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Sample records for twin pregnancy suffering

  1. Twin pregnancy

    DEFF Research Database (Denmark)

    Sperling, Lene; Tabor, A

    2001-01-01

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

  2. 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.

  3. 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

  4. Teenage pregnancy: who suffers?

    Science.gov (United States)

    Paranjothy, S; Broughton, H; Adappa, R; Fone, D

    2009-03-01

    In this review, we examine the epidemiology of teenage pregnancy (girls aged 15-17 years) in the UK and consider the evidence for its impact on the health and well-being of the mother, the baby, the father and society. There has been some decrease in the teenage pregnancy rate over the last decade in the UK but rates are still considerably higher than those in other European countries. Pregnancy and childbirth during the teenage years are associated with increased risk of poorer health and well-being for both the mother and the baby, possibly reflecting the socio-economic factors that precede early pregnancy and childbirth. There is little evidence concerning the impact of teenage fatherhood on health and future studies should investigate this. The effect on society is a perpetuation of the widening gap in health and social inequalities. Public health interventions should aim to identify teenagers who are vulnerable and support those who are pregnant with evidence based interventions such as teenage antenatal clinics and access to initiatives that provide support for early parenthood.

  5. 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

  6. 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 ...

  7. Successful twin pregnancy after orthotopic liver transplantation

    Directory of Open Access Journals (Sweden)

    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

  8. 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

  9. Diabetes and perinatal mortality in twin pregnancies.

    Directory of Open Access Journals (Sweden)

    Zhong-Cheng Luo

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

  10. 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...

  11. 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

  12. 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....

  13. 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.

  14. 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.

  15. 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 ...

  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. 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.

  18. 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.

  19. [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.

  20. 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...

  1. 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 ...

  2. 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....

  3. 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.

  4. 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 ...

  5. 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 ...

  6. 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...

  7. 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

  8. 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

  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.

    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

  10. 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

  11. [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.

  12. 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.

  13. 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

  14. 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...

  15. 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.

  16. 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 ...

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

    Directory of Open Access Journals (Sweden)

    R Benn

    2016-02-01

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

  18. 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....

  19. 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

  20. 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)

  1. 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.

  2. 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:

  3. 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.

  4. 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.

  5. 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 ...

  6. 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.

  7. 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.

  8. 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....

  9. 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 ...

  10. 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, ...

  11. 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.

  12. 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.

  13. 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.

  14. 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:

  15. Cornual pregnancy in a patient suffering from sickle cell anemia

    Directory of Open Access Journals (Sweden)

    Onilda Labrada Silva

    2015-10-01

    Full Text Available Nowadays, ectopic pregnancy is a pathological entity of great incidence, which is increased, among other things, by each time earlier sexual relations. Cornual pregnancy is as a result of the implantation of the blastocyte within the segment of the fallopian tube that goes into the uterus wall or between the tubal ostium and the proximal portion of the isthmus. This is a case of a cornual pregnancy in which the use of ultrasonography played an essential role for its diagnosis, since it is about a patient suffering from sickle cell anemia, where it was not possible to clinically eliminate the possibility of an occlusive vessel crisis as the cause of abdominal pain. Subtotal hysterectomy of the right tube was performed. The patient’s evolution is satisfactory.

  16. [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.

  17. 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.

  18. 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.

  19. 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

  20. 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)

  1. 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.

  2. 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....

  3. 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.

  4. 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.

  5. 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 ...

  6. 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.

  7. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  9. 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 ...

  10. [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.

  11. 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.

  12. [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.

  13. 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...

  14. 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.

  15. [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.

  16. [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.

  17. 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.

  18. 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

  19. 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.

  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

    Among babies born by ART, do singleton survivors of a vanishing twin have lower birth weight than other singletons? Vanishing twin syndrome (VTS) was associated with lower birth weight among ART singletons; a sibship analysis indicated that the association was not confounded by maternal characteristics that remain stable between deliveries. Previous studies indicate that ART singletons with VTS have increased risk of adverse pregnancy outcomes, compared with other ART singletons. The potential contribution of unmeasured maternal background characteristics has been unclear. This was a Norwegian population-based registry study, including 17 368 mothers with 20 410 ART singleton deliveries between January 1984 and December 2013. The study population included 17 291 ART singletons without VTS, 638 ART singletons with VTS and 2418 ART singletons with uncertain vanishing twin status. We estimated differences in birth weight and gestational age comparing ART singletons with VTS first to all ART singletons without VTS, and subsequently to their ART siblings without VTS, using random- and fixed-effects linear regression, respectively. The corresponding comparisons for the associations with preterm birth and small for gestational age (SGA) were conducted using random-and fixed-effects logistic regression. The sibling analysis of preterm birth included 587 discordant siblings, while the sibling analysis of SGA included 674 discordant siblings. ART singletons with VTS had lower birth weight when compared to all ART singletons without VTS, with an adjusted mean difference (95% CI) of -116 g (-165, -67). When we compared ART singletons with VTS to their ART singletons sibling without VTS, the adjusted mean difference was -112 g (-209, -15). ART singletons with VTS also had increased risk of being born SGA, with an adjusted odds ratio (OR) (95% CI) of 1.48 (1.07, 2.03) compared to all ART singletons without VTS, and 2.79 (1.12, 6.91) in the sibship analyses. ART singletons with

  1. 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...

  2. 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.

  3. 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.

  4. 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.

  5. 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.)

  6. 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.

  7. 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...

  8. 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 ...

  9. 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

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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...

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. 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.

  9. 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

  10. 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....

  11. 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...

  12. 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.

  13. 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...

  14. 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.

  15. 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.

  16. 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...

  17. 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

  18. 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

  19. 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...

  20. 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

  1. 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.

  2. 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.

  3. 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 ...

  4. 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 ...

  5. 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

  6. 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.

  7. 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.

  8. 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: ...

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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 ...

  14. 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 ...

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. Relaxation Therapy on Fetal Outcomes in Complicated Pregnancies Suffering Sleep Disorders: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    azar nematollahi

    2016-10-01

    Full Text Available Background: Sleep disorders like snoring, mouth breathing, and insomnia are frequent in pregnancy and studies have shown that poor sleep is linked to obstetric complications. Muscle relaxation technique is an effective method used for improving sleep quality. The purpose of this study was to determine the effect of muscle relaxation technique on fetal outcomes in complicated pregnancies with sleep disorders. Methods: This study was performed as a clinical trial on 160 pregnant women who suffered from preeclampsia and gestational diabetes. The participants filled the Pittsburgh Sleep Quality Index (PSQI in order to measure the quality and patterns of their sleep. The participants with the total score of 5 or more were included in the present study. Intervention group were asked to use muscle relaxation technique twice a week at home for 8 weeks alongside the routine care. Study variables included sleep quality, Apgar scores, birth weight, levels of Interleukin- 6 (IL- 6, as well as umbilical cord PH and PO2. Results: The mean score of PSQI before the intervention was 9.28±4.16 and 9.18±3.06 in the intervention and control groups without a significant difference (P=0.6, respectively. However, PSQI global score of the experimental group was smaller than the control group at the end of the study (P<0.001. Also, birth weight (P=0.04, Apgar score (P=0.01, and umbilical cord blood po2 (P=0.03 and PH (P=0.01 were higher, and IL-6 (P=0.04 was smaller in the experimental group compared to the control group. Conclusion: The results of this study showed that muscle relaxation, as a simple, inexpensive and safe method, can improve the fetal outcomes such as birth weight, Apgar score, cord blood po2, and cord blood PH, and also it leads to lower IL-6 in complicated pregnancies.

  5. 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.

  6. [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.

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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...

  12. 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

  13. 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.

  14. 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.

  15. 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

  16. [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.

  17. 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...

  18. 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

  19. 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.

  20. 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

  1. 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.

  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. [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

  4. 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

  5. Pregnancy in women suffering from familial hypercholesterolemia: a harmful period for both mother and newborn?

    NARCIS (Netherlands)

    Avis, Hans J.; Hutten, Barbara A.; Twickler, Marcel Th B.; Kastelein, John J. P.; van der Post, Joris A. M.; Stalenhoef, Anton F.; Vissers, Maud N.

    2009-01-01

    Purpose of review The present review aims to highlight the consequences for mother and child of profound hypercholesterolemia during pregnancy of women with familial hypercholesterolemia. Recent findings Familial hypercholesterolemia is increasingly diagnosed in younger patients due to the existence

  6. Pregnancy in women suffering from familial hypercholesterolemia: a harmful period for both mother and newborn?

    NARCIS (Netherlands)

    Avis, H.J.; Hutten, B.A.; Twickler, T.B.; Kastelein, J.J.; Post, J.A. van der; Stalenhoef, A.F.H.; Vissers, M.N.

    2009-01-01

    PURPOSE OF REVIEW: The present review aims to highlight the consequences for mother and child of profound hypercholesterolemia during pregnancy of women with familial hypercholesterolemia. RECENT FINDINGS: Familial hypercholesterolemia is increasingly diagnosed in younger patients due to the

  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. 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.

  11. 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:

  12. 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

  13. 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...

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. 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

  6. 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...

  7. 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

  8. 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...

  9. 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 ...

  10. 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.

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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.

  16. A case report on a patient suffering from recurrent vomiting episodes, whose condition improved markedly during pregnancy and breast feeding

    Directory of Open Access Journals (Sweden)

    Ohlsson Bodil

    2006-10-01

    Full Text Available Abstract Background The normal physiology of the gastrointestinal tract has been only cursorily examined. Consequently, the pathophysiology of disturbances of the gastrointestinal functions is poorly known. Recurrent vomiting is one of many functional conditions for which it is difficult to find an explanation and to treat. In the following a case is described of a patient presenting with recurrent vomiting episodes, whose condition improved spontaneously during pregnancy and breast feeding. Case presentation A woman with recurrent vomiting episodes over several years was examined by esophagogastroduodenoscopy. This showed a non-peristaltic ventricle. Treatment with the procinetic drug cisapride (Prepulsid® improved the peristalsis and reduced the symptoms. During pregnancy and breast feeding, she was free of symptoms, in spite of having discontinued her medication with cisapride (Prepulsid®. Conclusion The fact that the patient improved during pregnancy and breast feeding, would seem to indicate the involvement of factors in the physiology of pregnancy and breast feeding that are of importance for gastric motility. This deserves further investigation.

  17. 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.

  18. 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....

  19. Impact of Kinesio Taping application on pregnant women suffering from pregnancy-related pelvic girdle pain - preliminary study.

    Science.gov (United States)

    Kuciel, Natalia; Sutkowska, Edyta; Cienska, Anna; Markowska, Dominika; Wrzosek, Zdzisława

    2017-01-01

    The aim of the study was to assess the impact of pregnancy-related pelvic girdle pain on every day functioning and evaluate how effective Kinesio Taping is in reducing pain for pregnant women. 24 women filled the author's questionnaire, Oswestry Disability Index Questionnaire and Pelvic Girdle Questionnaire before starting the therapy. Elastic tape was applied onto the lumbosacral area for 5 days and was evaluated 1st day of the test immediately before application, day 2, 3, 4, 5, 6 and 10 day of the examination. ODI score was 20.09 and showed major disability resulting from severity of the pain. PGQ score was 19.909. Sig-nificant pain reduction was registered on the 3rd day after tape was applied, significant pain reduction on the day of tape removal, and 5 days after tape removal. Elastic tape decreases pain in pregnancy-related pelvic girdle pain. Pelvic girdle pain deteriorates the quality of life for pregnant women.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. [Anesthetic Management of a Patient Complicated with Marfan Syndrome and Suffering from Stanford Type A Aortic Dissection during Pregnancy].

    Science.gov (United States)

    Uozaki, Nako; Mizuno, Kaori; Shiraishi, Yoshito; Doi, Matsuyuki; Sato, Shigehito

    2015-04-01

    We report a case of a 36-year-old woman at 34 weeks of gestation complicated with Marfan syndrome who underwent Bentall type aortic replacement surgery due to Stanford type A aortic dissection after undergoing caesarean section. Since this patient exhibited severe hypotension before coming to the operating room, it was very difficult to determine whether the cardiac surgery or caesarean section should be performed first. In this case, the caesarean section was performed first, followed by Bentall's surgery. Although intra-aortic balloon pumping and percutaneous cardiopulmonary support were required after weaning from the cardiopulmonary bypass, she was discharged on post-operative day (POD) 40 and the baby was discharged on POD 60, without signs of cerebral palsy. Unfortunately, this patient died on POD 57, due to heart failure. We discuss how to determine the priority of surgeries for patients who require emergency surgery for cardiovascular disease during pregnancy.

  5. 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

  6. 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.

  7. 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.

  8. [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.

  9. 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...

  10. 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.

  11. 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

  12. 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.

  13. 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.

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

    DEFF Research Database (Denmark)

    Pinborg, A; Ortoft, G; Loft, A

    2015-01-01

    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...

  15. 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.

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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.

