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Complications of twin pregnancies

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https://www.readbyqxmd.com/read/27926655/maternal-morbidity-after-previable-prelabor-rupture-of-membranes
#1
Sarah K Dotters-Katz, Alexis Panzer, Matthew R Grace, Marcela C Smid, J Adeolu Keku, Catherine J Vladutiu, Kim A Boggess, Tracy A Manuck
OBJECTIVE: To identify risk factors for maternal morbidity after previable prelabor rupture of membranes (PROM). METHODS: We conducted a case-control study of singleton and twin pregnancies complicated by previable PROM (14.0-22.9 weeks of gestation) at a single tertiary care referral institution, 2000-2015. Pregnancies complicated by fetal anomalies, previable PROM within 2 weeks of chorionic villus sampling or amniocentesis, and those with contraindications to expectant management (eg, chorioamnionitis) were excluded...
December 2, 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27907899/reducing-the-number-of-fetuses-in-a-pregnancy-providers-and-patients-views-of-challenges
#2
Robert L Klitzman
STUDY QUESTION: How do patients and providers perceive and make decisions about possible reductions of multi-fetal pregnancies? SUMMARY ANSWER: Physicians may be transferring additional embryos, assuming that patients will later undergo reduction if need be; but decisions to reduce pregnancies are difficult for patients, who may agree to undergo the procedure in advance and later renege. WHAT IS ALREADY KNOWN: Implanting more than one embryo increases the likelihood that at least one embryo will successfully lead to a child but also that the patient may end up with twins or higher-order multiple births...
November 2016: Human Reproduction
https://www.readbyqxmd.com/read/27891739/acardiac-twin-pregnancies-part-iv-acardiac-onset-from-unequal-embryonic-splitting-simulated-by-a-fetoplacental-resistance-model
#3
Martin J C van Gemert, Jeroen P H M van den Wijngaard, K Marieke Paarlberg, Helena M Gardiner, Peter G J Nikkels
BACKGROUND: Benirschke postulated that acardiac twinning occurs when markedly unequal embryonic splitting combines with arterioarterial (AA) and venovenous placental anastomoses. We tested this hypothesis by model simulations and by comparison of outcomes with 18 "pseudo-" (twin fetus with beating heart but otherwise with clear signs of an acardiac) and 3 "normal" acardiac cases. METHODS: The smaller/larger cell volume ratio at embryonic splitting becomes the smaller/larger embryonic/fetal blood volume ratio (a)...
November 28, 2016: Birth Defects Research. Part A, Clinical and Molecular Teratology
https://www.readbyqxmd.com/read/27891271/intrahepatic-cholestasis-of-pregnancy-with-severe-elevation-of-bile-acids-in-the-setting-of-acute-hepatitis-c-infection
#4
Megan L Lawlor, Agatha S Critchfield
Intrahepatic cholestasis of pregnancy (ICP) is a complication of pregnancy resulting in elevation of serum bile acid levels. ICP is often associated with underlying liver disease, including hepatitis C. Bile acids in relationship to the acute infection of hepatitis C virus have not yet been delineated in the literature. A 26-year-old gravida 4 para 2103 with dichorionic, diamniotic twin gestation and history of intravenous drug abuse developed ICP in the setting of acute hepatitis C infection. In addition to clinical symptoms of pruritus and right upper quadrant pain, she developed severe elevation in bile acids, 239 micromol/L, and transaminitis aspartate aminotransferase 1033 U/L, and alanine aminotransferase 448 U/L...
2016: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27885296/outcome-of-twin-deliveries-at-a-tertiary-care-centre-of-eastern-nepal
#5
S Chaudhary, R R Singh, G S Shah, J Agrawal, S Kafle, L Shah
BACKGROUND: Twins, compared to singletons, have higher perinatal mortality and morbidity. The aim of this study was to describe the twinning rate, epidemiological variables and hospital outcome of twin deliveries and to find out ways of better management of twins in our part. METHODS: A retrospective evaluation of the outcome of 92 twin pregnancies during one year study period (1st January 2014 to 31st December 2014) was conducted at BPKIHS. Twins delivered within the institution were included but cases less than 28 weeks gestation were excluded...
