe CHD, would not be adequately assessed if TOPFA are not included. © 2015 Royal College of Obstetricians and Gynaecologists.

  9. Twin trisomies-Edward and Patau syndromes.

    Science.gov (United States)

    Massiah, Nadine; Griffiths, Emma; Bamigboye, Vincent

    2008-11-01

    To report the rare occurrence of dichorionic diamniotic twins with dissimilar aneuploidies. Case report. District general hospital. A 36-year-old woman conceived by in vitro fertilization. Dichorionic diamniotic twins were found to have elevated nuchal translucencies and cystic hygromas. Intrauterine deaths occurred at 13 and 17 weeks gestation. Medical termination of pregnancy. Karyotypes. Cytogenetic studies confirmed Edward's and Patau's syndromes. The aetiology is unknown but maternal age and in vitro fertilization may be linked since the incidence of aneuploidy rises with maternal age and the incidence of twins' increases with assisted reproductive techniques. This case highlights the need for obstetricians to have good communication and counselling skills.

  10. Detection of chromosomal abnormalities, congenital abnormalities and transfusion syndrome in twins

    DEFF Research Database (Denmark)

    Sperling, Lene; Kiil, C; Larsen, L U

    2007-01-01

    observational study were women with twin pregnancies diagnosed before 14 + 6 gestational weeks. The monochorionic pregnancies were scanned every second week until 23 weeks in order to rule out early TTTS. All pregnancies had an anomaly scan in week 19 and fetal echocardiography in week 21 that was performed...... by specialists in fetal echocardiography. Zygosity was determined by DNA analysis in all twin pairs with the same sex. RESULTS: Among the 495 pregnancies the prenatal detection rate for severe structural abnormalities including chromosomal aneuploidies was 83% by the combination of a first-trimester nuchal...... translucency scan and the anomaly scan in week 19. The incidence of severe structural abnormalities was 2.6% and two-thirds of these anomalies were cardiac. There was no significant difference between the incidence in monozygotic and dizygotic twins, nor between twins conceived naturally or those conceived...

  11. Spontaneous hepatic rupture in a normotensive monoamniotic twin pregnancy: case report and review of the literature.

    Science.gov (United States)

    DeKoninck, P L J; Loquet, P; Leyman, P; Van Leemput, J; d'Archambeau, O; Van Wiemeersch, J; Devlieger, R

    2010-01-01

    Spontaneous liver rupture during pregnancy is extremely rare, and often associated with hypertensive disorders. Maternal outcomes are poor and morbidity is high. A 27-year-old women (G1P0), pregnant with monochorionic-monoamniotic twins, developed extensive abdominal pain while she was electively admitted at 32 weeks for fetal pulmonary maturation. Diagnosed with preterm labor, a caesarean section was performed. Postoperatively, our patient deteriorated and a second laparotomy revealed an extensive liver rupture. There was no evidence of hypertensive disorders or hepatic tumors. After perihepatic packing and embolization, our patient required long-term treatment in our intensive care unit. She survived, and both mother and children are healthy after 6 months. Despite being rare, spontaneous liver rupture in absence of hypertensive disorders during pregnancy is associated with high maternal morbidity and mortality. Adequate treatment requires a multidisciplinary approach. Copyright (c) 2010 S. Karger AG, Basel.

  12. 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.

  13. Obstetric and perinatal outcomes of dichorionic twin pregnancies according to methods of conception: spontaneous versus in-vitro fertilization.

    Science.gov (United States)

    Yang, Hyoin; Choi, Young Sik; Nam, Ka Hyun; Kwon, Ja Young; Park, Yong Won; Kim, Young Han

    2011-02-01

    We have observed the inconsistent findings from various studies on twin pregnancy outcomes obtained by assisted reproductive technology and spontaneous conception. In most studies, however, the concrete chorionicity, regarded as a confounding factor for predicting the perinatal outcomes of twin pregnancies, has not been determined. The purpose of this study was to compare obstetric and perinatal outcomes of only the dichorionic twin pregnancies according to the methods of conception: spontaneous and in-vitro fertilization (IVF). The twin pairs with dichorionicity reported from 1995 to 2008 were investigated and we divided them into two groups which consisted of 286 and 134 twins by spontaneous conception and IVF, respectively. Odds ratios for associations between IVF and pregnancy outcomes were analyzed after adjustment for maternal age and parity. There were no risk differences between the two groups regarding the obstetric complications, which include preterm delivery, preterm labor, preterm premature rupture of membranes, preeclampsia, placenta previa, and abruption. Any differences were not shown in the two groups for the risk estimates of perinatal outcomes, such as low birthweight, very low birthweight, small for gestational age, Apgar scores of conception.

  14. 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......-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...

  15. Long term costs and effects of reducing the number of twin pregnancies in IVF by single embryo transfer: the TwinSing study

    Directory of Open Access Journals (Sweden)

    van Goudoever Johannes B

    2010-10-01

    Full Text Available Abstract Background Pregnancies induced by in vitro fertilisation (IVF often result in twin gestations, which are associated with both maternal and perinatal complications. An effective way to reduce the number of IVF twin pregnancies is to decrease the number of embryos transferred from two to one. The interpretation of current studies is limited because they used live birth as outcome measure and because they applied limited time horizons. So far, research on long-term outcomes of IVF twins and singletons is scarce and inconclusive. The objective of this study is to investigate the short (1-year and long-term (5 and 18-year costs and health outcomes of IVF singleton and twin children and to consider these in estimating the cost-effectiveness of single embryo transfer compared with double embryo transfer, from a societal and a healthcare perspective. Methods/Design A multi-centre cohort study will be performed, in which IVF singletons and IVF twin children born between 2003 and 2005 of whom parents received IVF treatment in one of the five participating Dutch IVF centres, will be compared. Data collection will focus on children at risk of health problems and children in whom health problems actually occurred. First year of life data will be collected in approximately 1,278 children (619 singletons and 659 twin children. Data up to the fifth year of life will be collected in approximately 488 children (200 singletons and 288 twin children. Outcome measures are health status, health-related quality of life and costs. Data will be obtained from hospital information systems, a parent questionnaire and existing registries. Furthermore, a prognostic model will be developed that reflects the short and long-term costs and health outcomes of IVF singleton and twin children. This model will be linked to a Markov model of the short-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies to enable the

  16. Remembering Irving I. Gottesman: Twin Research Colleague and Friend Extraordinaire/Research Studies: Face-Lift Technique Comparison in Identical Twins; Raising Preterm Twins; Fetal Behavior in Dichorionic Twin Pregnancies; Co-Bedding and Stress Reduction in Twins/Public Interest: Identical Co-Twins' Same Day Delivery; Teaching Twins in Bosnia; Twin Auctioneers; Sister, the Play.

    Science.gov (United States)

    Segal, Nancy L

    2016-12-01

    Dr Irving I. Gottesman, a colleague, friend, and long-time member of the International Society of Twin Studies passed away on June 29, 2016. His contributions to twin research and some personal reflections are presented to honor both the man and the memory. This tribute is followed by short reviews of twin research concerning differences between cosmetic surgical techniques, the rearing of preterm twins, behavioral observations of dichorionic fetal twins, and the outcomes of co-bedding twins with reference to stress reduction. Interesting and informative articles in the media describe identical co-twins who delivered infants on the same day, educational policies regarding twins in Bosnia and the United Kingdom, unusual practices of twin auctioneers, and a theatrical production, Sister, featuring identical twins in the leading roles.

  17. 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.

  18. [Premature twins: clinic comparison, reproductive assisted techniques versus spontaneous conception].

    Science.gov (United States)

    Noriega-Alvarez, Roxana; Iglesias-Leboreiro, José; Bernardez-Zapata, Isabel

    2014-01-01

    Twin pregnancies occur one out of every 800. Due to the increase in maternal age and infertility, the use of assisted reproductive technology (ART) has risen. Thirty five percent of pregnancies solved using ART are twin pregnancies. A RT consists of infertility treatments in which oocytes and sperm are manipulated. The objective of this study was to compare the clinical behavior of premature twins born through ART versus those born after spontaneous conception (SC). Retrolective cohort study. The data was obtained from the records of preterm twins born between August 2010 and August 2013. Preterm twins were categorized in two groups: the ones conceived using ART versus those conceived through SC. Demographic characteristics and neonatal outcomes were compared. The total was of 398 patients: 208 conceived in consequence of ART and 190 through SC. The primary outcome and neonatal morbidities showed no significant difference, only the incidence of necrotizing enterocolitis and the use of parenteral nutrition showed significant difference. The length of hospital stay between groups was similar. In our population of preterm twins, the mode of conception had no detectable effect on mortality or short term morbidities.

  19. Posttraumatic stress disorder, anxiety and depression following pregnancies conceived through fertility treatments : the effects of medically assisted conception on postpartum well-being

    NARCIS (Netherlands)

    Warmelink, J Catja; Stramrood, Claire A I; Paarlberg, K Marieke; Haisma, Hinke H; Vingerhoets, A J J M; Schultz, Willibrord C M Weijmar; van Pampus, Maria G

    2012-01-01

    OBJECTIVE: To compare the postpartum prevalence of Posttraumatic Stress Disorder (PTSD), anxiety and depression in women who conceived via medically assisted conception (MAC) and women who conceived naturally. STUDY DESIGN: All women (n = 907) who delivered under supervision of four independent

  20. [Perinatal outcome of monochorionic and dichorionic twin gestations: a study of 775 pregnancies at Reunion Island].

    Science.gov (United States)

    Oger, A-S; Robillard, P-Y; Barau, G; Randrianaivo, H; Bonsante, F; Iacobelli, S; Boukerrou, M

    2013-11-01

    To compare the perinatal mortality and morbidity of infants born from monochorionic versus dichorionic twin pregnancies (TP). Retrospective, comparative study of monochorionic and dichorionic TP over 10 years in the south of Reunion Island. Information regarding demographic, gestational and perinatal variables of mothers and infants was collected from the hospital perinatal database. Six hundred and twenty dichorionic and 155 monochorionic TP were analyzed. In case of monochorionic TP, mothers had higher rates of pregnancy-related hypertension (OR=1.82, 95%CI=[1.02-3.29] ; P=0.03) and hospitalization (OR=1.48, 95%CI=[1.02-2.16]; P=0.03). Newborns from monochorionic TP had higher morbidity for : very preterm birth (birth before 33 weeks gestation) (OR=1.65, 95%CI=[1.02-2.66]; P=0.02), very low birth weight (birth weight<1500g) (OR=1.73, 95%CI=[1.57-3.13]; P<0.001), Apgar<7 at 1 minute (OR=1.76, 95%CI=[1.18-2.61]; P<0.01) and hospitalization (OR=2.08, 95%CI=[1.58-2.73]; P<0.001). Perinatal mortality was also significantly higher (OR=2.47, 95%CI=[1.54-3.94]; P<0.001), as well intrauterine fetal death (OR=3.96, 95%CI=[1.95-8.05]; P<0.001) CONCLUSION: This study confirms that few differences exist among dichorionic and monochorionic TP with regard to maternal morbidity, while neonatal morbidity and mortality are higher in twins born from monochorionic pregnancies. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  1. Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure

    NARCIS (Netherlands)

    Khalil, Asma; Beune, Irene; Hecher, Kurt; Wynia, Klaske; Ganzevoort, Wessel; Reed, Keith; Lewi, Liesbeth; Oepkes, Dick; Gratacos, Eduardo; Thilaganathan, Basky; Gordijn, Sanne J.

    2018-01-01

    Twin pregnancies complicated by selective fetal growth restriction (sFGR) are associated with increased perinatal mortality and morbidity. Inconsistences in the diagnostic criteria for sFGR employed in existing studies hinder the ability to compare or combine their findings. It is therefore

  2. 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

  3. Time trends in the natural dizygotic twinning rate.

    Science.gov (United States)

    Derom, Catherine; Gielen, Marij; Peeters, Hilde; Frijns, Jean-Pierre; Zeegers, Maurice P A

    2011-08-01

    The natural dizygotic (DZ) twinning rate has been proposed as a reliable and useful measure of human fecundity, if adjusted for maternal age at twin birth. The aim of this study was to analyze age-adjusted trends in natural DZ twinning rates over the past 40 years using data from the 'East Flanders Prospective Twin Survey (EFPTS)'. This study involved 4835 naturally conceived twin pregnancies between 1969 and 2009 from the population-based Belgian 'EFPTS'. Age-adjusted trends in the incidence of natural DZ twin pregnancies were calculated using a generalized linear model with Poisson distribution. Both the natural DZ twinning rates and maternal age at twin birth increased in a linear fashion from 1969 to 2009. When age-adjusted, we found that the trend in the natural DZ twinning rate was stable during the whole time period. According to our population-based data and after age-adjustment, a stable natural DZ twinning rate could be observed over the last four decades. Under the assumption that the spontaneous DZ twinning rate is a sensor of fecundity, this indicates a stable 'high' fecundity for this population.

  4. 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. 2016 BMJ Publishing Group Ltd.

  5. [Singleton and twin pregnancies of PKU patients - individual variability of phenylalanine tolerance: experience of a single treatment center (Preliminary report)].

    Science.gov (United States)

    Żółkowska, Joanna; Hozyasz, Kamil K; Nowacka, Maria

    2017-01-01

    Phenylketonuria (PKU) is the autosomal recessive deficiency of phenylalanine hydroxylase resulting in the accumulation of phenylalanine (Phe) in blood and in the brain. Phe restriction in a patient's diet is determined depending on the amount of Phe intake which allows for stable blood Phe levels within the therapeutic range of 120-360µmol/L. In clinical practice the empirical determination of Phe tolerance relies on frequent assessment of blood Phe concentrations in relation to Phe intake from food records. Untreated maternal PKU may lead to maternal PKU syndrome in offspring. The objective of the study was to compare Phe tolerance during the course of singleton and multiple pregnancies of PKU patients. Case subjects and methods: The cases reviewed included three sets of classical PKU-affected Polish women on a low-phenylalanine diet during the course of singleton and twin pregnancies and their PKU-unaffected newborns. All the patients were under regular supervision of a metabolic dietitian to stabilize blood Phe levels and determine Phe tolerance. Data on pregnancy weight gain, the gestational age when the diet initiated, the percent of Phe assessments 360 µmol/L, as well as offspring birth measurements were analyzed. The total increase in Phe tolerance and its pattern during the course of singleton and twin pregnancies differed remarkably in each patient. Three PKU women (Q383X/R408W, EX3DEL/EX3DEL, R281L/R408W) increased their Phe tolerance in singleton and twin pregnancies by 579%/468%, 674%/261%, and 427%/236%, respectively. During the last 10 weeks of singleton and twin pregnancy Phe tolerance showed an increase by 62%/149%, 33%/64%, and 37%/40%, respectively. The analysis of predictors for Phe tolerance showed that an individual's weight gain and the fetal weight gain as estimated from liveborn birth-weight data had no predictive capacity. Individual Phe tolerance in singleton pregnancies of PKU patients does not predict tolerance in twin pregnancy

  6. 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

  7. [Laparoscopic resection of an interstitial ectopic twin pregnancy resection: the role of barbed sutures in haemostatic control].

    Science.gov (United States)

    Cardoso Medina, Byron; Hernández Giraldo, Cristian; Manual Clavijo, Juan; Sarmiento, Piedad

    2012-12-01

    Interstitial pregnancy is a dangerous and uncommon variation of ectopic pregnancy occurring in the interstitial part of the fallopian tube and extending beyond the muscular layer of the uterus. This ectopic pregnancy-related mortality rate has been reported to be as high as 2%-2,5% due to complications involving bleeding and hypervascularity. No prospective clinical trials have evaluated available treatment options for interstitial ectopic pregnancy due to its low incidence; there is thus no consensus regarding optimal treatment. Surgical treatment can be divided into conservative approaches, such as cornuectomy or cornuostomy, and radical approaches such as hysterectomy. However, intraoperative hemorrhage is an ever-present risk, regardless of the surgical approach adopted. This paper presents a case involving a patient who underwent laparoscopic resection of an interstitial twin ectopic pregnancy; a barbed suture pursestring was used which proved useful during the surgical technique and improved hemostasia.

  8. 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. © 2013 S. Karger AG, Basel.

  9. Competing-risks model in screening for pre-eclampsia in twin pregnancy by maternal characteristics and medical history.

    Science.gov (United States)

    Francisco, C; Wright, D; Benkő, Z; Syngelaki, A; Nicolaides, K H

    2017-10-01

    A survival-time regression model for gestational age at delivery with pre-eclampsia (PE) in singleton pregnancy, using maternal demographic characteristics and medical history, was reported previously. The objective of this study was to extend this model to dichorionic (DC) and monochorionic (MC) twin pregnancy. The study population included 1789 DC and 430 MC twin pregnancies and 93 297 singleton pregnancies. A survival-time model for gestational age at delivery with PE was developed from variables of maternal characteristics and medical history. The risk of PE with delivery pregnancies was determined and compared with that in singleton pregnancies. In singleton pregnancies comprising women of Caucasian racial origin, mean weight of 69 kg at 12 weeks' gestation, mean height of 164 cm, nulliparous, with spontaneous conception, no family history of PE and no history of diabetes mellitus, systemic lupus erythematosus or antiphospholipid syndrome, the mean of the Gaussian distribution of gestational age at delivery with PE was 55 weeks. In DC twins with PE, mean gestational age at delivery was shifted to the left by 8.2 (95% CI, 7.2-9.1) weeks and in MC twins it was shifted to the left by 10.0 (95% CI, 8.5-11.4) weeks. The risk of delivery with PE occurring at, or before, a specified gestational age is given by the area under the fitted distribution curve. For a reference population with the above characteristics, the estimated risk of PE history has been developed for estimation of patient-specific risks for PE in DC and MC twin pregnancy. Such estimation of the a-priori risk for PE is an essential first step in the use of Bayes' theorem to combine maternal factors with biomarkers for the continuing development of more effective methods of screening for the disease. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

  10. The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies : an individual patient level meta-analysis

    NARCIS (Netherlands)

    Kindinger, L M; Poon, L C; Cacciatore, S; MacIntyre, D A; Fox, N S; Schuit, E; Mol, B W; Liem, S; Lim, A C; Serra, V; Perales, A; Hermans, F; Darzi, A; Bennett, P; Nicolaides, K H; Teoh, T G

    2016-01-01

    OBJECTIVE: To assess the effect of gestational age (GA) and cervical length (CL) measurements at transvaginal ultrasound (TVUS) in the prediction of preterm birth in twin pregnancy. DESIGN: Individual patient data (IPD) meta-analysis. SETTING: International multicentre study. POPULATION:

  11. 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

    : 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......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......, Aalborg University Hospital, Aalborg , Denmark. 5. Department of Obstetrics and Gynecology, Aarhus University Hospital Skejby, Aarhus, Denmark. 6. Department of Pathology, Aalborg University Hospital, Aalborg, Denmark. ABSTRACT BODY: Objectives: Intertwin birth weight discordance is associated...

  12. Induction of labour and scheduled cesarean deliveries in twin pregnancies at the Port-Royal Maternity Hospital in Paris France.

    Science.gov (United States)

    Papiernik, E; Hessabi, M; Dubourdieu, C; Zeitlin, J

    2001-06-01

    The study is a critical analysis of the decisions to induce labour or schedule cesareans in the practice of a third level referral centre, with as outcome criterion the reduction of fetal death. 783 women pregnant with twins were included from 1.1.1993 to 31.12.1998, in three groups: originally booked, referred for care during pregnancy, or transferred from another institution. The results show that an important proportion of preterm deliveries result from a medical decision to induce labour or from a scheduled cesarean in the originally booked group with even higher proportions in groups of referred and transferred women. These results are discussed in relation to fetal death rates and causes. Deaths related to fetal growth restriction were not observed in women originally booked for care. The hospital bias has been discussed. The conclusion is that decisions to minimize fetal deaths in twin pregnancies increased preterm deliveries by medical decision.

  13. Noninvasive prenatal testing of trisomies 21 and 18 by massively parallel sequencing of maternal plasma DNA in twin pregnancies.

    Science.gov (United States)

    Huang, Xuan; Zheng, Jing; Chen, Min; Zhao, Yangyu; Zhang, Chunlei; Liu, Lifu; Xie, Weiwei; Shi, Shuqiong; Wei, Yuan; Lei, Dongzhu; Xu, Chenming; Wu, Qichang; Guo, Xiaoling; Shi, Xiaomei; Zhou, Yi; Liu, Qiufang; Gao, Ya; Jiang, Fuman; Zhang, Hongyun; Su, Fengxia; Ge, Huijuan; Li, Xuchao; Pan, Xiaoyu; Chen, Shengpei; Chen, Fang; Fang, Qun; Jiang, Hui; Lau, Tze Kin; Wang, Wei

    2014-04-01

    The objective of this study is to assess the performance of noninvasive prenatal testing for trisomies 21 and 18 on the basis of massively parallel sequencing of cell-free DNA from maternal plasma in twin pregnancies. A double-blind study was performed over 12 months. A total of 189 pregnant women carrying twins were recruited from seven hospitals. Maternal plasma DNA sequencing was performed to detect trisomies 21 and 18. The fetal karyotype was used as gold standard to estimate the sensitivity and specificity of sequencing-based noninvasive prenatal test. There were nine cases of trisomy 21 and two cases of trisomy 18 confirmed by karyotyping. Plasma DNA sequencing correctly identified nine cases of trisomy 21 and one case of trisomy 18. The discordant case of trisomy 18 was an unusual case of monozygotic twin with discordant fetal karyotype (one normal and the other trisomy 18). The sensitivity and specificity of maternal plasma DNA sequencing for fetal trisomy 21 were both 100% and for fetal trisomy 18 were 50% and 100%, respectively. Our study further supported that sequencing-based noninvasive prenatal testing of trisomy 21 in twin pregnancies could be achieved with a high accuracy, which could effectively avoid almost 95% of invasive prenatal diagnosis procedures. © 2013 John Wiley & Sons, Ltd.

  14. Induction of labor in twin pregnancies with oral misoprostol versus vaginal dinoprostone--is it effective and safe?

    Science.gov (United States)

    Huber, Georgine; Schütz, Heike; Seelbach-Göbel, Birgit

    2015-06-01

    To compare the effectiveness and safety of oral misoprostol versus vaginal dinoprostone for the induction of labor in twin pregnancies. All twin pregnancies ≥ 34 weeks 0 days that were induced with either misoprostol or dinoprostone in St. Hedwig Hospital between 2002 and 2013 were included in this retrospective study. Length of induction, mode of delivery, maternal and neonatal outcomes were compared between the two groups. After identifying 186 twin mothers matching the inclusion criteria, 154 women were induced with misoprostol (group A) and 32 with dinoprostone (group B). There were no differences in demographic data between the groups. Rates of successful vaginal delivery (53.9% versus 56.3%) and length of induction to delivery (30.2 h versus 26.9 h) were also similar. There were slightly higher rates of postpartum hemorrhage in group B (16.6% versus 10.8%), but without reaching statistical significance. Neonatal outcomes regarding umbilical artery pH misoprostol and vaginal dinoprostone are similarly effective and safe for the induction of labor in twin gestations. Further trials with larger series are needed to confirm these results.

  15. Occupational exposure of man to ionizing radiations and necessary time to conceive a pregnancy. Study on fertility at Beaumont-La hague and St Brieuc; Exposition professionnelle de l'homme aux rayonnements ionisant et delai necessaire pour concevoir une grossesse. L'etude sur la fertilite a Beaumont-Hague et Saint-Brieuc

    Energy Technology Data Exchange (ETDEWEB)

    Slama, R.; Boutou, O.; Ducot, B.; Aussel, L.; Spira, A. [Institut National de la Sante et de la Recherche Medicale (INSERM) - Hopital de Bicetre, 94 - Le Kremlin-Bicetre (France)

    2002-10-01

    The association between short time allowed to conceive and high father exposure before pregnancy research must be interpreted carefully, and checked in other studies on workers fertility whom feasibility has been here demonstrated. (N.C.)

  16. Fertility treatment, twin births, and unplanned pregnancies in women with eating disorders: findings from a population-based birth cohort.

    Science.gov (United States)

    Micali, N; dos-Santos-Silva, I; De Stavola, B; Steenweg-de Graaff, J; Steenweg-de Graaf, J; Jaddoe, V; Hofman, A; Verhulst, F C; Steegers, Eap; Tiemeier, H

    2014-03-01

    To investigate fertility treatment, twin births, and unplanned pregnancies in pregnant women with eating disorders in a population-based sample. A longitudinal population-based birth cohort (Generation R). Rotterdam, the Netherlands. Women from the Generation R study who reported a history of (recent or past) anorexia nervosa (n = 160), bulimia nervosa (n = 265), or both (n = 130), and a history of psychiatric disorders other than eating disorders (n = 1396) were compared with women without psychiatric disorders (n = 4367). Women were compared on the studied outcomes using logistic regression. We performed crude and adjusted analyses (adjusting for relevant confounding factors). Fertility treatment, twin births, unplanned pregnancies, and women's feelings towards unplanned pregnancies. Relative to women without psychiatric disorders, women with bulimia nervosa had increased odds (odds ratio, OR, 2.3; 95% confidence interval, 95% CI, 1.1-5.2) of having undergone fertility treatment. Women with all eating disorders had increased odds of twin births (anorexia nervosa, OR 2.7, 95% CI 1.0-7.7; bulimia nervosa, OR 2.7, 95% CI 1.1-6.6; anorexia and bulimia nervosa, OR 3.795% CI 1.3-10.7). Anorexia nervosa was associated with increased odds of unplanned pregnancies (OR 1.8, 95% CI 1.2-2.6) and mixed feelings about these pregnancies (adjusted OR 5.0, 95% CI 1.7-14.4). Pre-pregnancy body mass index did not explain the observed associations. Eating disorders are associated with increased odds of receiving fertility treatment and twin births. Women with anorexia nervosa were more likely to have an unplanned pregnancy and have mixed feelings about the unplanned pregnancy. Fertility treatment specialists should be aware that both active and past eating disorders (both anorexia nervosa and bulimia nervosa) might underlie fertility problems. ©2013 Royal College of Obstetricians and Gynaecologists.

  17. 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. © 2016 Japan Society of Obstetrics and Gynecology.

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

    Science.gov (United States)

    Tan, Yueqiu; Gao, Ya; Lin, Ge; Fu, Meili; Li, Xihong; Yin, Xuyang; Du, Juan; Li, Jing; Li, Wen; Peng, Huanhuan; Yuan, Yuying; Chen, Fang; Jiang, Fuman; Zhang, Hongyun; Lu, Guangxiu; Gong, Fei; Wang, Wei

    2016-07-01

    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). In two years period, 565 pregnant women with ART twin pregnancies were prospectively tested by NIPT for screening for trisomy 21 (T21), 18 (T18), and 13 (T13) by sequencing cell-free DNA in maternal plasma. Positive NIPT results were confirmed by karyotyping, while negative results were interviewed after delivery. Pregnant decision based on NIPT and confirmation results was discussed during post-test counseling. 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. With apparently high positive predictive value and low false positive rate, NIPT has the potential to be used as a good alternative approach of conventional prenatal screening at the first trimester in ART twin pregnancy. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

  19. 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

  20. 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.

  1. First-trimester maternal serum ADAM12-s and PAPP-A levels are altered in pregnancies conceived after assisted reproduction techniques (ART).

    Science.gov (United States)

    Sahraravand, Maarit; Laitinen, Päivi; Järvelä, Ilkka; Ryynänen, Markku

    2016-02-01

    The objective of this article is to estimate whether the maternal serum levels of A disintegrin and metalloprotease domain 12 (ADAM12-s), pregnancy-associated plasma protein-A (PAPP-A), and free beta human chorionic gonadotrophin (fβ-hCG) are altered in assisted reproduction techniques (ART) pregnancies. A retrospective cohort study with a control group was performed. Two hundred eighty-three ART pregnancies and 1008 controls were studied. The patients were divided into groups according to the type of conception: (1) controls, (2) fresh embryo transfer (ET) following controlled ovarian stimulation (COH) and in vitro fertilization (IVF), (3) fresh ET following COH and intracytoplasmic sperm injection (ICSI), (4) frozen ET during natural menstrual cycle (NC-FET), and (5) frozen ET using hormone replacement therapy. The cases and controls were matched for gestational and maternal age and for the storage time of the samples. The ADAM12-s levels were statistically significantly higher in the entire ART group, IVF and ICSI groups, and NC-FET group when compared with those in the controls. The PAPP-A levels were decreased only in the ICSI group compared with those in the controls. fβ-hCG levels were not altered in assisted pregnancies. The ADAM12-s levels tended to increase with advanced gestational age. ADAM12-s levels were correlated with PAPP-A and fβ-hCG levels in several subgroups of ART pregnancies. ADAM12-s and PAPP-A levels are altered in several subgroups of ART pregnancies. Larger studies are required to confirm these findings. © 2015 John Wiley & Sons, Ltd.

  2. Pretense and Conceivability

    DEFF Research Database (Denmark)

    Steffensen, Asger Bo Skjerning

    2014-01-01

    is presented based on the fact that we find the nonidentity inconceivable under pretense of identity between names. On the one horn, conceivability proper is shown to be able to be the whole story of our knowledge of one de re principle, at least, primitively or by brute fact; on the second horn, the notion...

  3. Pretense and Conceivability

    DEFF Research Database (Denmark)

    Steffensen, Asger Bo Skjerning

    is presented based on the fact that we find the nonidentity inconceivable under pretense of identity between names. On the one horn, conceivability proper is shown to be able to be the whole story of our knowledge of one de re principle, at least, primitively or by brute fact; on the second horn, the notion...

  4. Polyhydramnios and arterio-arterial placental anastomoses may beneficially affect monochorionic twin pregnancies

    NARCIS (Netherlands)

    van Gemert, M. J.; Kranenburg-Lakeman, P.; Milovanović, Z.; Vergroesen, I.; Boer, K.

    2001-01-01

    Our objective was to appraise whether an increased amniotic fluid pressure by polyhydramnios can beneficially affect monochorionic twins that are haemodynamically connected by arterio-venous plus arterio-arterial placental anastomoses. We assessed the effects of polyhydramnios in monochorionic twin

  5. NOTE: Polyhydramnios and arterio-arterial placental anastomoses may beneficially affect monochorionic twin pregnancies

    Science.gov (United States)

    van Gemert, Martin J. C.; Kranenburg-Lakeman, Phillis; Milovanovic, Zeljko; Vergroesen, Isabelle; Boer, Kees

    2001-03-01

    Our objective was to appraise whether an increased amniotic fluid pressure by polyhydramnios can beneficially affect monochorionic twins that are haemodynamically connected by arterio-venous plus arterio-arterial placental anastomoses. We assessed the effects of polyhydramnios in monochorionic twin placentas, combining (a) data from previous in vitro placental perfusion experiments in singleton term placentas under simulated normal and increased amniotic fluid pressures with (b) logical deduction from observations made in monochorionic twins. Our hypothesis is that in monochorionic placentas, an increased amniotic fluid pressure increases the placental microvascular resistance but not the resistance of placental chorionic plate arteries. Hence, an increased amniotic fluid pressure increases the microvascular resistance of the joint cotyledon, the arterio-venous resistance, but not the arterio-arterial resistance. This proposed mechanism reduces arterio-venous but not oppositely directed arterio-arterial transfusion. Therefore, reversal of the normal direction of net foeto-foetal transfusion may develop, which will reduce the circulatory imbalance that evolved between the monochorionic foetal twins. In contrast, in monochorionic twins connected by unidirectional or bidirectional arterio-venous anastomoses reversal of the normal direction of net foeto-foetal transfusion will not occur. In conclusion, reversal of the normal direction of net foeto-foetal transfusion, induced by polyhydramnios, is protective against the onset and severity of twin-twin transfusion syndrome in monochorionic twins connected by arterio-venous plus arterio-arterial anastomoses, but not by unidirectional or bidirectional arterio-venous anastomoses.

  6. First-trimester screening in pregnancies conceived by assisted reproductive technology: significance of gestational dating by oocyte retrieval or sonographic measurement of crown-rump length

    DEFF Research Database (Denmark)

    Gjerris, A.C.; Loft, A.; Pinborg, A.

    2008-01-01

    -associated plasma protein-A. The SDs were similar for CRL and DOA dating. According to Monte Carlo simulation, the use of DOA or CRL for GA dating did not appreciably influence the performance of first-trimester screening. CONCLUSIONS: DOA and CRL are practically equivalent when calculating GA for first......-trimester screening. The correct method of GA dating for other purposes (e.g. estimated time of delivery) in IVF/ICSI pregnancies is still unresolved Udgivelsesdato: 2008/10...

  7. 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.

  8. A review of factors that impact on the capacity of beef cattle females to conceive, maintain a pregnancy and wean a calf-Implications for reproductive efficiency in northern Australia.

    Science.gov (United States)

    Burns, B M; Fordyce, G; Holroyd, R G

    2010-10-01

    A review of factors that may impact on the capacity of beef cattle females, grazing semi-extensive to extensive pastures in northern Australia, to conceive, maintain a pregnancy and wean a calf was conducted. Pregnancy and weaning rates have generally been used to measure the reproductive performance of herds. However, this review recognises that reproductive efficiency and the general measures associated with it more effectively describe the economic performance of beef cattle enterprises. More specifically, reproductive efficiency is influenced by (1) pregnancy rate which is influenced by (i) age at puberty; (ii) duration of post-partum anoestrus; (iii) fertilisation failure and (iv) embryo survival; while (2) weight by number of calves per breeding female retained for mating is influenced by (i) cow survival; (ii) foetal survival; and (iii) calf survival; and (3) overall lifetime calf weight weaned per mating. These measures of reproductive efficiency are discussed in depth. Further, a range of infectious and non-infectious factors, namely, environmental, physiological, breed and genetic factors and their impact on these stages of the reproductive cycle are investigated and implications for the northern Australian beef industry are discussed. Finally, conclusions and recommendations to minimise reproductive inefficiencies based on current knowledge are presented. Crown Copyright © 2010. Published by Elsevier B.V. All rights reserved.

  9. 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. Keywords: Cri du Chat, Léjéune, 5p translocation, Selective termination

  10. Modal Epistemology and Conceivability

    DEFF Research Database (Denmark)

    Steffensen, Asger Bo Skjerning

    Philosophical argumentation often depends on modal facts, i.e. facts about what is possible, contingent, or necessary. For thought and cognition outside the domain of philosophy modal facts are also often decisive. It seems we have an easy access to modal facts, but how so? Through a presentation...... of the state-of-the-art in modal epistemology I wish to outline a research project based on conceivability that will try to explain how we come to know modal facts....

  11. 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...

  12. Trying to Conceive

    Science.gov (United States)

    ... Know your pregnancy rights Getting ready for baby Birthing, breastfeeding, and parenting classes Breastfeeding Circumcision Health care for baby Making your home safe for baby Last-minute to-dos Childbirth ...

  13. Conceivability Theses and Objections

    DEFF Research Database (Denmark)

    Steffensen, Asger Bo Skjerning

    In the literature on epistemology of modality there is a curious thesis stating that our imaginative capacities enables us to know of absolute or metaphysical modality – the conceivability thesis. From times less recent to the current debate, the thesis has undergone transformations and different...... versions have been offered. In the philosophical opinion at large the thesis has gone from being considered “an established maxim in metaphysics”, as Hume writes in the Treatise, to being considered somewhat of an anachronism to be avoided in serious epistemological thought. At least, it seems criticizing...

  14. Obstetric Outcome in Twin Gestation in a Nigerian Tertiary Hospital ...

    African Journals Online (AJOL)

    BACKGROUND: Twin pregnancies are high risk pregnancies. Foetal and maternal complications are common in twin pregnancies. Therefore, periodic review is necessary to improve on the twin pregnancy outcome. OBJECTIVE: To determine the incidence and outcome of twin pregnancies in the hospital. MATERIALS AND ...

  15. 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.

  16. ARE THE TWINS, BORN AFTER AN IVF-ET PROCEDURE ANY DIFFERENT THAN TWINS, BORN AFTER SPONTANEOUS CONCEPTION?

    Directory of Open Access Journals (Sweden)

    Sara Korošec

    2003-12-01

    caesarean sections were determined for the IVF group than for the control group and the differences were all statistically significant.Conclusions. Multiple pregnancies are a complication of an IVF-ET procedure. Women who conceive after an IVF-ET procedure and with a twin pregnancy outcome are not subject to any more danger than pregnant women after spontaneous conception. Children are born somewhat earlier and are therefore lighter, however the perinatal outcome of newborns is no different and the morbidity and mortality rates are similar to that of newborns after spontaneous conception.