  1. 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

  2. Gestação gemelar de mola hidatiforme completa com feto vivo Twin pregnancy with complete hydatidiform mole and living fetus

    Directory of Open Access Journals (Sweden)

    Daniela Angerame Yela

    2011-04-01

    Full Text Available A gestação gemelar de uma mola hidatiforme completa coexistindo com um feto vivo é uma entidade rara. Os poucos casos descritos na literatura mostram que, em geral, esse tipo de gestação cursa com risco aumentado de aborto espontâneo, parto prematuro, morte fetal intraútero, sangramento, pré-eclâmpsia e doença trofoblástica persistente. Neste artigo, descreveremos o caso de uma primigesta de 20 anos de idade que apresentou uma gestação gemelar de feto vivo com mola completa, a qual transcorreu sem intercorrências e complicações e cujo diagnóstico diferencial com degeneração da placenta foi feito com anatomopatológico.Twin pregnancy with a complete hydatidiform mole and a living fetus is a rare entity. According to the few cases described in the literature, this kind of gestation commonly has higher risks of miscarriage, preterm delivery, intrauterine fetal death, bleeding, preeclampsia and persistent trophoblastic disease. This study reports the case of a 20 years old primiparous patient with complete hydatidiform mole and living fetus, whose pregnancy was successfully carried to term. The differential diagnosis with placental degeneration was reached through anatomopathological investigation.

  3. 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.

  4. 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; ...

  5. 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 ...

  6. 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

  7. 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

  8. [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.

  9. 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.

  10. 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

  11. 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....

  12. 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.)

  13. 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....

  14. 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.

  15. 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 ...

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. 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....

  1. 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 ...

  2. 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...

  3. [Irregular blood group antibodies during pregnancy: screening is mandatory].

    Science.gov (United States)

    Semmekrot, B A; de Man, A J; Boekkooi, P F; van Dijk, B A

    1999-07-10

    During pregnancy irregular blood group antibodies, originating either from earlier pregnancies or from blood transfusions, may severely jeopardize both mother and child. Three patients are described with pregnancy-associated blood group incompatibility. In one case of Kell antagonism a previous child had reportedly died of cot death, but in retrospect it had most probably suffered from erythroblastosis fetalis as a result of anti Kell antibodies. In the second case, a twin pregnancy, the diagnosis of neonatal haemolytic anaemia on the basis of blood group incompatibility with a very rare antibody (anti-Kpb) had been established in the previous child. No precautions had been taken during this pregnancy, putting both mother and children at risk. All three children recovered, the twins after repeated transfusion of Kpb-free erythrocytes. The described cases emphasize the importance of being informed about the presence of antibodies during pregnancy. Such information can only be obtained by assessing the antibody status during pregnancy. In the Netherlands, the screening of all pregnant women for the presence of irregular antibodies was introduced last year.

  4. 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 ...

  5. 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 ...

  6. 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....

  7. 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...

  8. 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).

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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 ...

  17. 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.

  18. 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 ...

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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 ...

  4. 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

  5. High prevalence of same-sex twins in patients with cloacal exstrophy: Support for embryological association with monozygotic twinning.

    Science.gov (United States)

    Fullerton, Brenna S; Sparks, Eric A; Hall, Amber M; Velazco, Cristine S; Modi, Biren P; Lund, Dennis P; Jaksic, Tom; Hendren, W Hardy

    2017-05-01

    Previous studies have hypothesized that cloacal exstrophy may be caused by errors early in embryological development related to monozygotic twinning. This study reports the prevalence of twins in a large cohort of patients with cloacal exstrophy. Patients with cloacal exstrophy treated 1974-2015 were reviewed for reports of multiple gestation or conjoined twinning. The genetic sex of the patient and their twin, and any mention of anomaly in the twin were recorded. Neither placental exam nor genetic testing results were available to definitively determine zygosity. Of 71 patients, 10 had a live born twin (14%), all of whom were of the same genetic sex as the affected patient. One additional patient's twin suffered intrauterine fetal demise, and another patient had a conjoined heteropagus twin. None of the twins were affected by exstrophy-epispadias complex. The rate of twin birth in this cohort was 4.4-7.7 higher than that reported by the Centers for Disease Control in the general population time period (P<0.001), with a striking preponderance of same-sex pairs. The highly significant prevalence of same-sex twin pairs within this cohort supports the hypothesis that the embryogenesis of cloacal exstrophy may be related to errors in monozygotic twinning. 2b. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. 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...

  7. 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

  8. 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....

  9. Headache Sufferers' Diet

    Science.gov (United States)

    ... Find A Provider Contact Membership Donate 13 Jan Headache Sufferers' Diet Posted at 21:35h in Headache ... No Comments Post A Comment Cancel Reply NATIONAL HEADACHE FOUNDATION Financials Annual Benefit HeadWise Magazine Subscribe to ...

  10. Spiritual pain and suffering.

    Science.gov (United States)

    Brunjes, George B

    2010-01-01

    Spiritual pain/suffering is commonly experienced by persons with life-limiting illness and their families. Physical pain itself can be exacerbated by non-physical causes such as fear, anxiety, grief, unresolved guilt, depression and unmet spiritual meets. Likewise, the inability to manage physical pain well can be due to emotional and spiritual needs. This is why a holistic, interdisciplinary assessment of pain and suffering is required for each patient and family. The mind, body and spirit are understood in relationship to each other and, in those cases, in relationship to a deity or deities are important to understand. Cultural interpretations of pain and suffering may conflict with the goals of palliative care. Understanding the spiritual framework of the patient and family can help to assure that the physical and spiritual suffering of the patient can be eliminated to provide a peaceful death. Spiritual practices may help in the management of physical pain.

  11. 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/.

  12. 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

  13. Gêmeos unidos e autorização judicial para o aborto Conjoined twins and legal authorization for abortion

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2011-04-01

    conjoined twins and without fetal prognosis, legal termination of the pregnancy is an alternative. Moreover, a successful vaginal delivery can be performed in most cases before the third trimester, further reducing maternal risks and parental suffering.

  14. 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'.

  15. Trauma, suffering and resilience

    DEFF Research Database (Denmark)

    de Casas Soberón, Elena; Berliner, Peter

    2011-01-01

    The article discusses the challenge of using a conceptual framework to understand traumatic stress and still be open to listening to the stories of suffering, of lamentation, grief, hope, and values of people being oppressed by organised violence. The complexity of responses to the losses caused ...

  16. 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)

  17. 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.

  18. [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.

  19. 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.

  20. Does God Suffer?

    OpenAIRE

    Sarot, M.

    2001-01-01

    The author argues that Thomas G. Weinandy in his book Does God Suffer? starts from the axiom of divine apathy, rather than that he argues for it. He criticizes the hermeneutic implicit in Weinandy's interpretation of 1 Samuel 15, and proposes an alternative approach. Moreover, he criticizes Weinandy's appeal to agreement among the church fathers (based on a non-representative selection) and his appeal to the doctrine of the Trinity (based on a most speculative, but insuffciently warranted int...

  1. 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.

  2. 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

  3. 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

  4. 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

    Full Text Available Background. Multiple pregnancy is in itself already a risk factor for the course and outcome of the pregnancy and birth. Its frequency in in-vitro fertilisation is approximately twenty fold in comparison to natural conception which is also why it is one of the main problem areas of pregnancy and birth after an IVF-ET procedure. The aim of our research is to determine whether the twins, born after an IVF-ET procedure are any different than twins, born after spontaneous conception.Methods. The research was retrospective in nature. It included 1511 twin pregnancy patients who gave birth to twins between April 1987 and May 1995 and between January 1997 and December 1999. Our research group consisted of 255 mothers and 510 twins, born after an IVF-ET procedure. The research was divided into a cohort and controlled study. In the cohort study the research group was compared to the entire Ljubljana cohort of 1256 mothers and 2512 twins resulting from spontaneous conception. In the controlled study 93 mothers and 186 twins from the research group were compared with 93 mothers and 186 newborns after spontaneous conception. In this group the mothers matched the research group in age, parity and birth year. The course of and complications during the pregnancy, and the course, complications and outcome of the birth as well as the characteristics of the newborns were compared.Results. Certain serious complications during the course of the pregnancy, including hypertension, gestation diabetes and threatened preterm labours, were no more frequent with the IVF group of mothers with twin pregnancy than with the control group. However more bleeding in the first trimester and less proteinuria were determined in comparison to the control group. During the course of birth and its outcome more premature labours were determined (62.3–68.8% vs. 51.4– 50.5%, a 6 to 7 days lower average gestation age, a coresponding birth weight, three times more elective and urgent

  5. [Temporal meaning of suffering].

    Science.gov (United States)

    Porée, J

    2015-09-01

    If we had to find a few simple words to express what a suffering human being experiences, no matter what ills are causing the suffering and no matter what circumstances underlie the ills themselves, we could unmistakably say that it is the experience of not being able to go on like this. Suffering can be described, in this same sense, as an alteration in temporality. However, describing suffering as such only makes sense if we already have a conception of normal temporality. Yet for this, philosophical tradition offers not one but four competing conceptions. In the present article, we begin by briefly presenting these different conceptions. We then show how each one sheds light, by way of contrast, on a phenomenon whose meaning thus appears to be essentially negative. But does this phenomenon have a negative meaning only? Doesn't it correspond as much to a transformation as an alteration of temporality? This is what we will strive to establish in the third part of the article by relating suffering to hope, in a paradoxical sense of the term. Of the four conceptions of time likely to shed a contrasting light on the upheavals that suffering introduces into our life experience, the one described by Aristotle in Physics is historically the first. In particular, the notion of succession originates therein. But this conception does not account for what makes time the unit of a past, a present, and a future. In Book XI of Confessions, St. Augustine situated this unit not in nature but in the human mind. Hence, his definition of time as a distension of the soul and the necessary division into physical time and psychic time it entails. Husserl's Lessons on the phenomenology of the consciousness of internal time lend credit to this division, but they illuminate only the internal constitution of the "present", which is at the heart of the psychological conception of time. In Being and Time, Heidegger breaks away from this long-standing tradition; in his view, physical time

  6. To See the Suffering.

    Science.gov (United States)

    Charon, Rita

    2017-12-01

    The author notes the impressive growth in medical humanities programs, scholarly journals, textbooks, and national and international conferences as well as the convening of two recent national forums or boards addressing the potential of the humanities and the arts to improve medical practice. She also notes that the field of medical humanities seems to have shifted from addressing topics on the margins of medical education to equipping students with the foundational skills required for effective doctoring. This Invited Commentary proposes a number of personal, relational, and interpretive consequences to rigorous training in the humanities or the arts that might lead to improvement in the skills of doctoring. Where else but in hospitals with very ill patients and very young doctors who care for them are such skills needed the most? The author suggests that to see the suffering might be what the humanities in medicine are for, and that those who become capable of seeing the suffering around them in medical practice both experience the cost of countenancing the full burden of illness and death and, simultaneously, comprehend with clarity the worth of this thing, this life.

  7. 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

  8. 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.

  9. 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.

  10. 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.)

  11. 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.)

  12. 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

  13. [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.

  14. 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 ...

  15. 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

  16. 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.

  17. 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...

  18. 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.

  19. 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....

  20. 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.

  1. 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).

  2. 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...

  3. 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...

  4. 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...

  5. The Moral Economy of Suffering

    DEFF Research Database (Denmark)

    Danneskiold-Samsøe, Sofie

    2006-01-01

    . In contrast to approaches, which relate to the suffering of individual refugees, this study approaches suffering as a relational and social matter. Among other things this involves examining the quest of Iraqis for recognition of suffering as a social value that enters social exchange. When Iraqi refugges...

  6. 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...

  7. 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.

  8. 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.

  9. Suffering from Alopecia Areata

    Directory of Open Access Journals (Sweden)

    mitra Safa

    2008-02-01

    Full Text Available Safa M1, Jebraili2, Momen-nasab M3 1. Assistant Professor, Department of Psychiatry, School of Medicine, Lorestan University of Medical Sciences 2. Assistant Professor, Department of Dermatology, Faculty of Medicine, Lorestan University of Medical Sciences 3. Instructor, Department of Nursing, Lorestan University of Medical Sciences Abstract Background: Some of the skin diseases cause severe stress in patients and relieving these stresses greatly helps to treat the underlying disease. Alopecia areata is one of the common causes of alopecia which is an autoimmune disease. Other factors like genetics and psychological factors have important roles in the beginning or exacerbation of the disease. This study aimed to determine the frequency of depression and anxiety disorders in patient suffering from alopecia areata. Materials and methods: In this descriptive study, 80 patients with alopecia areata who had referred to dermatologic clinic of Shohaday-e Ashayer hospital in Khorramabad from 1382 to 1383(Hj. were evaluated. After filling the questionnaires, the patients were referred to the Psychiatric Clinic and the cases were diagnosed by interviews using SCL-90 test and DSM-IV-IIIR scale. The analysis of data was done by the SPSS software. Results: 80 patients were selected as the subjects of the study. including 52 men (65% and 28 women (35%. 43 patients (53.8% were less than 25 years old and 54 (67.5% were unmarried. 56 patients (70% had a family history of alopecia areata and 45 (56.25% had no history of drug intake. In most of the patients (63.8% the site of the first lesion was the scalp. Out of 80 patients, 64 (80% had anxiety and 60 (75% had depression. 27 (33.3% had major depressive disorders. These findings were statistically significant. Major depressive disorders were more in women. No correlation was found between education, marital status, family history, and the history of drug intake, and the site of first lesion. Conclusion: The

  10. 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...

  11. 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.

  12. 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.

  13. [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.