May 2016: Journal of Nepal Health Research Council
https://www.readbyqxmd.com/read/27861703/short-and-long-term-perinatal-outcome-in-twin-pregnancies-affected-by-weight-discordance
#6
Cathrine Vedel, Anna Oldenburg, Katharina Worda, Helle Larsen, Anni Holmskov, Kirsten Riis Andreasen, Niels Uldbjerg, Jan Ramb, Birgit Bødker, Lillian Skibsted, Lene Sperling, Stefan Hinterberger, Lone Krebs, Helle Zingenberg, Eva-Christine Weiss, Isolde Strobl, Lone Laursen, Jeanette Tranberg Christensen, Vibeke Ersbak, Inger Stornes, Elisabeth Krampl-Bettelheim, Ann Tabor, Line Rode
OBJECTIVE: To investigate the association between chorionicity-specific intertwin birthweight (BW) discordance and adverse outcomes including long-term follow-up at 6, 18, and 48-60 months after term via Ages and Stages Questionnaire (ASQ). MATERIAL AND METHODS: In this secondary analysis of a cohort study (Oldenburg et al,n=1688) and a randomized controlled trial (PREDICT study,n=1045) twin pairs were divided into three groups according to chorionicity-specific BW discordance; <75(th) -percentile, 75(th) -90(th) -percentile and >90(th) -percentile...
November 18, 2016: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/27825408/preterm-births-in-peking-union-medical-college-hospital-in-the-past-25-years
#7
Fang Jiang, Jin-Song Gao, Yi-Feng Zhong, Jing Hu, Jian-Qiu Yang, Liang-Kun Ma, Jun-Tao Liu
Objective To investigate the changes in preterm birth rate,its gestational age distribution,and possible contributors in Peking Union Medical College Hospital (PUMCH) over the last 25-year period. Methods The clinical data of premature deliveries,both singleton and twins,in PUMCH from January 1,1990 to December 31,2014 were retrospectively analyzed. We counted the number of premature fetuses and assessed the changes of preterm birth rate and its gestational age distribution (including extremely preterm birth,early preterm birth,and late preterm birth) over time...
October 10, 2016: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
https://www.readbyqxmd.com/read/27824942/identifying-maternal-constraints-on-fetal-growth-and-subsequent-perinatal-outcomes-using-a-multiple-embryo-implantation-model
#8
Nigel Pereira, Tyler Cozzubbo, Stephanie Cheung, Zev Rosenwaks, Gianpiero D Palermo, Queenie V Neri
INTRODUCTION: Although the majority of singleton births after in vitro fertilization (IVF) are uncomplicated, studies have suggested that IVF pregnancies may be independently associated with low birth weight (LBW), preterm birth (PTB), and perinatal mortality. These outcomes complicate multiple gestations as expected, but have also been reported in singletons. A multiple embryo implantation model allows for assessment of the early in utero environment, and therefore, assessment of any maternal constraints on developing fetuses...
2016: PloS One
https://www.readbyqxmd.com/read/27821985/perinatal-outcome-of-the-second-twin-at-a-tertiary-care-center-in-india
#9
Hiralal Konar, Madhutandra Sarkar, Joydip Paul
PURPOSE: This cross-sectional observational study was undertaken to assess perinatal outcome of the second twin in respect to gestational age, presentation, mode of delivery, and birth weight. METHODS: Seventy women with confirmed twin pregnancy were admitted and managed in a tertiary care teaching hospital in Kolkata, India from May 2008 to April 2009. All relevant data were recorded and analyzed statistically by simple proportions and χ(2) test. RESULTS: Women with frequent antenatal visits had highly favorable perinatal outcome than those with fewer or no visits in this hospital (p < 0...