  17. Successful pregnancy following medical management of heterotopic pregnancy

    Directory of Open Access Journals (Sweden)

    R Lavanya

    2009-01-01

    Full Text Available We present a case of sonographic demonstration of quadruplet heterotopic pregnancy consisting of twin intrauterine (IU pregnancy and a twin adnexal pregnancy after ovulation induction (OI with clomiphene citrate (CC and timed intercourse (TI. Both heterotopic pregnancy and spontaneous twinning are frequent after OI, this combination although extremely rare must be kept in mind. The role of early transvaginal sonography and serum beta human chorionic gonadotrophin after missed periods helps in early diagnosis. It gives us an opportunity for medical management, saving the patient the agony of surgery along with loss of pregnancy. The management of heterotopic pregnancy is controversial. This patient did not have a viable IU pregnancy and both the sacs in the adnexa were small. Thus, we treated her successfully by medical management with systemic methotrexate, with regular follow-up. This patient successfully conceived after 6 months with OI and TI, with ovulation occurring from the same side of the previous ectopic. She had a viable IU gestation corresponding to 12 weeks.

  18. Prevalence and risk factors of monochorionic diamniotic twinning after assisted reproduction: A six-year experience base on a large cohort of pregnancies.

    Science.gov (United States)

    Song, Bing; Wei, Zhao-Lian; Xu, Xiao-Feng; Wang, Xue; He, Xiao-Jin; Wu, Huan; Zhou, Ping; Cao, Yun-Xia

    2017-01-01

    To characterize the incidence and risk factors for monochorionic diamniotic(MC-DA) twinning after assisted reproductive technologies (ART). Retrospective population-based study. The study was conducted in China; Department of Reproductive Medicine Center at The First Affiliated Hospital of Anhui Medical University. A cohort of 8860 clinical pregnancies after embryo transfer (ET) carried out in our center between 2011 and 2016 were retrospectively analyzed for the incidence of MC-DA twinning. Logistic regression was used to model the effect on the incidence of MC-DA twinning after ART. Different clinical data (maternal age) and laboratory procedures (type of ET (fresh versus frozen), insemination (IVF or ICSI)), embryo stage at time of ET (cleavage or blastocyst)) on the incidence of MC-DA twinning were evaluated. Monochorionic-diamniotic pregnancies were identified when more than one fetal poles was visualized in one gestational sac via trans-vaginal ultrasound at early first-trimester (7 to 8 weeks). The overall MC-DA twinning rate was 2.55% (226/8860). Eighty one MC-DA twinnings occurred in the fresh cycles and 145 in the frozen cycles (2.67% vs. 2.49%). MC-DA twinning incidence showed no significant difference whether ICSI was performed or not (2.79% vs. 2.44%). The MZT that resulted from single embryo transfer (SET) cycles (1.99%) was slightly lower than multiple embryo transfer cycles (2.61%),but with non-significance. However, women women ≥35 years old (1.16%). Blastocyst transfer was associated with a significantly increase in MC-DA twinning incidence than cleavage-stage embryos transfer (2.79% VS 2.02%, P = 0.008). In the results of logistic regression analysis, blastocyst transfer is a major risk factor of MZT in the fresh cycles (P = 0.044), while maternal age plays a more important role in the frozen cycles (P = 0.004). There is an elevated prevalence of MC-DA twinning after ART. Both maternal age and blastocyst transfer are risk factors of monozygotic

  19. Prevalence and risk factors of monochorionic diamniotic twinning after assisted reproduction: A six-year experience base on a large cohort of pregnancies.

    Directory of Open Access Journals (Sweden)

    Bing Song

    Full Text Available To characterize the incidence and risk factors for monochorionic diamniotic(MC-DA twinning after assisted reproductive technologies (ART.Retrospective population-based study.The study was conducted in China; Department of Reproductive Medicine Center at The First Affiliated Hospital of Anhui Medical University.A cohort of 8860 clinical pregnancies after embryo transfer (ET carried out in our center between 2011 and 2016 were retrospectively analyzed for the incidence of MC-DA twinning.Logistic regression was used to model the effect on the incidence of MC-DA twinning after ART. Different clinical data (maternal age and laboratory procedures (type of ET (fresh versus frozen, insemination (IVF or ICSI, embryo stage at time of ET (cleavage or blastocyst on the incidence of MC-DA twinning were evaluated.Monochorionic-diamniotic pregnancies were identified when more than one fetal poles was visualized in one gestational sac via trans-vaginal ultrasound at early first-trimester (7 to 8 weeks.The overall MC-DA twinning rate was 2.55% (226/8860. Eighty one MC-DA twinnings occurred in the fresh cycles and 145 in the frozen cycles (2.67% vs. 2.49%. MC-DA twinning incidence showed no significant difference whether ICSI was performed or not (2.79% vs. 2.44%. The MZT that resulted from single embryo transfer (SET cycles (1.99% was slightly lower than multiple embryo transfer cycles (2.61%,but with non-significance. However, women <35 years displayed a significant higher rate (2.81% than women ≥35 years old (1.16%. Blastocyst transfer was associated with a significantly increase in MC-DA twinning incidence than cleavage-stage embryos transfer (2.79% VS 2.02%, P = 0.008. In the results of logistic regression analysis, blastocyst transfer is a major risk factor of MZT in the fresh cycles (P = 0.044, while maternal age plays a more important role in the frozen cycles (P = 0.004.There is an elevated prevalence of MC-DA twinning after ART. Both maternal age and

  20. Comparison of conventional 2D ultrasound to magnetic resonance imaging for prenatal estimation of birthweight in twin pregnancy.

    Science.gov (United States)

    Kadji, Caroline; Bevilacqua, Elisa; Hurtado, Ivan; Carlin, Andrew; Cannie, Mieke M; Jani, Jacques C

    2018-01-01

    During prenatal follow-up of twin pregnancies, accurate identification of birthweight and birthweight discordance is important to identify the high-risk group and plan perinatal care. Unfortunately, prenatal evaluation of birthweight discordance by 2-dimensional ultrasound has been far from optimal. The objective of the study was to prospectively compare estimates of fetal weight based on 2-dimensional ultrasound (ultrasound-estimated fetal weight) and magnetic resonance imaging (magnetic resonance-estimated fetal weight) with actual birthweight in women carrying twin pregnancies. Written informed consent was obtained for this ethics committee-approved study. Between September 2011 and December 2015 and within 48 hours before delivery, ultrasound-estimated fetal weight and magnetic resonance-estimated fetal weight were conducted in 66 fetuses deriving from twin pregnancies at 34.3-39.0 weeks; gestation. Magnetic resonance-estimated fetal weight derived from manual measurement of fetal body volume. Comparison of magnetic resonance-estimated fetal weight and ultrasound-estimated fetal weight measurements vs birthweight was performed by calculating parameters as described by Bland and Altman. Receiver-operating characteristic curves were constructed for the prediction of small-for-gestational-age neonates using magnetic resonance-estimated fetal weight and ultrasound-estimated fetal weight. For twins 1 and 2 separately, the relative error or percentage error was calculated as follows: (birthweight - ultrasound-estimated fetal weight (or magnetic resonance-estimated fetal weight)/birthweight) × 100 (percentage). Furthermore, ultrasound-estimated fetal weight, magnetic resonance-estimated fetal weight, and birthweight discordance were calculated as 100 × (larger estimated fetal weight-smaller estimated fetal weight)/larger estimated fetal weight. The ultrasound-estimated fetal weight discordance and the birthweight discordance were correlated using linear regression

  1. Short-term safety evaluation of the offspring conceived by 7272 artificial insemination cycles with donor spermatozoon.

    Science.gov (United States)

    Huang, D; Song, S; Liao, A

    2016-09-01

    This case-control study was designed to investigate the safety of the AID technology. The health status of the offspring conceived by 1620 couples who underwent 7272 AID cycles in our Center for Reproductive Medicine between June 2006 and December 2012 was retrospectively analysed. The control group included 1018 women who naturally conceived and delivered in the same period. Twin birth rate was significantly higher in the AID group (no triplet birth) than in the control group (2.01% versus 0.39%, P  0.05). Compared to natural pregnancy, a pregnancy through AID resulted in higher multiple birth rate, premature delivery rate and neonatal congenital malformation rate. Increased multiple birth rate was attributable to ovulation induction, and increased rate of low-birthweight infants was related to multiplets and premature delivery. Caesarean delivery was preferred in couples who received AID treatment. The male/female ratio of the AID offspring was similar between natural pregnancy and AID pregnancy. © 2016 Blackwell Verlag GmbH.

  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

  3. Neonatal status of twins

    Directory of Open Access Journals (Sweden)

    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.

  4. Utilization of International Association of Diabetes and Pregnancy Study Groups criteria vs. a two-step approach to screening for gestational diabetes mellitus in Chinese women with twin pregnancies.

    Science.gov (United States)

    Liu, X; Chen, Y; Zhou, Q; Shi, H; Cheng, W W

    2015-03-01

    To evaluate prevalence and pregnancy outcomes using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and screening protocol vs. a standard two-step screening approach for gestational diabetes mellitus in Chinese twin pregnancies. A retrospective cohort study for pregnancies during 2007-2013 was performed in a tertiary hospital in Shanghai, China. Data were abstracted from the medical records of twin pregnancies delivered at the hospital. During the period 2007-2011, this hospital used a two-step approach with a 50 g screening with a cut-off value of ≥ 7.8 mmol/l followed by a 100 g diagnostic oral glucose tolerance test (OGTT) utilizing Carpenter-Coustan criteria. In 2012-2013, the hospital switched to the IADPSG protocol of universal 75 g OGTT. Among 1461 twin pregnancies, 643 were screened utilizing IADPSG criteria and 818 using the two-step protocol. Gestational diabetes mellitus was diagnosed more frequently in the IADPSG group than in the two-step group [20.4% and 7.0%, respectively; adjusted odds ratio (aOR) = 3.22; 95% confidence interval (CI) = 2.30-4.52]. During the IADPSG period, the incidence of pre-eclampsia was 38% lower in non-gestational diabetes mellitus affected pregnancies compared with the two-step period (aOR = 0.62; 95% CI = 0.44-0.87). We observed no significant differences in most perinatal outcomes between the two groups. Compared with a standard two-step approach to screening and diagnosis, the IADPSG screening method resulted in a three-fold increase in the incidence of gestational diabetes mellitus in twin pregnancies, with a 38% lower risk of pre-eclampsia but no significant difference in most perinatal outcomes in non-gestational diabetes mellitus affected pregnancies. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

  5. Prenatal x-ray exposure and childhood cancer in twins

    International Nuclear Information System (INIS)

    Harvey, E.B.; Boice, J.D. Jr.; Honeyman, M.; Flannery, J.T.

    1985-01-01

    A case-control study was conducted to investigate the relation between prenatal exposure to x-rays and childhood cancer, including leukemia, in over 32,000 twins born in Connecticut from 1930 to 1969. Twins as opposed to single births were chosen for study to reduce the likelihood of medical selection bias, since twins were often exposed to x-rays to diagnose the twin pregnancy or to determine fetal positioning before delivery and not because of medical conditions that may conceivably pre-dispose to cancer. Each of 31 incident cases of cancer, identified by linking the Connecticut twin and tumor registries, was matched with four twin controls according to sex, year of birth, and race. Records of hospitals, radiologists, and private physicians were searched for histories of x-ray exposure and other potentially important risk factors. Documented prenatal x-ray exposures were found for 39 per cent of the cases (12 of 31) and for 26 per cent of the controls (28 of 109). No other pregnancy, delivery, or maternal conditions were associated with cancer risk except low birth weight: 38 per cent of the cases as compared with 25 per cent of the controls weighed under 2.27 kg at birth. When birth weight was adjusted for, twins in whom leukemia or other childhood cancer developed were twice as likely to have been exposed to x-rays in utero as twins who were free of disease (relative risk, 2.4; 95 per cent confidence interval, 1.0 to 5.9). The results, though based on small numbers, provide further evidence that low-dose prenatal irradiation may increase the risk of childhood cancer

  6. How to identify twins at low risk of spontaneous preterm delivery

    DEFF Research Database (Denmark)

    Sperling, Lene; Kiil, C; Larsen, L U

    2005-01-01

    OBJECTIVE: The aim of this study was to evaluate transvaginal sonographic assessment of cervical length at 23 weeks as a screening test for spontaneous preterm delivery in order to define a cut-off value that could be used to select twin pregnancies at low risk of spontaneous preterm delivery....... METHODS: In a prospective multicenter study of 383 twin pregnancies included before 14 + 6 weeks a cervical scan with measurement of the cervical length was performed at 23 weeks' gestation. The results were blinded for the clinicians if the cervical length was > or = 15 mm. The rates of spontaneous...... delivery at different cut-off levels of cervical length were determined. RESULTS: Eighty-nine percent of the twins had dichorionic placentation and 58% were conceived after assisted reproduction. The rate of spontaneous preterm delivery was 2.3% (1.5% for dichorionic (DC) and 9.1% for (MC) monochorionic...

  7. 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....

  8. Twin-twin transfusion syndrome.

    Science.gov (United States)

    Rossi, A C; D'addario, V

    2009-04-01

    Twin-twin transfusion syndrome (TTTS) is a condition unique to monochorionic pregnancies, although very few case reports described the syndrome in dichorionic placentas. The aetiology of TTTS relies in the presence of at least 1 arterio-venous placental anastomosis, through which unequal blood exchange from one twin (donor) to the co-twin (recipient) occurs. The diagnosis of TTTS relies on the sonographic detection of oligohydramnios in the donor's sac and polyhydramnios in the recipient's sac in the second trimester, although signs of TTTS are present since the first trimester. Treatment options for TTTS include serial amnioreduction, septostomy, selective feticide of the apparently sick twin, and selective photocoagulation of placental vessels (SLPCV). Because of the growing evidence that SLPCV is the most efficacious therapy compared to amnioreduction with/without septostomy, the authors reviewed in details the effects of SLPCV on fetal growth and circulation. The authors further explore literature with regard to the prognostic factors. Finally, because Quintero staging system is actually under debate, they discuss the most recent findings on this topic and propose a new staging system to assess severity of TTTS at presentation (Rossi staging system). New topics for future research, which would probably further clarify the natural history of TTTS, are also proposed.

  9. Twin Pregnancy with a Complete Hydatidiform Mole and a Coexisting Live Fetus; Rare entity

    Directory of Open Access Journals (Sweden)

    Shahila Sheik

    2015-11-01

    Full Text Available 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.

  10. 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.

  11. 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.

  12. Reproduction abnormalities and twin pregnancies in parents of sporadic patients with oculo-auriculo-vertebral spectrum/Goldenhar syndrome.

    NARCIS (Netherlands)

    Wieczorek, D.; Ludwig, M.; Boehringer, S.; Jongbloet, P.H.; Gillessen-Kaesbach, G.; Horsthemke, B.

    2007-01-01

    A great number of case reports on concordant and discordant twins with oculo-auriculo-vertebral spectrum (OAVS) suggest that there might be an association between reproductive abnormalities, twinning and OAVS. The etiology of OAVS is unknown, but may involve epigenetic dysregulation of the oocyte or

  13. The potential interaction between ewe body condition score and nutrition during very late pregnancy and lactation on the performance of twin-bearing ewes and their lambs

    Directory of Open Access Journals (Sweden)

    L. M. Cranston

    2017-09-01

    Full Text Available Objective The present study aimed to determine the impact of ewe body condition score (BCS (over a range of 2.0 to 3.0 and nutritional treatments (consisting of differing herbage masses during very late pregnancy and lactation and their potential interaction on the performance of twin-bearing ewes and their lambs to weaning. Methods On day 142 of pregnancy, twin-bearing ewes with a BCS of 2.0, 2.5, or 3.0 were allocated to a “Moderate’ or ‘Unrestricted’ nutritional treatment until day 95 of lactation (weaning. The nutritional treatments aimed to achieve average herbage masses of 1,200 to 1,300 kg dry matter (DM/ha (Moderate and 1,500 to 1,800 kg DM/ha (Unrestricted. Results There were no three-way interactions between ewe BCS group, nutritional treatment and time for any ewe or lamb parameter. The nutritional treatments had no effect (p>0.05 on lamb birth or weaning weight. Lambs born to Moderate ewes had greater survival and total litter weight at weaning (p1,200 kg DM/ha during very late pregnancy and lactation.

  14. The potential interaction between ewe body condition score and nutrition during very late pregnancy and lactation on the performance of twin-bearing ewes and their lambs.

    Science.gov (United States)

    Cranston, L M; Kenyon, P R; Corner-Thomas, R A; Morris, S T

    2017-09-01

    The present study aimed to determine the impact of ewe body condition score (BCS) (over a range of 2.0 to 3.0) and nutritional treatments (consisting of differing herbage masses) during very late pregnancy and lactation and their potential interaction on the performance of twin-bearing ewes and their lambs to weaning. On day 142 of pregnancy, twin-bearing ewes with a BCS of 2.0, 2.5, or 3.0 were allocated to a "Moderate' or 'Unrestricted' nutritional treatment until day 95 of lactation (weaning). The nutritional treatments aimed to achieve average herbage masses of 1,200 to 1,300 kg dry matter (DM)/ha (Moderate) and 1,500 to 1,800 kg DM/ha (Unrestricted). There were no three-way interactions between ewe BCS group, nutritional treatment and time for any ewe or lamb parameter. The nutritional treatments had no effect (p>0.05) on lamb birth or weaning weight. Lambs born to Moderate ewes had greater survival and total litter weight at weaning (p1,200 kg DM/ha during very late pregnancy and lactation.

  15. [An ongoing twin pregnancy after embryo time laps monitoring in a patient with a history of IVF failures--case report and literature review].

    Science.gov (United States)

    Radwan, Paweł; Krasiński, Rafał; Radwan, Michał; Połać, Ireneusz

    2014-04-01

    A standard assessment of embryo morphology at given time points does not always allow to transfer the embryo with the highest implantation potential. The effect of transfer of an improper embryo results in a lack of pregnancy or a miscarriage and, as a consequence, exposes the patient to unnecessary emotional stress and necessity to perform yet another transfer of frozen embryos. We present a case of a patient with earlier IVF failures. The use of time-lapse technique in this case helped to choose two good embryos. The transfer resulted in ongoing twin pregnancy. A 35-year-old woman with history of IVF-ET treatment failure was deemed eligible for an ICSI procedure because of the male factor. Ovarian stimulation was performed according to the agonist long protocol. Eight MII oocytes were fertilized and seven embryos were obtained. Continuous embryo monitoring was performed with the use of Primo Vision system. Forty-four hours after fertilization only 2 correctly developing embryos were identified. They were transferred on day 3. The development of the remaining 5 embryos was arrested. These embryos did not achieve the blastocyst stage on day 5-6 after fertilization. Forty days after embryo transfer a twin pregnancy, confirmed with fetal heart rate of both fetuses, was revealed on ultrasound examination. Currently the patient is at 27 weeks of ongoing twin gestation. The system of continuous embryo monitoring introduces new criteria for the examination of embryo development. These new parameters can be useful in clinical practice. However prospective randomized studies are necessary to provide data confirming the usefulness of time-lapse technique in IVF treatment.

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

    OpenAIRE

    Zhang, Changjun; Peng, Haiying; Hu, Yueyue

    2013-01-01

    A 24-year-old man was diagnosed with klinefelter’s syndrome (KS) and his wife was found to have an inversion on chromosome 9-46, XX, inv (9) (p11q21)- because of infertility. Intracytoplasmic sperm injection (ICSI) was performed for fertilization after fluorescence in-situ hybridization (FISH) was used to analyze the aneuploidy rate of the X and Y chromosomes of the ejaculated sperms of the patient, and 99 sperms were haploid among 100 sperms that were to be analyzed. A twin pregnancy was ach...

  17. 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.

  18. Ad libitum Pasture Feeding in Late Pregnancy Does Not Improve the Performance of Twin-bearing Ewes and Their Lambs

    Science.gov (United States)

    Corner-Thomas, R. A.; Back, P. J.; Kenyon, P. R.; Hickson, R. E.; Ridler, A. L.; Stafford, K. J.; Morris, S. T.

    2015-01-01

    The present study evaluated the effect of controlled ryegrass-white clover herbage availability from day 128 until day 142 of pregnancy in comparison to unrestricted availability, on the performance of twin-bearing ewes of varying body condition score (BCS; 2.0, 2.5, or 3.0) and their lambs. It was hypothesised that under conditions of controlled herbage availability, the performance of lambs born to ewes with a greater BCS would be greater than those born to ewes with a lower BCS. During the period that the nutritional regimens were imposed, the pre- and post-grazing herbage masses of the Control regimen (1,070±69 and 801±30 kg dry matter [DM]/ha) were lower than the ad libitum regimen (1,784±69 and 1,333±33 kg DM/ha; pewe live weight, BCS and back fat depth or on lamb live weight, indices of colostrum uptake, maximal heat production, total litter weight weaned or survival to weaning (p>0.05). The difference in ewe BCSs and back fats observed among body condition groups was maintained throughout pregnancy (pewes from the BCS2.0 group had lower BCS and live weight (2.4±0.2, 74.3±2.6 kg) than both the BCS2.5 (2.6±0.2, 78.6±2.4 kg) and BCS3.0 ewes (2.7±0.2, 79.0±2.6 kg; p0.05). Ewe BCS group had no effect on lamb live weight at birth or weaning or on maximal heat production (p>0.05). Serum gamma glutamyl transferase concentrations of lambs born to BCS3.0 ewes were higher within 36 hours of birth than lambs born to BCS2.0 ewes and BCS2.5 ewes (51.8±1.9 vs 46.5±1.9 and 45.6±1.9 IU/mL, respectively [pewe body condition on lamb plasma glucose concentration (p>0.05). Lamb survival was the only lamb parameter that showed an interaction between ewe nutritional regimen and ewe BCS whereby survival of lambs born to BCS2.5 and BCS3.0 ewes differed but only within the Control nutritional regimen ewes (pewes with pre- and post-grazing ryegrass-white clover herbage covers of approximately 1,100 and 800 kg DM/ha in late pregnancy, provided that herbage covers are 1400

  19. Spontaneous uterine cornual rupture at 26 weeks' gestation in an interstitial heterotopic pregnancy following in vitro fertilization.

    Science.gov (United States)

    Paradise, Courtney; Carlan, S J; Holloman, Conisha

    2016-06-01

    Interstitial implantation in a heterotopic pregnancy is extremely rare, and despite currently available diagnostic modalities, early identification of an interstitial ectopic pregnancy remains difficult. This report describes a case of spontaneous cornual rupture at 26 weeks' gestation in a woman with diamniotic dichorionic twins that resulted in live births. The patient had previously undergone laparoscopic bilateral salpingectomy, and the pregnancy was conceived with in vitro fertilization. Interstitial implantation in a heterotopic pregnancy can go unrecognized, resulting in increased maternal and infant morbidity and mortality. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:322-325, 2016. © 2015 Wiley Periodicals, Inc.

  20. Twin pregnancy complicated by severe hemolytic disease of the fetus and newborn due to anti-g and anti-C.

    Science.gov (United States)

    Trevett, Thomas N; Moise, Kenneth J

    2005-11-01

    Hemolytic disease of the fetus and newborn caused by anti-G antibodies is rare, and in most previously reported cases, leads to a mild anemia. The RhG antigen is usually found in association with both RhD and RhC. We report a case of a twin pregnancy affected by both anti-G and anti-C alloantibodies leading to severe hemolytic disease of the fetus and newborn requiring multiple intrauterine transfusions and prolonged postnatal therapy. A patient with a prolonged history of previously affected pregnancies due to anti-D and anti-C was subsequently found to be affected with anti-G instead. She required aggressive therapy during her pregnancy, initially with intravenous immune globulin and plasmapheresis until umbilical blood sampling and intrauterine transfusions were feasible. Although hemolytic disease of the fetus and newborn due to anti-G antibodies is rare and usually mild, these pregnancies should be followed up closely and in utero therapy should be offered if necessary.

  1. Placental transfer of IgG antibodies specific to Klebsiella and Pseudomonas LPS and to group B Streptococcus in twin pregnancies.

    Science.gov (United States)

    Stach, S C L; Brizot, M L; Liao, A W; Palmeira, P; Francisco, R P V; Carneiro-Sampaio, M M S; Zugaib, M

    2015-02-01

    Group B Streptococcus (GBS), Klebsiella spp. and Pseudomonas spp. are important aetiological agents of neonatal infections in Brazil. There is a lack of data in the literature regarding the specific transport of immunoglobulin G (IgG) against these pathogens in multiple pregnancies. Maternal (n = 55) and umbilical cord (n = 110) blood samples were prospectively collected at birth from 55 twin pregnancies. The factors associated with cord levels and transfer ratios of IgG against GBS, Klebsiella and Pseudomonas were examined. The IgG umbilical cord serum levels specific to GBS, Klebsiella LPS and Pseudomonas LPS were significantly associated with maternal-specific IgG concentrations and the presence of diabetes. The anti-Klebsiella IgG cord serum concentrations were also related to birthweight and the presence of hypertension. The transfer ratios against GBS and Pseudomonas LPS were associated with maternal-specific IgG concentrations. The transfer ratios for GBS and Pseudomonas LPS were associated with gestational age at delivery and the presence of diabetes, respectively. None of the examined parameters were related to Klebsiella LPS transfer ratios. We conclude that in twin pregnancies, specific maternal IgG serum concentrations and diabetes were the parameters associated with umbilical cord serum IgG concentrations reactive with the three pathogens investigated. All the other parameters investigated showed different associations with neonatal-specific IgG levels according to the antigen studied. There was no uniformity of the investigated parameters regarding association with placental IgG transfer ratios against the GBS, Pseudomonas LPS and Klebsiella LPS. © 2014 John Wiley & Sons Ltd.

  2. Mothers of IVF twins: the mediating role of employment and social coping resources in maternal stress.

    Science.gov (United States)

    Baor, Liora; Soskolne, Varda

    2012-01-01

    Twin pregnancies and births resulting from assisted reproductive technologies have been associated with adverse perinatal outcomes and maternal health complications leading to psychologically complex parenting. In the current study the authors assess the prevalence of clinical levels of maternal stress among mothers of twins resulting from in vitro fertilization and examine the association of social coping resources with three maternal stress sub-scales. During the years 2003-2005, 88 primiparous Israeli mothers of in vitro fertilization-conceived twins provided socio-demographic data during their third trimester of pregnancy, and at 6 months after birth provided data on delivery and medical condition of infants, coping resources (social support and marital quality), and a maternal stress scale. Forty-one percent of the mothers reached a clinically significant level of maternal stress. Social support and maternal employment were the most significant variables associated with experience of the stress in the early stages of adaptation to mothering in vitro fertilization twins. Primiparous mothers of in vitro fertilization twins are vulnerable to maternal stress in early stages of adaptation to the maternal role, some of whom reach clinical levels that may require professional interventions. Unemployed mothers with low social support were the most susceptible to the deleterious effects of in vitro fertilization treatment.

  3. 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

    biopsies. The main outcomes measures were PTB (PTB ≤ 37 + 0 gestational weeks), very preterm birth (VPTB ≤ 32 + 0 gestational weeks) and preterm premature rupture of membranes (PPROM). PARTICIPANTS/MATERIALS, SETTING, METHODS: In all 16 923 ART singletons and 4829 ART twin deliveries were included...

  4. 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.

  5. 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

  6. 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

  7. The effects of pasture availability for twin- and triplet-bearing ewes in mid and late pregnancy on ewe and lamb behaviour 12 to 24 h after birth.

    Science.gov (United States)

    Corner, R A; Kenyon, P R; Stafford, K J; West, D M; Morris, S T; Oliver, M H

    2010-01-01

    This experiment was conducted to evaluate the effect of offering ewes two different feeding levels, during mid and late pregnancy, on ewe and lamb behaviour 12 to 24 h after birth. Romney ewes, bearing twin (n = 80) or triplet foetuses (n = 56), were allocated to a pasture sward height of 2 or 4 cm between 70 and 107 days of pregnancy. In late pregnancy (day 107 to 147), half of the ewes were reallocated the alternate sward height, which produced four treatments: 2-2, 2-4, 4-2 and 4-4. Ewes were weighed on days 65, 92, 107 and 130 of pregnancy and lamb live weights were recorded 12 to 24 h after birth. Twelve to 24 h after birth the maternal behaviour score (MBS) of the ewes were determined, whilst their lambs were tagged. After the lambs were released, the behaviour of each ewe and her lambs was observed for 5 min. Ewe treatment and litter size had no effect on ewe MBS. However, as MBS increased (ewes stayed closer to lambs during tagging), ewes bleated less in a high-pitch and were quicker to make contact with their lamb. During the observation period, ewes in the 4-4 treatment had a greater percentage of their bleats in a low pitch (P ewes in the 2-2 and 4-2 treatment (61.3% v. 41.3% and 38.8% low bleats, respectively) and more lambs born to 4-4 ewes (95%) bleated than lambs born to 2-2 ewes (84%; P ewes in the 2-2 treatment bleated earlier than lambs in all other treatments (P ewes were less likely (P ewes (3.1% v. 16.9% and 16.7%, respectively). These findings suggest that under the conditions of the present study, ewe nutrition had little effect on maternal behaviour. However, lambs born to ewes offered 2 cm pasture sward heights during mid and/or late pregnancy (2-2, 2-4 and 4-2 treatments) displayed behaviour that demonstrated greater 'need' whereas lambs born to ewes offered 4 cm during mid and late pregnancy sought less attention from their dam.

  8. First-trimester diagnosis of conjoined twins

    NARCIS (Netherlands)

    Pajkrt, Eva; Jauniaux, Eric

    2005-01-01

    Conjoined twins are a rare and complex complication of monozygotic twinning, which is associated with high perinatal mortality. Early prenatal diagnosis of conjoined twins allows better counselling of the parents regarding the management options, including continuation of pregnancy with post-natal

  9. 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.

  10. 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.

  11. FAQs of Pregnancy Loss and Miscarriage

    Science.gov (United States)

    ... 2016). Trying to conceive soon after a pregnancy loss may increase chances of live birth. Retrieved July 24, 2017, from ... Release: Elevated blood pressure before pregnancy may increase chance of pregnancy loss Media Advisory: Air pollution exposure in early pregnancy ...

  12. Growth curves for twins in Slovenia.

    Science.gov (United States)

    Bricelj, Katja; Blickstein, Isaac; Bržan-Šimenc, Gabrijela; Janša, Vid; Lučovnik, Miha; Verdenik, Ivan; Trojner-Bregar, Andreja; Tul, Nataša

    2017-02-01

    Abnormalities of fetal growth are more common in twins. We introduce the growth curves for monitoring fetal growth in twin pregnancies in Slovenia. Slovenian National Perinatal Information System for the period between 2002 and 2010 was used to calculate birth weight percentiles for all live born twins for each week from 22nd to 40th week. The calculated percentiles of birth weight for all live-born twins in Slovenia served as the basis for drawing 'growth' curves. The calculated growth curves for twins will help accurately diagnose small or large twin fetuses for their gestational age in the native central European population.

  13. Acardiac acephalus twin: A case report | Bukar | Tropical Journal of ...

    African Journals Online (AJOL)

    Acardiac acephalus twin is a rare complication of monochorionic twinning. A case of a 26year old who presented to the emergency unit of the University of Maiduguri Teaching Hospital [UMTH] with ultrasound report of non viable but morphologically normal twin pregnancy is presented. She was delivered of a twin still born; ...

  14. What kind of twins were Jacob and Esau?

    African Journals Online (AJOL)

    common (or uncommon) then as it is now, the incidence of twins today being once in every 80 pregnancies, with dizygotic twins occurring three times more frequently than monozygotic twins.' The Bible probably only refers to these two particular cases of twin deliveries because they were exceptional: the first deliVery ...

  15. Twin reversed arterial perfusion sequence is more common than generally accepted

    NARCIS (Netherlands)

    Gemert, M.J. van; Wijngaard, J.P. van den; Vandenbussche, F.P.H.A.

    2015-01-01

    BACKGROUND: Approximately 75% of monozygotic twin pregnancies share one monochorionic placenta where placental anastomoses are virtually always present to connect the two fetoplacental circulations. These anastomoses cause several serious complications such as acardiac twinning. Acardiac twins lack

  16. Twin reversed arterial perfusion sequence is more common than generally accepted

    NARCIS (Netherlands)

    van Gemert, Martin J. C.; van den Wijngaard, Jeroen P. H. M.; Vandenbussche, Frank P. H. A.

    2015-01-01

    Approximately 75% of monozygotic twin pregnancies share one monochorionic placenta where placental anastomoses are virtually always present to connect the two fetoplacental circulations. These anastomoses cause several serious complications such as acardiac twinning. Acardiac twins lack a functional

  17. [Acardiac headless twin: a case report and review of the literature].

    Science.gov (United States)

    Boufettal, H; Noun, M; Hermas, S; Samouh, N

    2010-03-01

    Monochorial twin pregnancies are characterised by the presence of vascular connections between the twins. These connections can be the cause of pathologies such as the twin-twin transfusion syndrome or the TRAP syndrome, which is defined as the association of a headless, acardiac twin with a healthy twin. The case of an acardiac, headless twin diagnosed during pregnancy at 24 weeks of amenorrhea is described. An acardiac headless twin is a rare phenomenon. Yet early diagnosis is crucial during pregnancy to provide adequate monitoring. It is associated with a high death rate in the healthy twin caused by anaemia and heart failure. Therapeutic resources involve interruption of vascular anostomoses between the twins in order to perform a selective feticide. Treatment of acardiac headless twin pregnancy ranges from obstetric abstentionism to interventionism, which depends on the prognosis for the healthy twin, dominated by the risk of preterm birth and heart failure. Copyright 2009. Published by Elsevier SAS.

  18. Effect of maternal height and weight on risk of preterm birth in singleton and twin births resulting from in vitro fertilization: a retrospective cohort study using the Society for Assisted Reproductive Technology Clinic Outcome Reporting System.

    Science.gov (United States)

    Dickey, Richard P; Xiong, Xu; Gee, Rebekah E; Pridjian, Gabriella

    2012-02-01

    To examine the effect of height, weight, and body mass index (BMI) on the risk of preterm birth of singleton and twin pregnancies conceived by vitro fertilization (IVF). Retrospective cohort study using 2006-2008 data from the Society for Reproductive Technology Clinic Outcome Reporting System (SART CORS). SART-associated assisted reproductive technology programs. 56,556 singleton and 23,804 twin live births resulting from fresh nondonor IVF cycles. None. Rates of very early preterm (VEPTB; risk of preterm birth. Maternal overweight and obesity were associated with significantly increased risk of VEPTB and VPTB in twin pregnancies. For very obese women (BMI > 35 kg/m(2)) twins were associated with a threefold increased risk of VEPTB (6.1% vs. 2.0%) and a twofold increased risk of VPTB (11.5% vs. 5.9%) compared with women of normal weight (BMI 18.4-24.9 kg/m(2)). Obesity and short stature significantly increase the risk of VEPTB and VPTB in twins conceived by IVF. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  19. The effect of polyhydramnios on cervical length in twins: a controlled intervention study in complicated monochorionic pregnancies.

    Science.gov (United States)

    Engineer, Neelam; O'Donoghue, Keelin; Wimalasundera, Ruwan C; Fisk, Nicholas M

    2008-01-01

    To test the hypothesis that cervical shortening in polyhydramnios reflects the degree of excess amniotic fluid, and increases with normalisation of amniotic fluid volume. Prospective cohort study of 40 women with monochorionic twins undergoing interventional procedures between 16-26 weeks. Cervical length was assessed via transvaginal sonography pre-procedure, 1 and 24 hours post-procedure, and results compared between amnioreduction and control procedures. Amniotic fluid index (AFI) was measured pre- and post-procedure. Pre-procedural cervical length correlated with AFI (linear fit = 5.07 -0.04x, R(2) = 0.17, P = 0.03) in patients with polyhydramnios (n = 28). Drainage of 2000 ml fluid (range 700-3500 ml), reduced AFI from 42 cm to 21 cm (Ppolyhydramnios does not appear to be an acute process; cervical length can be measured before or after therapeutic procedures.

  20. 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

  1. On Maternal Attitude toward Young Children Conceived through in Vitro Fertilization

    Directory of Open Access Journals (Sweden)

    Solovyova E.V.,

    2015-02-01

    Full Text Available We present the results of a comparative study of maternal attitudes towards young children (11-37 months in 135 dyads (cases of spontaneous conception and 135 dyads (children conceived through in vitro fertilization - IVF. Data were collected in 2011-2012 in Center for Family Planning and Reproduction, Moscow, using the following techniques: questionnaire for mothers by M.E. Lantsburg, technique "Parental estimates of children" (M.E. Lantsburg modification of Dembo-Rubinstein techniques, medical history data. It has been shown that women who conceive through IVF, compared with those who conceived spontaneously, more often ignore the baby movements during pregnancy, and child birth often has a significant impact on the change in their lives. The mothers who conceived spontaneously have more realistic expectations about the actual possibilities and abilities of their children; mothers who conceived through IVF, often place inappropriate to their age requirements to the children and have higher expectations of their children

  2. 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....

  3. 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.)

