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Vincenzo Berghella, Lorraine Dugoff, Jack Ludmir
OBJECTIVES: To evaluate if cervical pessary placement prevents PTB in twin gestations with a short midtrimester transvaginal ultrasound (TVU) cervical length (CL). METHODS: Multicenter randomized controlled trial of asymptomatic women with twin gestations with a TVU CL ≤30 mm at 18(0) -27(6) weeks. TVU CL screening was performed at the time of the anatomy scan at 18(0) -23(6) , and at subsequent scheduled ultrasounds prior to 28 weeks. Women with a TVU CL ≤30 mm at 18(0) -27(6) weeks were randomized to receive the Bioteque cup cervical pessary or no pessary...
February 7, 2017: Ultrasound in Obstetrics & Gynecology
Hidenori Machino, Takayuki Iriyama, Toshio Nakayama, Atsushi Komatsu, Takeshi Nagamatsu, Yutaka Osuga, Tomoyuki Fujii
Monochorionic monoamniotic (MM) twin pregnancy carries a high risk of intrauterine fetal death (IUFD). Single IUFD in an MM twin pregnancy prior to 22 weeks of gestation has been reported to be strongly correlated with double twin demise. To our knowledge, there are no case reports on the natural course of a surviving co-twin in an MM twin pregnancy resulting in live birth after a single IUFD prior to 22 weeks of gestation. Here, we report a case of a surviving co-twin, after a single IUFD at 21 weeks of gestation in a MM twin pregnancy, with an antenatal diagnosis of renal hypoplasia and severe neurological damage leading to porencephaly, and live birth at 36 weeks of gestation...
January 2017: Oxford Medical Case Reports
Dick Oepkes, Marieke Sueters
Multiple pregnancies occur either spontaneously or because of assisted reproduction techniques in 1-3% of pregnancies. The presence of more than one fetus in the womb is associated with a range of possible complications, both for the mother and fetuses. Early detection of these complications followed by timely and appropriate management will reduce the risk of adverse outcomes. The techniques, skills, and experience for timely detection of complications and managing them appropriately require sufficient training and exposure...
January 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
Sumaiya Adam, Hennie Lombaard, Careni Spencer
Pena-Shokeir phenotype is a rare disorder. However, its etiology is incompletely understood. It may be familial or may be due to anoxic-ischemic etiology. Although rare, it can affect one twin in a monoamniotic pregnancy, most likely due to early cord entanglement.
October 2016: Clinical Case Reports
Y Wang, Y Wei, P B Yuan, X J Wang, Y Y Zhao
Objective: To analyze the prognosis of surviving monochorionic co-twin after single intrauterine fetal demise (sIUFD). Methods: Retrospectively analyzed the twin pregnancy cases admitted in Peking University Third Hospital between Jan 2008 and Feb 2015. We recorded perinatal characteristics, neuroimage in co-twin, and followed up the neonatal outcome. Results: 47 cases were found, including 45 cases of monochorionic diamniotic (MCDA) and 2 cases of monochorionic monoamniotic (MCMA). Median gestational age at sIUFD was 27 weeks...
October 11, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Y Sun
No abstract text is available yet for this article.
September 2016: Ultrasound in Obstetrics & Gynecology
Jennifer R King, Charlotte L Conturie, Joseph G Ouzounian, Lisa M Korst, Arlyn Llanes, Ramen H Chmait
INTRODUCTION: Umbilical cord occlusion (UCO) utilizing laser photocoagulation is often not considered an option for selective termination after 20 weeks of gestation due to reported limitations of the procedure because of umbilical cord size. We compared outcomes after laser umbilical cord occlusion (L-UCO) before and after 20 weeks of gestation. MATERIALS AND METHODS: We examined all patients with monochorionic- diamniotic twins and higher-order multiples (monoamniotic excluded) that underwent L-UCO at our facility between 2006 and 2014...