December 2016: Journal of Obstetrics and Gynaecology of India
https://www.readbyqxmd.com/read/27813120/prediction-of-neonatal-outcome-of-ttts-by-fetal-heart-and-doppler-ultrasound-parameters-before-and-after-laser-treatment
#10
A Delabaere, F Leduc, Q Reboul, F Fuchs, S Wavrant, J C Fouron, F Audibert
OBJECTIVES: To determine the prognostic value of fetal Doppler and echocardiographic parameters for neonatal survival up to 30 days after laser coagulation in monochorionic pregnancies complicated by twin-twin transfusion syndrome (TTTS). METHODS: Fetal echocardiography and outcome data of consecutive cases of TTTS treated by laser were retrospectively reviewed. Hemodynamic and cardiac function parameters were collected before and after laser. RESULTS: Between February 2006 and January 2015, 106 fetoscopic laser were performed...
November 3, 2016: Prenatal Diagnosis
https://www.readbyqxmd.com/read/27805908/twin-pregnancy-in-women-above-the-age-of-45-years-maternal-and-neonatal-outcomes
#11
Tomer Avnon, Alon Haham, Ariel Many
Childbearing age continues to rise and, with the increasing implementation of assisted reproductive technology (ART), the number of multiple pregnancies has also risen. This is a retrospective cohort study on maternal and neonatal outcomes of the twin pregnancies of 57 women aged ≥45 years compared to 114 younger women who gave birth in our institution between January 2011 and August 2015. Data were extracted from the real-time computerized database. The rates of hypertensive complications and pre-eclampsia (PE) were much higher in the study group compared to the controls (24/57 vs...
November 2, 2016: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/27764900/evaluation-of-long-term-neurodevelopment-in-twin-twin-transfusion-syndrome-after-laser-therapy
#12
Nicolas Sananès, Victor Gabriele, Anne Sophie Weingertner, Rodrigo Ruano, Magdalena Sanz-Cortes, Adrien Gaudineau, Bruno Langer, Israël Nisand, Chérif Youssef Akladios, Romain Favre
OBJECTIVE: 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. METHOD: 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...
October 20, 2016: Prenatal Diagnosis
https://www.readbyqxmd.com/read/27760663/-the-prognosis-of-monochorionic-co-twin-after-single-intrauterine-fetal-demise
#13
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]
https://www.readbyqxmd.com/read/27755130/twin-pregnancy-complicated-by-selective-growth-restriction
#14
Rosemary Townsend, Asma Khalil
PURPOSE OF REVIEW: Selective intrauterine growth restriction (sIUGR) in twin pregnancies presents a complex management problem for the fetal medicine specialist. This review summarizes what is currently known about sIUGR pathophysiology, particularly in monochorionic pregnancies and looks at the results of early trials of fetal intervention in high-risk sIUGR pregnancies. RECENT FINDINGS: sIUGR in monochorionic pregnancies is due to unequal placental sharing, but the clinical outcome is determined by the characteristics of the placental vascular anastomoses...
October 15, 2016: Current Opinion in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27753589/chorioamniotic-membrane-separation-found-on-routine-testing-in-an-otherwise-asymptomatic-woman-with-late-preterm-twin-gestation
#15
Sarah M Holmen, Tiki Bakhshi, Maria M Molina, Larissa F Weir
BACKGROUND: Chorioamniotic membrane separation (CMS) is a rare finding that is commonly preceded by invasive fetal procedures. The presence of CMS can also be associated with uncommon maternal or fetal conditions as well as preterm delivery, amniotic band syndrome, umbilical cord complications, and fetal and neonatal death. It is classified as a high-risk antepartum condition due to the significant fetal morbidity and mortality that may ensue. CASE REPORT: A 40-year-old gravida 5 para 1212 at 35 weeks presented for antepartum fetal testing...