  4. VACTERL association with hydrocephalus in a fetus conceived by in vitro fertilization and embryo transfer

    Directory of Open Access Journals (Sweden)

    Chih-Ping Chen

    2013-12-01

    Conclusion: Prenatal diagnosis of radial ray defects in fetuses conceived by assisted reproductive technology should include a differential diagnosis of VACTERL association with anorectal malformation. VACTERL-H may occur in pregnancy after IVF-ET.

  5. 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....

  6. Therapeutic modalities of twin to twin transfusion syndrome

    Directory of Open Access Journals (Sweden)

    Šulović N.

    2015-01-01

    Full Text Available Twin to twin transfusion syndrome (TTTTS accounts for approximately 10% of monochorionic twin pregnancies and, if left untreated, is associated with high morbidity and mortality rate. A net transfusion of blood flow from one fetus (donor twin to the other (recipient twin via placental vascular anastomoses has been supposed as the major etiology of TTTTS. The donor twin becomes hypovolemic and oliguria, oligohydramnios, and a variable degree of growth restriction develop, whereas the recipient twin manifests polyuria, polyhydramnios, and hydrops in response to hypervolemia. TTTTS can be treated by either serial amniocentesis or selective fetoscopic laser coagulation of the communicating vessels. The rationale for removal of large volumes of amniotic fluid is to prevent preterm delivery secondary to polyhydramnios and to improve fetal circulation by reducing pressure on the chorionic plate. On the other hand, the goal of laser therapy is to occlude vascular anastomoses, thereby interrupting intertwin blood exchange. Although laser treatment is associated with increased survival rate and reduced neurologic complications, compared with amnioreduction, it requires highly specialized centers, whereas serial amniocentesis has the advantage of being performed worldwide. Therefore, the optimal treatment for pregnancies complicated with TTTTS is still controversial.

  7. Pregnancy

    Science.gov (United States)

    ... Research Information Find a Study Resources and Publications Reading and Reading Disorders Condition Information NICHD Research Information Find a ... Medicine. (2013; Reaffirmed 2015). Committee Opinion No. 579. Definition of term pregnancy. Retrieved May 20, 2016, from ...

  8. Risk of hypertensive disorders in pregnancies following assisted reproductive technology: a cohort study from the CoNARTaS group.

    Science.gov (United States)

    Opdahl, S; Henningsen, A A; Tiitinen, A; Bergh, C; Pinborg, A; Romundstad, P R; Wennerholm, U B; Gissler, M; Skjærven, R; Romundstad, L B

    2015-07-01

    Is the risk of hypertensive disorders in pregnancies conceived following specific assisted reproductive technology (ART) procedures different from the risk in spontaneously conceived (SC) pregnancies? ART pregnancies had a higher risk of hypertensive disorders, in particular following cryopreservation, with the highest risk seen in twin pregnancies following frozen-thawed cycles. The risk of hypertensive disorders is higher in ART pregnancies than in SC pregnancies. The increased risk may be partly explained by multiple pregnancies and underlying infertility, but a contribution from specific ART procedures has not been excluded. Population-based cohort study, including sibling design with nationwide data from health registers in Sweden, Denmark and Norway. All registered ART pregnancies and a sample of SC pregnancies with gestational age ≥22 weeks from 1988 to 2007 were included. ART singleton pregnancies (n = 47 088) were compared with SC singleton pregnancies (n = 268 599), matched on parity and birth year. ART twin pregnancies (n = 10 918) were compared with SC twin pregnancies (46 674). We used logistic regression to estimate adjusted odds ratios and risk differences for hypertensive disorders in pregnancies following IVF, ICSI and fresh or frozen-thawed cycles. We also compared fresh and frozen-thawed cycles within mothers who had conceived following both procedures using conditional logistic regression (sibling analysis). Hypertensive disorders were reported in 5.9% of ART singleton and 12.6% of ART twin pregnancies. Comparing singleton pregnancies, the risk of hypertensive disorders was higher after all ART procedures. The highest risk in singleton pregnancies was seen after frozen-thawed cycles [risk 7.0%, risk difference 1.8%, 95% confidence interval (CI) 1.2-2.8]. Comparing twin pregnancies, the risk was higher after frozen-thawed cycles (risk 19.6%, risk difference 5.1%, 95% CI 3.0-7.1), but not after fresh cycles. In siblings, the risk was higher

  9. 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.

  10. 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.

  11. Lower perinatal mortality in preterm born twins than in singletons: a nationwide study from The Netherlands.

    Science.gov (United States)

    Vasak, Blanka; Verhagen, Jessica J; Koenen, Steven V; Koster, Maria P H; de Reu, Paul A O M; Franx, Arie; Nijhuis, Jan G; Bonsel, Gouke J; Visser, Gerard H A

    2017-02-01

    Twin pregnancies are at increased risk for perinatal morbidity and death because of many factors that include a high incidence of preterm delivery. Compared with singleton pregnancies, overall perinatal risk of death is higher in twin pregnancies; however, for the preterm period, the perinatal mortality rate has been reported to be lower in twins. The purpose of this study was to compare perinatal mortality rates in relation to gestational age at birth between singleton and twin pregnancies, taking into account socioeconomic status, fetal sex, and parity. We studied perinatal mortality rates according to gestational age at birth in 1,502,120 singletons pregnancies and 51,658 twin pregnancies without congenital malformations who were delivered between 2002 and 2010 after 28 weeks of gestation. Data were collected from the nationwide Netherlands Perinatal Registry. Overall the perinatal mortality rate in twin pregnancies (6.6/1000 infants) was higher than in singleton pregnancies (4.1/1000 infants). However, in the preterm period, the perinatal mortality rate in twin pregnancies was substantially lower than in singleton pregnancies (10.4 per 1000 infants as compared with 34.5 per 1000 infants, respectively) for infants who were born at <37 weeks of gestation; this held especially for antepartum deaths. After 39 weeks of gestation, the perinatal mortality rate was higher in twin pregnancies. Differences in parity, fetal sex, and socioeconomic status did not explain the observed differences in outcome. Overall the perinatal mortality rate was higher in twin pregnancies than in singleton pregnancies, which is most likely caused by the high preterm birth rate in twins and not by a higher mortality rate for gestation, apart from term pregnancies. During the preterm period, the antepartum mortality rate was much lower in twin pregnancies than in singleton pregnancies. We suggest that this might be partially due to a closer monitoring of twin pregnancies, which indirectly

  12. to-twin transfusion after fetoscopic laser surgery

    African Journals Online (AJOL)

    c and Caroline C. Hulsker a. Twin-to-twin transfusion syndrome (TTTS) occurs in 10% of monochorionic twin pregnancies, and can lead to a variety of complications due to imbalanced blood flow across placental vascular communications. In this report, we describe a case of intestinal injury in TTTS after fetoscopic.

  13. 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...... of the outcomes, since small apparent effects might be explicable in terms of chance, bias, or confounding, while larger and better studies yield lower estimated risks compared with smaller and weaker studies. In general, patients can be reassured that such work is associated with little, if any, adverse effect...... 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....

  14. Perinatal Complications of Twin Deliveries at Jimma University ...

    African Journals Online (AJOL)

    Twin pregnancy carries higher foetal and neonatal complications. This situation is worse in Sub-Saharan Africa due to lack of well-equipped facilities. Studies on twin pregnancy and its perinatal complications are limited in Ethiopia. Thus, this study aimed to fill this gap. A hospital-based cohort study was conducted in Jimma ...

  15. Conjoined Twins

    Science.gov (United States)

    ... individuals. Eight to 12 days after conception, the embryonic layers that will split to form monozygotic twins begin to develop into specific organs and structures. It's believed that when the embryo ...

  16. Severe twin-to-twin transfusion syndrome in a scared uterus ...

    African Journals Online (AJOL)

    Background: Twin-to-twin transfusion syndrome (TTTS) is a vascular abnormality unique to monochorionic pregnancies. The associated polyhydramniosportends significant risk to uterine rupture especially in a scared uterus. Serial amnioreduction is an established technique that reduces the risks of severe polyhydramnios ...

  17. IVF for premature ovarian failure: first reported births using oocytes donated from a twin sister.

    LENUS (Irish Health Repository)

    Sills, Eric Scott

    2010-01-01

    BACKGROUND: Premature ovarian failure (POF) remains a clinically challenging entity because in vitro fertilisation (IVF) with donor oocytes is currently the only treatment known to be effective. METHODS: A 33 year-old nulligravid patient with a normal karyotype was diagnosed with POF; she had a history of failed fertility treatments and had an elevated serum FSH (42 mIU\\/ml). Oocytes donated by her dizygotic twin sister were used for IVF. The donor had already completed a successful pregnancy herself and subsequently produced a total of 10 oocytes after a combined FSH\\/LH superovulation regime. These eggs were fertilised with sperm from the recipient\\'s husband via intracytoplasmic injection and two fresh embryos were transferred to the recipient on day three. RESULTS: A healthy twin pregnancy resulted from IVF; two boys were delivered by caesarean section at 39 weeks\\' gestation. Additionally, four embryos were cryopreserved for the recipient\\'s future use. The sister-donor achieved another natural pregnancy six months after oocyte retrieval, resulting in a healthy singleton delivery. CONCLUSION: POF is believed to affect approximately 1% of reproductive age females, and POF patients with a sister who can be an oocyte donor for IVF are rare. Most such IVF patients will conceive from treatment using oocytes from an anonymous oocyte donor. This is the first report of births following sister-donor oocyte IVF in Ireland. Indeed, while sister-donor IVF has been successfully undertaken by IVF units elsewhere, this is the only known case where oocyte donation involved twin sisters. As with all types of donor gamete therapy, pre-treatment counselling is important in the circumstance of sister oocyte donation.

  18. IVF for premature ovarian failure: first reported births using oocytes donated from a twin sister

    Directory of Open Access Journals (Sweden)

    Sills Eric

    2010-03-01

    Full Text Available Abstract Background Premature ovarian failure (POF remains a clinically challenging entity because in vitro fertilisation (IVF with donor oocytes is currently the only treatment known to be effective. Methods A 33 year-old nulligravid patient with a normal karyotype was diagnosed with POF; she had a history of failed fertility treatments and had an elevated serum FSH (42 mIU/ml. Oocytes donated by her dizygotic twin sister were used for IVF. The donor had already completed a successful pregnancy herself and subsequently produced a total of 10 oocytes after a combined FSH/LH superovulation regime. These eggs were fertilised with sperm from the recipient's husband via intracytoplasmic injection and two fresh embryos were transferred to the recipient on day three. Results A healthy twin pregnancy resulted from IVF; two boys were delivered by caesarean section at 39 weeks' gestation. Additionally, four embryos were cryopreserved for the recipient's future use. The sister-donor achieved another natural pregnancy six months after oocyte retrieval, resulting in a healthy singleton delivery. Conclusion POF is believed to affect approximately 1% of reproductive age females, and POF patients with a sister who can be an oocyte donor for IVF are rare. Most such IVF patients will conceive from treatment using oocytes from an anonymous oocyte donor. This is the first report of births following sister-donor oocyte IVF in Ireland. Indeed, while sister-donor IVF has been successfully undertaken by IVF units elsewhere, this is the only known case where oocyte donation involved twin sisters. As with all types of donor gamete therapy, pre-treatment counselling is important in the circumstance of sister oocyte donation.

  19. Ectopic pregnancy after infertility treatment

    Directory of Open Access Journals (Sweden)

    Madhuri Patil

    2012-01-01

    Full Text Available Early pregnancy complications are more common in women who conceive after infertility treatment. Most of these occur before 12 weeks of gestation and include miscarriage, vaginal bleeding, intrauterine hematoma, vanishing twin, and ectopic pregnancy (EP. The incidence of EPs following infertility treatment is much higher compared with that in spontaneous pregnancies. The occurrence of an EP is very distressing to an infertile couple, who has lots of hopes pinned on the treatment outcome, especially because of the cost incurred and the physical and mental trauma both have gone through during the treatment process. The association between infertility and EP is complex, as it can be a consequence of infertility as well as a cause. The two principal risk factors for an EP are genital tract infections and tubal surgeries. Though several etiologies are proposed, but patients with tubal factor infertility are at an increased risk of an EP. Earlier diagnosis of EP helps to improve prognosis and optimize subsequent fertility. It is pivotal to evaluate the likelihood of subsequent occurrence of an EP and be too vigilant when treating. The correct choice of the treatment modality should be made to prevent the recurrence. The early prediction of the pregnancy outcome therefore has great importance for both the couple and clinician. Today with the help of sensitive beta human chorionic gonadotropin (β-hCG assays and transvaginal sonography, one can diagnose an EP prior to symptoms, and conservative treatment for the preservation of the fallopian tube is possible. Conservative management in the form of expectant and medical management should be considered as a first-line treatment modality, provided that the overall clinical picture suggests that it is safe to do so. If not, laparoscopic management of EPs appears to be the favored approach of management as compared to laparotomy.

  20. Ergonomics issues in conceiving an accessible project.

    Science.gov (United States)

    Costa, A L; Coura, P V; Gomes, M M A; Peregrino, Y R; Sarmento, B R; Sousa, R A

    2012-01-01

    Public space is endowed with undeniable social relevance, thus becoming a defining element of integration and interaction among its users. Aware of this importance the Universidade Federal da Paraíba (UFPB), linked to the Ministério da Educação e Cultura (MEC), develops the project "UFPB para todos: eliminando barreiras'' (UFPB for all: removing barriers) that aims to conceive an architectural design of an accessible rout to UFPB's campus I, and execute a pilot stretch of this route. This article aims to subsidize the preprojectual phase by understanding the needs of this campus' users, through the concepts of ergonomics and universal design. Was performed out direct observation of the space, and the methods of interviews and observation of user behavior were applied to a group of students with disabilities, through the techniques of assisted walking, photographic and video recording. Based on those, projective guidelines have been defined, which will contribute to the final project's quality, so that this is not a simple application of the rule, but works free of segregating barriers.

  1. Screening and Invasive Testing in Twins

    Directory of Open Access Journals (Sweden)

    Giovanni Monni

    2014-07-01

    Full Text Available Prenatal screening and testing for trisomy 21 in twin pregnancies poses a number of challenges: the exact estimate of the a priori risk of trisomy 21, the choice of prenatal screening test and/or invasive techniques to employ for the diagnosis and the impact of the result on the options of treatment in case of discordant results within a twin pair or among multiples. These different aspects are discussed below while recognizing that many issues remain unresolved.

  2. The Gamble of Reproduction: Conceiving Ada’s Queer Temporalities

    Directory of Open Access Journals (Sweden)

    Sam McBean

    2014-01-01

    Full Text Available This paper will consider the relationship between the body, reproduction, and feminist history in Lynn Hershman Leeson's 1997 film Conceiving Ada. The film focuses on contemporary computer scientist Emmy's attempt to save Ada, Countess of Lovelace, from being forgotten from history. The main threat to both Ada and Emmy's work is their respective pregnancies and thus the film at first seems to represent the female body's biological reproduction as antagonistic to the (desired reproduction of feminist history. In a move that resonates with cyberfeminist theory, it is computer technology that enables Emmy to perfectly reproduce Ada's memories in the present. However, despite this seeming turn to digital reproduction, I argue that the film resists turning away from the female reproductive body. Instead, through Emmy's work to recover Ada, the film explores the pregnant body as a queer transmitter of history. Through the metaphor of 'gambling', the film explores the uneven temporalities of genetic inheritance, considering how inheritance is always tied to the past yet never entirely determined by this past. The 'gamble of reproduction' pushes queer temporality theory in its representation of the pregnant body while also offering a model of reproduction which is neither a barrier to feminist history nor a guarantee that the past can be copied perfectly into the future.

  3. Nutritional and Weight-Management Behaviors in Low-Income Women Trying to Conceive

    Science.gov (United States)

    Berenson, Abbey B.; Pohlmeier, Ali M.; Laz, Tabassum H.; Rahman, Mahbubur; McGrath, Christine J.

    2014-01-01

    Objective To evaluate the nutritional habits and weight management strategies of women trying to conceive as compared to women not trying to conceive. Methods This was a cross-sectional survey of health behaviors including nutritional habits and weight management strategies of women aged 16–40 years who were low-income, racially diverse, (n=1,711) and attending reproductive health clinics. Multivariable logistic regression analyses were performed to examine the association between pregnancy intention and various health behaviors after adjusting for demographic variables, gravidity, and obesity status. Results At total of 8.9% (n=153) of the participants stated they were trying to get pregnant. Women trying to conceive were more likely than those not trying to have participated in a number of unhealthy weight loss practices in the past year. These included taking diet pills, supplements or herbs (13.5% vs. 8.8%; adjusted odds ratio (aOR) 1.97, 95% confidence interval (CI) 1.11–3.49;), using laxatives or diuretics or inducing vomiting (7.7% vs. 3.0%; aOR 2.70, CI 1.23–5.91;), and fasting for 24 hours (10.7% vs. 5.5%; aOR 2.15, CI 1.03–4.51;). There were no significant differences between the two groups in amount of exercise, current smoking status or current alcohol consumption Further, fruit, green salad and other vegetables, and intake of soda and fast food were unrelated to pregnancy intention. Conclusion This study highlights that women trying to conceive are more likely to participate in unhealthy and potentially dangerous weight loss practices than women not trying to conceive. PMID:25162259

  4. Nutritional and weight management behaviors in low-income women trying to conceive.

    Science.gov (United States)

    Berenson, Abbey B; Pohlmeier, Ali M; Laz, Tabassum H; Rahman, Mahbubur; McGrath, Christine J

    2014-09-01

    To evaluate the nutritional habits and weight management strategies of women trying to conceive as compared with women not trying to conceive. This was a cross-sectional survey of health behaviors including nutritional habits and weight management strategies of women aged 16-40 years who were low income, racially diverse, (n=1,711), and attending reproductive health clinics. Multivariable logistic regression analyses were performed to examine the association between pregnancy intention and various health behaviors after adjusting for demographic variables, gravidity, and obesity status. A total of 8.9% (n=153) of the participants stated they were trying to get pregnant. Women trying to conceive were more likely than those not trying to have participated in a number of unhealthy weight loss practices in the past year. These included taking diet pills, supplements, or herbs (13.5% compared with 8.8%; adjusted odds ratio [OR] 1.97, 95% confidence interval [CI] 1.11-3.49), using laxatives or diuretics or inducing vomiting (7.7% compared with 3.0%; adjusted OR 2.70, CI 1.23-5.91), and fasting for 24 hours (10.7% compared with 5.5%; adjusted OR 2.15, CI 1.03-4.51). There were no significant differences between the two groups in amount of exercise, current smoking status, or current alcohol consumption Furthermore, fruit, green salad and other vegetables, and intake of soda and fast food were unrelated to pregnancy intention. This study highlights that women trying to conceive are more likely to participate in unhealthy and potentially dangerous weight loss practices than women not trying to conceive. II.

  5. Undiagnosed xiphopagus twins: a perinatal malady

    Directory of Open Access Journals (Sweden)

    Gowri Dorairajan

    2012-02-01

    Full Text Available Conjoined twins are a very rare entity. It is associated with poor survival rate in the presence of vital organ sharing. The entity can be diagnosed as early as the first trimester. A conjoined twin diagnosed late in labor is a malady with high perinatal mortality and maternal morbidity. We present one such case of xiphopagus twins. The management of a case diagnosed late in labor can be very challenging. Such obstetric challenges can be avoided by a meticulous early scan with a high index of suspicion, especially in the absence of separating membrane while scanning multiple pregnancies.

  6. Conjoined omphalopagus twins: a casereport

    Directory of Open Access Journals (Sweden)

    Sheila Yadira Gómez-Murillo

    2014-11-01

    Full Text Available Multiple pregnancies are 3% of the total. The most frequent are dizygotic females, however, a small group of them are of monozygotic conjoined twins in some anatomical area. This attracts the attention of physicians because of the rarity of the condition and the difficulties as well as the ethical dilemmas for their treatment. We report a case of male Siamese omphalopagus. They were separated surgically at seven weeks of age. One of them lived six months.

  7. Conjoined twins – role of imaging and recent advances

    Directory of Open Access Journals (Sweden)

    Rishi Philip Mathew

    2017-12-01

    Full Text Available Introduction: Conjoined twins are identical twins with fused bodies, joined in utero. They are rare complications of monochorionic twinning. The purpose of this study is to describe the various types of conjoined twins, the role of imaging and recent advances aiding in their management. Material and methods: This was a twin institutional study involving 3 cases of conjoined twins diagnosed over a period of 6 years from 2010 to 2015. All the 3 cases were identified antenatally by ultrasound. Only one case was further evaluated by MRI. Results: Three cases of conjoined twins (cephalopagus, thoracopagus and omphalopagus were accurately diagnosed on antenatal ultrasound. After detailed counseling of the parents and obtaining written consent, all the three cases of pregnancy were terminated. Delivery of the viable conjoined twins was achieved without any complications to the mothers, and all the three conjoined twins died after a few minutes. Conclusion: Ultrasound enables an early and accurate diagnosis of conjoined twins, which is vital for obstetric management. MRI is reserved for better tissue characterization. Termination of pregnancy when opted, should be done at an early stage as later stages are fraught with problems. Recent advances, such as 3D printing, may aid in surgical pre-planning, thereby enabling successful surgical separation of conjoined twins.

  8. Conjoined twins - role of imaging and recent advances.

    Science.gov (United States)

    Mathew, Rishi Philip; Francis, Swati; Basti, Ram Shenoy; Suresh, Hadihally B; Rajarathnam, Annie; Cunha, Prema D; Rao, Sujaya V

    2017-12-01

    Conjoined twins are identical twins with fused bodies, joined in utero. They are rare complications of monochorionic twinning. The purpose of this study is to describe the various types of conjoined twins, the role of imaging and recent advances aiding in their management. This was a twin institutional study involving 3 cases of conjoined twins diagnosed over a period of 6 years from 2010 to 2015. All the 3 cases were identified antenatally by ultrasound. Only one case was further evaluated by MRI. Three cases of conjoined twins (cephalopagus, thoracopagus and omphalopagus) were accurately diagnosed on antenatal ultrasound. After detailed counseling of the parents and obtaining written consent, all the three cases of pregnancy were terminated. Delivery of the viable conjoined twins was achieved without any complications to the mothers, and all the three conjoined twins died after a few minutes. Ultrasound enables an early and accurate diagnosis of conjoined twins, which is vital for obstetric management. MRI is reserved for better tissue characterization. Termination of pregnancy when opted, should be done at an early stage as later stages are fraught with problems. Recent advances, such as 3D printing, may aid in surgical pre-planning, thereby enabling successful surgical separation of conjoined twins.

  9. Pregnancy Outcomes Among Patients With Vasculitis

    Science.gov (United States)

    Clowse, Megan E. B.; Richeson, Rachel L.; Pieper, Carl; Merkel, Peter A.

    2015-01-01

    Objective Pregnancy outcomes of patients with vasculitis are unknown, but are of great concern to patients and physicians. Through an online survey, this study assessed pregnancy outcomes among patients with vasculitis. Methods Participants in the Vasculitis Clinical Research Consortium Patient Contact Registry were invited to respond to an anonymous, internet-based survey that included questions about pregnancy outcomes, the timing of pregnancy relative to a diagnosis of vasculitis, and medication use. Results A total of 350 women and 113 men completed the survey. After a diagnosis of vasculitis, 74 pregnancies were reported by women and 18 conceptions were reported by men. The rate of pregnancy loss was higher among women who conceived after a diagnosis of vasculitis compared to those who conceived prior to diagnosis (33.8% versus 22.4%; P = 0.04). Among women, the rate of preterm births increased significantly for pregnancies conceived after a diagnosis of vasculitis relative to those conceived before diagnosis (23.3% versus 11.4%; P = 0.03). Only 18% of women reported worsening of vasculitis during pregnancy, but those who experienced increased vasculitis activity were more likely to deliver preterm. Exposure to cyclophosphamide or prednisone did not appear to impact pregnancy outcomes; however, the number of pregnancies among women taking these medications was small. Among the pregnancies conceived by men with vasculitis, the timing of diagnosis had no significant effect on the rate of pregnancy loss. Conclusion Women who conceived after a diagnosis of vasculitis had a higher rate of pregnancy loss than those who conceived prior to diagnosis. Vasculitis did not worsen during the majority of pregnancies conceived after diagnosis. PMID:23401494

  10. Preparing for Twins

    Science.gov (United States)

    ... or fraternal, all twins have their individual personalities, styles, and temperament. Both identical and fraternal twins may ... you on how to cope with the special parenting challenges with twins. He also can suggest helpful ...

  11. Maternal 25-hydroxyvitamin d and preterm birth in twin gestations.

    LENUS (Irish Health Repository)

    Bodnar, Lisa M

    2013-07-01

    To assess whether there was an independent association between maternal 25-hydroxyvitamin D concentrations at 24-28 weeks of gestation and preterm birth in a multicenter U.S. cohort of twin pregnancies.

  12. Diecephalic thoraco-omphalopagus conjoined twins: case report ...

    African Journals Online (AJOL)

    We present a case report of conjoined twins discovered at 17 weeks gestation on routine trans-abdominal ultrasound in a 27 year old woman. The twins were joined at the chest and upper abdomen. They shared a heart, liver, sternum and diaphragm. The patient opted for termination of the pregnancy which was performed ...

  13. Congenital malaria in newborn twins | Opare | Ghana Medical Journal

    African Journals Online (AJOL)

    According to the mother, even though she did not sleep in insecticide treated bed net during her pregnancy, she took all the recommended drugs of sulfadoxine/ pyrimethamine- intermittent preventive treatment for malaria. She delivered twins on the same day. The mother and the twins developed fever on the same day.

  14. Twin Peaks

    Science.gov (United States)

    1997-01-01

    The two hills in the distance, approximately one to two kilometers away, have been dubbed the 'Twin Peaks' and are of great interest to Pathfinder scientists as objects of future study. The white areas on the left hill, called the 'Ski Run' by scientists, may have been formed by hydrologic processes.The image was taken by the Imager for Mars Pathfinder (IMP) after its deployment on Sol 3. Mars Pathfinder was developed and managed by the Jet Propulsion Laboratory (JPL) for the National Aeronautics and Space Administration. The IMP was developed by the University of Arizona Lunar and Planetary Laboratory under contract to JPL. Peter Smith is the Principal Investigator.

  15. Ileal blowout due to ileal atresia in a donor with twinto- twin ...

    African Journals Online (AJOL)

    Twin-to-twin transfusion syndrome (TTTS) occurs in 10% of monochorionic twin pregnancies, and can lead to a variety of complications due to imbalanced blood flow across placental vascular communications. In this report, we describe a case of intestinal injury in TTTS after fetoscopic laser ablation of the communicating ...

  16. Impact of ART on pregnancies in California: an analysis of maternity outcomes and insights into the added burden of neonatal intensive care.

    Science.gov (United States)

    Merritt, T A; Goldstein, M; Philips, R; Peverini, R; Iwakoshi, J; Rodriguez, A; Oshiro, B

    2014-05-01

    We reviewed the occurrence of prematurity, low birth weight, multiple gestations, frequency of stillbirths and maternity care-associated variables including hospital stay and hospital charges of women conceiving using assisted reproductive technology (ART) or artificial insemination (AI) compared with women with a history of infertility who conceived naturally, and all other naturally conceived pregnancies in California at non-federal hospitals between 2009 and 2011. At a single center, infants born after ART/AI were compared with infants provided care in the normal nursery. Publically available inpatient data sets from the California Office of Statewide Health Planning and Development for years 2009-2011 using data from all California non-federal hospitals were used to determine the impact of ART on a variety of pregnancy-related outcomes and infant characteristics. Infant data from a single center was used to determine hospital charges for infants delivered over an 18-month period to compare the hospital and physician charges indexed to similar charges for infants admitted to the 'normal' newborn nursery. Among ART/AI pregnancies, there was a 4-5-fold increase in stillbirths, compared with a 2-3-fold increase among women with infertility compared with other naturally conceiving women. ART/AI pregnancies underwent more cesarean sections (fourfold), and a near fourfold increase in the rate of preterm deliveries. Multiple gestations were increased 24-27-fold compared with naturally conceived pregnancies. Maternal hospital stay and hospital charges were increased among those undergoing ART/AI. Infant charges were increased multi-fold for singletons, twins and triplets delivered after ART/AI compared with naturally conceived infants. Multiple births, preterm births and a higher overall rate of fetal anomalies were found in California after ART/AI for 2009-2011. Cesarean section rates, longer length of maternal stay and hospital charges among women receiving ART

  17. 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

  18. The Qingdao Twin Registry

    DEFF Research Database (Denmark)

    Duan, Haiping; Ning, Feng; Zhang, Dongfeng

    2013-01-01

    In 1998, the Qingdao Twin Registry was initiated as the main part of the Chinese National Twin Registry. By 2005, a total of 10,655 twin pairs had been recruited. Since then new twin cohorts have been sampled, with one longitudinal cohort of adolescent twins selected to explore determinants...... of metabolic disorders and health behaviors during puberty and young adulthood. Adult twins have been sampled for studying heritability of multiple phenotypes associated with metabolic disorders. In addition, an elderly twin cohort has been recruited with a focus on genetic studies of aging-related phenotypes...

  19. Development of customized fetal growth charts in twins.

    Science.gov (United States)

    Ghi, Tullio; Prefumo, Federico; Fichera, Anna; Lanna, Mariano; Periti, Enrico; Persico, Nicola; Viora, Elsa; Rizzo, Giuseppe

    2017-05-01

    Twin gestations are at significantly higher risk of fetal growth restriction in comparison with singletons. Using fetal biometric charts customized for obstetrical and parental characteristics may facilitate an accurate assessment of fetal growth. The objective of the study was to construct reference charts for the gestation of fetal biometric parameters stratified by chorionicity and customized for obstetrical and parental characteristics. Fetal biometric measurements obtained from serial ultrasound examinations in uncomplicated twin pregnancies delivering after 36 weeks of gestation were collected by 19 Italian fetal medicine units under the auspices of the Società Italiana di Ecografia Ostetrica e Ginecologica. The measurements acquired in each fetus at each examination included biparietal diameter, head circumference, abdominal circumference, and femur length. Multilevel linear regression models were used to adjust for the serial ultrasonographic measurements obtained and the clustering of each fetus in twin pregnancy. The impact of maternal and paternal characteristics (height, weight, ethnicity), parity, fetal sex, and mode of conception was also considered. Models for each parameter were stratified by fetal chorionicity and compared with our previously constructed growth curves for singletons. The data set included 1781 twin pregnancies (dichorionic, n = 1289; monochorionic diamniotic, n = 492) with 8923 ultrasonographic examinations with a median of 5 (range, 2-8) observations per pregnancy in dichorionic and 6 in (range, 2-11) monochorionic pregnancies. Growth curves of twin pregnancies differed from those of singletons, and differences were more marked in monochorionic twins and during the third trimester. A significant influence of parental characteristics was found. Curves of fetal biometric measurements in twins are influenced by parental characteristics. There is a reduction in the growth rate during the third trimester. The reference limits for

  20. Perinatal Outcomes of Newborn Infants Conceived by Assisted Reproductive Techniques in Royan Institute

    Directory of Open Access Journals (Sweden)

    Sharareh Dadashloo

    2009-01-01

    Full Text Available Background: The outcomes of such pregnancies have been rarely evaluated in our country. Adescriptive study was planned to assess the health and condition of neonates conceived with assistedtechniques in a one year period.Materials and Methods: At Royan Institute, Tehran, 443 women who became pregnant by oneof the assisted techniques in vitro fertilization (IVF, intrauterine insemination (IUI andintracytoplasmic sperm injection (ICSI enrolled in a descriptive study during 16 month periodbeginning on September, 2007. The sampling method used was non-incidental, consecutive.Questionnaires regarding the contents of the baby birth card were completed after interviews withthe mothers. The time from fertilization of the ovum until delivery was considered as the gestational(conception age. Pregnant mothers were under periodic evaluation until delivery. Women withstillborn babies were followed via phone contact.Results: From a total of 443 conceptions, there were 13 (2.9% pregnancies demised in utero(stillbirths and 10 (2.6% who died during the neonatal period. Additionally, 133 (43% infantswere born after multifetal pregnancies and 96 (31% infants were prematurely born. There were 106(34.3% infants with low birth weight (LBW; less than 2500 g, of which 83 (78.3% LBW infantswere multiplets. After completion of the study, 71 women were still passing their pregnancy periodand no assessed.Conclusion: The most important factor for untoward perinatal events was multifetal pregnancy. Suchpregnancies were more frequently complicated and higher risk. Low birth weight and prematuritywere more frequent in singletons conceived by assisted techniques in respect to control singletons.

  1. A study of the occurrence of monochorionic and monozygotic twinning in the pig

    DEFF Research Database (Denmark)

    Bjerre, Ditte; Thorup, F.; Jørgensen, Claus Bøttcher

    2009-01-01

    Summary In humans as well as in most farm animals, monozygotic twins have been described. Nevertheless, only a few reports of twinning in the pig have been published. It has been suggested that monozygotic twins are formed during the first 14 days of pregnancy. This monozygotic twin study include...... was found among these embryos. In the latter group, three monozygotic twin pairs were identified. Thus, it can be concluded that although the occurrence of monozygotic twins in pigs is a sporadic event, the fusion of extra-embryonic membranes is relatively common....

  2. Haemoglobin discordances in twins: due to differences in timing of cord clamping?

    Science.gov (United States)

    Verbeek, Lianne; Zhao, Depeng P; Middeldorp, Johanna M; Oepkes, Dick; Hooper, Stuart B; Te Pas, Arjan B; Lopriore, Enrico

    2017-07-01

    Our objective was to study the differences in haemoglobin (Hb) at birth in dichorionic (DC) versus monochorionic (MC) twins in relation to birth order and mode of delivery. All consecutive DC twin pregnancies and uncomplicated MC twin pregnancies with two live-born twins delivered at our centre were included in this retrospective cohort study. Hb levels at birth and on day 2 were evaluated in association with birth order and mode of delivery. The occurrence of polycythaemia (venous haematocrit >65%) was also recorded. A total of 300 DC and 290 MC twin pairs were included. In DC and MC twins delivered vaginally, second-born twins had a higher Hb level at birth compared with their co-twin (mean Hb level 16.7 vs 15.9 g/dL (p<0.01) in DC twins and 17.8 vs 16.1 g/dL (p<0.01) in MC twins). In twins delivered through caesarean section, no intertwin differences in Hb levels were detected. Polycythaemia occurred significantly more often in second-born twins compared with first-born twins delivered vaginally: 10 (5%) vs 2 (1%) (p=0.02) in DC twins and 20 (12%) vs 2 (1%) (p<0.01) in MC twins. Second-born DC and MC twins delivered vaginally have higher Hb levels at birth compared with first-born twins. Intertwin Hb differences in MC twins may partly be related to blood transfusion through the vascular anastomoses. Since DC twins do not have anastomoses, other factors may lead to Hb differences, including differences in timing of umbilical cord clamping. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  3. Ectopic pregnancy after bilateral salpingectomy

    International Nuclear Information System (INIS)

    Al-Sunaidi, M.; Sylvestre, C.

    2007-01-01

    Ectopic pregnancy is a life threatening condition and is a major event in a woman's reproductive life. We report herein an unusual case of repeated ectopic pregnancy even after the excision of both fallopian tubes with a deleterious consequences and a near miss. This case teaches us a lesson not to forget ectopic pregnancy. The lady in this report underwent in vitro fertilization treatment cycle due to absence of both fallopian tubes as a consequence of previous ectopic pregnancy and a hydrosalpinx, she conceived successfully but unfortunately the pregnancy was another ectopic pregnancy. (author)

  4. Risk of Cancer in Children Conceived by Assisted Reproductive Technology.

    Science.gov (United States)

    Reigstad, Marte Myhre; Larsen, Inger Kristin; Myklebust, Tor Åge; Robsahm, Trude Eid; Oldereid, Nan Birgitte; Brinton, Louise A; Storeng, Ritsa

    2016-03-01

    An increasing number of children are born after assisted reproductive technology (ART), and monitoring their long-term health effects is of interest. This study compares cancer risk in children conceived by ART to that in children conceived without. The Medical Birth Registry of Norway contains individual information on all children born in Norway (including information of ART conceptions). All children born between 1984 and 2011 constituted the study cohort, and cancer data were obtained from the Cancer Registry of Norway. Follow-up started at date of birth and ended on the date of the first cancer diagnosis, death, emigration, or December 31, 2011. A Cox proportional hazards model was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) of overall cancer risk between children conceived by ART and those not. Cancer risk was also assessed separately for all childhood cancer types. The study cohort comprised 1 628 658 children, of which 25 782 were conceived by ART. Of the total 4554 cancers, 51 occurred in ART-conceived children. Risk of overall cancer was not significantly elevated (HR 1.21; 95% CI 0.90-1.63). However, increased risk of leukemia was observed for children conceived by ART compared with those who were not (HR 1.67; 95% CI 1.02-2.73). Elevated risk of Hodgkin's lymphoma was also found for ART-conceived children (HR 3.63; 95% CI 1.12-11.72), although this was based on small numbers. This population-based cohort study found elevated risks of leukemia and Hodgkin's lymphoma in children conceived by ART. Copyright © 2016 by the American Academy of Pediatrics.

