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https://www.readbyqxmd.com/read/29153312/discordant-intrauterine-transfusion-in-dichorionic-twin-pregnancy-with-rh-isoimmunization
#1
Jing Wu, Lin-Huan Huang, Yan-Min Luo, Qun Fang
Discordant intrauterine transfusion (IUT) in twin pregnancy with Rh isoimmunization is uncommon and complicated. We report a gravida 3, para 2 woman with a dichorionic diamniotic (DCDA) twin pregnancy and two fetuses received discordant transfusions. Middle cerebral artery peak systolic velocity (MCA-PSV) was used to evaluate the anemic degree in each foetus. IUT was performed 3 times in twin A and 4 times in twin B to reverse foetal anaemia. Transfusions were distinct due to the different tolerance to IUT, and the procedure could be continued in one foetus even if the other one underwent complications...
November 7, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/29122542/twin-twin-transfusion-syndrome-what-we-have-learned-from-clinical-trials
#2
REVIEW
Fatiha Djaafri, Julien Stirnemann, Imen Mediouni, Claire Colmant, Yves Ville
Monochorionic twin pregnancies are at increased risk for adverse outcome compared to dichorionic twin pregnancies and singletons. Monochorionic-specific complications include twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence, single intrauterine fetal demise and its consequences on the co-twin, and selective intrauterine growth restriction. Whereas the natural history of monochorionic-specific complications carries a high risk of fetal death or severe neurologic disability, a framework now exists, based on well-designed clinical trials, for optimal treatment of these entities...
November 6, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29108135/regimens-of-ultrasound-surveillance-for-twin-pregnancies-for-improving-outcomes
#3
REVIEW
Jane G Woolcock, Rosalie M Grivell, Jodie M Dodd
BACKGROUND: Increased ultrasound surveillance of twin pregnancies has become accepted practice due to the higher risk of complications. There is no current consensus however as to the method and frequency of ultrasound monitoring that constitutes optimal care. OBJECTIVES: To systematically review the effects of different types and frequency of ultrasound surveillance for women with a twin pregnancy on neonatal, fetal and maternal outcomes. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials...
November 7, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29103877/ethical-considerations-in-the-care-of-complicated-twin-pregnancies
#4
Naomi T Laventhal, Marjorie C Treadwell
Twin gestations are increasing in prevalence worldwide, and are potentially subject to medical complications which present uniquely complex ethical and psychosocial challenges for the pregnant patient and obstetrician to navigate. In this article, we explore these issues as they relate to medical decision-making in cases of discordant growth and discordant anomalies in both monochorionic and dichorionic twin pregnancies, including those affected by twin-twin transfusion syndrome, with particular attention to scenarios in which the individual fetuses hold competing interests...
November 2, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29101986/acr-appropriateness-criteria-%C3%A2-multiple-gestations
#5
Phyllis Glanc, David A Nyberg, Nadia J Khati, Sandeep Prakash Deshmukh, Kika M Dudiak, Tara Lynn Henrichsen, Liina Poder, Thomas D Shipp, Lynn Simpson, Therese M Weber, Carolyn M Zelop
Women with twin or higher-order pregnancies will typically have more ultrasound examinations than women with a singleton pregnancy. Most women will have at minimum a first trimester scan, a nuchal translucency evaluation scan, fetal anatomy scan at 18 to 22 weeks, and one or more scans in the third trimester to evaluate growth. Multiple gestations are at higher risk for preterm delivery, congenital anomalies, fetal growth restriction, placenta previa, vasa previa, and velamentous cord insertion. Chorionicity and amnionicity should be determined as early as possible when a twin pregnancy is identified to permit triage of the monochorionic group into a closer surveillance model...
November 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29057694/early-unexpected-diagnosis-of-fetal-life-limiting-malformation-antenatal-palliative-care-and-parental-decision
#6
Federico Mariona, Marianne Burnett, Melody Zoma, Janice Blake, Hanna Khouri
INTRODUCTION: Conjoined twins are an infrequent occurrence in obstetric practice. Live-conjoined twins on a late preterm triplet pregnancy is an even rarer event. OBJECTIVE: The objective of this study is to emphasize the critical importance of perinatal palliative care and non-directive parental counseling, informed decision making and respect for autonomy following full disclosure of findings, fetal life-limiting diagnosis, treatment alternatives, maternal-fetal potential complications, and most likely perinatal outcomes...