August 31, 2016: Fetal Diagnosis and Therapy
Meena Khandelwal, Vanitha B Revanasiddappa, Sindy C Moreno, Gunda Simpkins, Stuart Weiner, Thomas Westover
INTRODUCTION: Current ACOG technical bulletin #144, 2014 states "Women with monoamniotic twin gestations should undergo cesarean delivery to avoid an umbilical cord complication of the nonpresenting twin at the time of the initial twin's delivery." To assess feasibility of vaginal delivery, we compared neonatal outcomes after attempted VD versus planned cesarean delivery (CD). METHODS: This retrospective cohort study from 2 tertiary-care centers, reviewed all viable MoMo twin pregnancies beyond 24 weeks gestation, delivered over last 15 years...
May 2016: Obstetrics and Gynecology
A C Engels, S Haide, K Schanz, J Knabl, F Bartzsch, F Kainer
INTRODUCTION: Monoamniotic twins are considered a cause of high-risk pregnancies. Thereby, discordant malformations do occur rarely. A discordant exencephaly has been described in only a few cases. Transcervical embryoscopy can be performed in cases of monoamniotic twins with missed abortion directly before the abort-curettage. CASE REPORT: The case of a 35-year-old G1/P0 women in the 12(th) week of pregnancy is described. She had a monoamniotic twin pregnancy with discordant exencephaly and missed abortion diagnosed at 11+2 weeks...
June 2016: Zeitschrift Für Geburtshilfe und Neonatologie
Nathan S Fox, Simi Gupta, Jennifer Lam-Rachlin, Andrei Rebarber, Chad K Klauser, Daniel H Saltzman
OBJECTIVE: To evaluate cervical pessary as an intervention to prevent preterm birth in twin pregnancies with a short cervix. METHODS: This was a retrospective cohort study of twin pregnancies managed by a single maternal-fetal medicine practice from 2005 to 2015. We included patients at 28 weeks of gestation or less who were diagnosed with a cervical length less than 20 mm. At the time of diagnosis, all patients were prescribed vaginal progesterone. Starting in 2013, they were also offered pessary placement in addition to vaginal progesterone...
April 2016: Obstetrics and Gynecology
Rika Sugibayashi, Katsusuke Ozawa, Masahiro Sumie, Seiji Wada, Yushi Ito, Haruhiko Sago
OBJECTIVE: To report the pregnancy outcomes of patients with twin reversed arterial perfusion (TRAP) sequence treated by radiofrequency ablation (RFA). METHODS: This was a retrospective study of TRAP sequences treated in a single center between March 2002 and February 2015. Forty patients underwent RFA with expandable tines through a multistep coagulation method between 15 and 26 gestational weeks. The primary outcome was neonatal survival to discharge. RESULTS: The overall survival of the pump twin was 85%...
May 2016: Prenatal Diagnosis
Felipe Tudela, Simi Gupta, Andrei Rebarber, Daniel H Saltzman, Chad K Klauser, Nathan S Fox
OBJECTIVE: We sought to assess the association between maternal height and the risk of preterm birth, fetal growth restriction and mode of delivery in twin gestations. STUDY DESIGN: Cohort study of patients with twin pregnancies delivered from 2005 to 2014. We compared pregnancy outcomes between patients of short stature ≤159 cm to those of normal stature ≥160 cm. Patients with monoamniotic twins and major fetal anomalies were excluded. Pearson's correlation, Chi-square and Student's t-test were used as appropriate...
December 2016: Journal of Maternal-fetal & Neonatal Medicine
Sohyun Shim, Yoon-Mi Hur, Da Hee Kim, Seok Ju Seong, Mi-La Kim, Joong Sik Shin
The present article aimed to evaluate the impact of congenital Müllerian anomalies (MA) on twin pregnancy after 24 gestational weeks in Korean women. All records of twin pregnancies in a large maternity hospital in Korea between January 2005 and July 2013 were analyzed. Patients with monochorionic monoamniotic (MCMA) twins, non-Korean patients, patients with twins delivered prior to 24 gestational weeks, and patients with miscarriage of one fetus or intrauterine fetal death (IUFD) before 24 gestational weeks were excluded from data analysis...