  5. ECTOPIC PREGNANCY AFTER SEQUENTIAL EMBRYO TRANSFER: REVIEW OF 22 CASES

    OpenAIRE

    Nadkarni Purnima K, Nadkarni Kishore, Singh Pooja P, Singh Prabhakar , Nadkarni Aditi A , Agarwal Neha R

    2015-01-01

    Objective: To assess the prevalence of ectopic pregnancy among women who conceived with assisted reproductive technology and to see if there is increased risk after sequential embryo transfer. Methods: The ectopic pregnancy rate for ART pregnancies was calculated among women who conceived and had ectopic pregnancy after ICSI followed by Sequential embryo transfer from an ART centre. Variation in ectopic risk by patient and ART treatment factors was assessed including Sequential transfer, risk...

  6. Dizygotic twinning is not associated with methylenetetrahydrofolate reductase haplotypes

    NARCIS (Netherlands)

    Montgomery, GW; Zhao, Z.Z.; Morley, K.I.; Marsh, A.J.; Boomsma, D.I.; Martin, N.G.; Duffy, DL

    2003-01-01

    Background: Folate metabolism is critical to embryonic development, influencing neural tube defects (NTD) and recurrent early pregnancy loss. Polymorphisms in 5,10-methylenetetrahydrofolate reductase (MTHFR) have been associated with dizygotic (DZ) twinning through pregnancy loss. Methods: The C677T

  7. Pathophysiology of twin to twin transfuzion syndrome

    Directory of Open Access Journals (Sweden)

    Šulović Nenad

    2014-01-01

    Full Text Available Twin-twin transfusion syndrome (TTTTS is a pathological condition whereby a donor fetus bleeds into the circulation of a recipient fetus through the abnormal inter-twin placental anastomoses. The donor twin becomes anemic, hypovolemic, growth restricted, and as a consequence has a reduced urinary production. Since swallowing of the fluid is not impaired, the amniotic fluid volume progressively decreases. The recipient twin becomes hypervolemic. Lacking a mechanism to remove blood, the recipient twin eliminates as much fluid as possible, thus becoming hypercytemic or even hydropic in the more severe cases. The elevated urinary production from the recipient twin leads to polyhydramnios and an overdistension of the amniotic cavity, that compresses the donor and it's vascular supply against the uterine wall, further decreasing perfusion to the donor fetus. The reduction in amniotic fluid on the donor side results in a close apposition of the inter-twin membrane that fixes the donor fetus to the uterus, a condition nicknamed 'stuck twin'.

  8. A genome wide linkage scan for dizygotic twinning in 525 families of mothers of dizygotic twins.

    Science.gov (United States)

    Painter, Jodie N; Willemsen, Gonneke; Nyholt, Dale; Hoekstra, Chantal; Duffy, David L; Henders, Anjali K; Wallace, Leanne; Healey, Sue; Cannon-Albright, Lisa A; Skolnick, Mark; Martin, Nicholas G; Boomsma, Dorret I; Montgomery, Grant W

    2010-06-01

    The tendency to conceive dizygotic (DZ) twins is a complex trait influenced by genetic and environmental factors. To search for new candidate loci for twinning, we conducted a genome-wide linkage scan in 525 families using microsatellite and single nucleotide polymorphism marker panels. Non-parametric linkage analyses, including 523 families containing a total of 1115 mothers of DZ twins (MODZT) from Australia and New Zealand (ANZ) and The Netherlands (NL), produced four linkage peaks above the threshold for suggestive linkage, including a highly suggestive peak at the extreme telomeric end of chromosome 6 with an exponential logarithm of odds [(exp)LOD] score of 2.813 (P = 0.0002). Since the DZ twinning rate increases steeply with maternal age independent of genetic effects, we also investigated linkage including only families where at least one MODZT gave birth to her first set of twins before the age of 30. These analyses produced a maximum expLOD score of 2.718 (P = 0.0002), largely due to linkage signal from the ANZ cohort, however, ordered subset analyses indicated this result is most likely a chance finding in the combined dataset. Linkage analyses were also performed for two large DZ twinning families from the USA, one of which produced a peak on chromosome 2 in the region of two potential candidate genes. Sequencing of FSHR and FIGLA, along with INHBB in MODZTs from two large NL families with family specific linkage peaks directly over this gene, revealed a potentially functional variant in the 5' untranslated region of FSHR that segregated with the DZ twinning phenotype in the Utah family. Our data provide further evidence for complex inheritance of familial DZ twinning.

  9. Twin chorionicity and prospective stillbirth risk: experience at a tertiary care hospital

    International Nuclear Information System (INIS)

    Masheer, S.; Islam, Z.; Dileep, D.; Munim, S.

    2017-01-01

    To determine the prospective risk of stillbirth, perinatal death and neonatal morbidities in twins. Methods: This retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised cases of twin pregnancies from January 2001 to December 2012. . Cases of both monochorionic diamniotic and dichorionic diamniotic twin pregnancies were included. SPSS 19 was used for data analysis. Results: Of the 394 cases, 84(21.3%) were monochorionic diamniotic twins and 310(78.7%) were dichorionic diamniotic twins. There were no cases of stillbirth beyond 30 and 34 weeks in monochorionic and dichorionic twins, respectively. Neonatal mortality stood reduced beyond 36 weeks of gestation in both groups. Neonatal morbidity reduced beyond 35 weeks of gestation in both groups. Conclusion: Perinatal mortality and morbidity in twin gestation decreased as the gestation advanced. (author)

  10. Twins and neurodevelopmental outcomes: the effect of IVF, fetal growth restriction, and preterm birth.

    Science.gov (United States)

    Briana, Despina D; Malamitsi-Puchner, Ariadne

    2018-01-16

    This invited review aimed at presenting the evidence concerning neurodevelopmental outcomes, particularly cerebral palsy (CP), motor disability, cognitive impairment, mental retardation, any major disability, blindness and deafness in cases of twins, conceived after in vitro fertilization, presenting fetal/intrauterine growth restriction (FGR/IUGR) or being prematurely born. FGR/IUGR, prematurity and zygosity affect neurodevelopmental outcome; CP is higher in term infants, those presenting with FGR/IUGR, as well as in survivors of intrauterine co-twin death; cognitive ability of twins versus singletons mainly relates to confounding factors, as FGR/IUGR and prematurity, while evidence for differences in behavioral and psychiatric disorders between twins and singletons is limited. The impact of IVF per se has not been documented. Nevertheless, available literature, usually of heterogeneous and retrospective nature, diverges in the criteria for neurodevelopmental delay. Furthermore, differences in selection/exclusion criteria and small mixed cohorts, including the full range of complications, make comparison of the existing studies difficult. Future studies should focus in confirming the lack of IVF impact on twins' neurodevelopment and general health, in comparing long-term outcome of naturally conceived twins with those conceived following assisted reproduction techniques and in including evaluation of individual, longitudinal trajectories of growth, and development. In this respect, worldwide population-based registries will enable more precise description of neurodevelopmental outcomes among twins.

  11. 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.

  12. [Peculiarities of multiple pregnancy: embryology].

    Science.gov (United States)

    Leszczyńska-Gorzelak, B; Oleszczuk, J J; Machin, G A; Sawulicka-Oleszczuk, H; Kiczyńska, A; Keith, L G

    2000-11-01

    Multiple pregnancies are not physiologic in humans and the understanding of the pathogenesis of this phenomenon is not fully established. Embriology of multiple pregnancy has been extensively investigated and this paper presents the phases of embrional development of monozygotic and dizygotic twins.

  13. Transvaginal cervical length scans to prevent prematurity in twins: a randomized controlled trial.

    Science.gov (United States)

    Gordon, Michael C; McKenna, David S; Stewart, Theresa L; Howard, Bobby C; Foster, Kimberly F; Higby, Kenneth; Cypher, Rebecca L; Barth, William H

    2016-02-01

    Twin pregnancies are associated with an increased risk of perinatal morbidity and mortality primarily due to spontaneous preterm deliveries. The mean gestational age for delivery is 35.3 weeks and twins account for 23% of preterm births twin pregnancies. It follows that TVCL assessment may allow identification of a subset of twin pregnancies that re better candidates for interventions intended to prevent prematurity. We sought to determine whether use of TVCL prolongs gestation in twin pregnancies. This is a multicenter, randomized, controlled trial of 125 dichorionic or monochorionic/diamniotic twin pregnancies without prior preterm birth digital exams monthly from 16-28 weeks and were managed with a standard algorithm for activity restriction and cerclage. The control group (n = 62) had monthly digital cervical examinations but no routine TVCL ultrasound examinations. The primary outcome was gestational age at delivery. Secondary outcomes included percentage of deliveries twin gestations managed with TVCL and digital exams monthly from 16-28 weeks with a standard algorithm for activity restriction and cerclage and controls who had monthly digital cervical examinations but no routine TVCL. Routine second-trimester transvaginal ultrasound assessment of cervical length is not associated with improved outcomes when incorporated into the standard management of otherwise low-risk twin pregnancies. Published by Elsevier Inc.

  14. OEIS complex (omphalocele-exstrophy-imperforate anus-spinal defects) in monozygotic twins.

    Science.gov (United States)

    Lee, D H; Cottrell, J R; Sanders, R C; Meyers, C M; Wulfsberg, E A; Sun, C C

    1999-05-07

    The omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex is a consistent and recognizable pattern of midline abdominal and pelvic defects. It is rare, affecting 1 in 200,000 to 400,000 pregnancies and is even rarer in twin gestations. This is an autopsy study of OEIS complex in monozygotic twins after pregnancy termination at 20 weeks of gestation. Unremarkable family history but concordance of monozygotic twins for the defects may support the theory that early malformation complexes, e.g., OEIS, and monozygotic twinning are manifestations of the same disturbance of early blastogenesis.

  15. High risk of unexpected late fetal death in monochorionic twins despite intensive ultrasound surveillance: a cohort study.

    Directory of Open Access Journals (Sweden)

    2005-06-01

    Full Text Available BACKGROUND: The rationale for fetal surveillance in monochorionic twin pregnancies is timely intervention to prevent the increased fetal/perinatal morbidity and mortality attributed to twin-twin transfusion syndrome and intrauterine growth restriction. We investigated the residual risk of fetal death after viability in otherwise uncomplicated monochorionic diamniotic twin pregnancies. METHODS AND FINDINGS: We searched an electronic database of 480 completed monochorionic pregnancies that underwent fortnightly ultrasound surveillance in our tertiary referral fetal medicine service between 1992 and 2004. After excluding pregnancies with twin-twin transfusion syndrome, growth restriction, structural abnormalities, or twin reversed arterial perfusion sequence, and monoamniotic and high-order multiple pregnancies, we identified 151 uncomplicated monochorionic diamniotic twin pregnancies with normal growth, normal liquor volume, and normal Doppler studies on fortnightly ultrasound scans. Ten unexpected intrauterine deaths occurred in seven (4.6% of 151 previously uncomplicated monochorionic diamniotic pregnancies, within 2 wk of a normal scan, at a median gestational age of 34(+1 wk (weeks(+days; range 28(+0 to 36(+3. Two of the five cases that underwent autopsy had features suggestive of acute late onset twin-twin transfusion syndrome, but no antenatal indicators of transfusional imbalance or growth restriction, either empirically or in a 1:3 gestation-matched case-control comparison. The prospective risk of unexpected antepartum stillbirth after 32 wk was 1/23 monochorionic diamniotic pregnancies (95% confidence interval 1/11 to 1/63. CONCLUSION: Despite intensive fetal surveillance, structurally normal monochorionic diamniotic twin pregnancies without TTTS or IUGR are complicated by a high rate of unexpected intrauterine death. This prospective risk of fetal death in otherwise uncomplicated monochorionic diamniotic pregnancies after 32 wk of

  16. The Kidney in Pregnancy | Adam | Obstetrics and Gynaecology Forum

    African Journals Online (AJOL)

    A close relationship exists between kidney function and a successful pregnancy outcome. Renal disease can affect the outcome of pregnancy, pregnancy can affect the progression of pre-existing renal disease, and pregnancy itself can cause renal impairment. Women with renal disease who conceive and continue the ...

  17. Long-awaited pregnancy

    DEFF Research Database (Denmark)

    Bay, Bjørn; Mortensen, Erik Lykke; Golombok, Susan

    2016-01-01

    test scores at age 19 years. Result(s): We found no evidence of school difficulties in childhood, impaired school performance in adolescence, or lower intelligence in young adulthood in multivariate analyses adjusted for parental age, educational level, maternal parity, before pregnancy body mass index......Objective: To study whether fertility treatment, subfertility, or pregnancy planning are related to long-term intellectual development. Design: Cohort study. Setting: Not applicable. Patient(s): A total of 5,032 singletons born from 1990 to 1992 in the Aarhus Birth Cohort were followed up to a mean...... age of 19 years. These children were born as a result of fertility treatment (n = 210), had subfertile parents who took more than 12 months before conceiving naturally (n = 334), had fertile parents who conceived naturally within 12 months (n = 2,661), or had parents who reported the pregnancy...

  18. South African end times: Conceiving an apocalyptic imaginary ...

    African Journals Online (AJOL)

    This article argues that catastrophic prediction—the trope of a looming racial Armageddon—is like a worn coin: familiar currency so often spent. Nonetheless, we need to conceive how this particular political theology settled into our polity; why it has proved so adaptable (through and despite the “miraculous” transformation ...

  19. [Health and development of children conceived through assisted reproductive technologies].

    Science.gov (United States)

    Epelboin, Sylvie; Patrat, Catherine; Luton, Dominique

    2014-01-01

    Around 3% of children are conceived by assisted reproductive technology (ART) in France. Several questions concerning the early or late follow-up of these children are raised, as there are differences in the population in charge and because of clinical or biological procedures used. Nevertheless, one has to be cautious in interpreting the data as it is difficult to study one factor at a time, and as many other events can bias the results. However, ART is associated with a higher risk, even moderate, of prematurity, foetal hypotrophy, and neo natal complications, as compared to natural conceived children. There is also increasing evidence that ART-conceived children present more epigenetic diseases and congenital mainly concerning cardio-vascular, uro-genital and musculo-skeletal systems, as natural conceived children. Absolute risks remain anyway moderate and reassuring. Long term follow up is encouraging, with correct growth or psychomotor development of these children, and no significant excess of risk for cancer, but it is necessary to carry on this follow up in order to have data on their development to adulthood and on their fertility.

  20. Can intra-uterine mortality be reduced in Nd-YAG laser treatment of Twin-Twin Transfusion Syndrome? An analysis

    NARCIS (Netherlands)

    van Gemert, M. J. C.; Scherjon, S. A.; Borst, C.; Sterenborg, H. J. C. M.; Ville, Y.; Hyett, J.; Nicolaides, K.

    1995-01-01

    Recent studies have shown that laser therapy can reduce the mortality and morbidity associated with Twin-Twin Transfusion Syndrome in the second trimester of pregnancy. The purpose of this paper is to analyse current treatment strategies using laser surgery, and to suggest ways in which fetal

  1. Maternal and neonatal outcomes in twin and triplet gestations in Western Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Samera F. AlBasri

    2017-06-01

    Full Text Available Objectives: Tocompare maternal and neonatal complications in twin and triplet gestations at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Methods: Retrospective medical records of 165 women with 144 twin and 21 triplet pregnancies from 2004 to 2011 were analyzed. Comparisons were carried out for maternal complications, gestational age at birth, neonatal birth weight, and neonatal intensive care admission. Results: Most common complications were preterm birth (49%, gestational diabetes mellitus (13.3%, and premature rupture of membrane (4.8%. All triplet pregnancies and 42% twin pregnancies terminated in preterm birth. Gestational length was longer (p less than 0.001 in twin births (36.0 ± 3.05 weeks than for triplet births (32 ± 3.81 weeks. Rates for in vitro fertilization, ovulation induction, and cesareans were higher in women with triplets than in those with twins. Neonatal intensive care unit (NICU admission was higher (p less than 0.001 for triplets (76.2% than for twins (23.6%. The mean weight of twins was 2333.83 ± 558.69 grams and triplets was 1553.41 ± 569.73 grams. Hyaline membrane disease, neonatal jaundice, and neonatal sepsis were most common neonatal complications. Conclusion: Neonates from triplet pregnancies were preterm, had low birth weight and needed more often NICU admission in comparison to those from twin pregnancies.

  2. Blood Chimerism in Dizygotic Monochorionic Twins During 5 Years Observation.

    Science.gov (United States)

    Dziegiel, M H; Hansen, M H; Haedersdal, S; Barrett, A N; Rieneck, K; Main, K M; Hansen, A T; Clausen, F B

    2017-10-01

    Dizygotic monochorionic twin pregnancies can result in blood chimerism due to in utero twin-to-twin exchange of stem cells. In this case, we examined the proportion of allogeneic red blood cells by flow cytometry and the proportion of allogeneic nucleated cells by digital polymerase chain reaction at 7 months and again at 5 years. We found an increase in the proportion of allogeneic cells from 63% to 89% in one twin, and a similar increase in autologous cells in the other twin from 57% to 84%. A paradigm for stem cell therapy could be modeled on this case: induction of tolerance and chimerism by antenatal transfusion of donor stem cells. The procedure would hold the promise of transplantation and tolerance induction without myeloablative conditioning for inheritable benign hematological diseases such as sickle cell disease and thalassemia. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  3. Twin-twin transfusion syndrome: cerebral ischemia is not the only fetal MR imaging finding

    Energy Technology Data Exchange (ETDEWEB)

    Kline-Fath, Beth M. [University of Cincinnati Medical Center, Department of Radiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Cincinnati Children' s Hospital, Department of Radiology, Cincinnati, OH (United States); Calvo-Garcia, Maria A.; O' Hara, Sara M.; Racadio, Judy M. [University of Cincinnati Medical Center, Department of Radiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Crombleholme, Timothy M. [University of Cincinnati Medical Center, Department of Surgery, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States)

    2007-01-15

    Twin-twin transfusion syndrome (TTTS) is a complication of monochorionic/diamniotic twin pregnancies. An imbalance of blood flow occurs through placental anastomoses, causing potentially significant morbidity and mortality in both twins. Although the sonographic findings of TTTS are well documented, we believe that MR imaging is a valuable adjunct. We describe the fetal MR imaging findings associated with TTTS. From 2003 to 2005, 37 consecutive MR imaging studies were performed on multiple-gestation pregnancies. Of the 37, 25 were consistent with TTTS, correlated and confirmed by sonographic criteria. MR fetal abnormalities were documented. Cerebral ischemia, which could not be demonstrated by sonography, was delineated well by MR imaging. New findings noted on fetal MR imaging were enlargement of cerebral venous sinuses in both twins, dilatation of the renal collecting system in the recipient, lung lesions in the recipient and cerebral malformations in the donor. MR imaging is an important adjunct in TTTS imaging. Its benefit over sonography is its clear definition of cerebral pathology, which is important for intervention and counseling. The new findings, particularly in the urinary tract and cerebral venous sinuses, also help support the diagnosis of TTTS and might reveal additional consequences of the altered hemodynamics that occur in TTTS. (orig.)

  4. Twin-twin transfusion syndrome: cerebral ischemia is not the only fetal MR imaging finding

    International Nuclear Information System (INIS)

    Kline-Fath, Beth M.; Calvo-Garcia, Maria A.; O'Hara, Sara M.; Racadio, Judy M.; Crombleholme, Timothy M.

    2007-01-01

    Twin-twin transfusion syndrome (TTTS) is a complication of monochorionic/diamniotic twin pregnancies. An imbalance of blood flow occurs through placental anastomoses, causing potentially significant morbidity and mortality in both twins. Although the sonographic findings of TTTS are well documented, we believe that MR imaging is a valuable adjunct. We describe the fetal MR imaging findings associated with TTTS. From 2003 to 2005, 37 consecutive MR imaging studies were performed on multiple-gestation pregnancies. Of the 37, 25 were consistent with TTTS, correlated and confirmed by sonographic criteria. MR fetal abnormalities were documented. Cerebral ischemia, which could not be demonstrated by sonography, was delineated well by MR imaging. New findings noted on fetal MR imaging were enlargement of cerebral venous sinuses in both twins, dilatation of the renal collecting system in the recipient, lung lesions in the recipient and cerebral malformations in the donor. MR imaging is an important adjunct in TTTS imaging. Its benefit over sonography is its clear definition of cerebral pathology, which is important for intervention and counseling. The new findings, particularly in the urinary tract and cerebral venous sinuses, also help support the diagnosis of TTTS and might reveal additional consequences of the altered hemodynamics that occur in TTTS. (orig.)

  5. Lesão vascular da placenta condicionando RCIU e hidropisia fetal não imune em gestação gemelar Placental vascular lesion as cause of IUGR and nonimmune fetal hydrops in twin pregnanc

    Directory of Open Access Journals (Sweden)

    Nuno Ricardo Gonçalves Baptista Pereira

    2011-12-01

    Full Text Available As lesões vasculares da placenta constituem um grupo de entidades distintas, mas inter-relacionadas, em que se incluem os corioangiomas e a corangiomatose multifocal difusa. O corioangioma é uma lesão nodular expansiva com incidência de cerca de 1%. A corangiomatose multifocal difusa é rara (0,2% e predominante em placentas em idade gestacional inferior a 32 semanas. Os autores apresentam um caso de gestação gemelar monocoriônica/biamniótica, no qual um dos fetos, à 26ª semana de gestação, apresentou quadro de restrição de crescimento intrauterino, hidropisia e anemia associado à formação tumoral da placenta com vascularização aumentada verificada pela doplervelocimetria. O estudo anatomopatológico da placenta permitiu o diagnóstico de corangiomatose multifocal difusa. Este raro caso de corioangiomatose multifocal difusa com forma de apresentação pré-natal mimetizando a de um corioangioma comprova que a detecção ultrassonográfica de um tumor da placenta com vascularização aumentada deve suscitar outras hipótese diagnóstica, além do corioangioma.Placenta vascular lesions are a group of distinct yet related entities that include chorangiomas and diffuse multifocal chorangiomatosis. Chorangioma is an expansive nodular lesion with an incidence of about 1%. Diffuse multifocal chorangiomatosis is rare (0.2% and mostly seen in placentas before the 32nd gestational week. The authors present a case of a monochorionic/biamniotic twin pregnancy, in which, at the 26th gestational week, one fetus developed intrauterine growth restriction (IUGR, hydrops, and anemia associated with a tumor of the placenta with increased vascularization in the Doppler study. Pathological examination of the placenta diagnosed diffuse multifocal chorangiomatosis. This rare case report of diffuse multifocal chorangiomatosis with prenatal manifestations resembling those of a chorangioma proves that prenatal ultrasound detection of a placenta tumor

  6. Multiple Pregnancy and Birth: Considering Fertility Treatments

    Science.gov (United States)

    ... be possible, the delivery of triplets or higher order births usually requires cesarean section, with some risk to ... Reproductive Medicine, Patient Information Series. Multiple Pregnancy and Birth: Twins, Triplets, & Higher Order Multiples. 2004. Current Practices and Controversies in Assisted ...

  7. Oclusão da artéria umbilical como opção terapêutica em gestações com gêmeo acárdio Umbilical artery occlusion as a therapeutic option in pregnancy with acardiac twin

    Directory of Open Access Journals (Sweden)

    Júlio César de Faria Couto

    2004-07-01

    Full Text Available Gestação gemelar com gêmeo acárdio é um evento raro que se caracteriza pela presença de uma anastomose placentária entre o gêmeo doador, morfologicamente normal, e o gêmeo acárdio, levando à perfusão contra-corrente de um dos gêmeos. As principais complicações encontram-se associadas à prematuridade e insuficiência cardíaca do gêmeo normal secundária à sobrecarga circulatória. Várias modalidades terapêuticas têm sido propostas, mas não há consenso em relação aos resultados observados. A oclusão intra-fetal da artéria umbilical do gêmeo acárdio tem se mostrado um método de baixo custo, fácil execução e alta eficácia no controle da sobrecarga circulatória. Apresentamos dois casos com ablação intra-fetal e boa evolução. Uma gestação trigemelar na qual se realizou a ablação intra-fetal com 29 semanas, evoluindo com parto prematuro e nascimento de um recém-nascido em boas condições. Uma gestação gemelar cuja ablação foi realizada com 31 semanas e que evoluiu com rotura prematura de membranas e parto prematuro com nascimento de uma criança saudável.Twin pregnancy with an acardiac twin is a rare event characterized by the presence of a placentary arterial anastomosis between the pump twin, morfologically normal, and the acardiac twin, causing a reverse circulation in one of the twins. The major complications are associated with cardiac failure in the normal twin, which is due to circulatory overload and prematurity. Many therapeutic options have been proposed, but there is no consensus about which one is the best therapy. However, intrafetal ablation of the umbilical artery of the acardiac fetus proved to be an inexpensive method that is easy to perform and highly efficient in controlling circulatory overload. We presented two cases of intra-fetal ablation and good evolution. A triplet pregnancy in which the intra-fetal ablation was done in a 29-week-old fetus that evolved to premature delivery of

  8. Yoruba customs and beliefs pertaining to twins.

    Science.gov (United States)

    Leroy, Fernand; Olaleye-Oruene, Taiwo; Koeppen-Schomerus, Gesina; Bryan, Elizabeth

    2002-04-01

    The Yoruba are an important ethnic group mainly occupying Southwestern Nigeria. Mainly for genetic reasons, this very large tribe happens to present the highest dizygotic twinning rate in the world (4.4 % of all maternities). The high perinatal mortality rate associated with such pregnancies has contributed to the integration of a special twin belief system within the African traditional religion of this tribe. The latter is based on the concept of a supreme deity called Olodumare or Olorun, assisted by a series of secondary gods (Orisha) while Yoruba religion also involves immortality and reincarnation of the soul based on the animistic cult of ancestors. Twins are therefore given special names and believed to detain special preternatural powers. In keeping with their refined artistic tradition, the Yoruba have produced numerous wooden statuettes called Ibejis that represent the souls of deceased newborn twins and are involved in elaborate rituals. Among Yoruba traditional beliefs and lore some twin-related themes are represented which are also found in other parts of the world. Basic features of the original Yoruba beliefs have found their way into the religious traditions of descendants of African slaves imported in the West Indies and in South America.

  9. Twin-twin Transfusion Syndrome with a Single Ectopic Kidney in a Twin Donor. Case Presentation

    OpenAIRE

    Gerardo Rogelio Robaina Castellanos; Solangel de la Caridad Riesgo Rodríguez; Esther María Tristá Ricardo

    2016-01-01

    Twin-twin Transfusion Syndrome presents more frequently in diamniotic monochromic twins. In advanced stages and without prenatal intervention, is associated to high rates of peri natal mortality and neurological sequel in the survivors. It is presented a case of a pair of twins with severe depression at birth in which it was diagnosed a Twin-twin Transfusion Syndrome, later confirmed with the presence of anemia in the donor twin and polycythemia in the receptor twin. Both twins had an unfavou...

  10. Impact of Different Treatment Approaches on Pregnancy Outcomes in 99 Women Treated for Hodgkin Lymphoma

    International Nuclear Information System (INIS)

    De Sanctis, Vitaliana; Filippone, Francesco Romeo; Alfò, Marco; Muni, Roberta; Cavalieri, Elena; Pulsoni, Alessandro; Annechini, Giorgia; Valeriani, Maurizio; Osti, Mattia Falchetto; Minniti, Giuseppe; Enrici, Riccardo Maurizi

    2012-01-01

    Purpose: The aim of this study was to evaluate the pregnancy outcomes in women with Hodgkin lymphoma (HL) diagnosis, treated between 1972 and 1999 at Department of Radiotherapy and Hematology of University “Sapienza” of Roma. Methods and Materials: We retrospectively studied 99 female patients that conceived after treatment for HL. Fifty-nine (59%) were treated with chemotherapy and radiotherapy, 32 (32%) with radiotherapy alone as supradiaphragmatic or as infradiaphragmatic and 8 (8%) patients with chemotherapy alone. Results: Ninety-nine patients reported 145 pregnancies. We observed 132 deliveries (2 of them twin births) after a median of 55 months (range, 14–278 months) from the end of therapy. Twelve women (12%) experienced 13 miscarriages after a median of 50 months (range, 13–120) from the end of therapy. We recorded 9/132 (7%) premature births and 3/134 babies (2%) were underweight at the time of birth. We recorded 2 cases of congenital malformations. No statistical differences were recorded when adverse pregnancy outcomes were analyzed with respect to chemotherapy alone, radiotherapy alone, or combined therapy. Conclusions: No significant associations between pregnancy outcomes and therapeutic approaches were found. In particular, the infradiaphragmatic radiotherapy showed no statistical association with miscarriages, premature birth, and low birth weight at term when compared with other therapeutic approaches.

  11. Reflectance spectrometry of placental vessels in cases of twin-twin transfusion syndrome: experiments and modeling

    Science.gov (United States)

    Lines, Collin; Kim, Oleg; McMurdy, John; Luks, Francois; Alber, Mark; Crawford, Greg

    2013-03-01

    A stochastic photon transport model in multilayer skin tissue combined with reflectance spectroscopy measurements is used to study placental vessels in cases of twin-twin transfusion syndrome (TTTS). TTTS occurs in about 12% of monozygotic (identical) twin pregnancies wherein flow within placental vessels linking the twins together becomes unbalanced, leading to dual mortality. Endoscopic laser ablation can halt the syndrome by occluding the anastomoses connecting the two fetuses. The objective of this study is to develop a technique to determine hemoglobin (Hb) content through spectral analysis of diffuse reflectance spectra of placental vessels to aid in identification of the anastomoses. Previous work by researchers at Brown University has shown that the reflectance spectra of the donor twin and recipient twin are considerably different in the wavelengths for Hb absorbance. This presentation will give preliminary results for a Monte Carlo model adapted to fit the physiology of the placenta that can be used to quantitative determine the Hb levels. The reflectance spectra of the vessels are simulated for different values of Hb as well oxygenation and water concentration with the vessel and placental mass. The preliminary results will be shown to be in good approximation with the prior experimental data. The combination of modeling with spectroscopic measurement will provide a new tool for detailed prenatal study.

  12. Growth and development of children conceived by intracytoplasmic sperm injection at King Chulalongkorn Memorial Hospital.

    Science.gov (United States)

    Pruksananonda, C

    2001-06-01

    A number of concerns have been raised about children conceived by intracytoplasmic sperm injection (ICSI). In this study, 75 babies in the King Chulalongkorn Memorial Hospital ICSI programme were determined during pediatric follow-up to assess the growth, development and congenital malformations from April 1997 to December 2000. Male to female ratio was 1:1.27. Mean birth weight for singletons was not different from the general population. Thirty six per cent of the babies weighed less than 2,500 g, which was almost four times higher than naturally conceived babies. Approximately 27 per cent of deliveries were multiple pregnancies compared to 0.93 per cent from natural conception. Prematurity rate was 25 per cent and 85.7 per cent of deliveries were carried out by caesarian section. One baby (1.3%) had major congenital malformation and 37 babies (49.3%) had one or more minor defects. Most of the babies had weight, height, and head circumference within normal ranges. After correction for gestational age, all the premature babies caught up growth within the first year of life. Eleven babies (14.7%) had abnormal or questionable results or Denver II at different ages. Longer-term follow-up is necessary to properly assess the growth and developmental outcome of the ICSI babies.

  13. Conformity expectations: Differential effects on IVF twins and singletons' parent-child relationships and adjustment.

    Science.gov (United States)

    Anderson, Kayla N; Rueter, Martha A; Connor, Jennifer J; Chen, Muzi; Damario, Mark

    2015-08-01

    Increased utilization of in vitro fertilization (IVF) to treat infertility has resulted in a growing twin birthrate. Despite early childhood risks, twins have fewer psychosocial problems in middle childhood than singleton children. This study proposes that parents' conformity expectations for children have differential effects on parent-child relationships for twin and singleton children, which indirectly explains twins' more optimum psychosocial adjustment. Parental conformity expectations, parent-child relationship satisfaction, and children's emotional, behavioral, and attention problems were assessed in a sample of 288 6- to 12-year-old IVF-conceived twins and singletons. Overall, parents of twins had higher expectations for child conformity to parent rules than singleton parents. Path models demonstrate that twin status and parental expectations for child conformity interact to influence parent-child relationships, and this interaction indirectly accounted for differences in twins' and singletons' psychosocial adjustment. Findings suggest parenting constructs have differential influences on the association between twin status and parent-child relationships. Parenting research, predominantly conducted with singletons, should be reexamined before applying existing research to twin children and their families. (c) 2015 APA, all rights reserved).

  14. The Danish Twin Register

    DEFF Research Database (Denmark)

    Kyvik, K O; Christensen, Kaare; Skytthe, A

    1996-01-01

    BACKGROUND: Population based twin registers represent a valuable tool for genetic epidemiological research, since twin studies aim at separating the effect of genes and environment for complex traits. The Danish Twin Register's history, size, ascertainment and completeness of data, as well as dat......-1952 og 1983-1993 are being ascertained at the moment. The register is available for research given certain conditions are fulfilled. CONCLUSION: This register will in a few years be the most comprehensive twin register in the world. It is a very valuable Danish research resource....

  15. Higher Prevalence of Left-Handedness in Twins? Not After Controlling Birth Time Confounders.

    Science.gov (United States)

    Heikkilä, Kauko; Vuoksimaa, Eero; Saari-Kemppainen, Aulikki; Kaprio, Jaakko; Rose, Richard J; Haukka, Jari; Pitkäniemi, Janne; Iivanainen, Matti

    2015-10-01

    Pregnancy- and birth-related factors may have an effect on handedness. Compared with singletons, twins have a lower birth weight, shorter gestational age, and are at higher risk for birth complications. We tested whether the prevalence of left-handedness is higher among twins than singletons, and if so, whether that difference is fully explained by pregnancy and birth-related differences between twins and singletons. We analyzed Finnish population-based datasets; included were 8,786 twins and 5,892 singletons with information on birth weight (n = 12,381), Apgar scores (n = 11,129), and gestational age (n = 11,811). Two twin cohorts were involved: FinnTwin12 included twins born during 1983-1987, and FinnTwin16 included twins born during 1974-1979. We had two comparison groups of singletons: 4,101 individuals born during 1986-1988 and enrolled in the Helsinki Ultrasound Trial, and 1,791 individuals who were partners of FinnTwin16 twins. We used logistic regression models with writing hand as the outcome for comparison and evaluating effects of covariates. Left-handedness was more common in twins (9.67%) than in singletons (8.27%; p = .004). However, Apgar scores were associated with handedness, and after controlling for covariates, we found no difference in the prevalence of left-handedness between twins and singletons. Increased left-handedness among twins, often reported by others, was evident in our data, but only among our older twin cohorts, and that association disappeared after removing effects of perinatal covariates.

  16. Conjoined (Siamese) Twins in Zambia

    African Journals Online (AJOL)

    year-old Zambian multiparous mother gave birth to a set of twins with two heads ... (symmetric or mirror image) but one twin attached with an incomplete foetus is known as hetropagtrs. (asymmetrical). Thoracopagus twins (joined at the chest).

  17. Achievement test performance in children conceived by IVF.

    Science.gov (United States)

    Mains, L; Zimmerman, M; Blaine, J; Stegmann, B; Sparks, A; Ansley, T; Van Voorhis, B

    2010-10-01

    Long-term follow-up studies of children conceived by IVF are limited. We examine academic performance on standardized tests [Iowa Tests of Basic Skills/Educational Development (ITBS/ITED)] of children conceived by IVF. Parents of children 8-17 years of age at the onset of the study (March 2008) who were conceived by IVF at the University of Iowa Hospitals and Clinics and living in the state of Iowa were contacted by mail. Parents completed questionnaires on their child's health and education and parental education. ITBS/ITED scores from school grades 3-12 were obtained on IVF children and a group of anonymous children matched by grade, year, gender and school district. Scores were analyzed using linear mixed models. Four hundred and ninety-seven couples were contacted. Two hundred and ninety-five couples (463 children) agreed to participate (59.4% of parents), with ITBS/ITED scores available on 423 children (91.4% of participants). IVF children scored higher than the national mean (P divorce and child's BMI. Cryopreservation, length of embryo culture and method of insemination did not affect scores. IVF children scored higher on standardized tests than their matched peers, suggesting that IVF does not have a negative effect on cognitive development. However, long-term follow-up of IVF children is still limited. Further research should be performed on the effect of multiple gestation on academic performance.