November 2, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29055174/maternal-outcomes-in-first-and-second-trimester-termination-of-pregnancy-which-are-the-risk-factors
#7
Giulia Garofalo, Anna Garofalo, Olga Sochirca, Maria Grazia Alemanno, Eleonora Pilloni, Marilisa Biolcati, Elisabetta Muccinelli, Elsa Viora, Tullia Todros
AIMS: To evaluate maternal complications of first trimester and second trimester termination of pregnancy (TOP) performed after first or second trimester positive prenatal diagnosis (PD). RESULTS: We performed a retrospective study from January 2007 to December 2011, on 844 patients, who underwent a TOP after positive amniocentesis or chorionic villus sampling (CVS) for foetal aneuploidies, performed for maternal age ≥35 years of age, positive prenatal screening (PS) or for genetic reasons...
October 21, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/29046073/influence-of-farewell-rituals-and-psychological-vulnerability-on-grief-following-perinatal-loss-in-monochorionic-twin-pregnancy
#8
Mònica Druguet, Laura Nuño, Carlota Rodó, Silvia Arévalo, Elena Carreras Moratonas, Juana Gómez-Benito
AIM: To analyze whether the absence of farewell rituals and previous psychological vulnerability are associated with the intensity of grief following perinatal loss in monochorionic twin pregnancy. METHOD: The sample comprised 28 women who experienced perinatal loss following fetal surgery. Sociodemographic and clinical data and information about farewell rituals were collected through interview. The women also completed a questionnaire about perinatal grief. RESULTS: A history of psychological and/or psychopharmacological treatment was associated with more intense grief following perinatal loss...
October 18, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29034746/clinical-characteristics-of-acute-fatty-liver-of-pregnancy-in-a-tertiary-indonesian-hospital
#9
Muhammad Ilham Aldika Akbar, Indah Mayang Sari, Aditiawarman, Erry Gumilar Dachlan, Gustaaf Dekker
Acute fatty liver of pregnancy (AFLP) is a rare, often autosomal recessive disorder with a major risk for maternal and perinatal mortality and morbidity. In order to achieve a more favorable outcome, awareness of its clinical signs and symptoms and early recognition are of pivotal importance. Over a 5-year period 18 patients were diagnosed with AFLP (one twin, 19 babies). The most common sign and symptoms were jaundice, hypoglycemia, nausea and vomiting, encephalopathy, and hypertension. Abnormal laboratory test results included: elevated total/ conjugated (direct) bilirubin, AST, ALT, PT, APTT, creatinine, leukocyte count, and hypoalbuminemia...
October 16, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29028139/birthweight-discordance-and-neonatal-morbidity-in-twin-pregnancies-analysis-of-the-stork-multiple-pregnancy-cohort
#10
Francesco D'Antonio, Basky Thilaganathan, Arianna Laoreti, Asma Khalil
OBJECTIVES: The main aim of this study was to investigate the relationship between weight discordance and neonatal morbidity in twin pregnancies progressing beyond 34 weeks of gestation. The secondary aim was to determine the predictive accuracy of different weight discordant cut-offs in predicting neonatal morbidity in twin pregnancies. METHODS: This was a retrospective multicentre cohort study of all twin pregnancies booked for antenatal care in four hospitals in the Southwest Thames region of London Obstetric Research Collaborative (STORK) over a period of ten years...
October 13, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29027529/-twin-pregnancy-with-complete-hydatidiform-mole
#11
I N Voloshchuk, I V Barinova, N I Kondrikov, R A Barto
The paper describes a case of twin pregnancy with complete hydatidiform mole (CHM). According to the data available in the literature, the concurrence of CHM with a normal placenta and a viable fetus occurs in 1 per 20,000-100,000 pregnancies, requires a differential diagnosis with partial hydatidiform mole and placental mesenchymal dysplasia, and is characterized by a high rate of complications. In this concurrence, the frequency of persistent trophoblastic disease is as high as 50%. In this case, the pregnancy ended in a spontaneous abortion at 16-17 weeks of pregnancy...