  14. Monozygotic twins are discordant for chronic periodontitis: clinical and bacteriological findings

    NARCIS (Netherlands)

    Torres de Heens, G.L.; Loos, B.G.; van der Velden, U.

    2010-01-01

    Objectives: The aim of this study was to assess, in monozygotic (MZ) and dizygotic (DZ) twin pairs in whom the proband of the twin pair was suffering from moderate to severe chronic periodontitis, the contribution of genetics, periodontal pathogens and lifestyle factors towards the clinical

  15. 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.

  16. 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.

  17. 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 ...

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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♀♀.

  6. 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

  7. 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

  8. 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

  9. 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.

  10. 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.

  11. 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

  12. The Paradox of Modern Suffering

    DEFF Research Database (Denmark)

    Dræby, Anders

    . According to Buddhism, existence is suffering, and each persons desire to reach a state of nothingness (Nirvana) causes them to return over and over through reincarnation, in order to work out their karma. In Christianity suffering is inseparable from man's earthly existence, and it must serve to overcome...

  13. 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.

  14. 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...

  15. 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.

  16. Suffering: toward a contextual praxis.

    Science.gov (United States)

    Georges, Jane M

    2002-09-01

    Janice M. Morse's article in Advances in Nursing Science (24:1) revised and summarized the major findings of a research program exploring the behavioral-experiential nature of suffering. Using a feminist critical theory stance, this article addresses Morse's conceptualization of a praxis of suffering. First, it identifies the strengths and contributions of Morse's body of research to nursing science. Next, it undertakes a critique situated in feminist critical theory in which the limitations of Morse's work are explored using exemplars from the Western literary tradition. Finally, the article proposes a new conceptualization of an alternative contextual praxis of suffering in which nurses' responses to suffering are situated in an emancipatory paradigm of authentic presence.

  17. 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...

  18. Renal function in neonates with twin-twin transfusion syndrome treated with or without fetoscopic laser surgery.

    Science.gov (United States)

    Verbeek, Lianne; Joemmanbaks, Faiez A; Quak, Jacoba M E; Sukhai, Ram N; Middeldorp, Johanna M; Oepkes, Dick; Lopriore, Enrico

    2017-09-01

    The aim of this study is to investigate the short-term renal function in neonates with twin-twin transfusion syndrome (TTTS), treated with fetoscopic laser surgery (laser group) or conservatively (non-laser group). Creatinine and urea levels and urine output were recorded in the first week after birth. Primary outcome was short-term renal dysfunction, defined as a creatinine level of >100 μmol/L during the first week postpartum. We evaluated 312 twins (laser group, n = 274; non-laser group, n = 38). Median creatinine and urea levels were lower in the laser group than in the non-laser group (71 versus 82 μmol/L, p = 0.002). Short-term renal dysfunction was lower in the laser group compared to the non-laser group (7.2 versus 34.4%, p < 0.001). Within the laser group, creatinine levels were significantly higher in the subgroup with incomplete laser surgery compared to twins with successful laser surgery (76 versus 69 μmol/L, p = 0.018). No differences were found between donors and recipients except for a higher incidence of oliguria in donors in the non-laser group on day 1. Short-term renal dysfunction occurs less frequently in TTTS twins treated with fetoscopic laser coagulation, particularly after complete surgery, suggesting that laser surgery may have a protective effect on renal function. What is Known: • Antenatally, donor twins in TTTS have severe oliguria due to chronic hypovolemia and impaired renal perfusion • Postnatally, donor twins may suffer from severe renal complications, particularly in TTTS twins treated conservatively. What is New: • The incidence of short-term renal failure in TTTS twins treated with complete laser surgery is low. • After incomplete laser surgery, the incidence of short-term renal dysfunction is increased.

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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...

  5. 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.

  6. 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

  7. 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...

  8. 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 ...

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. [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.

  14. 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)

  15. 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.

  16. Benefits of Suffering: Communicator Suffering. Benefiting, and Influence.

    Science.gov (United States)

    1980-07-01

    period of greatest influence. Jesus , for example, had only a handful of followers until after his death. It was subsequent to the crucifixion that the...sacrifice and suffering of religious leaders such as Jesus , Moses or Joseph Smith is, of course, well known, and similar ex- periences among certain...political and/or ideological reasons which the communicator in the current study, and historical leaders such as Jesus , Mao, Hitler, etc., had for

  17. 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

  18. A Comparison of Personality, Life Events, Comorbidity, and Health in Monozygotic Twins Discordant for Anorexia Nervosa.

    Science.gov (United States)

    Thornton, Laura M; Trace, Sara E; Brownley, Kimberly A; Ålgars, Monica; Mazzeo, Suzanne E; Bergin, Jocilyn E; Maxwell, Millie; Lichtenstein, Paul; Pedersen, Nancy L; Bulik, Cynthia M

    2017-08-01

    Genetic and environmental factors contribute to the etiology of anorexia nervosa (AN). The co-twin control design is one of the most powerful methods available to evaluate environmental factors that could contribute to differences between monozygotic (MZ) twins who are discordant for AN. Using available data from a unique and rare sample of 22 Swedish female MZ pairs discordant for AN, we compared personality, life events, comorbidity, and health factors. Twins with AN had significantly higher perfectionism scores than unaffected co-twins and reported younger ages at first diet than unaffected co-twins who had dieted. Consistent with previous literature, more twins with AN reported gastrointestinal problems than unaffected co-twins. Although not significant due to low statistical power, more unaffected co-twins reported experiencing emotional neglect than twins with AN. Early dieting may be a harbinger of the development of AN or an early symptom. Higher perfectionism may represent a risk factor, sequela, or both. Sibling perception of neglect is noteworthy given the impact of an ill child with AN on family function and wellbeing. The health and wellbeing of siblings should be addressed clinically when one child in the family suffers from AN.

  19. 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.”[...

  20. Pregnancy outcome in women with polycystic ovary syndrome comparing the effects of laparoscopic ovarian drilling and clomiphene citrate stimulation in women pre-treated with metformin: a retrospective study.

    Science.gov (United States)

    Ott, Johannes; Kurz, Christine; Nouri, Kazem; Wirth, Stefan; Vytiska-Binstorfer, Elisabeth; Huber, Johannes C; Mayerhofer, Klaus

    2010-05-13

    Ovarian stimulation in women with polycystic ovary syndrome (PCOS) increases the risk for perinatal complications. Ovulation induction by laparoscopic ovarian drilling (LOD) might improve the overall pregnancy outcomes. The aim of our study was to assess the adverse events or effects on pregnancy of LOD and clomiphene citrate (CC) stimulation in patients who received metformin. Academic research institution. We retrospectively analyzed the courses of 40 spontaneous pregnancies after LOD for CC-resistance, 40 pregnancies after CC stimulation, and 40 pregnancies after metformin treatment alone. Patients in the LOD and the CC groups had been pre-treated with Metformin. Primary outcome parameters were: the rate of multiple pregnancies; the rate of early pregnancy losses/miscarriages; the development of gestational diabetes, pregnancy-induced hypertension, and preeclampsia/HELLP-syndrome; premature delivery; and birth weight. The rate of twin pregnancies did not differ between the CC group (12.5%), the LOD group (7.5%), and the metformin only group (2.5%, p=0.239). Seventeen women suffered an early miscarriage. There were no differences with regard to the rates of gestational diabetes, pregnancy-induced hypertension, preeclampsia, and preterm delivery. By analyzing all pregnancy complications together, the overall pregnancy complication rate was highest in the CC group (70.0%, 28/40), followed by the LOD group (45.0%, 18/40), and the metformin only group (47.5%, 19/40; p=0.047). CC, but not LOD, increases the complication rate in pregnant patients who received metformin.

  1. Pregnancy outcome in women with polycystic ovary syndrome comparing the effects of laparoscopic ovarian drilling and clomiphene citrate stimulation in women pre-treated with metformin: a retrospective study

    Directory of Open Access Journals (Sweden)

    Vytiska-Binstorfer Elisabeth

    2010-05-01

    Full Text Available Abstract Background Ovarian stimulation in women with polycystic ovary syndrome (PCOS increases the risk for perinatal complications. Ovulation induction by laparoscopic ovarian drilling (LOD might improve the overall pregnancy outcomes. The aim of our study was to assess the adverse events or effects on pregnancy of LOD and clomiphene citrate (CC stimulation in patients who received metformin. Methods Setting: Academic research institution. We retrospectively analyzed the courses of 40 spontaneous pregnancies after LOD for CC-resistance, 40 pregnancies after CC stimulation, and 40 pregnancies after metformin treatment alone. Patients in the LOD and the CC groups had been pre-treated with Metformin. Primary outcome parameters were: the rate of multiple pregnancies; the rate of early pregnancy losses/miscarriages; the development of gestational diabetes, pregnancy-induced hypertension, and preeclampsia/HELLP-syndrome; premature delivery; and birth weight. Results The rate of twin pregnancies did not differ between the CC group (12.5%, the LOD group (7.5%, and the metformin only group (2.5%, p = 0.239. Seventeen women suffered an early miscarriage. There were no differences with regard to the rates of gestational diabetes, pregnancy-induced hypertension, preeclampsia, and preterm delivery. By analyzing all pregnancy complications together, the overall pregnancy complication rate was highest in the CC group (70.0%, 28/40, followed by the LOD group (45.0%, 18/40, and the metformin only group (47.5%, 19/40; p = 0.047. Conclusions CC, but not LOD, increases the complication rate in pregnant patients who received metformin.

  2. 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.

  3. Deep brain stimulation during pregnancy and delivery: experience from a series of DBS babies

    Directory of Open Access Journals (Sweden)

    Emma eSCELZO

    2015-09-01

    Full Text Available Introduction: Deep brain stimulation (DBS is widely used to improve quality of life in movement disorders and psychiatric diseases. Even though the ability to have children has a big impact on patients’ life, only a few studies describe the role of DBS in pregnancy. Objective: To describe risks and management of women treated by DBS for disabling movement disorders (MD or psychiatric diseases during pregnancy and delivery. Methods: We report a retrospective case series of women, followed in two DBS centers, who became pregnant and went on to give birth to a child while suffering from disabling MD or psychiatric diseases (Parkinson’s disease (PD, dystonia, Tourette’s syndrome (TS, Obsessive Compulsive Disorder (OCD treated by DBS. Clinical status, complications and management before, during and after pregnancy are reported. Two illustrative cases are described in greater detail.Results: DBS improved motor and behavioural disorders in all patients and allowed reduction in, or even total interruption of disease-specific medication during pregnancy. With the exception of the spontaneous early abortion of one fetus in a twin pregnancy, all pregnancies were uneventful in terms of obstetric and pediatric management. DBS parameters were adjusted in five patients in order to limit clinical worsening during pregnancy. Implanted material limited breast-feeding in one patient because of local pain at submammal stimulator site and led to local discomfort related to stretching of the cable with increasing belly size in another patient whose stimulator was implanted in the abdominal wall. Conclusions: Not only is it safe for young women with MD, TS and OCD who have a DBS-System implanted to become pregnant and give birth to a baby but DBS seems to be the key to becoming pregnant, having children, and thus greatly improves quality of life.

  4. 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.

  5. 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.)

  6. 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.

  7. Comparison of subjective and objective measures of insomnia in monozygotic twins discordant for chronic fatigue syndrome.

    Science.gov (United States)

    Watson, Nathaniel F; Kapur, Vishesh; Arguelles, Lester M; Goldberg, Jack; Schmidt, Douglas F; Armitage, Roseanne; Buchwald, Dedra

    2003-05-01

    To examine the objective and subjective measures of insomnia in chronic fatigue syndrome (CFS). Monozygotic co-twin control study. Academic medical center. Twenty-two pairs of monozygotic twins where 1 member of the pair had CFS and the other did not. N/A. Twenty-two CFS-discordant twin pairs completed a Sleep Disorders Questionnaire, overnight polysomnography, and a postpolysomnography sleep survey. Mean and percent differences in the sleep measures were compared between the CFS and healthy twins using matched-pair methods of analysis. Compared with their healthy co-twins, the CFS twins more frequently endorsed 8 subjective measures of insomnia and poor sleep (all p insomnia, including sleep latency, total sleep time, sleep efficiency, arousal number, arousal index, hypnogram awakenings, rapid eye movement (REM)-sleep latency, and percent stages 1, 2, and 3-4 (delta). Percent stage REM sleep was increased in the CFS twins compared with the healthy twins (27.7% vs. 24.4%, p < or = 0.05). On the postpolysomnography survey, CFS twins reported that they had slept fewer hours (6.2 vs. 6.7; p < or = 0.05), and were less well rested (p < or = 0.001) compared to their co-twins. CFS patients had worse subjective sleep than their co-twins despite little objective data supporting this discrepancy, suggesting they suffer from an element of sleep-state misperception. The higher percentage of REM sleep in the CFS twins implies that REM sleep may play a role in this illness.

  8. 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.

  9. 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

  10. Onset of Systemic Lupus Erythematosus During Pregnancy

    Directory of Open Access Journals (Sweden)

    Ming-Jie Yang

    2006-03-01

    Full Text Available When systemic lupus erythematosus (SLE is first suspected during pregnancy, though rare, the diagnostic criteria are not different from those for nonpregnant women. The pregnancy outcome is good if treatment with adequate immunosuppressive agents starts as soon as the diagnosis is made. There are 4 cases in this report who had SLE onset during pregnancy. Although 2 of them suffered from preeclampsia, all 4 pregnancies resulted in favorable outcomes after the lupus was controlled by medical treatment.