  18. Nuchal translucency measurements are highly correlated in both mono- and dichorionic twin pairs

    DEFF Research Database (Denmark)

    Wøjdemann, Karen R; Larsen, Severin Olesen; Shalmi, Anne-Cathrine

    2006-01-01

    OBJECTIVES: To establish the distribution of serological and ultrasound first-trimester Down syndrome markers in twins and identify correlations of significance for risk calculation. METHODS: Nuchal translucency (NT), PAPP-A and betahCG data were extracted from 181 twin pregnancies (31 mono......- and 150 dichorionic) with a normal outcome. All pregnancies were consecutively and prospectively included and examined in the Copenhagen First-Trimester Study. The variance of the sum and the difference of log MoM NT values in twin pairs was used to calculate the correlation. RESULTS: The serological...... that the NT is influenced by placental and maternal factors specific for the particular pregnancy, for example, nutrient supply or vascularisation. The correlation may be useful to improve the precision of the prenatal risk assessment for Down syndrome in first-trimester twin pregnancies. The serological...

  19. Infertility, infertility treatment and twinning: the Danish National BirthCohort

    DEFF Research Database (Denmark)

    Zhu, Jin Liang; Basso, Olga; Obel, Carsten

    2007-01-01

    BACKGROUND We have previously observed that an increasing time to pregnancy (TTP) is associated with a reduced frequency of twin deliveries in couples not receiving infertility treatment. By using updated information, we assessed the frequencies of dizygotic (DZ) and monozygotic (MZ) twin...

  20. The Danish Twin Registry

    DEFF Research Database (Denmark)

    Skytthe, Axel; Ohm Kyvik, Kirsten; Vilstrup Holm, Niels

    2011-01-01

    Introduction: The Danish Twin Registry is a unique source for studies of genetic, familial and environmental factors on life events, health conditions and diseases. Content: More than 85,000 twin pairs born 1870-2008 in Denmark. Validity and coverage: Four main ascertainment methods have been emp...

  1. Rotational Twin Paradox

    Science.gov (United States)

    Smarandache, Florentin

    2012-10-01

    Two twins settle on a massive spherical planet at a train station S. Let's consider that each twin has an accompanying clock, and the two clocks are synchronized. One twin T1 remains in the train station, while the other twin T2 travels at a uniform high speed with the train around the planet (on the big circle of the planet) until he gets back to the same train station S. Assume the planet is not rotating. Since the planet is massive, we can consider that on a very small part on its surface the train rail road is linear, so the train is in a linear uniform motion. The larger is the planet's radius the more the rail road approaches a linear trajectory. Because the GPS clocks are alleged to be built on the Theory of Relativity, one can consider the twin T2 train's circular trajectory alike the satellite's orbit. In addition, the gravitation is the same for the reference frames of T1 and T2. Each twin sees the other twin as traveling, therefore each twin finds the other one has aged slower than him. Thus herein we have a relativistic symmetry. When T2 returns to train station S, he finds out that he is younger than T1 (therefore asymmetry). Thus, one gets a contradiction between symmetry and asymmetry.

  2. Doppler assessment of patients with twin-to-twin transfusion syndrome and survival following fetoscopic laser surgery.

    Science.gov (United States)

    Gil Guevara, Enrique; Pazos, Andrea; Gonzalez, Otilia; Carretero, Pilar; Molina, Francisca S

    2017-06-01

    To investigate fetal-survival rates following laser surgery for twin-to-twin transfusion syndrome (TTTS) and the impact of Doppler analysis. The present retrospective single-center study included data from patients with pregnancies exhibiting TTTS treated with fetoscopic laser surgery between January 1, 2007, and December 31, 2016. Perinatal outcomes were examined and variables were compared between the donor and recipient fetuses that survived and died, respectively. There were 86 pregnancies exhibiting TTTS treated with fetoscopic laser surgery included in the study. The median length of pregnancy at the time of surgery was 21.1 weeks. Both twin fetuses and at least one fetus survived in 61 (71%) and 73 (85%) pregnancies, respectively. Among recipient fetuses, ductus venosus a-wave anomalies (P=0.026), shorter cervical length (P=0.044), and a greater than 25% discrepancy in the estimated weight of the twin fetuses (P=0.045) were associated with reduced survival. Among pregnancies exhibiting TTTS, laser surgery was associated with significant dual-fetus survival. Preoperative ductus venosus anomalies were associated with lower survival among recipient fetuses, and 1-week postsurgical ultrasonography data demonstrated lower survival among recipient fetuses with persistent anomalous ductus venosus compared with normalized ductus venosus. © 2017 International Federation of Gynecology and Obstetrics.

  3. A prospective study of twinning and perinatal mortality in urban Guinea-Bissau

    DEFF Research Database (Denmark)

    Bjerregaard-Andersen, Morten; Lund, Najaaraq; Jepsen, Frida Staarup

    2012-01-01

    .24, CI: 2.39-7.51) and caesarean section (RR = 1.78, CI: 1.06-2.99) were significant risk factors for perinatal twin mortality. Male sex (RR = 1.38, CI: 0.97-1.96), unawareness of twin pregnancy (RR = 1.64, CI: 0.97-2.78) and high blood pressure during pregnancy (RR = 1.77, CI: 0.88-3.57) were borderline...

  4. Assisted Reproduction versus Spontaneous Conception: A Comparison of the Developmental Outcomes in Twins

    Science.gov (United States)

    Kelly-Vance, Lisa; Anthis, Kristine S.; Needelman, Howard

    2004-01-01

    The use of assisted reproductive technology is increasing rapidly. Research, although sparse, has resulted in inconsistent findings as to the developmental prognosis for infants conceived by assisted reproductive techniques such as in vitro fertilization and the use of fertility drugs. In the present study, the authors compared twins who were…

  5. Birth weight centiles by gestational age for twins born in south India.

    Science.gov (United States)

    Premkumar, Prasanna; Antonisamy, Belavendra; Mathews, Jiji; Benjamin, Santhosh; Regi, Annie; Jose, Ruby; Kuruvilla, Anil; Mathai, Mathews

    2016-03-24

    Birth weight centile curves are commonly used as a screening tool and to assess the position of a newborn on a given reference distribution. Birth weight of twins are known to be less than those of comparable singletons and twin-specific birth weight centile curves are recommended for use. In this study, we aim to construct gestational age specific birth weight centile curves for twins born in south India. The study was conducted at the Christian Medical College, Vellore, south India. The birth records of all consecutive pregnancies resulting in twin births between 1991 and 2005 were reviewed. Only live twin births between 24 and 42 weeks of gestation were included. Birth weight centiles for gestational age were obtained using the methodology of generalized additive models for location, scale and shape (GAMLSS). Centiles curves were obtained separately for monochorionic and dichorionic twins. Of 1530 twin pregnancies delivered during the study period (1991-2005), 1304 were included in the analysis. The median gestational age at birth was 36 weeks (1st quartile 34, 3rd quartile 38 weeks). Smoothed percentile curves for birth weight by gestational age increased progressively till 38 weeks and levels off thereafter. Compared with dichorionic twins, monochorionic twins had lower birth weight for gestational age from after 27 weeks. We provide centile values of birth weight at 24 to 42 completed weeks of gestation for twins born in south India. These charts could be used both in routine clinical assessments and epidemiological studies.

  6. [Asynchronous twin births. Case report and obstetric management review].

    Science.gov (United States)

    Magdaleno-Dans, F; López-Magallón, S; Sancha-Naranjo, M; De la Calle, M; Bartha José, L

    2016-01-01

    The incidence of multiple pregnancy has increased in the last years. These pregnancies are associated with more obstetric complications regarding single pregnancies, one of the most important is prematurity. In extremely rare cases premature delivery of one fetus may occur, being retained in the uterine cavity the second fetus until birth later, producing the so-called delayed delivery of twins. We report the case of a double twin pregnancy with delayed delivery of the second fetus after birth of the first one within 22.6 weeks of gestation and the second one birth at at 24 weeks of gestation, eight days later after the first one. A review of cases published in the literature is performed and the obstetric management of delayed delivery discussed.

  7. Cardiac pathophysiology in twin-twin transfusion syndrome: new insights into its evolution.

    Science.gov (United States)

    Wohlmuth, C; Boudreaux, D; Moise, K J; Johnson, A; Papanna, R; Bebbington, M; Gardiner, H M

    2018-03-01

    In twin-twin transfusion syndrome (TTTS), unbalanced transfer of vasoactive mediators and fluid from the donor to the recipient cotwin alters their cardiovascular function. The aims of this study were to describe the impact of TTTS on fetal cardiac function in a large cohort of monochorionic-diamniotic (MCDA) pregnancies, and determine the early hemodynamic response to selective fetoscopic laser photocoagulation (SFLP). Echocardiography was performed in 145 MCDA pregnancies, including 26 uncomplicated MCDA, 61 TTTS Stages I+II and 58 TTTS Stages III+IV pregnancies, prior to SFLP for TTTS. Echocardiographic data after SFLP were available in a subset of 41/119 (34%) TTTS cases at a mean of 1.7 ± 1.9 days. Mitral (MAPSE) and tricuspid (TAPSE) annular systolic excursion, myocardial performance index (MPI), tissue Doppler velocities (E', A', S') and filling pressures (E/E') were measured and transformed into Z-scores. Ventricular pressure was estimated from peak atrioventricular regurgitation velocity. Left ventricular hemodynamics of the recipient twin were affected in early TTTS. In all stages of TTTS, left MPI and E/E' of the recipient twin were elevated in comparison to those of the donor (all P group difference in right ventricular E/E' was significant only in TTTS Stages III+IV recipients compared with TTTS Stages I+II (P = 0.007) and uncomplicated MCDA (P = 0.041). Recipient left and right MPI decreased while S', MAPSE and TAPSE increased after SFLP; in donors, left E/E' and cardiac output increased. Cardiac function of the recipient twin in TTTS is abnormal, even in the early stages of the disease. Left ventricular filling pressures are elevated and systolic function is decreased before abnormalities in the right heart become apparent. SFLP produces rapid hemodynamic improvement. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

  8. 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.

  9. Ascites in the Puerperium in the Context of a Woman with Turner Syndrome Who Conceived through Assisted Reproductive Technology

    Directory of Open Access Journals (Sweden)

    Nikolaos Tsagkas

    2015-01-01

    Full Text Available The case is about a young female who delivered twins by caesarean section (CS. On the 4th postoperative day, she presented with ascites which was resistant to empirical antibiotic and diuretic treatment. The woman was affected by Turner syndrome (TS; she had a medical background of chronic use of hormonal medication since puberty and conceived through ART- (assisted reproduction techniques- IVF-oocyte donation. It is important to exhibit high suspicion for clot formation in the hepatic vasculature during the puerperium, especially in the case of history of chronic hormone treatment. Ascites albumin gradient and Doppler values lead to the diagnosis of thrombosis and the administration of high doses of anticoagulants is considered to be fundamental.

  10. Multiple Pregnancy

    Science.gov (United States)

    ... Education & Events Advocacy For Patients About ACOG Multiple Pregnancy Home For Patients Search FAQs Multiple Pregnancy Page ... Multiple Pregnancy FAQ188, July 2015 PDF Format Multiple Pregnancy Pregnancy How does multiple pregnancy occur? What are ...

  11. Delivery of the second twin: comparison of two approaches.

    Science.gov (United States)

    Pons, Jean-Claude; Dommergues, Marc; Ayoubi, Jean-Marc; Gélébart, Marie; Papiernik, Emile

    2002-08-05

    To compare two obstetrical approaches toward delivery of the second twin: one of expectant management, and the other, active; to compare the neonatal and maternal results and thereby identify, if possible, the optimal approach. This retrospective study looked at twin births in two maternity units in the Paris, France metropolitan region: Antoine Béclère (AB) in Clamart, and Port-Royal (PR) in Paris and concerned 113 deliveries of pairs of twins at AB and 78 at PR. The mean duration of the interbirth interval was 9 min at AB and 5 min at PR (P < 0.001). The characteristics of the pregnancies and the deliveries of twin A were comparable. Spontaneous birth accounted for 51% of twin A births at AB and 27% at PR (P < 0.001). Intrauterine manipulation of twin B occurred in 2% of the births at AB and 43% at PR (P < 0.001). At AB, there were five cesareans to deliver the second twin, but none at PR. The Apgar scores at AB and PR were identical, at 1 and 5 min, and for births before 32 weeks' gestation as well as for those afterwards. At AB, 19% (n = 21) of second twins were transferred to the neonatal intensive care unit, and at PR, 18% (n = 14). The neonatal results were similar in both groups, even though both the rate of obstetric maneuvers and the interbirth interval differed significantly. The two methods therefore appear to be equivalent when judged by the second twin's neonatal indicators. Our data suggest that an active approach diminishes the likelihood of cesarean delivery for the second twin, without increasing the neonatal risk.

  12. Prenatal diagnosis of chorionicity in twins.

    LENUS (Irish Health Repository)

    Hassan, T

    2012-02-01

    The aim of this audit was to assess the accuracy of transabdominal ultrasound scan in predicting chorionicity in twin pregnancies in our unit. The presence or absence of lambda sign, T-sign, dividing membrane thickness and number of placentae were used to determine chorionicity. We retrospectively analysed these antenatal markers in 268 sets of twins delivered over a 5 year period and compared it with the postpartum placental histology and neonatal gender. Of 268 twin deliveries, 204 (76%) had both chorionicity and placental histology to compare. 67 of 84 (80%) were correctly diagnosed antenatally as monochorionic and 137 of 151 (91%) as dichorionic. In 31 cases (15%) the ultrasound diagnosis of chorionicity didn\\'t match placental histology. Seventeen were thought to be monochorionic antenatally but were confirmed dichorionic on placental histology. Overall chorionicity was correctly diagnosed in 171\\/204 (84%) using transabdominal ultrasound scan (USS) in all trimesters. However the sensitivity and specificity of USS was much higher for dichorionic twins when carried out before 14 weeks of gestation.

  13. Do subfertile women adjust their habits when trying to conceive?

    Science.gov (United States)

    Joelsson, Lana Salih; Berglund, Anna; Wånggren, Kjell; Lood, Mikael; Rosenblad, Andreas; Tydén, Tanja

    2016-08-01

    The aim of this study was to investigate lifestyle habits and lifestyle adjustments among subfertile women trying to conceive. Women (n = 747) were recruited consecutively at their first visit to fertility clinics in mid-Sweden. Participants completed a questionnaire. Data were analyzed using logistic regression, t tests, and chi-square tests. The response rate was 62% (n = 466). Mean duration of infertility was 1.9 years. During this time 13.2% used tobacco daily, 13.6% drank more than three cups of coffee per day, and 11.6% consumed more than two glasses of alcohol weekly. In this sample, 23.9% of the women were overweight (body mass index, BMI 25-29.9 kg/m(2)), and 12.5% were obese (BMI ≥30 kg/m(2)). Obese women exercised more and changed to healthy diets more frequently than normal-weight women (odds ratio 7.43; 95% confidence interval 3.7-14.9). Six out of ten women (n = 266) took folic acid when they started trying to conceive, but 11% stopped taking folic acid after some time. Taking folic acid was associated with a higher level of education (p habits but did not reduce their body mass index. Women of fertile age would benefit from preconception counseling, and the treatment of infertility should routinely offer interventions for lifestyle changes.

  14. SUSY Meets Her Twin

    CERN Document Server

    Katz, Andrey; Pokorski, Stefan; Redigolo, Diego; Ziegler, Robert

    2017-01-31

    We investigate the general structure of mirror symmetry breaking in the Twin Higgs scenario. We show, using the IR effective theory, that a significant gain in fine tuning can be achieved if the symmetry is broken hardly. We emphasize that weakly coupled UV completions can naturally accommodate this scenario. We analyze SUSY UV completions and present a simple Twin SUSY model with a tuning of around 10% and colored superpartners as heavy as 2 TeV. The collider signatures of general Twin SUSY models are discussed with a focus on the extended Higgs sectors.

  15. Dicephalus parapagus conjoined twins discordant for anencephaly: a case report

    Directory of Open Access Journals (Sweden)

    Udo Jacob J

    2010-02-01

    Full Text Available Abstract Introduction Cases of conjoined twins occur so rarely that it is important to learn as much as possible from each case. Case presentation We present a case of 9-hour-old, female, Nigerian dicephalus parapagus conjoined twins discordant for anencephaly diagnosed only after the birth of the twins. The anencephalic twin was stillborn while the normal one died within 9 hours of birth from cardiopulmonary failure. Conclusion Many congenital defects of interest can now be detected before birth. A severe lesion such as that found in our index case, which is incompatible with postnatal life, requires counselling. If detected early enough during a properly monitored antenatal care, it may indicate termination of pregnancy.

  16. Laparoscopic management of interstitial pregnancy with automatic stapler.

    Science.gov (United States)

    Ahsan Akhtar, Muhammad; Izzat, Feras; Keay, Stephen D

    2012-10-22

    A 36-year-old woman was referred by general practitioner to the early pregnancy unit with pelvic pain in her seventh week of pregnancy. She had a transvaginal ultrasound. Unruptured live twin tubal ectopic pregnancy was diagnosed on. Diagnostic laparoscopy revealed an unruptured left interstitial ectopic pregnancy. The interstitial tubal pregnancy was removed by laparoscopic automatic stapler with minimal blood loss. The patient had an uneventful recovery to health.

  17. Laparoscopic management of interstitial pregnancy with automatic stapler

    OpenAIRE

    Ahsan Akhtar, Muhammad; Izzat, Feras; Keay, Stephen D

    2012-01-01

    A 36-year-old woman was referred by general practitioner to the early pregnancy unit with pelvic pain in her seventh week of pregnancy. She had a transvaginal ultrasound. Unruptured live twin tubal ectopic pregnancy was diagnosed on. Diagnostic laparoscopy revealed an unruptured left interstitial ectopic pregnancy. The interstitial tubal pregnancy was removed by laparoscopic automatic stapler with minimal blood loss. The patient had an uneventful recovery to health.

  18. Risk of Monozygotic Twins After Assisted Reproduction: A Population-Based Approach.

    Science.gov (United States)

    Parazzini, Fabio; Cipriani, Sonia; Bianchi, Stefano; Bulfoni, Camilla; Bortolus, Renata; Somigliana, Edgardo

    2016-02-01

    Recent studies have suggested that ovarian stimulation and assisted reproductive techniques (ART) may increase the frequency of monozygotic twins. In this article, we present the analysis of the estimated frequency of twin deliveries following in vitro fertilization (IVF) in Lombardy during the period 2010-2014 for a total of 450,949 pregnancies. This is a population-based study using data from the regional data base of Lombardy, a northern Italian region with a population of about 10 million inhabitants. During the considered period, a total of 461,424 single or multiple births were registered in Lombardy. After exclusion of triplets or more pregnancies, the total number of twin deliveries, in separate strata of like and unlike sex pregnancies twin deliveries, were obtained and the rate of twin deliveries was computed according to spontaneous and non-spontaneous conception and type of ART. Further, estimates of dizygotic or monozygotic twin births were calculated using Weinberg's methods. The frequency of twins deliveries was 1.24/100 deliveries after natural conception and 20.05 after assisted conception. The estimated rates of monozygotic twins was 0.45 and 0.72/100 (95% CI: 0.58-0.91) deliveries after natural and assisted conception, respectively. This difference was statistically significant (p assisted than after natural conception.

  19. Twinning in Holstein-Friesian Dairy Cows: Proportion Carried to Term and Calf Sex Ratios.

    Science.gov (United States)

    Cockcroft, Peter D; Sorrell, Emma J

    2015-07-07

    The purpose of this study was to investigate the proportion of twins carried to term and the sex ratio of twin calves at birth in Holstein-Friesian dairy cattle kept on commercial farms in Devon and Cornwall, England. Ten farms were used in the study. Fifty four cows with twin pregnancies were identified using trans-rectal ultra-sonographic examination between 30 and 70 days of gestation. The farm records were subsequently used to derive the number of calves born. Farm records of 66 additional sets of twin births with the sex of the calves recorded were also identified. Of the 54 cows diagnosed with twin pregnancies, 16 cows (29.6%) aborted or absorbed both fetuses, 11 cows (20.4%) carried one calf to term and 27 cows (50%) carried both calves to term. In the calf sex analysis of the additional 66 sets of twins: 13♂♂ calves (19.7%), 18 ♀♀ calves (27.3%) and 35 ♂♀ calves (53.0%). There was no statistically significant difference from an expected ratio of 1♂♂:2♂♀:1♀♀ ( p = 0.61). This study provides bench marks for the expected abortion/absorption rates following the early ultra-sonographic diagnosis of twin pregnancies in comparable populations and supports earlier observations that the expected sex ratio for twinning approximates to1♂♂:2♂♀:1♀♀.

  20. Jejunal atresia in twins

    NARCIS (Netherlands)

    Moorman-Voestermans, C. G.; Heij, H. A.; Vos, A.

    1990-01-01

    In the past 2 1/2 years a sudden increase in the frequency of jejunal atresia in discordant, nonidentical twins was observed. Reported are the details of 11 cases and some reflections on possible pathogenetic mechanisms involved

  1. Reclaiming fertility awareness methods to inform timed intercourse for HIV serodiscordant couples attempting to conceive.

    Science.gov (United States)

    Liao, Caiyun; Wahab, Maybel; Anderson, Jean; Coleman, Jenell S

    2015-01-01

    Increased life expectancy of HIV-positive individuals during recent years has drawn attention to their quality of life, which includes fulfillment of fertility desires. In particular, heterosexual HIV serodiscordant couples constitute a special group for whom the balance between desired pregnancy and the risk of viral transmission should be carefully considered and optimized. Although advanced assisted reproductive technologies are available, such treatments are expensive and are often unavailable. Moreover, standard viral load testing and antiretroviral therapy may not be accessible due to structural or individual barriers. To reduce the risk of HIV transmission, a lower cost alternative is timed condomless sex combined with other risk-reduction strategies. However, timed condomless sex requires specific knowledge of how to accurately predict the fertile window in a menstrual cycle. The aim of this study was to summarize inexpensive fertility awareness methods (FAMs) that predict the fertile window and may be useful for counselling HIV-positive couples on lower cost options to conceive. Original English-language research articles were identified by a detailed Medline and Embase search in July 2014. Relevant citations in the included articles were also retrieved. Calendar method, basal body temperature and cervicovaginal mucus secretions are the most accessible and sensitive FAMs, although poor specificity precludes their independent use in ovulation detection. In contrast, urinary luteinizing hormone testing is highly specific but less sensitive, and more expensive. To maximize the chance of conception per cycle, the likelihood of natural conception needs to be assessed with a basic fertility evaluation of both partners and a combination of FAMs should be offered. Adherence to other risk-reduction strategies should also be advised, and timely referral to reproductive medicine specialists is necessary when sub/infertility is suspected. FAMs provide effective

  2. Long-term neurodevelopmental outcome of monochorionic and matched dichorionic twins.

    Directory of Open Access Journals (Sweden)

    Karien E A Hack

    Full Text Available BACKGROUND: Monochorionic (MC twins are at increased risk for perinatal mortality and serious morbidity due to the presence of placental vascular anastomoses. Cerebral injury can be secondary to haemodynamic and hematological disorders during pregnancy (especially twin-to-twin transfusion syndrome (TTTS or intrauterine co-twin death or from postnatal injury associated with prematurity and low birth weight, common complications in twin pregnancies. We investigated neurodevelopmental outcome in MC and dichorionic (DC twins at the age of two years. METHODS: This was a prospective cohort study. Cerebral palsy (CP was studied in 182 MC infants and 189 DC infants matched for weight and age at delivery, gender, ethnicity of the mother and study center. After losses to follow-up, 282 of the 366 infants without CP were available to be tested with the Griffiths Mental Developmental Scales at 22 months corrected age, all born between January 2005 and January 2006 in nine perinatal centers in The Netherlands. Due to phenotypic (unalikeness in mono-or dizygosity, the principal investigator was not blinded to chorionic status; perinatal outcome, with exception of co-twin death, was not known to the examiner. FINDINGS: Four out of 182 MC infants had CP (2.2% - two of the four CP-cases were due to complications specific to MC twin pregnancies (TTTS and co-twin death and the other two cases of CP were the result of cystic PVL after preterm birth - compared to one sibling of a DC twin (0.5%; OR 4.2, 95% CI 0.5-38.2 of unknown origin. Follow-up rate of neurodevelopmental outcome by Griffith's test was 76%. The majority of 2-year-old twins had normal developmental status. There were no significant differences between MC and DC twins. One MC infant (0.7% had a developmental delay compared to 6 DC infants (4.2%; OR 0.2, 95% 0.0-1.4. Birth weight discordancy did not influence long-term outcome, though the smaller twin had slightly lower developmental scores than its

  3. The 16th International Twin Congress: Highlights from Madrid/Twin Research: Twin Study of Partner Aggression; ABO Incompatibility in Dizygotic Twins; Growth Discordance in a Monoamniotic Twin Pair; Quick Note on Twin Implantation/In the Media: Long-Lost Twins Found; NASA Twin Experiment; Twin Brothers and the Las Vegas Attack; Retired Twin Airline Pilots; Twin Film Clips.

    Science.gov (United States)

    Segal, Nancy L

    2018-02-01

    Highlights from the 16th International Twin Congress, held in Madrid, Spain from November 16-18, 2017, are presented. The Twin Congress, formerly held every three years, now takes place biennially with a single-day meeting organized during the off years. This meeting is the largest gathering of scientific twin researchers, medical personnel, and representatives of multiple birth organizations in the world. This overview is followed by reviews of recent twin research and commentary concerning partner aggression, ABO incompatibility in dizygotic twins, growth discordance in a monoamniotic twin pair and twin implantation. The article closes with summaries of timely topics in the media, namely a father's finding of his long-lost twin children, early results from the NASA twin experiment, twin brothers at the center of the October 2017 Las Vegas attack, retired twin airline pilots, and clips from recent films with twin-based themes.

  4. Dogs discriminate identical twins.

    Directory of Open Access Journals (Sweden)

    Ludvík Pinc

    Full Text Available Earlier studies have shown variation among experimental attempts to establish whether human monozygotic twins that are genetically identical also have identical individual scents. In none of the cases were the dogs able to distinguish all the individual scents of monozygotic twins living in the same environment if the scents were presented to them separately. Ten specially trained police German Shepherd dogs of three Czech Republic Police Regional Headquarters were used for scent identification in our study. The dogs were supposed to match scents of two monozygotic pairs (5 and 7 years old and two dizygotic twin pairs (8 and 13 years old. Scents were collected on cotton squares stored in glass jars. Dog handlers were blind to the experiment details. In each trial (line-up, one scent was used as a starting scent and the dog was then sent to determine if any of the 7 presented glass jars contained a matching scent. Scents of children of similar ages were used as distractors. In the matching procedure, the dogs matched correctly the scent of one twin with the other, as well as two scents collected from every single identical and non-identical twin to prove their efficacy and likewise, the presence of the matching twin scent in any given glass jar. All dogs in all trials distinguished correctly the scents of identical as well as non-identical twins. All dogs similarly matched positively two scents collected from the same individuals. Our findings indicated that specially trained German Shepherd dogs are able to distinguish individual scents of identical twins despite the fact that they live in the same environment, eat the same food and even if the scents are not presented to them simultaneously.

  5. Dogs Discriminate Identical Twins

    Science.gov (United States)

    Pinc, Ludvík; Bartoš, Luděk; Reslová, Alice; Kotrba, Radim

    2011-01-01

    Earlier studies have shown variation among experimental attempts to establish whether human monozygotic twins that are genetically identical also have identical individual scents. In none of the cases were the dogs able to distinguish all the individual scents of monozygotic twins living in the same environment if the scents were presented to them separately. Ten specially trained police German Shepherd dogs of three Czech Republic Police Regional Headquarters were used for scent identification in our study. The dogs were supposed to match scents of two monozygotic pairs (5 and 7 years old) and two dizygotic twin pairs (8 and 13 years old). Scents were collected on cotton squares stored in glass jars. Dog handlers were blind to the experiment details. In each trial (line-up), one scent was used as a starting scent and the dog was then sent to determine if any of the 7 presented glass jars contained a matching scent. Scents of children of similar ages were used as distractors. In the matching procedure, the dogs matched correctly the scent of one twin with the other, as well as two scents collected from every single identical and non-identical twin to prove their efficacy and likewise, the presence of the matching twin scent in any given glass jar. All dogs in all trials distinguished correctly the scents of identical as well as non-identical twins. All dogs similarly matched positively two scents collected from the same individuals. Our findings indicated that specially trained German Shepherd dogs are able to distinguish individual scents of identical twins despite the fact that they live in the same environment, eat the same food and even if the scents are not presented to them simultaneously. PMID:21698282

  6. Decreased Brain and Placental Perfusion in Omphalopagus Conjoined Twins on Fetal MRI

    Directory of Open Access Journals (Sweden)

    Sureyya Burcu Gorkem

    2016-01-01

    Full Text Available The aim of this study is to evaluate perfusional changes in brain and placenta of omphalopagus conjoined twins and to compare them with singleton fetuses by using diffusion weighted imaging and apparent diffusion coefficient. Fetal MRIs of 28-week-old omphalopagus conjoined twins with a shared liver with two separate gallbladders and portal and hepatic venous systems and three singleton fetuses with unilateral borderline ventriculomegaly at the same gestational week as control group were enrolled retrospectively. There was a significant decrease in ADC values of brain regions (p=0.018 and placenta (p=0.005 of conjoined twins compared to the control group. The decreased ADC values in placenta and brain regions in conjoined twins might be due to decreased placental perfusion compared to singleton pregnancy. Our results would be a keystone for future studies which will compare larger group of monochorionic multiple pregnancies with singleton pregnancies.

  7. Management of Systemic Lupus Erythematosus During Pregnancy.

    Science.gov (United States)

    Sammaritano, Lisa R

    2017-01-14

    Reproductive issues including contraception, fertility, and pregnancy are important components of the comprehensive care of women with systemic lupus erythematosus (SLE). SLE pregnancies are complicated due to risk for maternal disease exacerbation and potential for fetal and neonatal complications. Pre-pregnancy assessment is important to identify patients with severe disease-related damage who should avoid pregnancy, counsel patients to conceive when disease has been stable and inactive on appropriate medications, and assess relevant risk factors including renal disease, antiphospholipid antibody, and anti-Ro/SS-A and anti-La/SS-B antibodies. With careful planning, monitoring, and care, most women with SLE can anticipate a successful pregnancy.

  8. Determinants of monozygotic twinning in ART

    DEFF Research Database (Denmark)

    Hviid, Kathrine Vauvert R; Malchau, Sara Sofia; Pinborg, Anja

    2018-01-01

    BACKGROUND: The incidence of monozygotic twins (MZT) after ART appears to be higher than the incidence after spontaneous conceptions contradicting the aim of ART to avoid multiple pregnancies because of the associated risks. OBJECTIVE AND RATIONALE: The aim was to study the frequency of MZT after...... only on case studies. All of the articles were categorized according to the Oxford Centre for Evidence-based Medicine's 'Levels of Evidence', and quality and risk of bias assessment was performed with 'The Cochrane Collaboration's Risk of Bias Tools'. A meta-analysis was performed to study the impact...

  9. Management of breech and twin labor during registrarship: A two-year prospective, observational study.

    Science.gov (United States)

    Chevreau, J; Foulon, A; Abou Arab, O; Luisin, M; Parent, C; Sergent, F; Gondry, J

    2018-03-03

    Breech presentation and twin pregnancy are regarded as stressful situations for medical staff. This stress is often associated with an increased likelihood of intervention during labor - especially when the on-shift obstetrician lacks experience. We performed a 2-year prospective, observational study of cesarean section (CSDs) and assisted vaginal (AVDs) deliveries in a tertiary maternity unit for attempted vaginal deliveries of breech presentations and twin pregnancies. The obstetric management decisions taken by a group of four registrars were compared with those taken by a group of 11 experienced obstetricians. Changes over time in practice were also monitored. Registrars managed 66 and 52 breech presentations and twin pregnancies respectively (30 and 27 in the experienced group). Groups' neonatal outcomes were similar. There were no intergroup differences in proportions of CSDs for either breech presentations (25 [37.5%] vs. 15 [50%] in the registrar and experienced groups, respectively; P=0.26) or twin pregnancies (11 [21.1%] vs. 6 [22.2%], respectively; P=0.91) or in proportion of AVDs for twin pregnancies (41 [78.8%] vs. 21 [77.8%], respectively; P=0.91). Proportions of CSDs for breech presentation and AVDs for twin pregnancies did not change over time in either group. However, proportion of CSDs for twin pregnancies increased over time in the registrar group (P=0.004). Well-trained registrars appeared to have acquired the skills required to safely manage an obstetric ward; this pleads to maintain clinical practice during residency to preserve low CSD and AVD rates. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  10. Hypoalbuminemia in Donors with Twin-Twin Transfusion Syndrome

    NARCIS (Netherlands)

    Verbeek, L.; Middeldorp, J. M.; Hulzebos, C. V.; Oepkes, D.; Walther, F. J.; Lopriore, E.

    2013-01-01

    Objective: To estimate the differences in albumin levels between donors and recipients with twin-twin transfusion syndrome (TTTS). Methods: We performed a matched case-control study including twin pairs with TTTS treated conservatively (conservative group) or with fetoscopic laser surgery (laser

  11. Prevalence, risk factors and outcomes of velamentous and marginal cord insertions: a population-based study of 634,741 pregnancies.

    Directory of Open Access Journals (Sweden)

    Cathrine Ebbing

    Full Text Available OBJECTIVES: To determine the prevalence of, and risk factors for anomalous insertions of the umbilical cord, and the risk for adverse outcomes of these pregnancies. DESIGN: Population-based registry study. SETTING: Medical Birth Registry of Norway 1999-2009. POPULATION: All births (gestational age >16 weeks to <45 weeks in Norway (623,478 singletons and 11,263 pairs of twins. METHODS: Descriptive statistics and odds ratios (ORs for risk factors and adverse outcomes based on logistic regressions adjusted for confounders. MAIN OUTCOME MEASURES: Velamentous or marginal cord insertion. Abruption of the placenta, placenta praevia, pre-eclampsia, preterm birth, operative delivery, low Apgar score, transferral to neonatal intensive care unit (NICU, malformations, birthweight, and perinatal death. RESULTS: The prevalence of abnormal cord insertion was 7.8% (1.5% velamentous, 6.3% marginal in singleton pregnancies and 16.9% (6% velamentous, 10.9% marginal in twins. The two conditions shared risk factors; twin gestation and pregnancies conceived with the aid of assisted reproductive technology were the most important, while bleeding in pregnancy, advanced maternal age, maternal chronic disease, female foetus and previous pregnancy with anomalous cord insertion were other risk factors. Velamentous and marginal insertion was associated with an increased risk of adverse outcomes such as placenta praevia (OR = 3.7, (95% CI = 3.1-4.6, and placental abruption (OR = 2.6, (95% CI = 2.1-3.2. The risk of pre-eclampsia, preterm birth and delivery by acute caesarean was doubled, as was the risk of low Apgar score, transferral to NICU, low birthweight and malformations. For velamentous insertion the risk of perinatal death at term was tripled, OR = 3.3 (95% CI = 2.5-4.3. CONCLUSION: The prevalence of velamentous and marginal insertions of the umbilical cord was 7.8% in singletons and 16.9% in twin gestations, with marginal insertion being more

  12. Sculptors, Architects, and Painters Conceive of Depicted Spaces Differently.

    Science.gov (United States)

    Cialone, Claudia; Tenbrink, Thora; Spiers, Hugo J

    2018-03-01

    Sculptors, architects, and painters are three professional groups that require a comprehensive understanding of how to manipulate spatial structures. While it has been speculated that they may differ in the way they conceive of space due to the different professional demands, this has not been empirically tested. To achieve this, we asked architects, painters, sculptors, and a control group questions about spatially complex pictures. Verbalizations elicited were examined using cognitive discourse analysis. We found significant differences between each group. Only painters shifted consistently between 2D and 3D concepts, architects were concerned with paths and spatial physical boundedness, and sculptors produced responses that fell between architects and painters. All three differed from controls, whose verbalizations were generally less elaborate and detailed. Thus, for the case of sculptors, architects, and painters, profession appears to relate to a different spatial conceptualization manifested through a systematically contrasting way of talking about space. Copyright © 2017 The Authors. Cognitive Science published by Wiley Periodicals, Inc. on behalf of Cognitive Science Society.