2017: Arkhiv Patologii
https://www.readbyqxmd.com/read/29027307/transient-amniotic-fluid-leakage-after-fetoscopic-laser-photocoagulation-for-twin-twin-transfusion-syndrome
#12
Shiyo Ota, Keisuke Ishii, Hiroshi Kawamura, Aki Mabuchi, Ryo Yamamoto, Shusaku Hayashi, Takeshi Kanagawa, Nobuaki Mitsuda
AIM: Iatrogenic premature rupture of membrane (PROM) is one of the major complications related to fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS). However, amniotic fluid leakage (AFL) sometimes spontaneously disappears. This study evaluated the incidence and clinical characteristics of transient AFL after FLP. METHODS: We retrospectively reviewed pregnancies that underwent FLP for TTTS at a single center. Patients with apparent AFL within 2 weeks after FLP were divided into two groups: transient AFL, defined by the disappearance of fluid leakage within a week; and PROM, if AFL persisted continuously for more than a week or premature birth occurred, including miscarriage, within a week of the first symptom of AFL...
October 13, 2017: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/29024208/does-the-site-of-the-cord-insertion-increase-the-risk-of-adverse-outcome-twin-to-twin-transfusion-syndrome-and-discordant-growth-in-monochorionic-twin-pregnancies
#13
Isabel Couck, Nada Mourad Tawfic, Jan Deprest, Luc De Catte, Roland Devlieger, Liesbeth Lewi
BACKGROUND: It is insufficiently known to what degree the site of the cord insertions influences the risk of a complicated outcome in monochorionic twin pregnancies. OBJECTIVES: The purpose is to examine if the site of cord insertions as determined on prenatal ultrasound scan increases the risk of adverse outcome -defined as fetal or neonatal loss or birth prior to 32 weeks-, twin-to-twin transfusion syndrome (TTTS) and discordant growth. METHODS: We retrospectively studied a consecutive cohort of monochorionic diamniotic twin pregnancies followed from the first trimester...
October 11, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29020780/-selective-feticide-in-monochorionic-twin-pregnancies-with%C3%A2-discordant-fetal-anomalies-management-and-outcome
#14
J Vojtěch, L Hašlík, R Pock, K Běhávková, K Macková, P Hanulíková, H Heřman, L Krofta
OBJECTIVE: To analyze results and outcome after selective feticide for discordant anomalies in monochorionic twins. DESIGN: Prospective cohort study. SETTING: Fetal medicine center, Institute for the Care of Mother and Child, Praha. METHODS: Analysis of outcome of monochorionic pregnancies after intrauterine surgery for structural abnormalities between January 2013 and June 2016. RESULTS: We performed 13 intrauterine operations in monochorionic twins with structural anomalies during the period...
2017: Ceská Gynekologie
https://www.readbyqxmd.com/read/28981984/obstetrical-complications-in-dichorionic-twin-pregnancies-in-women-with-polycystic-ovary-syndrome
#15
Fjola Jonsdottir, Lisbeth Nilas, Kirsten R Andreasen, Jørgen Grinsted, Michael Christiansen, Paula L Hedley, Klara V Naver
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 AND METHODS: A retrospective study of 360 women with dichorionic twin pregnancies: 72 women with PCOS from a fertility clinic (years 1997-2010) and 288 women without PCOS from a hospital cohort (years 2005-2007)...