  11. Motion sickness in migraine sufferers.

    Science.gov (United States)

    Marcus, Dawn A; Furman, Joseph M; Balaban, Carey D

    2005-12-01

    Motion sickness commonly occurs after exposure to actual motion, such as car or amusement park rides, or virtual motion, such as panoramic movies. Motion sickness symptoms may be disabling, significantly limiting business, travel and leisure activities. Motion sickness occurs in approximately 50% of migraine sufferers. Understanding motion sickness in migraine patients may improve understanding of the physiology of both conditions. Recent literature suggests important relationships between the trigeminal system and vestibular nuclei that may have implications for both motion sickness and migraine. Studies demonstrating an important relationship between serotonin receptors and motion sickness susceptibility in both rodents and humans suggest possible new motion sickness prevention therapies.

  12. 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

  13. 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.

  14. 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 ...

  15. 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 ...

  16. 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.

  17. Psychological functioning in headache sufferers.

    Science.gov (United States)

    Andrasik, F; Blanchard, E B; Arena, J G; Teders, S J; Teevan, R C; Rodichok, L D

    1982-05-01

    The present study examined the psychological test responses of 99 headache sufferers and 30 matched nonheadache controls. Headache subjects were of four types: migraine (n = 26), muscle contraction (n = 39), combined migraine-muscle contract ion (n = 22), and cluster (n = 12). Measures consisted of the Minnesota Multiphasic Personality Inventory, a modified hostility scale derived from the MMPI, Back Depression Inventory, State-Trait Anxiety Inventory, Autonomic Perception Questionnaire, Rathus Assertiveness Schedule, Social Readjustment Rating Scale, Psychosomatic Symptom Checklist, Schalling-Sifneos Scale, Need for Achievement, and Hostile Press. Significant differences were found on five clinical scales of the MMPI--1, 2, 3, 6, and 7. Of the non-MMPI scales, only the Psychosomatic Symptom Checklist and Trait Anxiety Inventory were significant. Control subjects revealed no significant findings on any tests. The headache groups fell along a continuum, beginning with cluster subjects, who showed only minimal distress, continuing through migraine and combined migraine-muscle contraction, and ending with muscle contraction subjects, who revealed the greatest degree of psychological disturbance. However, none of the headache groups could be characterized by marked elevations on any of the psychological tests, which contrasts with past research findings. It is suggested that the present results may be more representative of the "typical" headache sufferer.

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. 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 ...

  3. 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

  4. 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.

  5. Coping styles of headache sufferers.

    Science.gov (United States)

    Siniatchkin, M; Riabus, M; Hasenbring, M

    1999-04-01

    Psychological factors are important in the chronification and aggravation of headaches. We studied 90 patients suffering from migraine, chronic daily headache (CDH) evolved from migraine, and episodic or chronic tension-type headache (TTH). Emotional, cognitive, and behavioral pain coping were assessed using the Kiel Pain Inventory (KPI), Beck's Depression Inventory, the State-Trait-Anxiety Inventory, and Quality of Life Questionnaire. In addition, the clinical course of headache was analyzed using a validated headache diary. The results were as follows. Firstly, the KPI is reliable internally for the assessment of pain-coping strategy employment among headache patients. Secondly, migraine sufferers were characterized by pronounced psychological abnormalities during the headache phase, demonstrating a less adaptive coping behavior. This was in contrast to the TTH patients, who showed more general distress manifesting in elevated anxiety and lower quality of life. The only factor which appeared to be essential for differentiating between migraine and TTH was the intensity of headache. Thirdly, chronic TTH and CDH evolved from migraine demonstrated more pronounced psychological disabilities and more severe clinical courses of headaches than episodic TTH or nontransformed migraine. The predictor variable for transformation of migraine was impairment of well-being/quality of life, and for transformation of TTH, the frequency of headaches and depression. Finally, analgesic misuse seems to be less important for chronification and transformation of headaches than the degree of psychological disability. This study draws attention to the role of psychological factors in the chronification of TTH and transformation of migraine and provides some recommendations for the behavioral treatment of chronic headaches.

  6. 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...

  7. 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...

  8. 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.

  9. 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.

  10. [Acne and rosacea in pregnancy].

    Science.gov (United States)

    Bechstein, S K; Ochsendorf, F

    2017-02-01

    Acne and rosacea are common chronic inflammatory skin diseases. During pregnancy these skin disorders may become aggravated, in rare cases occurring for the first time. There are no data available for rosacea and little data for acne concerning the course of these skin disorders during pregnancy. Up to 42% of the pregnant women suffer from acne. In 90% of these women the disease existed before pregnancy. In 1/3, however, acne relapsed during pregnancy after a prior disease-free period. In 60% acne deteriorated during pregnancy. Randomized controlled trials for the treatment of acne or rosacea during pregnancy do not exist. In this article the recommendations of current guidelines are modified, so that effective treatments can be recommended without harming the embryo or fetus.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. 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...

  17. 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.

  18. 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

  19. 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…

  20. 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.

  1. 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.

  2. 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

  3. Suffering in people with rheumatoid arthritis.

    Science.gov (United States)

    Dildy, S P

    1996-11-01

    Knowledge of the nature, meaning, and impact of suffering from the perspective of people with rheumatoid arthritis is needed to determine what nursing interventions are most helpful in reducing suffering. Grounded theory was used to identify the nature of suffering in 14 people with rheumatoid arthritis. Suffering was found to be a process directed toward regaining normalcy and consisted of three phases: disintegration of self; the shattered self; and reconstruction of self. Experiencing suffering resulted in struggling, lose of dreams, restructuring a future orientation, and withdrawing. Finding meaning through positive life changes was an outcome of suffering. The informants' differentiation between pain and suffering also was examined. The provision of comfort measures along with a caring and empathetic attitude were identified as helpful nursing interventions in reducing suffering.

  4. 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.

  5. 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...

  6. 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.

  7. 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.

  8. 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.

  9. 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...

  10. 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

  11. 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

  12. Fetal programming by co-twin rivalry in sheep.

    Science.gov (United States)

    Casellas, J; Caja, G

    2014-01-01

    Fetal rivalry for space and nutrients compromises intrauterine environment and fetal growth, this leading to further consequences during adult life (i.e., fetal programming). Focusing on sheep, relevant fetal programming effects have been revealed on body composition and growth although little is known about their potential impact on the reproductive performance of adult ewes. This research focused on the analysis of fetal programming-related effects on 41,475 litter size (LS) records from 7,177 purebred Ripollesa ewes. Fetal programming sources of variation accounted for the linear and quadratic effect of absolute birth BW (ABBW), relative birth BW (RBBW) of twin-born ewes (i.e., both magnitude and direction of the birth BW difference between the ewe and its co-twin), and sex of twin ewe's littermate (SLM). More specifically, data were analyzed under a threshold mixed model and the statistical relevance of models accounting for different combinations of ABBW, RBBW, and SLM effects was compared by Bayes factors (BF; i.e., the ratio between the posterior probability of 2 competing models). The model accounting for RBBW and discarding both ABBW and SLM effects was clearly preferred; its posterior probability was 35.2 to 362.3 times higher than from remaining models and provided very strong (31.6 100) supporting the relevance of RBBW and the negligibility of both ABBW and SLM. Single-born ewes were included as reference group and they reached a predicted LS of 1.189 lambs per lambing. Twin-born ewes being >600 g lighter than their co-twins suffered from an impaired reproductive ability with 1.162 lambs per lambing (95% credible interval [95CI], 1.147 to 1.179), and this estimate increased until ewes were 151 to 300 g lighter than their co-twins (1.226 lambs per lambing; 95CI, 1.208 to 1.244). Remaining categories (i.e., ewes being heavier or equal than their co-twins) did not provide significant differences and showed an enhanced reproductive ability of approximately

  13. 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

  14. Anxiety during pregnancy among Sudanese pregnant women ...

    African Journals Online (AJOL)

    Many women suffer psychological symptoms during pregnancy but few studies have examined anxiety among pregnant ladies in relation to the level of education, previous bad obstetrical history and female circumcision. Aims: To determine frequency of anxiety among Sudanese women as related to pregnancy and ...

  15. 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.

  16. 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.

  17. 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.

  18. 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....

  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. Misdiagnosis of an interstitial ectopic pregnancy after unilateral salpingectomy.

    Science.gov (United States)

    Yim, S; Fung, H Y; To, K

    1996-02-01

    A 36-year-old primigravida presented to us with symptoms and signs of ectopic pregnancy repeatedly but was misdiagnosed to have an intrauterine pregnancy based on 1 early ultrasound examination showing an 'intrauterine sac'. She suffered the morbidity due to ectopic pregnancy which included hysterectomy which may have been prevented had the correct diagnosis been made.

  2. Teenage pregnancy in Jos, North-Central Nigeria | Mutihir ...

    African Journals Online (AJOL)

    Background: Teenage pregnancy is an obstetric risk factor. They are more likely to suffer from complications of pregnancy, labour and delivery with increased morbidity and mortality in both infants and mothers. Objective: To determine the prevalence of teenage births, demographic characteristics and pregnancy outcome in ...

  3. Between Two Worlds: Twin Peaks and the Film/Television Divide

    Directory of Open Access Journals (Sweden)

    Siobhan Lyons

    2017-04-01

    Full Text Available In 1992, the year David Lynch’s cult television series 'Twin Peaks' was pulled off air, Lynch released the film 'Twin Peaks: Fire Walk with Me', a prequel to the television series which filled in some of the gaps left from the series finale cliff-hanger. The film was received with unanimously negative reviews from critics and fans alike, condemning both its subtle and obvious deviations from the series and its inclusion of the character Laura Palmer, whose absence was a crucial narrative device at the centre of 'Twin Peaks'. In film form, the 'Twin Peaks' narrative suffers from thematic inconsistencies and aesthetic deviations. The scope of 'Twin Peaks' seems much more capable in the setting of television and its gradual, episodic set-up. In recent years, however, with the announcement of a revival of the series, retrospective analysis of 'Fire Walk with Me' has become more positive, and the film has also become an integral part of the overall 'Twin Peaks' canon. Nevertheless, the transition from television to film in the case of 'Twin Peaks' has remained a point of fan and scholarly controversy, with issues of continuity, narrative and aesthetics between the two different mediums continually being addressed and compared. In light of the news that the new season of 'Twin Peaks' is set to be released in 2017, this article examines the significance of 'Fire Walk with Me' as a cinematic counterpart and prequel to the original series, and how this has helped shape – whether positively or not – the overall narrative of 'Twin Peaks'.

  4. 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.

  5. 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 ...

  6. 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 ...

  7. 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 ...

  8. 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. ...

  9. Nietzsche and the dilemma of suffering.

    Science.gov (United States)

    Johnston, J S; Johnston, C

    1999-01-01

    In this paper, we attempt to view a long-held assumption in nursing as mistaken. That is, that patient suffering is something to be overcome. Utilizing Nietzsche's statements on Amor Fati, we carefully examine the cultural assumptions behind our denigration of suffering, look at specific nursing examples of this situation, and attempt the beginnings of a discourse on what it would take for nurses to overcome their own predetermined views of suffering in order to better help their patients "own" their own suffering.

  10. 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.

  11. 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

  12. 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...

  13. 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)

  14. 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

  15. 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.

  16. 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

  17. [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

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

    Science.gov (United States)

    Segal, Nancy L

    2015-12-01

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

  1. Fatique life and twinning in alphazirconium

    DEFF Research Database (Denmark)

    Warren, M.R.; Beevers, C.J.

    1970-01-01

    −21}, and {11•22} twins and {1O−10} slip. In grains completely enclosed by surrounding material fatigue damage has been found in association with 11•21 twins and very occasionally with {11−22} twins but not with 10•12 twins. A further quantitative interpretation has shown that there is a critical resolved shear...... direction. Formerly with the Department of Physical Metallurgy and Science of Materials, The University, Birmingham, England...

  2. Medical expertise, existential suffering and ending life.

    Science.gov (United States)

    Varelius, Jukka

    2014-02-01

    In this article, I assess the position that voluntary euthanasia (VE) and physician-assisted suicide (PAS) ought not to be accepted in the cases of persons who suffer existentially but who have no medical condition, because existential questions do not fall within the domain of physicians' professional expertise. I maintain that VE and PAS based on suffering arising from medical conditions involves existential issues relevantly similar to those confronted in connection with existential suffering. On that basis I conclude that if VE and PAS based on suffering arising from medical conditions is taken to fall within the domain of medical expertise, it is not consistent to use the view that physicians' professional expertise does not extend to existential questions as a reason for denying requests for VE and PAS from persons who suffer existentially but have no medical condition.

  3. 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.

  4. Twins or two single children

    OpenAIRE

    Rainer Walke

    2002-01-01

    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. ...

  5. Concordance for multiple sclerosis in Danish twins

    DEFF Research Database (Denmark)

    Hansen, T; Skytthe, Axel; Stenager, Egon

    2005-01-01

    The occurrence of multiple sclerosis (MS) in twins has not previously been studied in complete nationwide data sets. The existence of almost complete MS and twin registries in Denmark ensures that essentially unbiased samples of MS cases among twins can be obtained. In this population-based study...