  13. Predictors of 2-year cognitive performance after laser surgery for twin-twin transfusion syndrome.

    Science.gov (United States)

    Vanderbilt, Douglas L; Schrager, Sheree M; Llanes, Arlyn; Hamilton, Anita; Seri, Istvan; Chmait, Ramen H

    2014-10-01

    The purpose of this study was to determine risk factors for poor cognitive performance among children who are treated with in utero selective laser photocoagulation of communicating vessels for twin-twin transfusion syndrome. This was a prospectively enrolled cohort study. Cognitive performance at age 2 years (±6 weeks) was assessed with the Battelle Developmental Inventory 2nd Edition (BDI-2). Multilevel regression models evaluated risk factors for poor cognitive performance at shared (pregnancy) and individual (child) levels. In addition to development, blindness, deafness, and cerebral palsy were assessed based on physical examination. A priori power analysis determined that a sample of ≥100 children was required for adequate statistical power (0.80). One hundred children (57 families) were evaluated. Total BDI-2 score was within normal range (mean, 101.3 ± [SD]12.2); 1 child had a BDI-2 score of cognitive outcomes. Donor/recipient status, gestational age at surgery, fetal growth restriction, and co-twin fetal death were not risk factors. The rate of neurodevelopmental impairment (blindness, deafness, cerebral palsy, and/or a BDI-2 score cognitive performance quotients were in the normal range, with risk factors for poor outcomes seen at the pregnancy and child levels. Clinical and socioeconomic characteristics can identify at-risk children who need additional interventions. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Evaluation of long-term neurodevelopment in twin-twin transfusion syndrome after laser therapy.

    Science.gov (United States)

    Sananès, Nicolas; Gabriele, Victor; Weingertner, Anne Sophie; Ruano, Rodrigo; Sanz-Cortes, Magdalena; Gaudineau, Adrien; Langer, Bruno; Nisand, Israël; Akladios, Chérif Youssef; Favre, Romain

    2016-12-01

    The primary objective of our study was to evaluate the long-term neurodevelopment outcome after laser surgery for twin-twin transfusion syndrome (TTTS). The secondary objective was to identify perinatal prognostic factors associated with neurodevelopmental impairment. This was a single-center cohort prospective study carried out in pregnancies complicated by TTTS and treated by laser. Neurodevleopmental assesment included the administration of Ages and Stages Questionnaires® (ASQ), for the infants between 2 and 5 years of age. A total of 187 patients underwent a laser for TTTS between 2004 and 2013. Significant brain lesions were detected in eight (2.9%) cases by ultrasound and/or magnetic resonance imaging including intraventricular hemorrhage, periventricular leukomalacia, and porencephaly. Questionnaires were administered to 126 children (50.4%) at 24 months or older at the moment of testing. There were 13.5% of those infants who had an abnormal ASQ (established as one area or more scoring < 2 SD) at 3.6 years ±1.3 follow-up. There was a higher rate of abnormal ASQ among the infants with a birth weight below the fifth percentile (p = 0.036). Twin-twin transfusion syndrome is associated with a risk of abnormal neurological development, even in case of laser surgery. Further studies are necessary to identify the risk factors for neurological impairment. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

  15. Congenital Malformations in Singleton Infants Conceived by Assisted Reproductive Technologies and Singleton Infants by Natural Conception in Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Ramin Mozafari Kermani

    2017-10-01

    Full Text Available Background: Multiple pregnancies occur more frequently in assisted reproductive technology (ART compared to normal conception (NC. It is known that the risk of congenital malformations in a multiple pregnancy are higher than single pregnancy. The aim of this study is to compare congenital malformations in singleton infants conceived by ART to singleton infants conceived naturally. Materials and Methods: In this historical cohort study, we performed a historical cohort study of major congenital malformations (MCM in 820 singleton births from January 2012 to December 2014. The data for this analysis were derived from Tehran’s ART linked data file. The risk of congenital malformations was compared in 164 ART infants and 656 NC infants. We performed multiple logistic regression analyses for the independent association of ART on each outcome. Results: We found 40 infants with MCM 29 (4.4% NC infants and 14 (8.3% ART infants. In comparison with NC infants, ART infants had a significant 2-fold increased risk of MCM (P=0.046. After adjusting individually for maternal age, infant gender, prior stillbirth, mother’s history of spontaneous abortion, and type of delivery, we did not find any difference in risk. In this study the majority (95.1% of all infants were normal but 4.9% of infants had at least one MCM. We found a difference in risk of MCMs between in vitro fertilization (IVF and intracytoplasmic sperm injection (ICSI. We excluded the possible role of genotype and other unknown factors in causing more malformations in ART infants. Conclusion: This study reported a higher risk of MCMs in ART singleton infants than in NC singleton infants. Congenital heart disease, developmental dysplasia of the hip (DDH, and urogenital malformations were the most reported major malformations in singleton ART infants according to organ and system classification.

  16. Outcome reporting across randomised trials and observational studies evaluating treatments for Twin-Twin Transfusion Syndrome: a systematic review.

    Science.gov (United States)

    Perry, Helen; Duffy, James M N; Umadia, Ogochukwu; Khalil, Asma

    2018-04-01

    Twin-Twin Transfusion syndrome is associated with significant mortality and morbidity. Potential treatments require robust evaluation. The aim of this study was to evaluate outcome reporting across observational studies and randomised controlled trials assessing treatments for twin-twin transfusion syndrome (TTTS). Cochrane Central Register of Controlled Trials, EMBASE and Medline were searched from inception to August 2016. Observational studies and randomised controlled trials reporting outcomes following a treatment for TTTS in monochorionic-diamniotic twin pregnancies and monochorionic-triamniotic or dichorionic-triamniotic triplet pregnancies were included. We systematically extracted and categorised outcome reporting. Six randomised trials and 94 observational studies, reporting data from 20,071 maternal participants and 3,199 children, were included. Six different treatments were evaluated. Included studies reported sixty-two different outcomes, including 10 fetal, 28 neonatal, 6 early childhood and 18 maternal outcomes. The outcomes were inconsistently reported across trials. For example, when considering offspring mortality, 31 studies (31%) reported live birth, 31 studies (31%) reported intrauterine death, 49 studies (49%) reported neonatal mortality, and 17 studies (17%) reported perinatal mortality. Four studies (4%) reported respiratory distress syndrome. Only 19 (19%) of studies were designed for long-term follow-up and 11 of these studies (11%) reported cerebral palsy. Most studies evaluating treatments for TTTS, have often neglected to report clinically important outcomes, especially neonatal morbidity outcomes. Most studies are not designed for long-term follow-up. The development of a core outcome set could help standardised outcome collection and reporting in Twin-Twin Transfusion syndrome studies. This article is protected by copyright. All rights reserved.

  17. Reflections on twin relationships: twins reared apart and twins of opposite gender.

    Science.gov (United States)

    Segal, Nancy L

    2012-12-01

    The complexities of twin relationships posed by separate rearing and by opposite sex are considered. Unusual cases may highlight unique social-interactional processes and outcomes occurring in these pairs. Research reviews include recent twin studies on second language acquisition, political behavior, and multiple birth rates. Items of more general interest include twin 'cousins' reared apart, indistinguishable monozygotic quadruplets, a genetic testing dilemma, and a performance about separated twins.

  18. Asthma affects time to pregnancy and fertility

    DEFF Research Database (Denmark)

    Gade, Elisabeth J; Thomsen, Simon F; Lindenberg, Svend

    2014-01-01

    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...... 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...

  19. Progesterone supplementation during the time of pregnancy recognition after artificial insemination improves conception rates in high-producing dairy cows.

    Science.gov (United States)

    Garcia-Ispierto, I; López-Helguera, I; Serrano-Pérez, B; Paso, V; Tuono, T; Ramon, A; Mur-Novales, R; Tutusaus, J; López-Gatius, F

    2016-04-15

    This study examines the possible effects of progesterone (P4) supplementation during the time of pregnancy recognition, from Days 15 to 17 post-artificial insemination (AI), on reproductive performance in high-producing dairy cows. Cows in their 15th day post-AI were alternately assigned to a control, no-treatment group (C: n = 257) or treatment group (P4: n = 287) on a weekly rotational basis according to the chronologic order of their gynecologic visit. On the basis of the odds ratio, the interaction treatment × previous placenta retention had a significant effect (P = 0.02) on conception rate. Thus, cows in P4 that had not suffered a retained placenta were 1.6 times more likely to conceive 28 to 34 days post-AI than the remaining cows. In nonpregnant cows, treatment had no effect on subsequent return to estrus or AI interval and neither were any effects of treatment observed on twin pregnancy and early fetal loss rates. The results of this study demonstrate the efficacy of P4 supplementations during the time of pregnancy recognition after AI in cows without a clinical history of placenta retention. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Outcomes after physical examination-indicated cerclage in twin gestations.

    Science.gov (United States)

    Miller, Emily S; Rajan, Priya V; Grobman, William A

    2014-07-01

    To compare outcomes of physical examination-indicated cerclage in women with twin gestations to those with singleton gestations and to identify whether risk factors for extremely preterm birth (before 28 weeks) differ between these 2 groups. This is a single institution retrospective cohort study of women who underwent a physical examination-indicated cerclage between Jan. 1, 1980, and Aug. 15, 2012. Differences in characteristics and outcomes were compared between women with twin and singleton gestations. A multivariable analysis was performed to examine whether twin gestation was independently associated with delivery before 28 weeks and whether any effect modification was present between risk factors for preterm birth and the presence of a twin gestation. Of the 442 women who underwent a cerclage during the period of study, 104 (23.5%) had twins. Mean gestational age and digital cervical length at placement did not differ by plurality. Although twins were more likely to deliver at a slightly earlier median gestation than singletons (31.9 weeks; interquartile range, 24.9-35.1 vs 32.7 weeks; interquartile range, 24.6-38.3; P = .015), the frequency of delivery before 28 weeks did not differ between these 2 groups (33.7% vs 35.8%, P = .69). Greater cervical dilation and prolapsing membranes were identified as risk factors for birth digital cervical length twin gestations. Women with a twin pregnancy who received a physical examination-indicated cerclage had similar risk factors for extreme preterm birth and may experience similar obstetric outcomes as women with singleton gestations. Copyright © 2014 Mosby, Inc. All rights reserved.

  1. Impact of Monochorionicity and Twin to Twin Transfusion Syndrome on Prenatal Attachment, Post Traumatic Stress Disorder, Anxiety and Depressive Symptoms.

    Directory of Open Access Journals (Sweden)

    Berengere Beauquier-Maccotta

    Full Text Available Monochronioric (MC twin pregnancies are considered as high-risk pregnancies with potential complications requiring in-utero interventions. We aimed to assess prenatal attachment, anxiety, post-traumatic stress disorder (PTSD and depressive symptoms in MC pregnancies complicated with Twin-To-Twin-transfusion syndrome (TTTS in comparison to uncomplicated monochorionic (UMC and dichorionic pregnancies (DC. Auto-questionnaires were filled out at diagnosis of TTTS and at successive milestones. Prenatal attachment, PTSD, anxiety and perinatal depression were evaluated respectively by the Prenatal Attachment Inventory (PAI completed for each twin, the Post-traumatic Checklist Scale (PCLS, the State-Trait Anxiety Inventory (STAI and the Edinburgh Perinatal Depression Scale (EPDS. There was no significant difference in the PAI scores between the two twins. In the DC and UMC groups, PAI scores increased throughout pregnancy, whilst it didn't for TTTS group. TTTS and DC had a similar prenatal attachment while MC mothers expressed a significantly higher attachment to their fetuses and expressed it earlier. At the announcement of TTTS, 72% of the patients present a score over the threshold at the EPDS Scale, with a higher score for TTTS than for DC (p = 0.005, and UMC (p = 0.007 at the same GA. 30% of mothers in TTTS group have PTSD during pregnancy. 50% of TTTS- patients present an anxiety score over the threshold (STAI-Scale, with a score significantly higher in TTTS than in UMC (p<0.001 or DC (p<0.001. The proportion of subject with a STAI-State over the threshold is also significantly higher in TTTS than in DC at 20 GW (p = 0.01 and at 26 GW (p<0.05. The STAI-state scores in UMC and DC increase progressively during pregnancy while they decrease significantly in TTTS. TTTS announcement constitutes a traumatic event during a pregnancy with an important risk of PTSD, high level of anxiety and an alteration of the prenatal attachment. These results should

  2. Mitral valve regurgitation in twins

    DEFF Research Database (Denmark)

    Bakkestrøm, Rine; Larsen, Lisbeth Aagaard; Møller, Jacob Eifer

    2016-01-01

    BACKGROUND: Smaller observational studies have suggested familial clustering of mitral regurgitation (MR). Using a large twin cohort, the aims were to assess MR concordance rates and assess mortality in MR twins and unaffected cotwins. METHODS: Through the Danish Twin Registry, twins with an Inte.......57, 95% CI 1.86-3.54). Overall there was no increased mortality risk for unaffected cotwins to MR cases compared with matched controls (HR 1.02, 95% CI 0.90-1.17) except for first year of life (HR 1.92, 95% CI 1.10-3.36) and for monozygotic twins older than 65 years (HR 1.49, 95% CI 1...

  3. Anaesthesia for conjoined twins

    African Journals Online (AJOL)

    draw~ver patient system consisting of a paediatric. "Ambu" bag and "Paedivalven drawing oxygen-en- riched air through a halothane vaporiser. Oxygen was supplied from an electric oxygen concentrator which can give 2 litres of 95% oxygen per minute. This apparatus has been described I. Mter 3 minutes the Sa02 of Twin ...

  4. Twin Hub Network (poster)

    NARCIS (Netherlands)

    Kreutzberger, E.D.; Konings, J.W.

    2014-01-01

    Twin hub network, a European Interreg IVB project, aims at making intermodal rail transport within, to and from North West Europe more competitive, in particular between seaports and inland terminals. Improving rail competitiveness enables to shift freight flows from road to rail, providing a more

  5. Sleep Terrors in Twins

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2008-12-01

    Full Text Available In an attempt to clarify the genetic and environmental causes of sleep terrors in childhood, reasearchers in Canada followed 390 pairs of monozygotic and dizygotic twins by assessing the frequency of sleep terrors at 18 and 30 months of age using a questionnaire administered to the biological mothers.

  6. Sleep Terrors in Twins

    OpenAIRE

    J Gordon Millichap

    2008-01-01

    In an attempt to clarify the genetic and environmental causes of sleep terrors in childhood, reasearchers in Canada followed 390 pairs of monozygotic and dizygotic twins by assessing the frequency of sleep terrors at 18 and 30 months of age using a questionnaire administered to the biological mothers.

  7. Twin Higgs WIMP dark matter

    Science.gov (United States)

    García García, Isabel; Lasenby, Robert; March-Russell, John

    2015-09-01

    Dark matter (DM) without a matter asymmetry is studied in the context of twin Higgs (TH) theories in which the LHC naturalness problem is addressed. These possess a twin sector related to the Standard Model (SM) by a (broken) Z2 symmetry, and interacting with the SM via a specific Higgs portal. We focus on the minimal realization of the TH mechanism, the fraternal twin Higgs, with only a single generation of twin quarks and leptons, and the S U (3 )'×S U (2 )' gauge group. We show that a variety of natural twin-WIMP DM candidates are present (directly linked to the weak scale by naturalness), the simplest and most attractive being the τ' lepton with a mass mτ'>mHiggs/2 , although spin-1 W'± DM and multicomponent DM are also possible (twin baryons are strongly disfavored by tuning). We consider in detail the dynamics of the possibly (meta)stable glueballs in the twin sector, the nature of the twin QCD phase transition, and possible new contributions to the number of relativistic degrees of freedom, Δ Neff . Direct detection signals are below current bounds but accessible in near-future experiments. Indirect detection phenomenology is rich and requires detailed studies of twin hadronization and fragmentation to twin glueballs and quarkonia and their subsequent decay to SM, and possible light twin sector states.

  8. [Cholecystectomy during pregnancy].

    Science.gov (United States)

    Bonfante Ramírez, E; Bolaños Ancona, R; Juárez García, L; Estrada Altamirano, A; Castelazo Morales, E

    1998-06-01

    Cholecystectomy during pregnancy happens to be the second most common cause of laparotomy. The reported incidence of the procedure is I of every 1250 to 12,500 pregnancies. We have done a retrospective study from january 1989 to december 1994, at Instituto Nacional de Perinatología, having 35,080 deliveries registered, four of them with reported cholecystectomy during pregnancy. The average of maternal age resulted in 20.2 years, varying from 16 to 23 years. Three patients were multigravidas, and just one primigravida. Gestational age at the time of diagnosis and surgery was reported in 17 to 23.4 weeks. We found one twin pregnancy, and that two patients had history of chronic colecistitis. In the 100% of cases laparotomy and cholecystectomy was done, with preterm labor as the most frequent complication. There were 3 fetal loss in study and only 2 pregnancies were delivered at term. In this review the estimated frequency of cholecystectomy was 1 of 8780 deliveries, being the second cause of quirurgical treatment during pregnancy, after appendicectomy. There were reported 50% fetal deaths, and no severe maternal complications.

  9. Prenatal diagnosis of conjoined twins by magnetic resonance imaging: report of two cases

    International Nuclear Information System (INIS)

    Souza, Alex Sandro Rolland de; Medeiros, Cynthia Coelho de; Lins, Glaucia Virginia de Queiroz; Noronha Neto, Carlos; Lima, Marcelo Marques de Souza

    2006-01-01

    Conjoined twins have a rare prevalence and special curiosity among physicians and the general population. The reported frequency varies from 1:50,000 to 1:200,000 pregnancies. Its early diagnosis becomes very important when we think about pregnancy management, method of delivery and neonatal care. We describe two cases of conjoined twins diagnosed by ultrasound and magnetic resonance during prenatal care with the aim to better studying the fetus anatomy. The first conjoined twins were cephalopagus sharing head, thorax and abdominal wall and with two pelvis and four arms and four legs. The second were thoracopagus, united by thorax and part of abdomen. Magnetic resonance imaging contribution was not important to diagnose conjoined twins. However, it was useful to describe the shared organs, contributing to define fetal outcome. (author)

  10. Autopsy Findings in Conjoined Twin with Single Heart and Single Liver

    Directory of Open Access Journals (Sweden)

    Kar Asaranti

    2012-01-01

    Full Text Available Thoracoomphalopagus is the commonest type of conjoined twin where the bodies are fused from upper chest to lower chest. The autopsy done can help counsil the parents for further pregnancies and determine the prognosis depending upon the type of cardiac anomaly by Seo classification when detected antenatally. We describe the detail pathological autopsy of such a case with single heart and single liver. A detail autopsy was done on the twin fetus. The twins shared a single heart and sometimes the liver and part of digestive system. The combined weight was 4.1 KG. Both were full-term male babies joined from below the nipple till umbilicus. Autopsy in conjoined twins helps in deciding the type of fusion of the body and also of the heart and great vessels. It can help in counseling parents about future pregnancies that there is no chance of recurrence of this abnormality and no need to be scared.

  11. Preconception Optimization of Glucose and Insulin Metabolism in Women Wanting to Conceive - High Rate of Spontaneous Conception Prior to Planned Assisted Reproduction.

    Science.gov (United States)

    Fill Malfertheiner, Sara; Gutknecht, Dagmar; Bals-Pratsch, Monika

    2017-12-01

    A hyperglycemic metabolic status with insulin resistance can have a negative effect on fertility and pregnancy outcomes. The aim of this retrospective study was to investigate disorders of glucose and insulin metabolism in women wanting to conceive who conceived spontaneously prior to planned assisted reproduction (ART). Associated risk factors of patients in terms of live births and miscarriages were also analyzed. Out of total study population of 589 pregnancies, the pregnancies of 129 women wishing to have children who conceived spontaneously prior to planned ART were analyzed in more detail. A 75 g OGTT (OGTT: oral glucose tolerance test) was carried out prior to conception and after determination of pregnancy, including glucose measurement and testing of insulin resistance. If anomalies or risk factors for gestational diabetes (GDM) were detected, patients received metformin therapy prior to conception (off-label use). The course and outcome of pregnancies in the defined cohort were recorded. The rate of spontaneous conception before planned ART after treatment for disorders of glucose/insulin metabolism was 21.9% (n = 129/589). 66.7% of the 129 pregnancies resulted in a live birth, 32 patients had a miscarriage. 76.0% of patients were treated with metformin (off-label use) for polycystic ovary syndrome (PCOS), positive risk profile for GDM, or abnormal glucose/insulin metabolism prior to conception. 55.8% of the cohort developed GDM. The insulin requirements of patients with GDM differed significantly depending on their metformin intake. 24.6% of GDM patients receiving metformin treatment developed GDM requiring insulin treatment compared to 53.8% who did not receive metformin medication. The PCOS rate in the study population who had live births was significantly higher (57.0%) than in the group who had miscarriages (31.3%). There were no significant differences with regard to rate of live births and rate of miscarriages with/without metformin treatment

  12. Mode of birth in twins: data and reflections.

    Science.gov (United States)

    Reitter, A; Daviss, B A; Krimphove, M J; Johnson, K C; Schlößer, R; Louwen, F; Bisits, A

    2018-02-12

    Our primary objective was to compare neonatal and maternal outcomes in women with twin pregnancies, beyond 32 weeks, having a planned vaginal birth or a planned caesarean section (CS). This was a retrospective cohort study from a single tertiary centre over nine years. 534 sets of twins ≥32 + 0 weeks of gestation were included. 401 sets were planned vaginally and 133 sets were planned by CS. We compared a composite adverse perinatal outcome (perinatal mortality or serious neonatal morbidity; five minute APGAR score ≤4, neurological abnormality and need for intubation) and a composite maternal adverse outcome (major haemorrhage, trauma or infection) between the groups. There were no significant differences. Given the similarity of these results with several other larger studies of twin birth, we sought to look at reasons why there is still a rising rate of CS for twin births. We further make suggestions for keeping this rate to a sensible minimum. Impact statement What is already known on this subject? The largest randomised controlled study comparing planned vaginal birth with planned CSs for lower risk twins between 32 and 39 weeks of gestation, showed no added safety from planned CS. However, in most of the Western countries this conclusion has failed to increase the number of planned vaginal births for lower risk twins. What do the results of this study add? This observational study from a single tertiary centre provides external validation of the twin trial results in a practical day-to-day setting. It also provides insights as to how planned vaginal birth can be developed and maintained, with a key focus on safety and maternal participation in decision making. It does focus on consent and providing accurate data. What are the implications of these findings for clinical practice and/or further research? There are good grounds to encourage vaginal birth for low-risk twin pregnancies. The trend of rising caesarean rates in low-risk twin

  13. Ovulation, pregnancy, placentation and husbandry in the African elephant (Loxodonta africana)

    Science.gov (United States)

    Allen, W.R

    2006-01-01

    The African elephant reproduces so efficiently in the wild that overpopulation is now a serious problem in some game parks in Zimbabwe, Botswana and South Africa. The female reaches puberty between 10 and 12 years of age in the wild and, when in captivity, shows oestrous cycles of 14–15 weeks duration. She readily conceives a singleton in the wild yet her uterus has the capacity for twins. She shows a gestation length of 22 months and, in the wild, shows a population density and feed dependent intercalving interval of 4–8 years. The trophoblast erodes the lumenal epithelium of the endometrium and stimulates upgrowths of blood vessel-containing stromal villi, which develop eventually into the broad, tightly folded lamellae of the zonary, endotheliochorial placenta. Significant quantities of leaked maternal erythrocytes and ferric iron are phagocytosed by specialized trophoblast cells in the haemophagous zones at the lateral edges of the placental band. Although the placenta itself is endocrinologically inert, the foetal gonads, which enlarge greatly during the second half of pregnancy can synthesize 5α-dihydryoprogesterone and other 5α pregnane derivatives from cholesterol and pregnenolone. These products may synergize with progestagens secreted by the 2–8 large corpora lutea which are always present in the maternal ovaries throughout gestation to maintain the pregnancy state. PMID:16627297

  14. Correction: Grömminger, S., et al. Fetal Aneuploidy Detection by Cell-Free DNA Sequencing for Multiple Pregnancies and Quality Issues with Vanishing Twins. J. Clin. Med. 2014, 3, 679-692

    Directory of Open Access Journals (Sweden)

    Sebastian Grömminger

    2014-11-01

    Full Text Available The authors wish to make the following corrections to this paper [1]: On page 683 at the end of Section 3.2. lines 13–14, the word “no” is missing. The correct sentence should be: “There has been no evidence of false-negative NIPT results so far in the pregnancies included in this study.”[...

  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. ECTOPIC PREGNANCY AFTER SEQUENTIAL EMBRYO TRANSFER: REVIEW OF 22 CASES

    Directory of Open Access Journals (Sweden)

    Nadkarni Purnima K, Nadkarni Kishore, Singh Pooja P, Singh Prabhakar , Nadkarni Aditi A , Agarwal Neha R

    2015-07-01

    Full Text Available Objective: To assess the prevalence of ectopic pregnancy among women who conceived with assisted reproductive technology and to see if there is increased risk after sequential embryo transfer. Methods: The ectopic pregnancy rate for ART pregnancies was calculated among women who conceived and had ectopic pregnancy after ICSI followed by Sequential embryo transfer from an ART centre. Variation in ectopic risk by patient and ART treatment factors was assessed including Sequential transfer, risk factor for ectopic pregnancy, tubal infertility and previous ectopic pregnancy. Results: Of 1960 women, who underwent ICSI, 1047(53.41% had positive pregnancy, 22(2.1% women had an ectopic pregnancy out of which 2(9% had heterotrophic pregnancy. The mean age was 30.4±4.33. Tubal factor contributed to 31.81% cases and 27.27% had previous history of ectopic pregnancy. Sequential transfer was done in all the patients with more than one embryo transferred. There was no significant increase in the ectopic pregnancy when Sequential embryo transfer was done. Conclusion: Tubal factor infertility and history of previous ectopic pregnancy contributed to risk factor for ectopic pregnancy in our study. Sequential transfer did not increase the risk of ectopic pregnancy.

  17. Twins with neonatal pemphigus vulgaris born to a mother with pemphigus vulgaris: a case report.

    Science.gov (United States)

    Itsukaichi, Mina; Takakuwa, Koichi; Yamaguchi, Masayuki; Serikawa, Takehiro; Tanaka, Kenichi; Kojima, Kinuko; Sakakibara, Seiichi; Usuda, Tohei; Matsunaga, Masamichi; Hashimoto, Tsuyoshi

    2013-01-01

    Dichorionic diamniotic twins were born at 37 weeks of gestation by cesarean section to a 34-year-old primigravid Japanese woman because the first twin was in breech presentation. The mother had been diagnosed with pemphigus vulgaris prior to her pregnancy. In addition to a high antidesmoglein 3 autoantibody titer, flaccid bullae and erosions on both of the twins' lips and in their oral cavities at 13 days of age led to the diagnosis of neonatal pemphigus vulgaris. This case highlights the need for awareness that pemphigus vulgaris may not occur immediately after birth. © 2012 Wiley Periodicals, Inc.

  18. Guidelines for scanning twins and triplets with US and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Calvo-Garcia, Maria A. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2016-02-15

    Multiple-fetus gestations have an increased risk of discordant anomalies, aneuploidy and growth restriction compared to singleton pregnancies. In addition, twins sharing the same placenta are at risk for developing specific conditions that are potentially amenable to surgical management. In those scenarios, patients might need to be evaluated not only with US but with fetal MRI as well. This paper outlines basic guidelines to consider when imaging complicated multiple-fetus gestations during the 2nd and 3rd trimesters. (orig.)

  19. Perinatal mortality in second- vs firstborn twins: a matter of birth size or birth order?

    Science.gov (United States)

    Luo, Zhong-Cheng; Ouyang, Fengxiu; Zhang, Jun; Klebanoff, Mark

    2014-08-01

    Second-born twins on average weigh less than first-born twins and have been reported at an elevated risk of perinatal mortality. Whether the risk differences depend on their relative birth size is unknown. The present study aimed to evaluate the association of birth order with perinatal mortality by birth order-specific weight difference in twin pregnancies. In a retrospective cohort study of 258,800 twin pregnancies without reported congenital anomalies using the US matched multiple birth data 1995-2000 (the available largest multiple birth dataset), conditional logistic regression was applied to estimate the odds ratio (OR) of perinatal death adjusted for fetus-specific characteristics (sex, presentation, and birthweight for gestational age). Comparing second vs first twins, the risks of perinatal death were similar if they had similar birthweights (within 5%) and were increasingly higher if second twins weighed progressively less (adjusted ORs were 1.37, 1.90, and 3.94 if weighed 5.0-14.9%, 15.0-24.9%, and ≥25.0% less, respectively), and progressively lower if they weighed increasingly more (adjusted ORs were 0.67, 0.63, and 0.36 if weighed 5.0-14.9%, 15.0-24.9%, and ≥25.0% more, respectively) (all P birth size. Vaginal delivery at term is associated with a substantially greater risk of perinatal mortality in second twins. Copyright © 2014 Mosby, Inc. All rights reserved.

  20. Transferência de blastocisto após descongelamento de embriões em mórula resultando em gestação gemelar: relato de caso Twin pregnancy after thawing of morula embryos and blastocyst transfer: case report

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo T. Albuquerque

    1999-12-01

    Full Text Available A criopreservação de embriões em estágios mais tardios do desenvolvimento parece apresentar resultados satisfatórios. Com o objetivo de melhor testar a sobrevivência e o desenvolvimento de embriões, os mesmos foram criopreservados e descongelados em estadio de mórula ou blastocisto e deixados em cultura para que pudesse ser avaliada sua evolução natural. Dos 2 blastocistos e 5 mórulas congelados, 4 mórulas sobreviveram ao descongelamento, tendo sido transferidas em estadio de blastocisto, 24 horas depois. A transferência, realizada em paciente jovem, segundo casamento de homem vasectomizado há dez anos, resultou em gestação gemelar. O descongelamento de embriões em estadio de mórula e a observação in vitro da retomada de seu desenvolvimento até o estadio de blastocisto fornecem um parâmetro adicional na avaliação da qualidade do embrião e, provavelmente, melhore as taxas de gravidez.The cryopreservation of embryos in late developing stages seems to present satisfactory results. With the purpose of better testing the embryos' survival, they were cryopreserved in the morula or blastocyst stage, thawed and left in culture for 24 hours so that their natural evolution could be observed. Amongst the frozen 2 blastocysts and 5 morulas, 4 morulas survived the thawing process, being transferred as blastocysts 24 hours later. The transfer was performed in a young patient, second marriage of a ten-year vasectomized man and resulted in twin pregnancy. Thawing morula embryos and the in vitro observation of their development resumption until the blastocyst stage give us an additional parameter in the quality evaluation of the embryo and probably an improvement in pregnancy rates.

  1. Costs and benefits of individuals conceived after IVF: a net tax evaluation in The Netherlands

    NARCIS (Netherlands)

    Moolenaar, L. M.; Connolly, M.; Huisman, B.; Postma, M. J.; Hompes, P. G. A.; van der Veen, F.; Mol, B. W. J.

    2014-01-01

    This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative to those naturally conceived. A model based on the method of generational accounting was developed to evaluate investments in IVF. Calculations were based on average investments paid and received

  2. Costs and benefits of individuals conceived after IVF : a net tax evaluation in The Netherlands

    NARCIS (Netherlands)

    Moolenaar, L. M.; Connolly, M.; Huisman, B.; Postma, M. J.; Hompes, P. G. A.; van der Veen, F.; Mol, B. W. J.

    This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative to those naturally conceived. A model based on the method of generational accounting was developed to evaluate investments in IVF. Calculations were based on average investments paid and received

  3. Costs and benefits of individuals conceived after IVF: a net tax evaluation in The Netherlands.

    Science.gov (United States)

    Moolenaar, L M; Connolly, M; Huisman, B; Postma, M J; Hompes, P G A; van der Veen, F; Mol, B W J

    2014-02-01

    This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative to those naturally conceived. A model based on the method of generational accounting was developed to evaluate investments in IVF. Calculations were based on average investments paid and received from the government by an individual. All costs were discounted to their net present values and adjusted for survival. The lifetime net present value of IVF-conceived individuals was -€81,374 (the minus sign reflecting negative net present value). The lifetime net present value of IVF-conceived men and women were -€47,091 and -€123,177, respectively. The lifetime net present value of naturally conceived individuals was -€70,392; respective amounts for men and women were -€36,109 and -€112,195. The model was most sensitive to changes in the growth of healthcare costs, economic growth and the discount rate. Therefore, it is concluded that, similarly to naturally conceived individuals in the Netherlands, IVF-conceived individuals have negative discounted net tax revenue at the end of life. The analytic framework described here undervalues the incremental value of an additional birth because it only considers the fiscal consequences of life and does not take into consideration broader macroeconomic benefits. This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative those naturally conceived. A model based on the method of generational accounting to evaluate investments in IVF was used. Calculations were based on average investments paid and received from the government by an individual. The lifetime net present value of IVF-conceived individuals was -€81,374 (the minus sign reflecting negative net present value). The lifetime net present value of IVF-conceived men and women were -€47,091 and -€123,177, respectively. The lifetime net present value of naturally conceived individuals was -€70,392; respective

  4. Correlação entre a idade materna, paridade, gemelaridade, síndrome hipertensiva e ruptura prematura de membranas e a indicação de parto cesáreo The influence of maternal age, parity, twin pregnancy, hypertensive syndrome and premature rupture of membranes on the indication for cesarean section

    Directory of Open Access Journals (Sweden)

    Simone Angélica Leite de Carvalho Silva Cabral

    2003-12-01

    Full Text Available OBJETIVO: verificar a contribuição da idade materna, paridade, gemelaridade, síndrome hipertensiva, ruptura prematura das membranas como fator de risco para cesárea. MÉTODOS: após aprovação do Comitê de Ética em Pesquisa da Maternidade Professor Monteiro de Morais, situada em Recife-PE, realizou-se estudo de caso-controle com 3919 gestantes, sem antecedente de duas ou mais cesáreas, que deram à luz concepto vivo, com idade gestacional igual ou superior a 28 semanas, peso mínimo de 1.000 g, em apresentação cefálica, no período de 1 de setembro de 1999 a 31 de agosto de 2000. No grupo caso foram incluídas mulheres submetidas a operação cesariana e no grupo controle, a parto vaginal. Com os dados constantes dos prontuários neonatais e obstétricos, realizou-se análise multivariada por regressão logística, buscando a equação matemática que relacione a probabilidade de ocorrência de cesárea decorrente de mais de uma variável independente atuando como fator de risco, utilizando odds ratio e intervalo de confiança de 95% (IC 95%, consideradas as variáveis: idade materna, paridade, gemelaridade, síndrome hipertensiva e ruptura prematura das membranas. RESULTADOS: as chances de cesárea foram aumentadas em 8,3 vezes (OR = 8,3; IC 95%: 3,7-19,1 na gemelaridade, 3,4 na síndrome hipertensiva (OR = 3,4; IC 95%: 2,9-4,0, 1,9 na primiparidade (OR = 1,9; IC 95% : 1,8-2,0, 1,5 na idade superior a 34 anos (OR = 1,5; IC 95%: 1,2-1,8 e 1,2 na presença de ruptura prematura das membranas (OR = 1,2; IC 95%: 1,0-1,4. CONCLUSÕES: ruptura prematura das membranas, idade superior a 34 anos, primiparidade, síndrome hipertensiva e gemelaridade constituíram fatores de risco para cesárea.PURPOSE: to verify the contribution of maternal age, parity, twin pregnancy, hypertensive syndrome, and premature rupture of membranes as risk factors for cesarean section. METHODS: after approval by the Ethics in Research Committee of the "Maternidade

  5. Comparison of Congenital Abnormalities of Infants Conceived by Assisted Reproductive Techniques versus Infants with Natural Conception in Tehran.