April 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Amanda Roman, Burton Rochelson, Pasquale Martinelli, Gabriele Saccone, Kemoy Harris, Noelia Zork, Melissa Spiel, Karen O'Brien, Ilia Calluzzo, Kristy Palomares, Todd Rosen, Vincenzo Berghella, Adiel Fleischer
BACKGROUND: Cervical dilation in the second trimester is associated with a greater than 90% rate of spontaneous preterm birth and a poor perinatal prognosis. OBJECTIVE: To compare the perinatal outcomes of twin pregnancies with dilated cervix in women who underwent either cerclage or expectant management. STUDY DESIGN: Retrospective cohort study of asymptomatic twin pregnancies identified with cervical dilation of ≥1 cm at 16-24 weeks (1997-2014) at 7 institutions...
July 2016: American Journal of Obstetrics and Gynecology
Bettina Paek, Melissa Dorn, Martin Walker
BACKGROUND: The diagnosis of twin-to-twin transfusion syndrome (TTTS) usually relies the presence of polyhydramnios in one sac with concomitant oligohydramnios in the other sac in a monochorionic diamniotic twin pregnancy. However, TTTS does not always show a linear progression and may present with cardiac compromise or critically abnormal Doppler velocimetry in either fetus before fluid measurements meet the typically used cutoff. OBJECTIVE: The aim of this study was to investigate the prevalence of atypical presentations of TTTS in a population undergoing laser fetoscopy...
July 2016: American Journal of Obstetrics and Gynecology
Yuka Sato, Keisuke Ishii, Tae Yokouchi, Takeshi Murakoshi, Kenji Kiyoshi, Soichiro Nakayama, Naoto Yonetani, Nobuaki Mitsuda
INTRODUCTION: This study aimed to determine the incidences of feto-fetal transfusion syndrome (FFTS) and perinatal outcomes in triplet gestations with monochorionic placentation. MATERIALS AND METHODS: In this retrospective cohort study, we evaluated the incidences of FFTS and perinatal outcomes at 28 days of age in cases of triplet gestations with monochorionic placentation who visited our centers before 16 weeks of gestation and delivered over a period of 11 years...
2016: Fetal Diagnosis and Therapy
F A Anca, A Negru, A E Mihart, C Grigoriu, R E Bohîlțea, A Șerban
UNLABELLED: Twin pregnancy generally represents a high-risk pregnancy, but monozygous twin pregnancy is a real challenge for the obstetrician due to the serious complications that may occur during its evolution. A very rare, severe complication of monozygous twin pregnancy, which we recently dealt with in the Obstetrics and Gynecology Department of the University Emergency Hospital Bucharest, was a monochorionic monoamniotic twin pregnancy with acardiac twin (TRAP). One of the fetuses (acardiac twin) presented a rudimentary unfunctional heart or even no heart at all, underdeveloped inferior part of the body and head, being transfused by the other fetus with a normal heart (pumping twin) by one superficial arterio-arterial anastomosis through which blood pumped backwards...
October 2015: Journal of Medicine and Life
Whitney Booker, Nathan S Fox, Simi Gupta, Rachel Carroll, Daniel H Saltzman, Chad K Klauser, Andrei Rebarber
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...
November 2015: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
O Anselem, A Mephon, C Le Ray, L Marcellin, D Cabrol, F Goffinet
OBJECTIVE: 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. STUDY DESIGN: Single-centre retrospective study including all monoamniotic pregnancies managed over a 20-year period at Port-Royal Obstetrics Department, Paris, France. METHODS: 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...
November 2015: European Journal of Obstetrics, Gynecology, and Reproductive Biology
F A Anca, A Negru, A E Mihart, C Grigoriu, R E Bohîlțea
Twin pregnancies generally represent a high-risk pregnancy. However, monozygous twins are real challenges for obstetricians due to the complications that may occur. Among the particular cases of monozygous twins in the University Emergency Hospital of Bucharest, Department of Obstetrics and Gynecology, a monochorial monoamniotic pregnancy with conjoined twins has been described. These particular medical circumstances require a deeper understanding of the vascular anatomical particularities. An accurate diagnosis implies a most detailed description of the morphological dynamics of the fetuses with the study of the impact of the vascular anomaly on their development so that the maximum chances of survival and the best outcome for the viable fetus can be obtained...
2015: Journal of Medicine and Life
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