October 5, 2017: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/28976606/the-significance-of-placental-cord-insertion-site-in-twin-pregnancy
#16
Erkan Kalafat, Basky Thilaganathan, Aris Papageorghiou, Amar Bhide, Asma Khalil
OBJECTIVE: The aim of this study was to investigate the association between abnormal cord insertion and the development of the twin-specific complications, including birthweight discordance, selective fetal growth restriction (sFGR) and twin-to-twin transfusion syndrome (TTTS). METHODS: A single-center cohort study of twin pregnancies. Abnormal cord insertion was defined as either marginal (cord attachment site less than 2cm to the nearest margin of the placental disc) or velamentous (when the umbilical cord was attached to the membrane before reaching the placental disc with clear evidence of vessels traversing the membranes to connect with the placental disc), as described in placental pathology reports...
October 4, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28969512/placental-histopathology-differences-and-neonatal-outcome-in-dichorionic-diamniotic-as-compared-to-monochorionic-diamniotic-twin-pregnancies
#17
Eran Weiner, Elad Barber, Ohad Feldstein, Ann Dekalo, Letizia Schreiber, Jacob Bar, Michal Kovo
OBJECTIVE: We aimed to compare the differences in placental histopathology lesions and pregnancy outcome in dichorionic-diamniotic (DCDA) versus uncomplicated monochorionic-diamniotic (MCDA) twin gestations. STUDY DESIGN: Maternal characteristics, neonatal outcome, and placental histopathology reports of all twin deliveries between 24 and 41 weeks were reviewed. Excluded were pregnancies complicated by twin-to-twin transfusion syndrome, twin anemia-polycythemia sequence, selective intrauterine growth restriction, placenta previa, intrauterine fetal death, and malformation...
January 1, 2017: Reproductive Sciences
https://www.readbyqxmd.com/read/28969220/pregnancy-outcomes-in-isolated-oligohydramnios-during-second-trimester-a-case-series
#18
Ashima Taneja, Kamaldeep Arora, Isha Chopra, Sushree Samiksha Naik
Oligohydramnios is associated with increased maternal and foetal morbidities. However, some of the recent studies have shown no adverse effect of isolated oligohydramnios on perinatal outcome and recommends continuation of pregnancy. Pregnancies between 18-28 weeks with isolated Oligohydramnios were included. History and physical examination was recorded in a pre-designed proforma. All the cases received care as per the protocol. A total of seven patients were recruited of which one was a twin pregnancy with Oligohydramnios in both sacs...
August 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28964964/expectant-management-and-laser-photocoagulation-in-isolated-selective-intra-uterine-growth-restriction-a-single-center-series
#19
A Koch, R Favre, B Viville, G Fritz, M Kohler, F Guerra, L Lecointre, A Gaudineau, B Langer, A-S Weingertner, N Sananès
INTRODUCTION: The objective was to report on a consecutive series of monochorionic diamniotic pregnancies complicated by selective Intra-Uterine Growth Restriction (sIUGR) and to describe perinatal outcomes based on whether or not there were umbilical Doppler findings, and specifically to study those pregnancies treated by laser. MATERIAL AND METHODS: This was a retrospective cohort study enrolling monochorionic diamniotic pregnancies presenting isolated sIUGR after 16 weeks' gestation (WG)...
September 28, 2017: Journal of gynecology obstetrics and human reproduction
https://www.readbyqxmd.com/read/28960292/case-report-of-a-potential-association-between-burkholderia-cepacia-and-preterm-delivery-of-a-twin-pregnancy-following-in-vitro-fertilization
#20
Stavroula Baka, Mariana Dramountani, Charalambos Karachalios, Iraklis Michaliadis, Evangelia Kouskouni, Konstantinos Panoulis
Vaginal colonization of Burkholderia cepacia was identified as a potentially complicating factor during a high-risk pregnancy. Although first described as a phytopathogen and used as a bio-pesticide, Burkholderia cepacia, an aerobic, glucose non-fermenting, multidrug-resistant Gram-negative rod, has emerged as a significant opportunistic pathogen causing severe pulmonary infections, mostly in patients who have cystic fibrosis and are immunocompromised [1]. Owing to its ability to survive and proliferate in nutrient-poor liquids and moist environments, hospital outbreaks have been associated with contaminated intravenous solutions, disinfectants, hospital equipment, and person-to-person contact [1,2]...
September 28, 2017: International Journal of Gynaecology and Obstetrics
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