    Science.gov (United States)

    Farhangniya, Mansoureh; Dortaj Rabori, Eshagh; Mozafari Kermani, Ramin; Haghdoost, Ali Akbar; Bahrampour, Abbas; Bagheri, Pezhman; A L Lancaster, Paul; Ashrafi, Mahnaz; Vosough Taqi Dizaj, Ahmad; Gourabi, Hamid; Shahzadeh Fazeli, Abolhassan

    2013-10-01

    In many countries, 1 to 3% of newborn infants are conceived by assisted reproductive techniques (ART). Despite the success of ART, there is concern about the risk of congenital malformations among these infants. We report our experience to determine whether use of ART is associated with an increase in major congenital malformations or adverse pregnancy outcomes. Historical cohort study of major congenital malformations (MCM) was performed in 978 births from January 2008 to December 2010. The data for this analysis were derived from a Tehran's ART linked data file by simple sampling method. In our study, the risk of congenital malformations was compared in 326 ART infants and 652 naturally conceived (NC) infants. We also performed multiple logistic regression analyses to calculate the odds ratio (OR) and 95% confidence intervals (CI) for the independent association of ART on each outcome. We found 56 infants with major congenital malformations, these included 29 NC infants (4.4%) and 27 ART infants (8.3%). In comparison with NC infants, ART infants had a significant 1.94-fold increased risk of MCM.After adjustment for maternal age, infant's sex stillbirth, abortion and type of delivery, we found a relatively small difference in risk (OR=2.04). In this study the majority (94.3%) of all infants were normal but 5.7% of infants had at least one MCM. The prevalence rate for the intracytoplasmic sperm injection (ICSI) was 6.5% for the In vitro fertilisation (IVF) group was 15.9% or 2.73-fold higher than ICSI group (P=0.018). Also we ignore the possible role of genotype and other unknown factors in causing more malformations in ART infants. Other studies have shown a slightly increased risk of major congenital malformations in pregnancies resulting from ART. Likewise, this study reports a greater risk of MCMs in ART infants than in naturally conceived infants. We also found evidence of a difference in risk of MCMs between IVF and ICSI. Musculoskeletal and urogenital

  6. Comparison of Congenital Abnormalities of Infants Conceived by Assisted Reproductive Techniques versus Infants with Natural Conception in Tehran

    Directory of Open Access Journals (Sweden)

    Hamid Gourabi

    2013-01-01

    Full Text Available Background: In many countries, 1 to 3% of newborn infants are conceived by assisted reproductivetechniques (ART. Despite the success of ART, there is concern about the risk of congenitalmalformations among these infants. We report our experience to determine whether use of ARTis associated with an increase in major congenital malformations or adverse pregnancy outcomes.Materials and Methods: Historical cohort study of major congenital malformations (MCMwas performed in 978 births from January 2008 to December 2010. The data for this analysiswere derived from a Tehran’s ART linked data file by simple sampling method. In our study, therisk of congenital malformations was compared in 326 ART infants and 652 naturally conceived(NC infants. We also performed multiple logistic regression analyses to calculate the odds ratio(OR and 95% confidence intervals (CI for the independent association of ART on each outcome.Results: We found 56 infants with major congenital malformations, these included 29 NC infants(4.4% and 27 ART infants (8.3%. In comparison with NC infants, ART infants had a significant1.94-fold increased risk of MCM.After adjustment for maternal age, infant’s sex stillbirth,abortion and type of delivery, we found a relatively small difference in risk (OR=2.04. Inthis study the majority (94.3% of all infants were normal but 5.7% of infants had at least oneMCM. The prevalence rate for the intracytoplasmic sperm injection (ICSI was 6.5% for the Invitro fertilisation (IVF group was 15.9% or 2.73-fold higher than ICSI group (P=0.018. Alsowe ignore the possible role of genotype and other unknown factors in causing more malformationsin ART infants.Conclusion: Other studies have shown a slightly increased risk of major congenital malformationsin pregnancies resulting from ART. Likewise, this study reports a greater risk ofMCMs in ART infants than in naturally conceived infants. We also found evidence of a differencein risk of MCMs between IVF

  7. Risk of hypertensive disorders in pregnancies following assisted reproductive technology

    DEFF Research Database (Denmark)

    Opdahl, S; Henningsen, A A; Tiitinen, A

    2015-01-01

    STUDY QUESTION: Is the risk of hypertensive disorders in pregnancies conceived following specific assisted reproductive technology (ART) procedures different from the risk in spontaneously conceived (SC) pregnancies? SUMMARY ANSWER: ART pregnancies had a higher risk of hypertensive disorders...... confounding cannot be excluded. In addition, we did not have information on all SC pregnancies in each woman's history, and could therefore not compare risk in ART versus SC pregnancies in the same mother. WIDER IMPLICATIONS OF THE FINDINGS: Pregnancies following frozen-thawed cycles have a higher risk......, the Danish Agency for Science, Technology and Innovation, the Nordic Federation of Societies of Obstetrics and Gynecology and the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology. None of the authors has any competing interests...

  8. Multiple Pregnancies in CKD Patients: An Explosive Mix

    Science.gov (United States)

    Arduino, Silvana; Attini, Rossella; Parisi, Silvia; Fassio, Federica; Biolcati, Marlisa; Pagano, Arianna; Bossotti, Carlotta; Vasario, Elena; Borgarello, Valentina; Daidola, Germana; Ferraresi, Martina; Gaglioti, Pietro; Todros, Tullia

    2013-01-01

    Summary Background and objectives CKD and multiple pregnancies bear important risks for pregnancy outcomes. The aim of the study was to define the risk for adverse pregnancy-related outcomes in multiple pregnancies in CKD patients in comparison with a control group of “low-risk” multiple pregnancies. Design, setting, participants, & measurements The study was performed in the Maternal Hospital of the University of Turin, Italy. Of 314 pregnancies referred in CKD (2000–2011), 20 were multiple (15 twin deliveries). Control groups consisted of 379 low-risk multiple pregnancies (314 twin deliveries) and 19 (15 twin deliveries) cases with hypertension-collagen diseases. Baseline data and outcomes were compared by univariate and logistic regression analyses. Results The prevalence of multiple pregnancies was relatively high in the CKD population (6.4%); all referred cases were in early CKD stages (I-II); both creatinine (0.68 to 0.79 mg/dl; P=0.010) and proteinuria (0.81 to 3.42 g/d; P=0.041) significantly increased from referral to delivery. No significant difference in demographic data at baseline was found between cases and low-risk controls. CKD was associated with higher risk of adverse pregnancy outcomes versus low-risk twin pregnancies. Statistical significance was reached for preterm delivery (<34 weeks: 60% vs 26.4%; P=0.005; <32 weeks: 53.3% vs 12.7%; P<0.001), small for gestational age babies (28.6% vs 8.1%; P<0.001), need for Neonatal Intensive Care Unit (60% vs 12.7%; P<0.001), weight discordance between twins (40% vs 17.8%; P=0.032), and neonatal and perinatal mortality (6.6% vs 0.8%; P=0.032). Conclusion This study suggests that maternal-fetal risks are increased in multiple pregnancies in the early CKD stages. PMID:23124785

  9. Multiple pregnancies in CKD patients: an explosive mix.

    Science.gov (United States)

    Piccoli, Giorgina Barbara; Arduino, Silvana; Attini, Rossella; Parisi, Silvia; Fassio, Federica; Biolcati, Marlisa; Pagano, Arianna; Bossotti, Carlotta; Vasario, Elena; Borgarello, Valentina; Daidola, Germana; Ferraresi, Martina; Gaglioti, Pietro; Todros, Tullia

    2013-01-01

    CKD and multiple pregnancies bear important risks for pregnancy outcomes. The aim of the study was to define the risk for adverse pregnancy-related outcomes in multiple pregnancies in CKD patients in comparison with a control group of "low-risk" multiple pregnancies. The study was performed in the Maternal Hospital of the University of Turin, Italy. Of 314 pregnancies referred in CKD (2000-2011), 20 were multiple (15 twin deliveries). Control groups consisted of 379 low-risk multiple pregnancies (314 twin deliveries) and 19 (15 twin deliveries) cases with hypertension-collagen diseases. Baseline data and outcomes were compared by univariate and logistic regression analyses. The prevalence of multiple pregnancies was relatively high in the CKD population (6.4%); all referred cases were in early CKD stages (I-II); both creatinine (0.68 to 0.79 mg/dl; P=0.010) and proteinuria (0.81 to 3.42 g/d; P=0.041) significantly increased from referral to delivery. No significant difference in demographic data at baseline was found between cases and low-risk controls. CKD was associated with higher risk of adverse pregnancy outcomes versus low-risk twin pregnancies. Statistical significance was reached for preterm delivery (<34 weeks: 60% vs 26.4%; P=0.005; <32 weeks: 53.3% vs 12.7%; P<0.001), small for gestational age babies (28.6% vs 8.1%; P<0.001), need for Neonatal Intensive Care Unit (60% vs 12.7%; P<0.001), weight discordance between twins (40% vs 17.8%; P=0.032), and neonatal and perinatal mortality (6.6% vs 0.8%; P=0.032). This study suggests that maternal-fetal risks are increased in multiple pregnancies in the early CKD stages.

  10. Multifoetal Pregnancies At A Maternity Hospital In Nairobi | Musili ...

    African Journals Online (AJOL)

    Objective: To review some of the aspects of multiple pregnancies. Design: A retrospective review of multiple pregnancy deliveries. Setting: Pumwani Maternity Hospital- Nairobi Kenya, between 1st January and 31st December 2006. Subjects: Three hundred and twenty eight mothers with twins and two sets of triplet ...

  11. Bilateral tubal ectopic pregnancies: A report of two cases | Eze ...

    African Journals Online (AJOL)

    Bilateral tubal ectopic pregnancies are rare occurrences. Two recently managed cases are discussed. The first was a single, sexually active 23-year-old nullipara with family history of twinning who presented with eight weeks amenorrhea, positive pregnancy test, lower abdominal discomfort and other clinical and ultrasound ...

  12. Twin-twin transfusion syndrome: neurodevelopment of infants treated with laser surgery

    Directory of Open Access Journals (Sweden)

    Denise Campos

    2016-04-01

    Full Text Available ABSTRACT Objective To assess the neurodevelopmental functions of survivors of twin-twin transfusion syndrome (TTTS treated by fetoscopic laser coagulation (FLC, during the first year of life, comparing them to a control group; and to verify the influence of specific variables on neurodevelopment. Method This was a prospective, longitudinal study. The sample comprised 33 monochorionic diamniotic twins who underwent FLC for treatment of TTTS and 22 full-term infants of single-fetus pregnancies. Bayley Scales of Infant and Toddler Development Screening Test were used for evaluation. Prenatal, perinatal and postnatal information were obtained. Results There was an increased frequency of infants in the TTTS group with inadequate performance compared to the control group. The identified variables (fetal donor, low economic income and cardiorespiratory disease negatively impacted expressive communication and fine motor skills. Conclusion Although through follow-up is recommended in all TTTS survivors, particular attention is required for the high-risk group as defined in this study.

  13. Twinning across the Developing World.

    Directory of Open Access Journals (Sweden)

    Jeroen Smits

    Full Text Available BACKGROUND: Until now, little was known about the variation in incidence of twin births across developing countries, because national representative data was lacking. This study provides the first comprehensive overview of national twinning rates across the developing world on the basis of reliable survey data. METHODS: Data on incidence of twinning was extracted from birth histories of women aged 15-49 interviewed in 150 Demographic and Health Surveys, held between 1987 and 2010 in 75 low and middle income countries. During the interview, information on all live births experienced by the women was recorded, including whether it was a singleton or multiple birth. Information was available for 2.47 million births experienced by 1.38 million women in a period of ten years before the interview. Twinning incidence was measured as the number of twin births per thousand births. Data for China were computed on the basis of published figures from the 1990 census. Both natural and age-standardized twinning rates are presented. RESULTS/CONCLUSIONS: The very low natural twinning rates of 6-9 per thousand births previously observed in some East Asian countries turn out to be the dominant pattern in the whole South and South-East Asian region. Very high twinning rates of above 18 per thousand are not restricted to Nigeria (until now seen as the world's twinning champion but found in most Central-African countries. Twinning rates in Latin America turn out to be as low as those in Asia. Changes over time are small and not in a specific direction. SIGNIFICANCE: We provide the most complete and comparable overview of twinning rates across the developing world currently possible.

  14. Twin Legacies: Victor and Vincent McKusick/Twin Studies: Twinning Rates I; Twinning Rates II; MZ Twin Discordance for Russell-Silver Syndrome; Twins' Language Skills/Headlines: Babies Born to Identical Twin Couples; Identity Exchange; Death of Princess Ashraf (Twin); Yahoo CEO Delivers Identical Twins.

    Science.gov (United States)

    Segal, Nancy L

    2016-04-01

    The lives of the illustrious monozygotic (MZ) twins, Victor A. and Vincent L. McKusick, are described. Victor earned the distinction as the 'Father of Medical Genetics', while Vincent was a legendary Chief Justice of the Maine Supreme Court. This dual biographical account is followed by two timely reports of twinning rates, a study of MZ twin discordance for Russell-Silver Syndrome (RSS) and a study of twins' language skills. Twin stories in the news include babies born to identical twin couples, a case of switched identity, the death of Princess Ashraf (Twin) and a new mother of twins who is also Yahoo's CEO.

  15. Twin classics: research that always inspires/Twin studies: elder twin relationships; Superfecundated twinning in chimpanzees; Conjoined twinning and embryo transfer; Reduced frequency of in vitro multiples/Professional and human interest: first identical twin renal transplant; Identical triplet wedding; Spanakos twins: boxers; Twins in space; Political twins.

    Science.gov (United States)

    Segal, Nancy L

    2015-08-01

    Ten classic works in twin research are described. These volumes are rich in data, interpretation, and impact, and contain life history material that adds depth and dimension to the quantitative findings. Next, research on social relationships in older twins, superfecundated twinning in chimpanzees; effects of embryo transfer on conjoined twinning and the reduced frequency of in vitro multiples is reviewed. Finally, there has been considerable public interest surrounding the first identical twin renal transplant, an identical triplet wedding; identical twin boxers, a twin living in space, and a politically active twin pair.

  16. Mortality among twins and singletons in sub-Saharan Africa between 1995 and 2014: a pooled analysis of data from 90 Demographic and Health Surveys in 30 countries

    NARCIS (Netherlands)

    Monden, C.W.S.; Smits, J.P.J.M.; Monden, C.

    2017-01-01

    BACKGROUND - Sub-Saharan Africa has the world's highest under-5 and neonatal mortality rates as well as the highest naturally occurring twin rates. Twin pregnancies carry high risk for children and mothers. Under-5 mortality has declined in sub-Saharan Africa over the last decades. It is unknown

  17. A study of risk factors for anaemia in pregnancy at the first antenatal ...

    African Journals Online (AJOL)

    Aim: To identify the risk factors for anaemia in pregnancy and evaluate the effects of these risk factors of anaemia in pregnancy among pregnant women ... were low socioeconomic status ( OR = 2.3), primigravidity ( OR = 3.2 ), inter-delivery interval of 2 years or less ( OR = 35.2 ), twin pregnancy (OR = 3.2), HIV infection ( OR ...

  18. Twin Peaks - 3D

    Science.gov (United States)

    1997-01-01

    The two hills in the distance, approximately one to two kilometers away, have been dubbed the 'Twin Peaks' and are of great interest to Pathfinder scientists as objects of future study. 3D glasses are necessary to identify surface detail. The white areas on the left hill, called the 'Ski Run' by scientists, may have been formed by hydrologic processes.The IMP is a stereo imaging system with color capability provided by 24 selectable filters -- twelve filters per 'eye.Click below to see the left and right views individually. [figure removed for brevity, see original site] Left [figure removed for brevity, see original site] Right

  19. Holographic twin Higgs model.

    Science.gov (United States)

    Geller, Michael; Telem, Ofri

    2015-05-15

    We present the first realization of a "twin Higgs" model as a holographic composite Higgs model. Uniquely among composite Higgs models, the Higgs potential is protected by a new standard model (SM) singlet elementary "mirror" sector at the sigma model scale f and not by the composite states at m_{KK}, naturally allowing for m_{KK} beyond the LHC reach. As a result, naturalness in our model cannot be constrained by the LHC, but may be probed by precision Higgs measurements at future lepton colliders, and by direct searches for Kaluza-Klein excitations at a 100 TeV collider.

  20. High twin resemblance for sensitivity to hypoxia.

    Science.gov (United States)

    Masschelein, Evi; Van Thienen, Ruud; Thomis, Martine; Hespel, Peter

    2015-01-01

    Physiological responses to hypoxia vary between individuals, and genetic factors are conceivably involved. Using a monozygotic twin design, we investigated the role of genetic factors in physiological responses to acute hypoxia. Thirteen pairs of monozygotic twin brothers participated in two experimental sessions in a normobaric hypoxic facility with a 2-wk interval. In one session, fraction of inspired O2 (FiO2) was gradually reduced to 10.7% (approximately 5300 m altitude) over 5 h. During the next 3 h at 10.7%, FiO2 subjects performed a 20-min submaximal exercise bout (EXSUB, 1.2 W·kg) and a maximal incremental exercise test (EXMAX). An identical control experiment was done in normoxia. Cardiorespiratory measurements were continuously performed, and 8-h urine output was collected. Compared with normoxia, hypoxia decreased (P < 0.05) arterial O2 saturation (%SpO2) at rest (-22%) and during exercise (-28%). Furthermore, V˙O2max (-39%), HRmax (HR, -8%), maximal pulmonary ventilation (V˙Emax, -11%), and urinary norepinephrine excretion (-31%) were reduced (P < 0.05) whereas HR at rest (25%) and during EXSUB (16%) and V˙E at rest (38%) and during EXSUB (70%) were increased (P < 0.05). However, hypoxia-induced changes (Δ) were not randomly distributed between subjects. Between-pair variance was substantially larger than within-pair variance (P < 0.05) for Δ%SpO2 at rest (approximately threefold) and during exercise (approximately fourfold), ΔV˙O2max (approximately fourfold), ΔHR during exercise (approximately seven- to eightfold), hypoxic ventilatory response (approximately sixfold), and Δ urinary norepinephrine output (approximately threefold). Incidence of acute mountain sickness (AMS) also yielded significant twin similarity (P < 0.05). AMS subjects showed approximately 50% greater drop in urinary norepinephrine and lower hypoxic ventilator response than AMS individuals. Our data suggest that genetic factors regulate cardiorespiratory responses, exercise

  1. Conceivability and De Re Modal Knowledge: A reply to Roca-Royes

    DEFF Research Database (Denmark)

    Steffensen, Asger Bo Skjerning

    In a recent paper, Roca-Royes argues that conceivability cannot be the whole story about our access to de re modal knowledge. Her claim is that conceivability-based epistemologies fails to comply with a principle any epistemology of de re modality must observe. I critically assess Roca-Royes' arg......-Royes' argument in two respects. First, I will argue that the notion of 'pretense' at play in her conceivability method, the method by which the conceivabilist establishes de re necessities, is illicit. Second, I shall consider wide content as an answer to the objection....

  2. Improved fertility following conservative surgical treatment of ectopic pregnancy

    DEFF Research Database (Denmark)

    Bangsgaard, Nannie; Lund, Claus Otto; Ottesen, Bent

    2003-01-01

    intrauterine pregnancy rate was significantly higher after tubotomy (88%) than after salpingectomy (66%) (log rank P ectopic pregnancy between the treatments (16% vs 17%). In patients with contralateral tubal......OBJECTIVE: To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy. DESIGN: Retrospective cohort study. SETTING: Clinical University Center, Hvidovre Hospital, Copenhagen. POPULATION: Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic...... pregnancy between January 1992 and January 1999 and who actively attempted to conceive were followed for a minimum of 18 months. METHODS: Retrospective cohort study combined with questionnaire to compare reproductive outcome following salpingectomy or tubotomy for ectopic pregnancy. Cumulative probabilities...

  3. Anemia in Pregnancy

    Directory of Open Access Journals (Sweden)

    Umran Kucukgoz Gulec

    2013-06-01

    Full Text Available Iron deficiency anemia (IDA is the most frequent form of anemia in pregnant women. Folic acid, vitamin B12 deficiency, and hemoglobinopathies are other causes of anemia in pregnancy. Finding the underlying cause are crucial to the management of the anemia. Anemia is defined as hemoglobin of <11 g/dl in the first and third trimester and <10.5 g/dl in second trimester. According to the literature, anemia, particularly severe anemia (Hb<7g/dl is associated with increased risk of maternal and perinatal mortality and morbidity, and long term adverse effects in the newborn. The association of hemoglobin levels to perinatal outcome has been shown to be U shaped with both high and low hemoglobin levels being associated adverse perinatal outcome such as low birth weight, increased stillbirths. Anemia in pregnancy is a major public health problem. Ideally a woman should have adequate iron stores when she conceives, in order meet to additional requirements of pregnancy. This review focuses on the occurrence, types, maternal and perinatal outcomes, prevention and treatment of anemia during pregnancy. [Archives Medical Review Journal 2013; 22(3.000: 300-316

  4. Socioeconomic position and twins' health

    DEFF Research Database (Denmark)

    Osler, Merete; McGue, Matt; Christensen, Kaare

    2007-01-01

    of middle-aged Danish twins was conducted in 1998-99. The study population included 1266 like-sex twin pairs [52.5% monozygotic (MZ) and 47.6% dizygotic (DZ)]. Data were obtained on childhood and adult social class and on height, BMI, grip strength, depression symptoms, self-rated health, cognitive function...... cognitive test scores. Among DZ female twins discordant on adult social class, the higher social class female twin was more physically active and had a higher cognitive test score. There were no significant health disparities or behavioural differences between the members of MZ twin pairs discordant......BACKGROUND: The association between socioeconomic circumstances and health in adulthood could come about through processes that may be divided into factors experienced early in life and those experienced in later adulthood. In order to disentangle the influences on health of the early genetic...

  5. Twin methodology in epigenetic studies

    DEFF Research Database (Denmark)

    Tan, Qihua; Christiansen, Lene; von Bornemann Hjelmborg, Jacob

    2015-01-01

    of diseases to molecular phenotypes in functional genomics especially in epigenetics, a thriving field of research that concerns the environmental regulation of gene expression through DNA methylation, histone modification, microRNA and long non-coding RNA expression, etc. The application of the twin method...... to molecular phenotypes offers new opportunities to study the genetic (nature) and environmental (nurture) contributions to epigenetic regulation of gene activity during developmental, ageing and disease processes. Besides the classical twin model, the case co-twin design using identical twins discordant...... for a trait or disease is becoming a popular and powerful design for epigenome-wide association study in linking environmental exposure to differential epigenetic regulation and to disease status while controlling for individual genetic make-up. It can be expected that novel uses of twin methods in epigenetic...

  6. A Computational Discriminability Analysis on Twin Fingerprints

    Science.gov (United States)

    Liu, Yu; Srihari, Sargur N.

    Sharing similar genetic traits makes the investigation of twins an important study in forensics and biometrics. Fingerprints are one of the most commonly found types of forensic evidence. The similarity between twins’ prints is critical establish to the reliability of fingerprint identification. We present a quantitative analysis of the discriminability of twin fingerprints on a new data set (227 pairs of identical twins and fraternal twins) recently collected from a twin population using both level 1 and level 2 features. Although the patterns of minutiae among twins are more similar than in the general population, the similarity of fingerprints of twins is significantly different from that between genuine prints of the same finger. Twins fingerprints are discriminable with a 1.5%~1.7% higher EER than non-twins. And identical twins can be distinguished by examine fingerprint with a slightly higher error rate than fraternal twins.

  7. Embryo-transfer twinning and performance efficiency in beef production.

    Science.gov (United States)

    Guerra-Martinez, P; Dickerson, G E; Anderson, G B; Green, R D

    1990-12-01

    Effects of twinning on efficiency of beef production were estimated from results of bilateral transfer of two Angus x Hereford (AxH) embryos into each of 241 heifers and 84 cows (H, A, HxA or Holstein x H) over 4 yr. Calves were weaned at 180 d and fed either 220 d in a feedlot (1977) or 170 d on forage and 140 d in a feedlot (1978 to 1980). Effects of parity, twinning and sex of calf were estimated as covariates within year-breed of dam. Pregnancy at 45 to 60 d of gestation was 68% in heifers (H) and 74% in cows (C), with 40% single (S) and 60% twin (T) births. Dystocia was 28% in H vs 10% in C (P less than .05), and tended to be less (P greater than .05) for T than S in H. More placentas were retained (P less than .05) for T than for S in both H (35 vs 12%) and C (24 vs 4%). Twin gestations averaged 3 d shorter and subsequent calving intervals 13 d longer (P less than .05), but total calf mortality was slightly higher (P greater than .05). Abortions were 4% in H only. Twinning females lost maternal weight during late gestation (P less than .05) when crowding limited voluntary feed intake, while fetal requirements were 60% higher (P less than .01). Twins increased milk output 25% (P less than .05), but 11% higher feed intake maintained cow weight during lactation. Twinning reduced birth weight 13% and weaning weight 17% (P less than .05), but 400-d feedlot weight only 9% because of compensating feedlot gain. Twins gained 18% faster than S during postweaning 170-d forage feeding, but 5% slower in feedlot to 8% lighter 490-d weight (P less than .05). Assuming 40% higher veterinary and labor costs for twins, estimated integrated herd costs per unit of age-constant output value would be lower for T than for S production by about 24% for marketing either at weaning or at 400 d.

  8. Legal termination of a pregnancy resulting from transplanted cryopreserved ovarian tissue due to cancer recurrence

    DEFF Research Database (Denmark)

    Ernst, Emil Hagen; Offersen, Birgitte Vrou; Andersen, Claus Yding

    2013-01-01

    To report on a woman who conceived naturally and had a normal intrauterine pregnancy following transplantation of frozen/thawed ovarian tissue but decided to have an early abortion due to recurrence of breast cancer.......To report on a woman who conceived naturally and had a normal intrauterine pregnancy following transplantation of frozen/thawed ovarian tissue but decided to have an early abortion due to recurrence of breast cancer....

  9. Spontaneous Heterotopic Triplet Pregnancy With Tubal Rupture

    Directory of Open Access Journals (Sweden)

    Lima Arsala MBBS, BBMedSci

    2014-04-01

    Full Text Available The recent increase in heterotopic pregnancies has been largely attributed to the increased use of assisted reproduction technologies. We report the rare case of a multiparous woman with a spontaneous conception resulting in a triplet heterotopic pregnancy: a twin intrauterine pregnancy and a single right tubal ectopic pregnancy. Heterotopic pregnancy is a rare and potentially life-threatening condition in which simultaneous gestations occur at 2 or more implantation sites. It is infrequent in natural conception cycles, occurring in 1:30 000 pregnancies. However, the prevalence is rising with the increased use of assisted reproduction techniques to that of 1:100 to 1:500 in these patient subgroups, highlighting the need to incorporate it into a clinician’s diagnostic algorithm.

  10. Reduced serum testosterone levels in infant boys conceived by intracytoplasmic sperm injection

    DEFF Research Database (Denmark)

    Mau Kai, Claudia; Main, Katharina M; Andersen, Anders Nyboe

    2007-01-01

    Concern has been raised for the health of the offspring conceived by assisted reproduction technologies. Basal reproductive hormones around 3 months of age reflect the pituitary-testicular axis, which is transiently active at this age....

  11. Heritability of gestational weight gain--a Swedish register-based twin study.

    Science.gov (United States)

    Andersson, Elina Scheers; Silventoinen, Karri; Tynelius, Per; Nohr, Ellen A; Sørensen, Thorkild I A; Rasmussen, Finn

    2015-08-01

    Gestational weight gain (GWG) is a complex trait involving intrauterine environmental, maternal environmental, and genetic factors. However, the extent to which these factors contribute to the total variation in GWG is unclear. We therefore examined the genetic and environmental influences on the variation in GWG in the first and second pregnancy in monozygotic (MZ) and dizygotic (DZ) twin mother-pairs. Further, we explored if any co-variance existed between factors influencing the variation in GWG of the mothers’ first and second pregnancies. By using Swedish nationwide record-linkage data, we identified 694 twin mother-pairs with complete data on their first pregnancy and 465 twin mother-pairs with complete data on their second pregnancy during 1982–2010. For a subanalysis, 143 twin mother-pairs had complete data on two consecutive pregnancies during the study period. We used structural equation modeling (SEM) to assess the contribution of genetic, shared, and unique environmental factors to the variation in GWG. A bivariate Cholesky decomposition model was used for the subanalysis. We found that genetic factors explained 43% (95% CI: 36–51%) of the variation in GWG in the first pregnancy and 26% (95% CI: 16–36%) in the second pregnancy. The remaining variance was explained by unique environmental factors. Both overlapping and distinct genetic and unique environmental factors influenced GWG in the first and the second pregnancy. This study showed that GWG has a moderate heritability, suggesting that a large part of the variation in the trait can be explained by unique environmental factors.

  12. Does continuous use of metformin throughout pregnancy improve pregnancy outcomes in women with polycystic ovarian syndrome?

    Science.gov (United States)

    Nawaz, Fauzia Haq; Khalid, Roha; Naru, Tahira; Rizvi, Javed

    2008-10-01

    Polycystic ovarian syndrome (PCOS) is one of the most common endocrinopathies in women of reproductive age. It is associated with hyperinsulinemia and insulin resistance which is further aggravated during pregnancy. This mechanism has a pivotal role in the development of various complications during pregnancy. In the past few years, metformin, an insulin sensitizer, has been extensively evaluated for induction of ovulation. Its therapeutic use during pregnancy is, however, a recent strategy and is a debatable issue. At present, evidence is inadequate to support the long-term use of insulin-sensitizing agents during pregnancy. It is a challenge for both clinicians and researchers to provide good evidence of the safety of metformin for long-term use and during pregnancy. This study aimed to evaluate pregnancy outcomes in women with PCOS who conceived while on metformin treatment, and continued the medication for a variable length of time during pregnancy. This case-control study was conducted from January 2005 to December 2006 at the antenatal clinics of the Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan. The sample included 137 infertile women with PCOS; of these, 105 conceived while taking metformin (cases), while 32 conceived spontaneously without metformin (controls). Outcomes were measured in three groups of cases which were formed according to the duration of use of metformin during pregnancy. Comparison was made between these groups and women with PCOS who conceived spontaneously. All 137 women in this study had a confirmed diagnosis of PCOS (Rotterdam criteria). These women were followed up during their course of pregnancy; data forms were completed once they had delivered. Cases were divided into three groups: group A, 40 women who stopped metformin between 4-16 weeks of pregnancy; group B, 20 women who received metformin up until 32 weeks of gestation; and group C; 45 women who continued metformin throughout pregnancy. All

  13. Pathologic conditions in pregnancy

    International Nuclear Information System (INIS)

    Beomonte Zobel, B.; Tella, S.; Innacoli, M.; D'Archivio, C.; Cardone, G.; Masciocchi, C.; Gallucci, M.; Passariello, R.; Cappa, F.

    1991-01-01

    Soma authors suggested that MR imaging could rapresent an effective diagnostic alternative in the study of pathologic conditions of mother and fetus during pregnancy. To verify the actual role of MR imaging, we examined 20 patients in the 2nd and 3rd trimester of gestation, after a preliminary US examination. Fifteen patients presented fetal or placental pathologies; in 4 patients the onset of the pathologic condition occurred during pregnancy; in 1 case of US diagnosis of fetal ascites, MR findings were nornal and the newborn was healty. As for placental pathologies, our series included a case of placental cyst, two hematomas between placenta and uterine wall, and two cases of partial placenta previa. As for fetal malformation, we evaluated a case of omphalocele, one of Prune-Belly syndrome, a case of femoral asimmetry, one of thanatophoric dwarfism, a case of thoracopagus twins with cardiovascular abnormalities, two fetal hydrocephali, and three cases of pyelo-ureteral stenosis. As for maternal pathologies during pregnancy, we observed a case of subserous uterine fibromyoma, one of of right hydronephrosis, one of protrusion of lumbar invertebral disk, and a large ovarian cyst. In our experience, MR imaging exhibited high sensitivity and a large field of view, which were both useful in the investigation of the different conditions occurring during pregnancy. In the evaluation of fetal and placental abnormalities, especially during the 3rd trimester, the diagnostic yieldof MR imaging suggested it as a complementary technique to US for the evaluation of fetal malformation and of intrauterine growth retardation

  14. Estimating twin concordance for bivariate competing risks twin data

    DEFF Research Database (Denmark)

    Scheike, Thomas; Holst, Klaus K.; Hjelmborg, Jacob B.

    2014-01-01

    For twin time-to-event data, we consider different concordance probabilities, such as the casewise concordance that are routinely computed as a measure of the lifetime dependence/correlation for specific diseases. The concordance probability here is the probability that both twins have experienced...... over time, and covariates may be further influential on the marginal risk and dependence structure. We establish the estimators large sample properties and suggest various tests, for example, for inferring familial influence. The method is demonstrated and motivated by specific twin data on cancer...

  15. DNA methylation and gene expression differences in children conceived in vitro or in vivo

    OpenAIRE

    Katari, Sunita; Turan, Nahid; Bibikova, Marina; Erinle, Oluwatoyin; Chalian, Raffi; Foster, Michael; Gaughan, John P.; Coutifaris, Christos; Sapienza, Carmen

    2009-01-01

    Epidemiological data indicate that children conceived in vitro have a greater relative risk of low birth-weight, major and minor birth defects, and rare disorders involving imprinted genes, suggesting that epigenetic changes may be associated with assisted reproduction. We examined DNA methylation at more than 700 genes (1536 CpG sites) in placenta and cord blood and measured gene expression levels of a subset of genes that differed in methylation levels between children conceived in vitro ve...

  16. Characterization of diastolic dysfunction in twin-twin transfusion syndrome: association between Doppler findings and ventricular hypertrophy.

    Science.gov (United States)

    Divanović, Allison; Cnota, James; Ittenbach, Richard; Tan, Xiao; Border, William; Crombleholme, Timothy; Michelfelder, Erik

    2011-08-01

    Twin-twin transfusion syndrome (TTTS) complicates 10% to 15% of monochorionic twin pregnancies. Cardiovascular changes of variable severity, such as ventricular hypertrophy, atrioventricular valve regurgitation, and systolic dysfunction, occur predominantly in recipient twins (RTs). It was the purpose of this study to perform a detailed assessment of ventricular geometry and diastolic function between controls, donor twins (DTs), and RTs. In this prospective, case-control study, two-dimensional, pulsed-wave, and Doppler tissue imaging were used to evaluate biventricular geometry and diastolic function in controls, DTs, and RTs. RTs were divided into two groups, severe and mild, on the basis of evidence of high central venous pressure. Specific variables evaluated included relative wall thickness, mitral valve and tricuspid valve E/A velocities, diastolic filling time corrected for heart rate, isovolumic relaxation time, and early (E') and late (A') diastolic myocardial velocities. A total of 120 fetuses (39 TTTS twin pairs and 42 controls) were compared. Increases in relative wall thickness and isovolumic relaxation time were seen in the mild group. In the severe group, further increases in relative wall thickness and isovolumic relaxation time as well as decreased diastolic filling time corrected for heart rate were accompanied by the appearance of a monophasic Doppler inflow profile and elevations in the E/E' ratio, consistent with elevated ventricular filling pressures. Concentric hypertrophy is observed in RTs affected by TTTS and is associated with impaired ventricular relaxation and shortened filling time. In severe cases, further decreases in diastolic filling time and Doppler signs of elevated ventricular filling pressures are present. Copyright © 2011 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  17. Performance of ultrasound fetal weight estimation in twins.

    Science.gov (United States)

    Dimassi, Kaouther; Karoui, Abir; Triki, Amel; Gara, Mohamed Faouzi

    2016-03-01

    Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weight estimation is useful to anticipate neonatal care in case of weight restriction or growth discordance. To assess the accuracy of estimated fetal weight (EFW) in twins and to assess the accuracy of sonographic examination to predict birth weight discordance (BWD) and small birth weight (SBW).    Methods : This was  a longitudinal prospective study over a period of one year. We have included 50 twin pregnancies with a first trimester ultrasound calculated term and specified chorionicity. An ultrasound EFW was scheduled for all patients within an interval of 4 days before delivery. We calculated the differences between EFW and BW in terms of absolute difference and percentage error. We studied the correlation and the agreement between EFW and BW. Finally we calculated the sensitivity, the specificity, PPV and NPV of ultrasound in the diagnosis of BWD and SBW. Absolute differences between BWF and BW were similar for the two twins. The relative difference was 7.7% [0-32] for T1 and 8.2% [0-27] for T2. The margin of error was greater than 10% in 38% of the cases for T1 and in 34% of cases for T2. Furthermore, correlation coefficients R1 and R2 for T1 and T2 were close to 1; R 1 =0.87 and  R 2 = 0.89. Linear regression analysis allowed us to calculate the birth weight based on the estimated weight and this according to the following equations: For the first twin BW T1 = 0.846 * EFW 415,57+ T1 For the second twin BW T2 = 65.68 + 0.963 * EFW T2 in 34% of cases for T2. Chorionicity, presentation and gestational age did not affect the estimations. Ultrasonography in the diagnosis of SBW had a sensitivity of 90.32%, a specificity of 76.82%, a (PPV) of 80% and a (VPN) of 87%. The performance of ultrasound in the diagnosis of BWD varied according to the adopted threshold. Ultrasound is an effective examination to estimate twins weight. Regarding prenatal diagnosis of birth weight

  18. Twins and Kindergarten Separation: Divergent Beliefs of Principals, Teachers, Parents, and Twins

    Science.gov (United States)

    Gordon, Lynn Melby

    2015-01-01

    Should principals enforce mandatory separation of twins in kindergarten? Do school separation beliefs of principals differ from those of teachers, parents of twins, and twins themselves? This survey questioned 131 elementary principals, 54 kindergarten teachers, 201 parents of twins, and 112 twins. A majority of principals (71%) believed that…

  19. The nature of pseudo-twinning modes on the basis of a twin classification scheme

    International Nuclear Information System (INIS)

    Singh, Jung B.; Sundararaman, M.; Krishnan, M.

    2011-01-01

    Pseudo-twins can form in ordered structures under high stress conditions. These twins are defined by lattice sites that are at twin positions but are incorrectly occupied by different species of atoms. The present note discusses if it is possible to further classify pseudo-twins into different modes based on the nature of associated twinning elements.