  6. Protease inhibitor (Pi) locus, fertility and twinning

    NARCIS (Netherlands)

    Boomsma, D.I.; Frants, R.R.; Bank, R.A.; Martin, N.G.

    1992-01-01

    In a sample of 160 Dutch twin pairs and their parents, we found that mothers of dizygotic twins had frequencies of the S and Z alleles at the protease inhibitor (Pi) locus that were 3 times higher than a control sample. Mothers of identical twins also had a higher frequency of S than controls. The S

  7. A study of malocclusion in identical twins

    Directory of Open Access Journals (Sweden)

    E. Akhavan Niaki

    1998-04-01

    Full Text Available   Monozygotic twins are genetically identical individuals who can also be mirror image twins and the Differences between them result from environmental factors. current study, monozygotic twins were analyzed in different dentitions of primary, mixed and permanent. As a conclusion, although genetic factors are naturally potent, environmental factors’ role can be increased and weaken the genetic factors.

  8. Epigenetic Epidemiology of Complex Diseases Using Twins

    DEFF Research Database (Denmark)

    Tan, Qihua

    2013-01-01

    through multiple epigenetic mechanisms. This paper reviews the new developments in using twins to study disease-related epigenetic alterations, links them to lifetime environmental exposure with a focus on the discordant twin design and proposes novel data-analytical approaches with the aim of promoting...... a more efficient use of twins in epigenetic studies of complex human diseases....

  9. Birth order of twins and risk of perinatal death related to delivery in England, Northern Ireland, and Wales, 1994-2003: retrospective cohort study.

    Science.gov (United States)

    Smith, Gordon C S; Fleming, Kate M; White, Ian R

    2007-03-17

    To determine the effect of birth order on the risk of perinatal death in twin pregnancies. Retrospective cohort study. England, Northern Ireland, and Wales, 1994-2003. 1377 twin pregnancies with one intrapartum stillbirth or neonatal death from causes other than congenital abnormality and one surviving infant. The risk of perinatal death in the first and second twin estimated with conditional logistic regression. There was no association between birth order and the risk of death overall (odds ratio 1.0, 95% confidence interval 0.9 to 1.1). However, there was a highly significant interaction with gestational age (Pbirth order and the risk of death among infants born before 36 weeks' gestation but there was an increased risk of death among second twins born at term (2.3, 1.7 to 3.2, Pbirths, there was a trend (P=0.1) towards a greater risk of the second twin dying from anoxia among those delivered vaginally (4.1, 1.8 to 9.5) compared with those delivered by caesarean section (1.8, 0.9 to 3.6). In this cohort, compared with first twins, second twins born at term were at increased risk of perinatal death related to delivery. Vaginally delivered second twins had a fourfold risk of death caused by intrapartum anoxia.

  10. Sports pairs: insights on athletic talent; research reviews: twins with leukemia; parents and twins.

    Science.gov (United States)

    Segal, Nancy L

    2007-06-01

    Twin research exploring genetic and environmental influences on athletic interests and talents is reviewed. Illustrative examples of twin athletes representing a variety of sports activities are presented. This is followed by an overview of twin studies offering critical insights into the onset and progress of leukemia. In the last section, timely events involving twins and parents of twins will be described--each case provides a new look at an old question.

  11. Prenatal x-ray and childhood cancer in twins

    International Nuclear Information System (INIS)

    Harvey, E.B.

    1983-01-01

    In order to evaluate the causal nature of the relationship between prenatal x-ray exposure and childhood cancer, a case control study was conducted in a population of over 32,000 twins born in the state of Connecticut from 1930-1969 and followed to age 15. Thirty-two incident cancer cases were identified by linking the Connecticut Twin and Tumor registries. Each case was matched with four controls on year of birth, sex, race, and survival. Prenatal x-ray information as well as reproductive, delivery and birth data were obtained from the hospital of birth, the physician providing prenatal care, private radiology groups and interviews with hospital staff. The case control study which obtained exposure information on selected subjects found an increased risk of childhood cancer from prenatal x-ray exposure. The risk associated with radiation exposure was elevated in the following subcategories: mother with history of pregnancy loss, a gravity greater than 1, under 30 years of age, and twins weighing five pounds or more at birth. The results, though based on small numbers, strengthen the association between prenatal x-ray exposure and childhood cancer

  12. Determination of hCG-alpha subunit in threatened pregnancy

    International Nuclear Information System (INIS)

    Talas, M.; Pohanka, J.; Fingerova, H.; Janouskova, M.; Krikal, Z.; Prasilova, J.; Zupkova, H.

    1987-01-01

    Radioimmunoassay of the hCG-alpha subunit was made using an antibody anti hCG-alpha serum, highly purified hCG-alpha for 125 I-labelling and the standard hCG-alpha. Sera of healthy pregnant women sampled throughout the whole pregnancies were used to determine x-bar±S.D. of hCG-alpha for 14-day intervals. Included in the study were groups of women with high risk of premature labor, late toxemia of pregnancy, twins and fetal hypotrophy. It was shown that increased hCG-alpha is found in pregnant women in whom signs of late toxemia of pregnancy are combined with high risk of premature labor, or with twin pregnancies, while in those with fetal hypotrophy hCG-alpha is within normal limits. (author). 3 figs., 7 refs

  13. Four twins for a paradox: on "sensitive" twins and the biological counterpart of the "twin paradox".

    Science.gov (United States)

    Ascioti, Fortunato A

    2009-03-01

    Monozygotic twin (MZT) epigenetic development, i.e., aging, diverges largely in time despite the initially very small genetic differences between MZTs. This fact is interpreted as a "sensitivity to initial conditions" phenomenon, a common property of either deterministic or stochastic chaotic systems. Some of the biotheoretical implications stemming from this empirical observation are briefly discussed here, while an actual measure of MZT epigenetic time divergence is given through an estimate of the (Stochastic) Lyapunov exponents (LEs) (i.e., the rate of exponential time divergence). These results suggest a reconsideration of the Langevin-Einstein thought experiment known as the "twin paradox." At least four twins are necessary in order to take into account the inertially independent divergent aging described here. Alternatively, LE estimates, like those given here, should be used. Finally suggested in the actual special-relativity experiments is the replacement of clocks with some nonlinear (chaotic) forced oscillator.

  14. Similarity of social security numbers among twins: data from the Virginia Twin Registry.

    Science.gov (United States)

    Page, W F; Corey, L

    1998-09-01

    At least two twin registries in the United States have been or are being assembled using the similarity of Social Security Numbers in computerized records to help identify possible twin pairs. While the success of such enterprises depends directly on a high probability of twinness given Social Security Numbers, there are theoretical and practical reasons to study the probability of Social Security Number similarity given twinness. For example, the number of twin pairs with similar Social Security Numbers obviously determines the maximum number of twin pairs that can be discovered by similarity algorithms. To study this issue, we examined the similarity of known Social Security Numbers in twin pairs from the Virginia Twin Registry by age, sex, race, and zygosity of the pair. We found that similarity between the Social Security Numbers of twin pairs varies markedly by age, and MZ twin pairs have significantly more similar Social Security Numbers than DZ pairs at all ages. Among older twins, there are also significant differences by sex and race. For younger twins, algorithms that identify putative twin pairs on the basis of the similarity of their Social Security Numbers hold the promise of being able to identify a large proportion of all true twin pairs. Such algorithms will be substantially less successful, however, in identifying a large proportion of older twin pairs.

  15. Growth discordance of monoamniotic twin because of difference of cords diameter in forked umbilical cord: Case report.

    Science.gov (United States)

    Guo, Yongbing; Sun, Yu; Yang, Huixia

    2017-09-01

    A case of monochorionic-monoamniotic (MCMA) twin pregnancy with growth discordance because of difference of cord diameter in forked umbilical cord is reported.MCMA twins were diagnosed at 12 weeks of gestation and twin growth discordance was considered during the follow-up twice-weekly visits to the ultrasound and prenatal care units. The pregnancy was terminated at 34 weeks. Two live female babies weighing 2510 g and 1940 g were delivered. Examination of placenta and umbilical cords after birth showed that the 2 cords merged into a conjoint cord 1 cm from insertion to the placenta (forked umbilical cord). Placental color injection showed that the 2 fetuses shared the same placenta area. The diameters of the 2 cords were significantly different (1.5 vs 0.8 cm). This caused an unequal distribution of blood and nutrients, which is the real reason of twin growth discordance in this case.This case reveals that the diameter discordance of cords can be an important factor for twin growth discordance. Few relevant cases have previously been reported. Cords diameter measurement is suggested for ultrasound surveillance of twin growth discordance.

  16. Muscle free amino acid profiles are related to differences in skeletal muscle growth between single and twin ovine fetuses near term.

    Science.gov (United States)

    Sales, Francisco; Pacheco, David; Blair, Hugh; Kenyon, Paul; McCoard, Sue

    2013-01-01

    Twin sheep fetuses have reduced skeletal muscle weight near birth relative to singles as a result of restricted muscle hypertrophy. Intracellular free amino acids (FAA) are reported to regulate metabolic pathways which control muscle protein accretion, whereby reduced intracellular content of specific FAA may reduce their activation and therefore, muscle hypertrophy. The aim of this study was to determine whether differences in muscle weight between singleton and twin fetuses, under different maternal conditions is associated with reduced concentration of specific FAA. The FAA content in the semitendinosus muscle (ST) in singleton and twin fetuses (rank) at 140 days of gestation from heavy (H) or light (L) ewes fed ad libitum (A) or maintenance (M) level of nutrition was measured. Muscle weight was reduced in twin fetuses compared to singletons in all groups. Reduced concentrations of leucine, threonine and valine, but higher concentrations of methionine, ornithine, lysine and serine were found in twin fetuses compared to singletons. Maternal size and nutrition interaction with rank resulted in reduced glutamine in twins from HM-ewes (H-ewes under M nutrition) compared to their singleton counterparts. Maternal weight interaction with pregnancy rank reduced the concentration of arginine in twins, with a larger effect on H-ewes compared with L-ewes. Maternal size interaction with pregnancy rank resulted in twins from M-ewes to have lower alanine, while twins from A-ewes had lower aspartic acid concentration compared to singletons. The ST muscle weight was positively correlated only with arginine concentration after taking into account rank, size and nutrition. The present results indicate that reduced concentrations of specific intracellular FAA, such as arginine, leucine, valine, glutamine, which are known to play a role in muscle growth, could be acting as limiting factors for muscle hypertrophy in twin fetuses during late gestation. Ewe size and nutrition can

  17. War, suffering and modern German history.

    Science.gov (United States)

    Hansen, Randall

    2011-01-01

    This introduction proceeds in five steps. First, it briefly considers the etymology of the term "suffering," as well as the way in which scholars from different disciplines have approached it conceptually and empirically. Second, drawing on the contributions to this issue, it raises general themes emerging from the study of the Thirty Years, Franco-Prussian and First World Wars, with particular attention to gender, the disabled, and Jewish-German veterans. Finally, it considers the most politically contested field of German suffering - the Second World War - and reflects on how that suffering can be narrated and understood without running into the intellectual dead ends of either self-pity or collective guilt.

  18. Back Pain During Pregnancy

    Science.gov (United States)

    ... Page Navigation ▼ ACOG Pregnancy Book Back Pain During Pregnancy Patient Education FAQs Back Pain During Pregnancy Patient Education Pamphlets - Spanish Back Pain During Pregnancy FAQ115, January ...

  19. Dilemma of increased obstetric risk in pregnancies following IVF-ET.

    Science.gov (United States)

    Zádori, J; Kozinszky, Z; Orvos, H; Katona, M; Pál, A; Kovács, L

    2003-06-01

    To determine the rates of pregnancy complications following in vitro fertilization in comparison with those in a matched control group. A total of 13,543 deliveries at the Department of Obstetrics and Gynecology, University of Szeged, between January 1, 1995 and February 28, 2002 were subjected to retrospective analysis The 230 (1.7%) pregnancies following IVF-ET were evaluated and matched with spontaneous pregnancies concerning age, parity, gravidity, and previous obstetric outcome. Demographic and selected maternal characteristics, pregnancy and labor complications, and neonatal outcome were compared in the two groups The pregnancy complication rate was partly significantly higher among the singleton IVF-ET pregnancies. The obstetric risk was elevated, though not significantly concerning twin pregnancies. IVF-ET presents an additional obstetric risk. The neonatal outcome displays a significant difference only concerning an increased premature birth rate of singleton pregnancies. Triplet IVF-ET pregnancies involve a much higher risk of both pregnancy complications and neonatal outcome.

  20. Isolated adnexal torsion in a 20-week spontaneous twin pregnancy

    Directory of Open Access Journals (Sweden)

    Ilker Kahramanoglu

    2016-01-01

    Discussion: Adnexal torsion as a cause of acute abdomen may be kept in mind in pregnants, even if there is no predisposing factor. Laparoscopy may be performed safely in 2nd trimester for acute abdomen.