  20. Successful separation of Xipho-Omphalopagus twins

    Directory of Open Access Journals (Sweden)

    Oak S

    2007-01-01

    Full Text Available Xipho-omphalopagus twins are conjoined twins sharing some part of gastrointestinal system and lower sternum. These types of twins have best chances of survival if successfully separated. We report a case of successfully separated Xipho-omphalopagus twins, highlighting the importance of proper planning and team effort in such separations.

  1. Avaliação do Comprimento do Colo Uterino nas Posições Ortostática e Decúbito Horizontal nas Gestações Gemelares Uterine Cervical Length Evaluation in the Standing and Recumbent Positions in Twin Pregnancies

    Directory of Open Access Journals (Sweden)

    Tatiana Bernáth

    2002-05-01

    Full Text Available Objetivo: avaliação ultra-sonográfica e comparação da medida do comprimento do colo uterino nas gestações gemelares com as pacientes nas posições de decúbito dorsal horizontal (DDH e ortostática. Métodos: 50 gestações gemelares foram submetidas a avaliações ultra-sonográficas para medida do comprimento do colo uterino no período de maio de 1999 a dezembro de 2000. Os exames foram realizados pela via transvaginal com periodicidade de 4 semanas totalizando 136 avaliações. A cérvice uterina foi avaliada, segundo técnica normatizada, com a paciente nas posições de decúbito dorsal horizontal e ortostática. Resultados: as medidas do colo uterino nas posições DDH e ortostática na primeira avaliação apresentaram correlação inversa com a idade gestacional (DDH: r=-0,60; pPurpose: to compare cervical length measurements in twin pregnancies obtained by transvaginal ultrasound examination in the recumbent and standing positions. Methods: fifty twin pregnancies underwent transvaginal ultrasound examinations to measure the cervical length with the women in recumbent and standing positions. The study was carried out between May 1999 and December 2000. The scans were repeated every 4 weeks and the total number of evaluations was 136. Two groups were analyzed: one included only the first ultrasound examinations carried out in each woman and the second group included all evaluations. Results: in the first group, cervical length measurements in the standing and recumbent positions correlated inversely with the gestational age (recumbent: r=-0.60; p<0.001; standing: r=-0.46; p=0.008. The mean measure in the recumbent position was 35.2 mm (SD=9.9 mm and 33.4 mm (SD=9.5 mm in the standing position. When the difference between the measure obtained in the standing and recumbent positions was expressed as percentage of the measure in the recumbent position, there was no significant association with gestational age (p=0.07. When all

  2. Rare case of spina bifida in both twins with possible genetic basis.

    Science.gov (United States)

    Lembet, Arda; Uğurlu, Evin Nil; Toprak, Taner; Bastu, Ercan

    2011-11-01

    Neural tube defects (NTD) are a group of congenital malformations of the brain and spine, the etiology of which is still debated. Although presumed to be the consequence of interactions between genetic and environmental factors, so far, it is not known which genes are involved in the pathogenesis of these malformations. NTD affecting both fetuses in a twin gestation is a rare event. In view of this rarity, we present a case of dichorionic diamniotic twin pregnancy with spina bifida in both fetuses concordantly. This gestation was preceeded by another dichorionic diamniotic twin pregnancy that was complicated by placental abruption. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

  3. Fivefold twinned boron carbide nanowires.

    Science.gov (United States)

    Fu, Xin; Jiang, Jun; Liu, Chao; Yuan, Jun

    2009-09-09

    Chemical composition and crystal structure of fivefold twinned boron carbide nanowires have been determined by electron energy-loss spectroscopy and electron diffraction. The fivefold cyclic twinning relationship is confirmed by systematic axial rotation electron diffraction. Detailed chemical analysis reveals a carbon-rich boron carbide phase. Such boron carbide nanowires are potentially interesting because of their intrinsic hardness and high temperature thermoelectric property. Together with other boron-rich compounds, they may form a set of multiply twinned nanowire systems where the misfit strain could be continuously tuned to influence their mechanical properties.

  4. Advanced methods in twin studies.

    Science.gov (United States)

    Kaprio, Jaakko; Silventoinen, Karri

    2011-01-01

    While twin studies have been used to estimate the heritability of different traits and disorders since the beginning of the twentieth century, statistical developments over the past 20 years and more extensive and systematic data collection have greatly expanded the scope of twin studies. This chapter reviews selected possibilities of twin study designs to address specific hypotheses regarding the role of both genetic and environmental factors in the development of traits and diseases. In addition to modelling latent genetic influences, current models permit inclusion of information on specific genetic variants, measured environmental factors and their interactive effects. Examples from studies of anthropometric traits are used to illustrate such approaches.

  5. Monozygotic Triplets and Dizygotic Twins following Transfer of Three Poor-Quality Cleavage Stage Embryos

    Directory of Open Access Journals (Sweden)

    Reshef Tal

    2012-01-01

    Full Text Available Background. Assisted reproductive technology has been linked to the increased incidence of monozygotic twinning. It is of clinical importance due to the increased risk of complications in multiple pregnancies in general and in monozygotic twins in particular. Case. A 29-year-old female, nulligravida underwent her first IVF cycle. Three poor-quality cleavage stage embryos were transferred resulting in monochorionic triamniotic triplets and dichorionic diamniotic twins. Selective embryo reduction was performed at 12 weeks leaving dichorionic twins. The patient underwent emergency cesarean section due to preterm labor and nonreassuring fetal heart tracing at 30 weeks of gestation. Conclusion. Our case emphasizes that even embryos with significant morphological abnormalities should be considered viable and the possibility of simultaneous spontaneous embryo splitting must be factored into determining number of embryos to transfer.

  6. The vanishing twin: morphologic and cytogenetic evaluation of an ultrasonographic phenomenon

    DEFF Research Database (Denmark)

    Rudnicki, M; Vejerslev, L O; Junge, Jette

    1991-01-01

    Twin pregnancy was observed by ultrasonographic examination in the 6th week of gestation. After singleton term delivery a thickening of the membranes opposite to the main placenta showed degenerated chorionic villi embedded between one layer of amnion and chorion; no fetal parts were observed. Vi...

  7. Increased levels and pulsatility of Follicle-Stimulating Hormone in mothers of hereditary dizygotic twins

    NARCIS (Netherlands)

    Lambalk, C.B.; Boomsma, D.I.; Boer, L.; de Koning, C.H.; Schoute, E.; Popp-Snyders, C.; Schoemaker, J.

    1998-01-01

    According to the endocrine model of hereditary dizygotic twinning, high FSH is responsible for multiple ovulation and pregnancy. Our study explored the underlying neuroendocrine causes. In a prospective clinical study, we compared the third day of menses parameters of episodic secretion of LH and

  8. North American Fetal Therapy Network: intervention vs expectant management for stage I twin-twin transfusion syndrome.

    Science.gov (United States)

    Emery, Stephen P; Hasley, Steve K; Catov, Janet M; Miller, Russell S; Moon-Grady, Anita J; Baschat, Ahmet A; Johnson, Anthony; Lim, Foong-Yen; Gagnon, Alain L; O'Shaughnessy, Richard W; Ozcan, Tulin; Luks, Francois I

    2016-09-01

    Stage I twin-twin transfusion syndrome presents a management dilemma. Intervention may lead to procedure-related complications while expectant management risks deterioration. Insufficient data exist to inform decision-making. The aim of this retrospective observational study was to describe the natural history of stage I twin-twin transfusion syndrome, to assess for predictors of disease behavior, and to compare pregnancy outcomes after intervention at stage I vs expectant management. Ten North American Fetal Therapy Network centers submitted well-documented cases of stage I twin-twin transfusion syndrome for analysis. Cases were retrospectively divided into 3 management strategies: those managed expectantly, those who underwent amnioreduction at stage I, and those who underwent laser therapy at stage I. Outcomes were categorized as no survivors, 1 survivor, 2 survivors, or at least 1 survivor to live birth, and good (twin live birth ≥30.0 weeks), mixed (single fetal demise or delivery between 26.0-29.9 weeks), and poor (double fetal demise or delivery <26.0 weeks) pregnancy outcomes. Outcomes were analyzed by initial management strategy. A total of 124 cases of stage I twin-twin transfusion syndrome were studied. In all, 49 (40%) cases were managed expectantly while 30 (24%) underwent amnioreduction and 45 (36%) underwent laser therapy at stage I. The overall fetal mortality rate was 20.2% (50 of 248 fetuses). Of those managed expectantly, 11 patients regressed (22%), 4 remained stage I (8%), 29 advanced in stage (60%), and 5 experienced spontaneous previable preterm birth (10%) during observation. The mean number of days from diagnosis of stage I to a change in status (progression, regression, loss, or delivery) was 11.1 (SD 14.3) days. Intervention by amniocentesis or laser therapy was associated with a lower risk of fetal loss (P = .01) than expectant management. The unadjusted odds of poor outcome were 0.33 (95% confidence interval, 0.09-01.20), for

  9. The effect of deformation twinning on irradiation embrittlement in iron single crystals

    International Nuclear Information System (INIS)

    Kayano, Hideo; Tokutomi, Shoichiro; Yajima, Seishi; Takaku, Hiroshi.

    1978-01-01

    Single crystals of iron with the [100] crystal orientation were irradiated in JMTR with fast neutrons to a fluence of 8 x 10 18 n/cm 2 (E > 1 MeV). All samples were deformed in tension at temperatures from liquid nitrogen temperature to 200 0 C at different strain rates using an Instron-type tensile testing machine. Scanning electron microscopy of the fractured surfaces revealed that deformation twinning is difficult to occur in irradiated samples, and also that twins formed in both irradiated and unirradiated samples inhibit fracture nucleation and growth. From the results of tensile deformation of the irradiated samples deformed in tension a different strain rates at 159 0 K, it is conceived that twinning suppression is greater in the irradiated than in the unirradiated samples, and that the nucleation and growth of twins are not necessarily related to those of cracks. It is suggested that the irradiation-induced defects impede plastic deformation of the crystals and deformation twinning is suppressed by irradiation, thus causing the irradiation embrittlement. (auth.)

  10. A case of bilateral tubal pregnancy

    Directory of Open Access Journals (Sweden)

    Ayano Funamizu

    2017-11-01

    Full Text Available Bilateral tubal pregnancy is very rare and occurs in only 1 out of every 200,000 spontaneous pregnancies. In this case, a 29-year-old woman with a history of primary infertility underwent treatment with human menopausal gonadotropin (hMG-human chorionic gonadotropin (hCG, and became pregnant. A gestational sac (GS was not detected in the uterus and transvaginal ultrasonography (USG revealed GS with fetal heartbeat in the left adnexa at 7 weeks and 6 days of gestation. The patient underwent laparoscopic surgery and ultimately, bilateral tubal pregnancy was diagnosed. Consequently, bilateral fallopian tube resection was performed. Afterwards, she conceived by assisted reproductive technology (ART and delivered vaginally. This case suggests that even if a GS is found in one fallopian tube by USG, it is important to evaluate the other fallopian tube carefully. Keywords: bilateral tubal pregnancy, ectopic pregnancy, human menopausal gonadotropin, laparoscopy

  11. Stress and anxiety-depression levels following first-trimester miscarriage: a comparison between women who conceived naturally and women who conceived with assisted reproduction.

    Science.gov (United States)

    Cheung, C S; Chan, C H; Ng, E H

    2013-08-01

    To compare the psychological impact following early miscarriage between women who conceived naturally and women who conceived following assisted reproduction. Prospective cohort study. Assisted reproduction clinic and general gynaecological unit in a university-affiliated, tertiary referral hospital. A cohort of 150 women (75 after natural conception; 75 after assisted reproduction). Completed semi-structured interviews using two standard questionnaires [the 12-item General Health Questionnaire (GHQ-12) and the 22-item Revised Impact of Events Scale (IES-R)], at 1, 4, and 12 weeks after a diagnosis of first-trimester miscarriage. The GHQ-12 and IES-R scores for the two groups of women. The GHQ-12 and IES-R scores were significantly higher in the assisted reproduction group than the scores in the natural conception group, at 4 weeks and 12 weeks after miscarriage. Further breakdown of the scores revealed significantly higher hyperarousal symptoms at 4 and 12 weeks in the assisted reproduction group, indicating the traumatic effect of miscarriage to these women. Following first-trimester miscarriage, subfertile women who conceived after assisted reproduction had higher stress and anxiety-depression levels, and experienced more traumatic impact from the event, than those after natural conception. A timely support and psychological intervention would be beneficial in the management of this group of women. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.

  12. Respiratory Failure in Premature Babies Born from Multiple Pregnancy

    Directory of Open Access Journals (Sweden)

    S. A. Perepelitsa

    2010-01-01

    Full Text Available Objective: to reveal the factors that are responsible for the development of respiratory distress syndrome (RDS and the specific features of its course in preterm twin neonates. Subjects and methods. Twenty-three patients who had had twin pregnancy, including 9 (39.1% and 14 (60% with monochorial and bichorial biamniotic twin pregnancies, respectively, were examined. Their mean age was 28.5±5.4 years. Obstetric and gynecologic histories, conditions at conception, the course of pregnancy, the type of pla-centation, and fetal presentation were considered. The placentas were morphologically examined. In all the patients, pregnancy ended in birth of 46 premature neonates, of them there were 19 (41.3% boys and 27 (58.7% girls. The gestational age of the neonates averaged 31.7±2.3 weeks. The evaluation of the efficiency of performed therapy used clinical assessment of the status of the premature neonates; measurement of partial oxygen tension (pO2 and calculation of alveolar-arterial oxygen gradient (A-a DO2, respiratory index (RI, and oxygenation index (OI; death rates were analyzed. Results. The main cause of respiratory failure (RF was RDS in premature twins. Neonatal blood aspiration-caused pneumonia occurred in one case. The course of RDS was variable. Most neonatal infants needed exogenous surfactant replacement therapy and mechanical ventilation (MV. No signs of RF were present in 7 (15.2% premature neonates. Conclusion. Premature twins are a high RDS risk group. The unfavorable factors that contribute to the development of the disease are multiple pregnancy, a past maternal obstetric history, in-vitro fertilization-induced pregnancy, severe gestosis in the second half of pregnancy, and preterm delivery. The type of placentation affects the fetal status after birth. Fatal outcome occurred in infants from the monochorial bioamniotic twins. In multiple pregnancies, there are pathological changes in the placenta, its membranes, and umbilical

  13. Health outcomes of school-aged children conceived using donor sperm.

    Science.gov (United States)

    Amor, David J; Lewis, Sharon; Kennedy, Joanne; Habgood, Emily; McBain, John; McLachlan, Robert I; Rombauts, Luk J; Williams, Katrina; Halliday, Jane

    2017-10-01

    The use of donor sperm is increasing, yet limited information is available about the health and development of children conceived from donor sperm. This retrospective descriptive study aimed to assess health and development in a cohort of school-aged children who were conceived using donor sperm. Participants included 224 children, aged 5-11 years, who were conceived using donor sperm. Participants' mothers completed a questionnaire comprising validated scales examining their child's current and past physical, psychosocial and mental health, healthcare needs and child development, as well as the mothers' health and wellbeing. At the conclusion of the study, the response rate was 296 out of 407 (72.7%), with a participation rate of 224 out o 407 (55.0%). Compared with the normative Australian population, sperm donor-conceived children had similar physical, psychosocial and mental health and development. A modest increase in healthcare needs was evident. The study concludes that in school-aged children conceived using donor sperm, most aspects of child health and wellbeing are similar to the general population. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  14. Teenage pregnancy outcome: a record based study.

    Science.gov (United States)

    Ambadekar, N N; Khandait, D W; Zodpey, S P; Kasturwar, N B; Vasudeo, N D

    1999-01-01

    Present record based study was undertaken in Medical record section of Government medical college, Nagpur, to assess teenage as a risk factor for pregnancy complications, outcome, and operative or assisted delivery. Five year (January 1993 to December 1997) data was scanned, which gave sample of 1830 teenage pregnancies; while equal number of subsequent partly matched controls (> 20.29 years) were taken. Results showed proportion of low birth weight baby to be significantly greater in teenagers (p pregnancies (p pregnancy, premature rupture of membrane, placenta previa, accidental haemorrhage though more in adult pregnancies was statistically not significant. There were no differences in cogenital anamoly and twins between cases and controls. But breech deliveries were significantly (p < 0.001) more in adults.

  15. Sunset over Twin Peaks

    Science.gov (United States)

    1997-01-01

    This image was taken by the Imager for Mars Pathfinder (IMP) about one minute after sunset on Mars on Sol 21. The prominent hills dubbed 'Twin Peaks' form a dark silhouette at the horizon, while the setting sun casts a pink glow over the darkening sky. The image was taken as part of a twilight study which indicates how the brightness of the sky fades with time after sunset. Scientists found that the sky stays bright for up to two hours after sunset, indicating that Martian dust extends very high into the atmosphere.Mars Pathfinder is the second in NASA's Discovery program of low-cost spacecraft with highly focused science goals. The Jet Propulsion Laboratory, Pasadena, CA, developed and manages the Mars Pathfinder mission for NASA's Office of Space Science, Washington, D.C. JPL is an operating division of the California Institute of Technology (Caltech). The Imager for Mars Pathfinder (IMP) was developed by the University of Arizona Lunar and Planetary Laboratory under contract to JPL. Peter Smith is the Principal Investigator.

  16. Pregnancy after uterine arterial embolization

    Directory of Open Access Journals (Sweden)

    Cláudio E. Bonduki

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate pregnancy outcomes, complications and neonatal outcomes in women who had previously undergone uterine arterial embolization. METHODS: A retrospective study of 187 patients treated with uterine arterial embolization for symptomatic uterine fibroids between 2005-2008 was performed. Uterine arterial embolization was performed using polyvinyl alcohol particles (500-900 mm in diameter. Pregnancies were identified using screening questionnaires and the study database. RESULTS: There were 15 spontaneous pregnancies. Of these, 12.5% were miscarriages (n = 2, and 87.5% were successful live births (n = 14. The gestation time for the pregnancies with successful live births ranged from 36 to 39.2 weeks. The mean time between embolization and conception was 23.8 months (range, 5-54. One of the pregnancies resulted in twins. The newborn weights (n = 14 ranged from 2.260 to 3.605 kg (mean, 3.072 kg. One (7.1% was considered to have a low birth weight (2.260 kg. There were two cases of placenta accreta (12.5%, treated with hysterectomy in one case [6.3%], one case of premature rupture of the membranes (PRM (6.3%, and one case of preeclampsia (6.3%. All of the patients were delivered via Cesarean section. CONCLUSION: In this study, there was an increased risk of Cesarean delivery. There were no other major obstetric risks, suggesting that pregnancy after uterine arterial embolization is possible without significant morbidity or mortality.

  17. Sex Ratio and Twinning in Women with Hyperemesis or Pre-eclampsia

    DEFF Research Database (Denmark)

    Basso, Olga; Olsen, Jørn

    2001-01-01

    We examined twinning and fetal gender in births of women with a hospital diagnosis of pre-eclampsia or hyperemesis. We also investigated sex ratio in infants whose mothers had had hyperemesis or pre-eclampsia in a different pregnancy. From all the hospitalized cases in Denmark between 1980 and 1996...... we extracted 6,227 births with hyperemesis and 24,764 with pre-eclampsia. Twins were more frequent in pregnancies with either condition. The male to female sex ratio was 1.04 (95%CI = 1.02-1.05) in the reference population, 0.87 (95% CI = 0.82-0.91) in births with hyperemesis, and 1.10 (95% CI = 1.......07-1.12) in births with pre-eclampsia. Women with pre-eclampsia had slightly more males also in non-affected pregnancies....

  18. The impact of expectant management, systemic methotrexate and surgery on subsequent pregnancy outcomes in tubal ectopic pregnancy.

    Science.gov (United States)

    Demirdag, E; Guler, I; Abay, S; Oguz, Y; Erdem, M; Erdem, A

    2017-05-01

    The most common treatment modalities of ectopic pregnancy may influence long-term subsequent fertility outcomes in women who previously treated for ectopic pregnancy. Our objective was to compare long-term subsequent fertility outcomes after treatment with expectant management, systemic methotrexate (MTX) and surgery in tubal ectopic pregnancy. We searched our database for all women diagnosed with tubal ectopic pregnancy between January 2007 and January 2011 who were managed expectantly, with systemic MTX and with surgery. Treatment success and spontaneous pregnancy rates were compared in patients who desire to conceive following a tubal pregnancy. One hundred twelve of 151 women desired to conceive following tubal ectopic pregnancy. Twenty-seven of 112 (24.1 %) patients were managed expectantly. Fifty-three (47.3 %) and 32 (28.5 %) patients were managed with systemic MTX or surgery, respectively. All patients in expectant and surgery groups were managed successfully. Two (3.7 %) patients had surgery after failed treatment with systemic MTX. Spontaneous intrauterine pregnancy rates were 62.9 % in expectantly managed women, 58.4 % in women with systemic MTX and 68.7 % in women with surgery (p > 0.05). Treatment of ectopic pregnancy with either expectant management or systemic MTX is equally effective as compared to surgery. Spontaneous intrauterine pregnancy rates were comparable in expectant management, systemic methotrexate and surgery.

  19. Spina bifida occulta and monozygotic twins.

    Science.gov (United States)

    Spacca, Barbara; Buxton, Neil

    2008-10-01

    Central nervous system maldevelopment can have different presentations in twins. We report on a case of different presentations of spina bifida occulta in monozygotic twins. The first twin presented at birth with a lipomyelomeningocele; a tethered cord was diagnosed in the second twin at 2 years of age. Neural tube defects (NTDs) are a group of common congenital malformations of the brain and spine generated during neurulation. The genetic basis of this process is still not well known. Whenever an NTD is diagnosed in one of a pair of twins, the other twin should also be evaluated for NTDs.

  20. [Twin dystocia: about one case of compaction].

    Science.gov (United States)

    Desseauve, D; Voluménie, J-L

    2008-09-01

    We report a case of twin dystocia during the evacuation of full-term fetus both in cephalic presentation. A low-outlet forceps for second-phase arrest was performed for the first twin but the head remained stuck to maternal perineum, mimicking a shoulder dystocia. Digital examination found a twin compaction, that is the presence of the second twin's fetal head at the level of the first twin's chest. The discrepancy between fetal weights and the use of forceps could favor this rare complication. Various maneuvers were described previously attempted to solve the problem. Forcing back the second head may help to achieve delivery of the first twin.

  1. Teenage Pregnancy

    Science.gov (United States)

    ... plan to get pregnant, but many do. Teen pregnancies carry extra health risks to both the mother ... later on. They have a higher risk for pregnancy-related high blood pressure and its complications. Risks ...

  2. Ectopic Pregnancy

    Science.gov (United States)

    ... Things That Help Feelings Expert Answers Q&A Movies & More for Teens Teens site Sitio para adolescentes ... or more surgery. What About Future Pregnancies? Many women who have had an ectopic pregnancy will go ...

  3. Ultrasound pregnancy

    Science.gov (United States)

    ... the baby's age Look for problems, such as ectopic pregnancies or the chances for a miscarriage Determine the ... to some of the following conditions: Birth defects Ectopic pregnancy Poor growth of a baby while in the ...

  4. Ectopic Pregnancy

    Science.gov (United States)

    ... a woman is pregnant. If you have an ectopic pregnancy, the fertilized egg grows in the wrong place, ... fallopian tubes. The result is usually a miscarriage. Ectopic pregnancy can be a medical emergency if it ruptures. ...

  5. Twin-twin transfusion syndrome: neurodevelopmental screening test

    Directory of Open Access Journals (Sweden)

    Amabile Vessoni Arias

    2015-03-01

    Full Text Available Objective To assess the neurodevelopmental functions (cognition, language and motor function of survivors of twin-twin transfusion syndrome (TTTS. Method Observational cross-sectional study of a total of 67 monochorionic diamniotic twins who underwent fetoscopic laser coagulation (FLC for treatment of TTTS. The study was conducted at the Center for Investigation in Pediatrics (CIPED, Universidade Estadual de Campinas. Ages ranged from one month and four days to two years four months. Bayley Scales of Infant and Toddler Development Screening Test-III, were used for evaluation. Results Most children reached the competent category and were classified as having appropriate performance. The preterm children scored worse than term infants for gross motor subtest (p = 0.036. Conclusion The majority of children reached the expected development according to their age. Despite the good neurodevelopment, children classified at risk should be monitored for development throughout childhood.

  6. Pregnancy & Motherhood >

    Science.gov (United States)

    Smoking when pregnant; Pregnancy and smoking; Smoking during pregnancy; Pregnant women smoking; Smoking when pregnant effects; Pregnancy and smoking effects; Pregnant quit smoking; Pregnant stop smoking; How to quit smoking when pregnant; Smoking and fertility; Smoking and infertility; Mom smoking; Smoking around children; Second hand smoke and children

  7. Reproductive performance in the next pregnancy for nulliparous women with history of first trimester spontaneous abortion.

    Science.gov (United States)

    El Behery, Manal M; Siam, Soha; Seksaka, Mahmoud A; Ibrahim, Zakia M

    2013-10-01

    To determine whether interpregnancy interval after the first spontaneous abortion has an effect on reproductive performance of women in their next pregnancy. A prospective cohort study was conducted on 4,619 women with history of spontaneous abortion in their first pregnancy. Of them 2,422 (52.4 %) conceived within 6 months of the miscarriage (group A) and 2,197 47.6 % after 12 months (group B). The primary outcome was abortion, live birth, termination, or ectopic pregnancy in the next pregnancy. Secondary outcomes were preterm delivery, low birth weight infants, caesarean section rate and occurrence of preeclampsia, placental abruption and induced labour in the second pregnancy. Women who conceived again within 6 months were less likely to have another abortion, termination, or ectopic pregnancy compared with women with interpregnancy interval more than 12 months. Women with an interpregnancy interval more than 12 months were less likely to have live birth in the second pregnancy and more likely to have a caesarean section, preterm delivery, or infant of low birth weight compared with women who conceived again within 6 months. Women who conceive within 6 months after their first spontaneous abortion have better reproductive outcomes and the lowest complication rates in their subsequent pregnancy.

  8. Improved fertility following conservative surgical treatment of ectopic pregnancy

    DEFF Research Database (Denmark)

    Bangsgaard, Nannie; Lund, Claus Otto; Ottesen, Bent

    2003-01-01

    OBJECTIVE: To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy. DESIGN: Retrospective cohort study. SETTING: Clinical University Center, Hvidovre Hospital, Copenhagen. POPULATION: Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic...... pregnancy between January 1992 and January 1999 and who actively attempted to conceive were followed for a minimum of 18 months. METHODS: Retrospective cohort study combined with questionnaire to compare reproductive outcome following salpingectomy or tubotomy for ectopic pregnancy. Cumulative probabilities...... of pregnancy for each group were calculated by the Kaplan-Meier estimator and compared by Cox regression analysis to control for potential confounders. MAIN OUTCOME MEASURES: Intrauterine pregnancy rates and recurrence rates of ectopic pregnancy after surgery for ectopic pregnancy. RESULTS: The cumulative...

  9. Induction of oestrus and early pregnancy diagnosis in Awassi sheep

    International Nuclear Information System (INIS)

    Al-Merestani, M.R.; Zarkawi, M.; Wardeh, M.

    1997-12-01

    significantly (P<0.05) higher than twin-born lambs, reaching 5.0 ± 0.6 Kg and 3.9 ± 0.5 Kg, 4.7 ± 0.6 Kg and 3.0 ± 0.5 Kg for single and twin-born lambs in groups T1 and T2, respectively. There were no significant differences in average birth weight between male and female lambs. Average birth weight were 4.4 ± 0.9 Kg vs. 4.2 ± 1.0 Kg, 4.1 ± 0.7 Kg vs. 4.5 ± 0.7 Kg and 4.2 ± 1.0 Kg vs. 3.6 ± 1.0 Kg for male and female lambs in groups T1, C1 and C2, respectively. Average progesterone concentration between days 17-19 post-mating in the conceived and lambed animals was 19.3 ± 7.1 n mol/1 (range 8.3-37.9 n mol/1) for group T1, and 17.6 ± 8.3 n mol/1 (range 8.4-52.0 n mol/1) for group T2. Early pregnancy diagnosis was 100%. It was concluded that, it is possible to induce and synchronize oestrus, and to increase the twinning rate in Syrian Awassi sheep out-side the normal breeding season, using intravaginal sponges and pregnant mare's serum gonadotrophin. In addition, early pregnancey diagnosis could be successfully determined in female Awassi sheep between days 17-19 post-mating. (author). 67 refs., 7 figs., 13 tabs

  10. Categorisation of Mapuche Ways of Conceiving Time and Space: Educational Knowledge of the "Kimches"

    Science.gov (United States)

    Quilaqueo, Daniel; Torres, Hector

    2013-01-01

    The object of this article is to present a categorisation of the ways in which time and space are conceived in the rationale of Mapuche family education. This approach considers knowledge of natural, social, and cultural elements that characterise the classification of time and space by "kimches" (sages) in the education of children and…

  11. Risk of Oral Clefts in Twins

    DEFF Research Database (Denmark)

    Grosen, Dorthe; Bille, Camilla; Petersen, Inge

    2011-01-01

    BACKGROUND:: Small studies have indicated that twinning increases the risk of oral cleft. METHODS:: We used data from a Danish national population-based cohort study to investigate whether twinning was associated with isolated oral cleft, and to estimate the twin probandwise concordance rate...... and heritability. Twins (207 affected/130,710) and singletons (7766 affected/4,798,526) born from 1936 through 2004 in Denmark were ascertained by linkage among the Danish Facial Cleft Database, the Danish Twin Registry, and the Civil Registration System. We computed oral cleft prevalence and prevalence proportion...... ratio for twins versus singletons, stratified for 3 subphenotypes. Probandwise concordance rates and heritability for twins were estimated for 2 phenotypes-cleft lip with or without cleft palate (CL/P) and cleft palate (CP). RESULTS:: The prevalence of oral cleft was 15.8 per 10,000 twins and 16.6 per...

  12. Nike Twins Seven Seven: Nigerian Batik Artist.

    Science.gov (United States)

    LaDuke, Betty

    1987-01-01

    Chronicles the personal and professional life of Nike Twins Seven Seven (born 1951), a Nigerian batik artist, and her husband, Twins Seven Seven, a musician-artist, both of whom have received international acclaim. (BJV)

  13. Preterm twin gestation and cystic periventricular leucomalacia

    NARCIS (Netherlands)

    Resch, B; Jammernegg, A; Vollaard, E; Maurer, U; Mueller, WD; Pertl, B

    Objective: To identify risk factors for the development of cystic periventricular leucomalacia (PVL) in twin gestation. Design: Retrospective case-control study. Setting: Tertiary care university hospital, Department of Paediatrics, Division of Neonatology, Graz, Austria. Patients: Preterm twin

  14. Congenital diaphragmatic hernia in identical twins

    Directory of Open Access Journals (Sweden)

    Mustafa T Gurbaz

    2012-01-01

    Full Text Available Congenital diaphragmatic hernia (CDH, Bochdalek type is rarely seen in both members of identical twins. Herein, we report a 37 weeks′ twins with CDH along with a brief review of the literature. Both the neonates survived.

  15. Significance of donor anuria differs between monoamniotic and diamniotic twin-twin transfusion syndrome

    NARCIS (Netherlands)

    Schaap, A. H. P.; van den Wijngaard, J. P. H. M.; Nikkels, P. G. J.; van den Broek, A. J. M.; Snieders, I.; van Gemert, M. J. C.

    2007-01-01

    Development of severe twin-twin transfusion syndrome (TTTS) in diamniotic-monochorionic twins includes five stages of increasing severity, i.e. recipient polyhydramnios and donor oligohydramnios, donor anuria, abnormal umbilical flow velocities in either twin, hydrops in the recipient, and

  16. [Twin delivery with the first twin in breech position. A study of 137 continuous cases].

    Science.gov (United States)

    Bourtembourg, A; Ramanah, R; Jolly, M; Gannard-Pechin, E; Becher, P; Cossa, S; Mulin, B; Maillet, R; Riethmuller, D

    2012-04-01

    The first twin (T1) in breech position is at risk of complications during vaginal delivery, making the choice of the appropriate delivery route highly important. Although British and American practice guidelines recommend the cesarean section, the French National College of Obstetricians and Gynecologists concluded that there was not enough data to choose one delivery route or the other. In this context, we set out to describe practices in our centre. Our retrospective study was conducted at a level III labor ward between January 1st, 1995 and December 31st, 2006. One hundred and thirty-seven twin pregnancies at more than 26 gestational weeks (GW), with T1 in breech and T2 in any position, were included. A cesarean section was performed before labor in 60.6 % cases. Among the 54 (39.4 %) cases where a trial of labor was accepted, 29 patients (53.7 % success rate) delivered vaginally and 25 (46.3 %) had a cesarean section during labor. No statistical difference was observed between the neonatal outcomes after cesarean section as compared to vaginal birth. However, a significant relationship was found between delivery route and parity. Less than one-third of nulliparas versus two-third of patients with a history of at least one delivery, having trials of labor, ultimately gave birth vaginally. Thus, we observed a high rate of cesarean section during labor in nulliparas (68 % of the initially accepted trials of labor). Our study is the first one that clearly shows that the success rate of the trial of labor is closely related to a history of vaginal birth. Following these results and because of more than two-third of cesarean section during labor in nulliparas, we subsequently plan an elective cesarean section at the 38th GW for nulliparas with twin pregnancies and T1 in breech position. Nevertheless, if any of these patients go in labor before the cesearean section, a careful trial of labor is offered. Copyright © 2011 Elsevier Masson SAS. All rights

  17. Successful pregnancy in a patient with Takayasu's arteritis

    International Nuclear Information System (INIS)

    Al-Ghamdi, Aisha A.

    2003-01-01

    This report describes a case of Takayasu's in a 19-year-old Palestinian female. She conceived after diagnosis.Her pregnancy was complicated by uncontrolled hypertension, which was not associated with other markers of disease activity.Despite aggressive medical treatment, cesarean section had to be carried out at 34 weeks of pregnancy because of uncontrolled hypertension.A live fetus was borne, and her blood pressure was subsequently controlled with a single antihypertensive agent. (author)

  18. Twin and triple peaks papilledema.

    Science.gov (United States)

    Mehta, Jodhbir S; Plant, Gordon T; Acheson, James F

    2005-07-01

    To describe 2 adult patients who presented with papilledema after band atrophy (i.e., twin and triple peaks papilledema). Retrospective small case series. Two outpatients. Observations made on 2 patients whose cases were reviewed in the neuro-ophthalmology clinic. The first patient had a pituitary tumor presenting with papilledema, causing a triple peaks clinical sign. Color photographs, optical coherence tomograms, and magnetic resonance images are shown. The second patient developed twin peaks papilledema due to a chiasmal glioma causing secondary raised intracranial pressure. Twin peaks papilledema is a rare clinical sign that may develop in adults as well as in children. The first report and optical coherence tomography features of triple peaks papilledema illustrate a new clinical sign.

  19. Twins or two single children

    Directory of Open Access Journals (Sweden)

    2002-08-01

    Full Text Available Based on Swedish register data, we compared the influence of a twin birth on the divorce risk with the influence of the sequential birth of two single children. The divorce risk for a woman with a very young child was lower than the risk for women without children or women with children older than 3.5 years. This behaviour was essentially independent of the number of children and whether or not the woman gave birth to twins. The effect of parity was much smaller than the effect of child age. The influence of twins on the divorce risk appeared to fall between that of a first and a second singleton.

  20. PROGESTERONE/ESTRADIOL RATIO IN THE LATE FOLLICULAR PHASE OF LONG GONADOTROPIN-RELEASING HORMONE AGONIST CYCLES DID NOT DIFFER BETWEEN CONCEIVED AND NOT-CONCEIVED WOMEN

    Directory of Open Access Journals (Sweden)

    L. Safdarian

    2008-04-01

    Full Text Available There is a challenging debate on the effect of premature luteinization on the clinical outcome of ‘controlled ovarian hyperstimulation' (COH using long ‘gonadotropin-releasing hormone agonist' (GnRHa cycles. Premature luteinization is defined as late follicular progesterone/estradiol ratio more than 1 on the day of human chorionic gonadotropin (HCG administration. We carried out a retrospective case-control study on 75 conceived cases versus 75 not-conceived control women, receiving long GnRHa cycles in their first cycle of treatment. Premature luteinization developed in 15% of the case group vs. 22% of the control group. Neither the late follicular progesterone/estradiol (P/E2 ratio was significantly different between the two groups, nor the day 3 follicle stimulating hormone (FSH, serum estradiol level on the HCG day, total amount of human menopausal gonadotropins ampoules, number of follicles, retrieved oocytes and transferred embryos. Endometrial thickness was significantly more in the pregnant women than in the non-pregnant group. Premature luteinization seems not to adversely affect the clinical outcome of COH.