  1. Twin Pregnancy in a Woman with Uterus Didelphys

    Directory of Open Access Journals (Sweden)

    Sohini Bhattacharya,

    2011-01-01

    Full Text Available Uterus didelphys is one of the congenital uterine anomalies due to defective medial fusion of mullerian ducts. This anomaly is known to have poor reproductive outcome and women with this condition often have to be treated for infertility. Multiple gestation is rare with this condition. An 18 years old primigravida presenting with threatened abortion at eight weeks, was found to have uterus didelphys. She was managed conservatively, aborted one of the fetuses at 16weeks of gestation, and went till term to deliver a healthy baby by cesarean section.

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

    African Journals Online (AJOL)

    2012-12-13

    Dec 13, 2012 ... and strong aversion for caesarean delivery, vaginal delivery would be more acceptable. This study aims to determine the predictors of vaginal delivery in ... vaginal delivery or loss of more than 1000 ml of blood during caesarean section. Fetal presentations were determined using clinical examination and ...

  3. Twin foetuses papyraeci in a spontaneous triplet pregnancy ...

    African Journals Online (AJOL)

    A 39‑year‑old, grand multipara multipara was referred to the University of Maiduguri Teaching Hospital at 27 weeks gestation with preterm contractions. Materno fetal monitoring did not reveal the cause of the preterm contractions. She was delivered via caesarean section, at 36 weeks of gestation, on account of decreased ...

  4. Elizabeth M. Bryan: tributes from home and abroad; research reviews: anorexia nervosa in opposite-sex twins, twin study of self-esteem, DNA differences in monozygotic twins; twins and more twins: twins living apart, twins playing together, twins working together, twins playing apart, multiple birth odds.

    Science.gov (United States)

    Segal, Nancy L

    2008-06-01

    Elizabeth M. Bryan: Tributes From Home and Abroad May 13, 1942 - February 21, 2008 The life and work of Dr Elizabeth M. Bryan, our late distinguished twin studies colleague, are remembered. Tributes come from colleagues in the United States and the United Kingdom, where Elizabeth lived and worked. This section is followed by reviews of twin research on anorexia nervosa, self-esteem and DNA differences in monozygotic twins. The lives of some noteworthy twins are also briefly chronicled, both for their scientific value and human interest. An update on current twinning rates follows.

  5. Twin Peaks (B/W)

    Science.gov (United States)

    1997-01-01

    The Twin Peaks are modest-size hills to the southwest of the Mars Pathfinder landing site. They were discovered on the first panoramas taken by the IMP camera on the 4th of July, 1997, and subsequently identified in Viking Orbiter images taken over 20 years ago. The peaks are approximately 30-35 meters (-100 feet) tall. North Twin is approximately 860 meters (2800 feet) from the lander, and South Twin is about a kilometer away (3300 feet). The scene includes bouldery ridges and swales or 'hummocks' of flood debris that range from a few tens of meters away from the lander to the distance of the South Twin Peak. The large rock at the right edge of the scene is nicknamed 'Hippo'. This rock is about a meter (3 feet) across and 25 meters (80 feet) distant.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 a division of the California Institute of Technology (Caltech). The IMP was developed by the University of Arizona Lunar and Planetary Laboratory under contract to JPL. Peter Smith is the Principal Investigator.

  6. Digital twins in farm management

    NARCIS (Netherlands)

    Verdouw, C.N.; Kruize, J.W.

    2017-01-01

    The Internet of Things (IoT) provides a vision of a world in which the Internet extends into the real world embracing everyday objects. In the IoT, physical objects are accompanied by Digital Twins: virtual, digital equivalents to physical objects. The interaction between real/physical and

  7. Comparison intercuspal mandible position twins

    Directory of Open Access Journals (Sweden)

    Kučević Esad

    2015-01-01

    Full Text Available The twins are the miracle of fetal biology, medical reproductive challenge, the closest and most durable biological connection. The aim is to identify, evaluate and compare the type, number and location interjaw functional contacts in the intercuspal position of the mandible, with MZ monozygotic (identical twins. Analysis of occlusal relationships in the most stable-intercuspal comparison was done on a sample of 60 identical twins, by 15 female and 15 male pairs, chronological ages 18 to 40, in which the means of articulation papers specific localization and distribution of contact relationships, in the region of the lateral teeth. Results of this study showed that in the lateral region, 57 respondents or 95%, has the modalities of occlusal relationships lump-ridges-marginal edge. Average more occlusal contacts identified in males (25.1 than in female twin pairs (19.1. Also, in male couples registered more three points (M: F = 7: 1, two points by gender is equal 24:12, and contacts at one point they outnumber men (22, compared to female respondents (18. Less Similarities than expected sameness, proving that the number, distribution and intensity of occlusal contacts in the mandible vary individually.

  8. Tuberous Sclerosis in Identical Twins

    Directory of Open Access Journals (Sweden)

    Dinesh C Govil

    1987-01-01

    Full Text Available Tuberous sclerosis was, observed in six year old identical twin brothers born with single placenta and a single amnion. Both had adenoma sebaceum shagreen patches, ash leaf spots and progressive mental deterioration. One of them had a verrucous pigmented nevus on the, left temple and recurrent localized motor seizures.

  9. Fetal growth disorders in twin gestations.

    LENUS (Irish Health Repository)

    Breathnach, Fionnuala M

    2012-06-01

    Twin growth is frequently mismatched. This review serves to explore the pathophysiologic mechanisms that underlie growth aberrations in twin gestations, the prenatal recognition of abnormal twin growth, and the critical importance of stratifying management of abnormal twin growth by chorionicity. Although poor in utero growth of both twins may reflect maternal factors resulting in global uteroplacental dysfunction, discordant twin growth may be attributed to differences in genetic potential between co-twins, placental dysfunction confined to one placenta only, or one placental territory within a shared placenta. In addition, twin-twin transfusion syndrome represents a distinct entity of which discordant growth is a common feature. Discordant growth is recognized as an independent risk factor for adverse perinatal outcome. Intertwin birth weight disparity of 18% or more should be considered to represent a discordance threshold, which serves as an independent risk factor for adverse perinatal outcome. At this cutoff, perinatal morbidity is found to increase both for the larger and the smaller twin within a discordant pair. There remains uncertainty surrounding the sonographic parameters that are most predictive of discordance. Although heightening of fetal surveillance in the face of discordant twin growth follows the principles applied to singleton gestations complicated by fetal growth restriction, the timing of intervention is largely influenced by chorionicity.

  10. Register-based research on twins

    DEFF Research Database (Denmark)

    Christensen, Kaare; Ohm Kyvik, Kirsten; Holm, Niels V

    2011-01-01

    Introduction: The Danish Twin Registry (DTR) has for more than 50 years been based on surveys and clinical investigations and over the two last decades also on register linkage. Currently these two approaches are merged within Statistics Denmark. Research topics: Here we report on three major...... groups of register-based research in the DTR that used the uniqueness of twinning. First, we focus on the ''long-term prognosis'' of being a twin compared with being a singleton and show that Danish twins have health trajectories in adulthood similar to singletons, which is a result of interest for twins...... illustrate how the co-twin control method in a register setting can be used to control for the effect of rearing environment and genetic factors in studies of the association between exposures and health. CONCLUSION: The spectrum of register-based twin studies is very wide and have changed in accordance...

  11. Surprised by joy: a journey through suffering.

    Science.gov (United States)

    Afeef, Majeda; Alkhoulli, Laila

    2010-01-01

    Understanding suffering as possible meaning of cancer for patients and their families is a necessary part of cancer nursing care. Suffering occurs when the intactness or integrity of the individuals is threatened or disrupted (Cassel 1999); the authors believe that exploring cancer patients' suffering is vital to improve patient quality care. This article discusses suffering as a feature for oncology patients at tertiary hospital in Jordan. We are aiming through understanding the three following narratives of cancer patients who experience and witness the suffer during their disease journey to illustrate how the suffering reflect their behavior and day to day life. The first case is a young man of 24 years old who was diagnosed with nasopharyngeal carcinoma five years ago, treated then relapsed and receiving palliative care up to moment, the narrative focus on his suffering from corrupted relations with his wife due to infected face wound and loss of the financial support. The Second case is a 38 years old female who diagnosed with melanoma 15 years ago, she experience psychological suffering due to changes in her body image. She is taking care of motor handicapped husband in addition to her Kids. The Last case is a 54 years old female who had lung cancer. She is still fighting her disease. Consequently, she is suffering from the disease, cause to affect her job.We found out that their spirituality and beliefs system enables them to endure and fight their disease, alleviate suffering, enhance adaptation and redefine hope. The health care team who provide the care for these cases focus interdisciplinary team approach who affirm that the transcendental is there when disease and mute or expressive suffering are recognized together, they do the work of creating a full meaning for patients and families. Nurses play a crucial role in managing such cases .It is the core of nursing care to presence the mean of listening, touching, acknowledging, honoring patient's wishes

  12. Why do we suffer? Understanding, treatment and processing of suffering in terms of existential analysis

    Directory of Open Access Journals (Sweden)

    Alfried Längle

    2016-12-01

    Full Text Available The paper describes the existential analytical model within which the content of suffering is denoted and structured. The model shows that we suffer from when we suffer. Suffering is diverse in its «how» and «why.» The author highlights the features of various forms of suffering in accordance with their classification in the existential-analytical anthropology and reveals the essence of suffering. Within the framework of existential analysis there is an assumption that experience is perceived as fulfilling with suffering when the fundamental structures of existence are threatened or damaged, and the features of the contents of these structures are considered. Significant attention is paid to the ratio of human suffering and the loss of human sense of life, what is behind the feeling of senselessness of suffering. Suffering and pain fully or partly represent a threat to our very life and throw into question human lust for life. To avoid this, it is necessary to appeal to the vast opportunities of a person, and drawing strength from its sources to meet adequately the destructive factors and the abyss of existence. The paper considers the issue of activity which enables stepwise treatment of suffering. The model of stepwise coping with suffering is proposed. It helps to overcome the stagnation in the condition of suffering and returns to the world and life. Practical steps are suggested. These steps are applicable for all forms of suffering. They lay the basis for gaining inner peace. So we can target our efforts over the suffering and prevent the occurrence of mental illness (e.g., depression, hysteria, addiction, PTSD, etc..

  13. Protecting Wild Animals from Unnecessary Suffering

    OpenAIRE

    Spark, Gareth

    2014-01-01

    This article compares the protection from unnecessary suffering afforded to wild animals with that afforded to domesticated animals and animals under human control. It considers various species-specific bio-diversity- and conservation-based protection for wild animals, under legislation such as the Wildlife and Countryside Act 1981 and the Conservation of Habitats and Species Regulations 2010, as well as the general protection from intentionally inflicted unnecessary suffering afforded to wil...

  14. Development of the Adolescent Cancer Suffering Scale.

    Science.gov (United States)

    Khadra, Christelle; Le May, Sylvie; Tremblay, Isabelle; Dupuis, France; Cara, Chantal; Mercier, Geneviève; Vachon, Marie-France; Lachance Fiola, Jacinthe

    2015-01-01

    While mortality due to pediatric cancer has decreased, suffering has increased due to complex and lengthy treatments. Cancer in adolescence has repercussions on personal and physical development. Although suffering can impede recovery, there is no validated scale in French or English to measure suffering in adolescents with cancer. To develop an objective scale to measure suffering in adolescents with cancer. A methodological design for instrument development was used. Following a MEDLINE search, semistructured interviews were conducted with adolescents 12 to 19 years of age who had undergone four to six weeks of cancer treatment, and with a multidisciplinary cohort of health care professionals. Adolescents with advanced terminal cancer or cognitive impairment were excluded. Enrollment proceeded from the hematology-oncology department⁄clinic in Montreal, Quebec, from December 2011 to March 2012. Content validity was assessed by five health care professionals and four adolescents with cancer. Interviews with 19 adolescents and 16 health care professionals identified six realms of suffering: physical, psychological, spiritual, social, cognitive and global. Through iterative feedback, the Adolescent Cancer Suffering Scale (ACSS) was developed, comprising 41 questions on a four-point Likert scale and one open-ended question. Content validity was 0.98, and inter-rater agreement among professionals was 88% for relevance and 86% for clarity. Adolescents considered the scale to be representative of their suffering. The ACSS is the first questionnaire to measure suffering in adolescents with cancer. In future research, the questionnaire should be validated extensively and interventions developed. Once validated, the ACSS will contribute to promote a holistic approach to health with appropriate intervention or referral.

  15. Collectivism and the meaning of suffering.

    Science.gov (United States)

    Sullivan, Daniel; Landau, Mark J; Kay, Aaron C; Rothschild, Zachary K

    2012-12-01

    People need to understand why an instance of suffering occurred and what purpose it might have. One widespread account of suffering is a repressive suffering construal (RSC): interpreting suffering as occurring because people deviate from social norms and as having the purpose of reinforcing the social order. Based on the theorizing of Emile Durkheim and others, we propose that RSC is associated with social morality-the belief that society dictates morality-and is encouraged by collectivist (as opposed to individualist) sentiments. Study 1 showed that dispositional collectivism predicts both social morality and RSC. Studies 2-4 showed that priming collectivist (vs. individualist) self-construal increases RSC of various types of suffering and that this effect is mediated by increased social morality (Study 4). Study 5 examined behavioral intentions, demonstrating that parents primed with a collectivist self-construal interpreted children's suffering more repressively and showed greater support for corporal punishment of children. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

  16. Concepts Joy and Suffering in Russian Linguaculture

    Directory of Open Access Journals (Sweden)

    Svetlana V. Korostova

    2017-12-01

    Full Text Available In the Russian linguistic consciousness, the concepts of emotions joy and suffering are verbalized at the lexical and phraseological levels, forming the basis for metaphorical combinations. Concepts of emotions, suffering and joy are mutually reinforcing: in the presupposition of the idea of suffering, there is a knowledge that it is not infinite and is always replaced by joy. Russian naive-linguistic consciousness reflects the oldest ideas about the alternation of phenomena and events, desirable and undesirable for man. The concepts of suffering and joy are closely related to the universal category of time. As observations on linguistic projections of concepts show, suffering is realized as a longer process than joy. Emotives of different levels of language represent emotional states of joy and suffering in Russian linguistic culture. According to the National Corpus of the Russian language, lexical demonstrators of the concept of joy dominate. Cognitive interpretation of events in the mind of a person can be changed under the influence of the emotional regime carried out by the media.

  17. Ectopic pregnancy.

    Science.gov (United States)

    Randall, S

    1986-12-01

    This discussion of ectopic pregnancy covers mortality, definition, etiology, diagnosis and management, and contraception. In the 1979-81 "Report on Confidential Enquiries into Maternal Deaths in England and Wales," ectopic pregnancy accounted for 11.4% of all maternal deaths. Avoidable factors were found in 64% of deaths from ectopic pregnancy, the most common being delay in diagnosis and operative intervention. Ectopic pregnancy is the implantation of the conceptus outside the uterus or in an abnormal location within the uterus. Tubal gestation invariably has a multifactorial etiology and occurs owing to delay in the transport of the fertilized ovum. Table 1 lists causes. Salpingitis is the main cause of tubal pregnancy and now is considered to be due primarily to chlamydia. The consequences of tubal surgery, for whatever reason, and hormonal treatment also are major etiological factors. Every woman of reproductive age, especially if she has 1 or more etiological factors in her past history, who presents with a history of a missed period and irregular vaginal bleeding or abdominal pain, must be considered to have an ectopic pregnancy until proved otherwise. Diagnosis still is essentially a clinical one. In difficult cases use should be made of radioimmunoassay of beta hCG, ultrasonic scanning, and laparoscopy. In 25% of cases, a correct diagnosis was made only at laparotomy. Culdocentesis and endometrial biopsy are of limited use. In cases of ruptured ectopic pregnancy with circulatory collapse, immediate operative intervention is essential. In regard to contraception, the combined oral contraceptive (OC), in suppressing ovulation and thickening the cervical mucus, has a protective effect. Method failure does not increase the incidence of extrauterline pregnancy above normal. The progestagen-only pill is associated with a small increase in the risk of an initial and recurrent ectopic pregnancy. It does not suppress ovulation and may affect tubal motility, but it

  18. Increased breast cancer risk in in vitro fertilisation treated women with a multiple pregnancy: A new hypothesis based on historical in vitro fertilisation treatment data

    NARCIS (Netherlands)

    Krul, I.M.; Groeneveld, E.; Spaan, M.; van den Belt-Dusebout, A.; Mooij, T.M.; Hauptmann, M.; Twisk, J.W.R.; Lambers, M.J.; Hompes, P.G.A.; Burger, C.W.; Lambalk, C.B.; van Leeuwen, F.E.

    2015-01-01

    Background Breast cancer risk is temporarily increased after a full-term pregnancy and declines thereafter, possibly due to increased levels of gonadal and placental hormones during pregnancy. Inconsistent results, however, have been reported after twin pregnancies with higher hormone levels. Among

  19. Is that me or my twin? Lack of self-face recognition advantage in identical twins.

    Directory of Open Access Journals (Sweden)

    Matteo Martini

    Full Text Available Despite the increasing interest in twin studies and the stunning amount of research on face recognition, the ability of adult identical twins to discriminate their own faces from those of their co-twins has been scarcely investigated. One's own face is the most distinctive feature of the bodily self, and people typically show a clear advantage in recognizing their own face even more than other very familiar identities. Given the very high level of resemblance of their faces, monozygotic twins represent a unique model for exploring self-face processing. Herein we examined the ability of monozygotic twins to distinguish their own face from the face of their co-twin and of a highly familiar individual. Results show that twins equally recognize their own face and their twin's face. This lack of self-face advantage was negatively predicted by how much they felt physically similar to their co-twin and by their anxious or avoidant attachment style. We speculate that in monozygotic twins, the visual representation of the self-face overlaps with that of the co-twin. Thus, to distinguish the self from the co-twin, monozygotic twins have to rely much more than control participants on the multisensory integration processes upon which the sense of bodily self is based. Moreover, in keeping with the notion that attachment style influences perception of self and significant others, we propose that the observed self/co-twin confusion may depend upon insecure attachment.

  20. Keratoconus in 18 pairs of twins.

    Science.gov (United States)

    Tuft, Stephen J; Hassan, Hala; George, Sonia; Frazer, David G; Willoughby, Colin E; Liskova, Petra

    2012-09-01

    To describe the concordance of keratoconus in 18 sets of twins. Thirteen monozygotic (MZ) and five dizygotic (DZ) pairs of twins were identified during an investigation of familial keratoconus. We used 16 forensic microsatellite markers to confirm the zygosity of same sex twins. Patients and available relatives were examined for signs of keratoconus using corneal topography. For each pair of twins, the severity of keratoconus in each eye was graded according to the steepest keratometry value and the average difference in score between the MZ and DZ twins compared. All of the MZ twins and four of the five DZ twins were concordant for keratoconus but with differences in age of onset and severity of disease. The subjective age of onset of keratoconus tended to be earlier in the MZ twins (16.4 years, SD 4.66) than in the DZ twins (20.3 years, SD 7.55) (p=0.086). Additional relatives with keratoconus were identified in two (16%) of the families with MZ twins and in three (60%) of the families of DZ twins. The mean difference in severity scores was 1.4 (SD 1.73) for the MZ twins and 3.0 (SD 1.00) for the DZ twins (p=0.035). This data provide evidence that the severity of keratoconus is more concordant in MZ than in DZ twins. The results support the currently accepted hypothesis of an important genetic contribution towards the pathogenesis of keratoconus, but suggest that there is also an environmental effect on the expression of disease. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

  1. Diagnóstico pré-natal de um gêmeo hemiacárdico: relato de caso Prenatal diagnosis of hemiacardiac twin: a case report

    Directory of Open Access Journals (Sweden)

    Júlio A. G. Alves

    1998-03-01

    Full Text Available A síndrome de acardia fetal é uma rara complicação de gestações gemelares monozigóticas, ocorrendo uma vez em cada 35.000 partos. O prognóstico é fatal para todos gêmeos acárdicos e para 50-75% dos gêmeos normais. Neste trabalho é apresentado um caso de hemiacardia fetal (acardia parcial em gravidez gemelar. O diagnóstico foi feito utilizando-se ultra-sonografia, ecocardiografia fetal e foi confirmado após o parto.The acardius syndrome is a rare complication of monozygotic twin pregnancies, occurring once in 35.000 births. The outcome is invariably fatal for the acardiac twin and for 50-75% of the normal twins. We report a case of partial (pseudoacardia in twin pregnancy. The diagnosis was made using ultrasonography, fetal echocardiography and confirmed after delivery.

  2. Lemierre's Syndrome Complicating Pregnancy

    Directory of Open Access Journals (Sweden)

    M. Thompson

    2007-01-01

    Full Text Available Lemierre's syndrome is an anaerobic suppurative thrombophlebitis involving the internal jugular vein secondary to oropharyngeal infection. There is only one previous case report in pregnancy which was complicated by premature delivery of an infant that suffered significant neurological damage. We present an atypical case diagnosed in the second trimester with a live birth at term. By reporting this case, we hope to increase the awareness of obstetricians to the possibility of Lemierre's syndrome when patients present with signs of unabating oropharyngeal infection and pulmonary symptoms.

  3. Infant twin mortality and hospitalisations after the perinatal period - a prospective cohort study from Guinea-Bissau

    DEFF Research Database (Denmark)

    Bjerregaard-Andersen, M; Biering-Sørensen, S; Gomes, G M

    2014-01-01

    at the National Hospital Simão Mendes in the capital Bissau. Children were examined clinically at enrolment. Maternal, pregnancy and obstetric information was collected and HIV testing offered at birth. Follow-up occurred at home at 2, 6 and 12 months and through linkage with the paediatric admission register...... at the National Hospital. RESULTS: About 495 twins and 333 singletons were alive on day 7 after birth. In total, 36 twins and 12 singletons died during follow-up, the post-perinatal infant mortality rate being 91/1000 person-years for twins and 42/1000 for singletons (HR = 2.11, 95% CI: 1.......09-4.07). In a multivariable analysis among twins only, birth weight

  4. Sociological and socio-psycho-historical problems of A-bomb exposed twin

    International Nuclear Information System (INIS)

    Watanabe, Shoji

    1983-01-01

    The atomic bombing of Hiroshima brought many casualities on human society, and collapsed human communities. The purpose of this study is to make mainly on pairs of monozygotic twins one of whom was exposed and the other was not, or both of whom were exposed, a general socio-psycho-historical investigations through a twin control study to find whether the bombing, which can be considered to cause major environmental changes, has had any psychological effects on the individuals. Due to the limited sample of atomic bomb exposed twins, in numbers available for study, it is necessary to have an understanding for their condions of the living and identity they have developed from the numerous mental stress they suffered, and rapid socio-cultural changes they experienced, including for changes in life from birth until the atomic bombing and aftermath of the disaster. As the result of this study, by depth interview, projective psychological research and research on socio-psycho-history of exposed twin and the nonexposed before the A-bomb and aftermath of disaster, the following were obtained: a) Although at the age of four and eight they exposed, they still keep it in clear memory of the damage and suffering in the minds. b) The damage and suffereng of the family who belonged were relatively small, the effects of their psychological sufferings continued even after these thirtyseven years. c) In the aftermath of the A-bomb disaster, the psychological bond showed strengthen through crises and following social distress. d) During the long period since the bombing, those who did not experienced A-bombing, have shown high degree of support and co-operation on their familial and social role to their counterpart. e) Even though their social or medical effects of A-bombing are relatively limited, if their spouse or close relative suffer psychological stress caused by A-bomb, they too suffer from their similar experiences. (J.P.N.)

  5. Social Comparison Orientation in Monozygotic and Dizygotic Twins.

    Science.gov (United States)

    Huguet, Pascal; Carlier, Michèle; Dolan, Conor V; de Geus, Eco J; Boomsma, Dorret I

    2017-12-01

    Twin research has offered evidence that monozygotic (MZ) twins are more socially close than dizygotic (DZ) twins, but has not paid much attention to the way twins compare themselves with their co-twin. The few studies in this area suggest that 'horizontal comparisons' (social comparison motivated by solidarity or communion with others) matter more for MZ twins than for DZ twins, at least when the co-twin is the social comparison standard. Consistent with this view, we predicted higher interest in MZ twins relative to DZ twins to select their co-twin rather than other people in general as the social comparison standard. The Social Comparison Orientation (SCO) scale, which measures the inclination to compare with others in a horizontal rather than vertical mode (comparing either upward or downward), was administered in 90 MZ pairs and 57 same-sex DZ pairs (63% female; average age 18.06 years) from the Netherlands Twin Register. MZ twin pairs showed significantly higher SCO scores than DZ twin pairs (with a large effect size) on the co-twin SCO, whereas the two groups did not differ from each other on the general SCO excluding the co-twin as social comparison standard. In MZ twin pairs, anxiety was associated with social comparison with others in general, not with their co-twin. For both scales, twin resemblance was explained by additive genetic variance. The present findings provide direct evidence that horizontal comparisons with the co-twin are of particular importance for MZ twins.

  6. On some phenomena concerning pregnancy and parturition of the Cetacea

    NARCIS (Netherlands)

    Slijper, E.J.

    1949-01-01

    1. A review is given of some phenomena concerning pregnancy and parturition of the Cetacea, depending on data in literature and on observations made in Antarctic Blue and Fin Whales on board the f.f. “Willem Barendsz” (1946—1947). 2. In Mystacoceti the frequency of twins appears to be less than in

  7. Placental characteristics in monochorionic twins with selective intrauterine growth restriction assessed by gradient angiography and three-dimensional reconstruction.

    Science.gov (United States)

    Gou, Chenyu; Li, Meizhi; Zhang, Xiaoling; Liu, Xiangzhen; Huang, Xuan; Zhou, Yi; Fang, Qun

    2017-11-01

    To investigate the placental characteristics in selective intrauterine growth restriction (sIUGR) using gradient angiography and three-dimensional (3D) reconstruction from computed tomography (CT) scan data. This study included 23 sIUGR cases and 16 monochorionic twin-pregnancies without sIUGR. We injected nonionic iodinated contrast agents into the umbilical arteries and veins. Placental characteristics were analyzed after CT scanning and 3D reconstruction. 73.9% of smaller twins in sIUGR cases had marginal or velamentous cord insertions and less placental sharing. The terminal branch of the arterial tree was scored III-IV in smaller sIUGR twins, while it was scored V-VII in normal monochorionic twins and larger sIUGR twins. Arterio-arterial (A-A) anastomoses presented in all monochorionic placentas. Veno-venous (V-V) anastomoses present in 83.3% (5/6) of Type III sIUGR cases, which was higher than observed in Type I-II cases. The mean diameters of A-A and V-V anastomoses were larger in Type III sIUGR cases. Gradient angiography and 3D placental models displayed different placental angioarchitectures and voluminal placental sharing among three types of sIUGR cases. Placental dysplasia in the smaller twin may cause abnormal cord insertion and unequal placental sharing. The inter-twin anatomoses influence the umbilical cord artery (UA) Doppler and natural pathogenesis of sIUGR.

  8. Periconceptional undernutrition and being a twin each alter kidney development in the sheep fetus during early gestation.

    Science.gov (United States)

    MacLaughlin, Severence M; Walker, Simon K; Kleemann, David O; Tosh, Darran N; McMillen, I Caroline

    2010-03-01

    Adaptive growth responses of the embryo and fetus to nutritional restraint are important in ensuring early survival, but they are implicated in the programming of hypertension. It has been demonstrated that kidney growth and nephrogenesis are each regulated by intrarenal factors, including the insulin-like growth factors, glucocorticoids, and the renin-angiotensin system. Therefore, we have investigated the impact of periconceptional undernutrition (PCUN; from approximately 6 wk before to 7 days after conception) in singleton (control, n = 18; PCUN, n = 16) and twin pregnancies (control, n = 6; PCUN, n = 5) on the renal mRNA expression of 11beta- hydroxysteroid dehydrogensase type 1 and type 2 (11beta-HSD-1 and -2), the glucocorticoid (GR), and mineralocorticoid receptors, angiotensinogen, angiotensin receptor type 1 (AT1R) and 2 (AT2R), IGF-1 and IGF-2, and IGF1R and IGF2R at approximately 55 days gestation. There was no effect of PCUN or fetal number on fetal weight on relative kidney weight at approximately day 55 of gestation. There was an inverse relationship between the relative weight of the fetal kidney at approximately day 55 and maternal weight loss during the periconceptional period in fetuses exposed to PCUN. Exposure to PCUN resulted in a higher expression of IGF1 in the fetal kidney in singleton and twin pregnancies. Being a twin resulted in higher intrarenal expression of IGF-1 and IGF-2, GR, angiotensinogen, AT1R, and AT2R mRNA at 55 days gestation. Renal 11beta-HSD-2 mRNA expression was higher in PCUN singletons, but not PCUN twins, compared with controls. Thus, there may be an adaptive response in the kidney to the early environment of a twin pregnancy, which precedes the fetal growth restriction that occurs later in pregnancy. The kidney of the twin fetus exposed to periconceptional undernutrition may also be less protected from the consequences of glucocorticoid exposure.

  9. Double jeopardy: multi-modality imaging of monozygotic "twin cap" atherosclerosis.

    Science.gov (United States)

    Murray, Scott W; Cooper, Robert M; Appleby, Clare; McCann, Caroline; Binukrishnan, Sukumaran; Radu, Maria D; Stables, Rodney H

    2014-11-01

    The investigation of asymptomatic but potentially vulnerable atherosclerosis is not yet a major focus for clinical Cardiologists. We have illustrated the contemporary investigation and treatment of such disease using a clinical case that involved monozygotic twins. One twin (T1) had unfortunately suffered a cardiac arrest whilst jogging and survived only due to bystander CPR and prompt defibrillation. His identical twin brother (T2), on subsequent investigation, harbours a compositionally identical lesion in a proximal coronary vessel that has not yet ruptured or provoked a clinical event. Following the presentation of both non-invasive and invasive images, we discuss the need for active suspicion and intensive treatment for those people with a 'genetic' risk of future myocardial infarction. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  10. Paradoxical scalloped placenta with polyhydramnios in twin-twin transfusion syndrome.

    Science.gov (United States)

    Chmait, Ramen H; Rossi, A Cristina; Quintero, Rubén A

    2007-01-01

    To describe the paradoxical occurrence of a scalloped placenta in the presence of polyhydramnios and assess its clinical significance in pregnancies complicated by twin-twin transfusion syndrome (TTTS) treated with laser therapy. All patients who underwent laser therapy for TTTS between January 2003 and April 2004 were studied. TTTS was diagnosed and staged using the Quintero staging system. Normally the placenta is characterized by undulations of the fetal-placental surface visible by ultrasound (scalloped placenta). Patients with polyhydramnios will typically have a flattened, smooth, non-scalloped placenta. Operative tapes were reviewed and placental type assigned. Pre-, intra-, and postoperative characteristics of each study patient were obtained. Fifteen of 120 patients (12.5%) were noted to have a scalloped placenta despite having polyhydramnios. There was no difference in mean gestational age at laser treatment (20.3+/-0.5 vs. 19.6+/-0.6 weeks, p=0.66) or in stage (p=0.07) between the two groups. The median and range preoperative maximum vertical pocket (MVP) in the recipient gestational sac differed significantly between the scalloped and non-scalloped patients (8.3 (8-12) vs. 10.5 (8-17), p=0.001). All 15 patients (100%) with a scalloped placenta required an amnioinfusion to expose all vascular anastomoses, while amnioinfusion was necessary in only 28 of the 105 patients (26.7%, por=8 cm in the recipient sac. Most patients will have a flattened placenta as a result of polyhydramnios in this sac. Our data show that a paradoxical scalloped placenta may still be present in approximately 12.5% of patients. This preoperative sonographic finding alerts to the potential need for amnioinfusion during laser therapy for TTTS to disclose all vessels to avoid missing placental vascular anastomoses. Amniocenteses should be avoided if possible in patients considering laser therapy to minimize the likelihood of iatrogenic placental scalloping.

  11. Teenage Pregnancy.

    Science.gov (United States)

    McClellan, Mary C.

    1987-01-01

    Reviews the problems of teenage pregnancy, including the costs to society, the challenge to educators, and the types of preventive programs developing across the country. Programs dealing strictly with reproduction and contraception are the least effective deterrents to teenage pregnancy. (MD)

  12. Caring conversations - psychiatric patients' narratives about suffering.

    Science.gov (United States)

    Fredriksson, Lennart; Lindström, Unni A

    2002-11-01

    The aim of this study was to increase and deepen the understanding of how psychiatric patients in conversations with nurses narrate their experience of suffering. Data were obtained in the years 2001-2002 by audio recording of 20 individual caring conversations between eight patients and three psychiatric nurses at a psychiatric outpatient unit in Sweden. Before the data were gathered the study was approved by a local research ethics committee. The methodology is inspired by the hermeneutics of Paul Ricoeur. The data is given a naïve reading which is followed by two structural analyses which explain the text. Finally, the structural analyses and the pre-understanding are confronted in a critical reflection. In the patients' narratives, suffering was at first concealed under a façade that helps the patient to cope with suffering and with shame. As they moved along to a turning point, something happened that made them able to risk everything, i.e. their very selves, but also gave them the possibility of regaining vital parts of themselves that where lost when the façade was constructed. As they took the suffering upon themselves, they grew to be fully visible as human beings and healing was possible as a re-establishment of the interpersonal bridge. This not only meant that the sufferer became open for relationships with others or an abstract other, but also that an opening in the relationship with themselves occurred. If psychiatric patients are allowed to narrate freely they develop different plot structures, which can either hide or reveal suffering. Patients who could establish an answer to the why-question of suffering could also interpret their suffering in a way that enabled growth and reconciliation. In order to do so, they had to abandon the shelter of the façade and confront suffering and shame. This turning point opened them up to life-sustaining relationships with themselves as well as with abstract and concrete others.

  13. Fingerprint recognition with identical twin fingerprints.

    Science.gov (United States)

    Tao, Xunqiang; Chen, Xinjian; Yang, Xin; Tian, Jie

    2012-01-01

    Fingerprint recognition with identical twins is a challenging task due to the closest genetics-based relationship existing in the identical twins. Several pioneers have analyzed the similarity between twins' fingerprints. In this work we continue to investigate the topic of the similarity of identical twin fingerprints. Our study was tested based on a large identical twin fingerprint database that contains 83 twin pairs, 4 fingers per individual and six impressions per finger: 3984 (83*2*4*6) images. Compared to the previous work, our contributions are summarized as follows: (1) Two state-of-the-art fingerprint identification methods: P071 and VeriFinger 6.1 were used, rather than one fingerprint identification method in previous studies. (2) Six impressions per finger were captured, rather than just one impression, which makes the genuine distribution of matching scores more realistic. (3) A larger sample (83 pairs) was collected. (4) A novel statistical analysis, which aims at showing the probability distribution of the fingerprint types for the corresponding fingers of identical twins which have same fingerprint type, has been conducted. (5) A novel analysis, which aims at showing which finger from identical twins has higher probability of having same fingerprint type, has been conducted. Our results showed that: (a) A state-of-the-art automatic fingerprint verification system can distinguish identical twins without drastic degradation in performance. (b) The chance that the fingerprints have the same type from identical twins is 0.7440, comparing to 0.3215 from non-identical twins. (c) For the corresponding fingers of identical twins which have same fingerprint type, the probability distribution of five major fingerprint types is similar to the probability distribution for all the fingers' fingerprint type. (d) For each of four fingers of identical twins, the probability of having same fingerprint type is similar.

  14. Fingerprint recognition with identical twin fingerprints.

    Directory of Open Access Journals (Sweden)

    Xunqiang Tao

    Full Text Available Fingerprint recognition with identical twins is a challenging task due to the closest genetics-based relationship existing in the identical twins. Several pioneers have analyzed the similarity between twins' fingerprints. In this work we continue to investigate the topic of the similarity of identical twin fingerprints. Our study was tested based on a large identical twin fingerprint database that contains 83 twin pairs, 4 fingers per individual and six impressions per finger: 3984 (83*2*4*6 images. Compared to the previous work, our contributions are summarized as follows: (1 Two state-of-the-art fingerprint identification methods: P071 and VeriFinger 6.1 were used, rather than one fingerprint identification method in previous studies. (2 Six impressions per finger were captured, rather than just one impression, which makes the genuine distribution of matching scores more realistic. (3 A larger sample (83 pairs was collected. (4 A novel statistical analysis, which aims at showing the probability distribution of the fingerprint types for the corresponding fingers of identical twins which have same fingerprint type, has been conducted. (5 A novel analysis, which aims at showing which finger from identical twins has higher probability of having same fingerprint type, has been conducted. Our results showed that: (a A state-of-the-art automatic fingerprint verification system can distinguish identical twins without drastic degradation in performance. (b The chance that the fingerprints have the same type from identical twins is 0.7440, comparing to 0.3215 from non-identical twins. (c For the corresponding fingers of identical twins which have same fingerprint type, the probability distribution of five major fingerprint types is similar to the probability distribution for all the fingers' fingerprint type. (d For each of four fingers of identical twins, the probability of having same fingerprint type is similar.

  15. Emergency separation of a xipho-omphalopagus twin in a ...

    African Journals Online (AJOL)

    Female conjoined twins (thoraco-omphalopagus) were delivered by emergency caesarean section in a private nursing home. On examination, one of the twins was dead and was threatening the survival of the surviving twin (twin A). An emergency separation was performed to salvage the surviving twin.

  16. Identical twins in forensic genetics

    DEFF Research Database (Denmark)

    Tvedebrink, Torben; Morling, Niels

    2015-01-01

    The increase in the number of forensic genetic loci used for identification purposes results in infinitesimal random match probabilities. These probabilities are computed under assumptions made for rather simple population genetic models. Often, the forensic expert reports likelihood ratios, where...... published results accounting for close familial relationships. However, we revisit the discussion to increase the awareness among forensic genetic practitioners and include new information on medical and societal factors to assess the risk of not considering a monozygotic twin as the true perpetrator...

  17. Ectodermal dysplasia in identical twins

    OpenAIRE

    Puttaraju, Gurkar Haraswarupa; Visveswariah, Paranjyothi Magadi

    2013-01-01

    Hereditary hypohidrotic ectodermal dysplasia (HED) is typically inherited as an X-linked recessive trait, characterized by deformity of at least two or more of the ectodermal structures - hair, teeth, nails and sweat glands. Two cases of hereditary HED involving identical male twins, is being documented for the rarity of its occurrence with special attention given to genetics, pathophysiology, clinical, intraoral manifestations and to the methods to improve the masticatory function, the facia...

  18. Travel during Pregnancy

    Science.gov (United States)

    ... Management Education & Events Advocacy For Patients About ACOG Travel During Pregnancy Home For Patients Search FAQs Travel ... Travel During Pregnancy FAQ055, April 2017 PDF Format Travel During Pregnancy Pregnancy Is travel safe during pregnancy? ...

  19. Early Pregnancy Loss

    Science.gov (United States)

    ... be signs of other pregnancy problems, such as ectopic pregnancy . If you have any of these signs or ... 13 weeks of pregnancy; also called a miscarriage. Ectopic Pregnancy: A pregnancy in which the fertilized egg begins ...

  20. Smoking during Pregnancy

    Science.gov (United States)

    ... Home > Pregnancy > Is it safe? > Smoking during pregnancy Smoking during pregnancy E-mail to a friend Please ... smoking, tell your health care provider. Why is smoking during pregnancy harmful? Smoking during pregnancy is bad ...