October 2016: Military Medicine
https://www.readbyqxmd.com/read/27751427/successful-treatment-with-granulocyte-colony-stimulating-factor-for-ritodrine-induced-neutropenia-in-a-twin-pregnancy
#16
Chen-Yu Wang, Yu-Ju Lai, Kwei-Shuai Hwang, Chi-Huang Chen, Mu-Hsien Yu, Huei-Tsung Chen, Her-Young Su
OBJECTIVE: Neutropenia developed after continuous intravenous infusion of ritodrine hydrochloride (Yutopar) for preterm uterine contractions in a twin pregnancy. We successfully returned the low neutrophil count to the normal range after discontinuation of infusion of ritodrine and treatment with granulocyte colony stimulating factor (G-CSF). CASE REPORT: A 34-year-old woman with twin pregnancy was treated with ritodrine for preterm uterine contractions at 27 weeks and 6 days gestation...
October 2016: Taiwanese Journal of Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27743695/oocyte-donation-recipients-of-very-advanced-age-perinatal-complications-for-singletons-and-twins
#17
Elodie Guesdon, Aurélie Vincent-Rohfritsch, Sarah Bydlowski, Pietro Santulli, François Goffinet, Camille Le Ray
OBJECTIVE: To compare maternal, obstetric, and neonatal outcomes between women who underwent oocyte donation at or after age 50 years and from 45 through 49 years. DESIGN: Single-center, retrospective cohort study. SETTING: Maternity hospital. PATIENT(S): Forty women aged 50 years and older ("older group") and 146 aged 45-49 years ("younger group"). INTERVENTION(S): Comparison between the older and younger groups, globally and after stratification by type of pregnancy (singleton/twin pregnancy)...
October 12, 2016: Fertility and Sterility
https://www.readbyqxmd.com/read/27734505/amniotic-fluid-discordance-in-monochorionic-diamniotic-twin-pregnancies-is-associated-with-increased-risk-for-twin-anemia-polycythemia-sequence
#18
Liran Hiersch, Mayan Eitan, Eran Ashwal, Boaz Weisz, Benny Chayen, Shlomo Lipitz, Yoav Yinon
OBJECTIVE: To estimate the risk for twin anemia-polycythemia sequence (TAPS) and adverse perinatal outcome in monochorionic diamniotic (MCDA) twin pregnancies with amniotic fluid discordance (AFD). METHODS: Retrospective cohort study of 34 MCDA pregnancies with AFD (intertwin difference of ≥3 cm in maximal vertical pocket measurement) without meeting the criteria for twin to twin transfusion syndrome (TTTS) or selective intrauterine growth restriction (sIUGR)...
October 12, 2016: Prenatal Diagnosis
https://www.readbyqxmd.com/read/27726479/death-of-one-twin-during-the-perinatal-period-an-interpretative-phenomenological-analysis
#19
Sarah Meaney, Paul Corcoran, Keelin O'Donoghue
BACKGROUND: Perinatal death is one of the most difficult bereavements due to the shock and profound grief experienced by parents. It has been established that such bereavement has a life-lasting impact. Twin pregnancy is associated with increased perinatal risk, with higher rates of perinatal mortality than in singleton pregnancy. OBJECTIVES: To date, few studies have examined the effect of the loss of one twin diagnosed with a congenital abnormality during pregnancy...
October 11, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27711965/measuring-circulating-placental-rnas-to-non-invasively-assess-the-placental-transcriptome-and-to-predict-pregnancy-complications
#20
REVIEW
Clare L Whitehead, Susan P Walker, Stephen Tong
Circulating nucleic acids have revolutionized prenatal diagnosis in the last decade, allowing non-invasive screening for single gene or chromosomal defects using a single sample of maternal blood. In addition to DNAs, RNAs from the placenta are released into the maternal blood from early in pregnancy and may reflect changes in gene expression occurring within the placenta. Measuring circulating RNA may therefore provide insights into the placental transcriptome without the need for invasive testing. Combined with advances in next-generation sequencing and molecular analyses, it may be possible to measure circulating RNA to improve our understanding of placental pathology and develop novel non-invasive biomarkers for pregnancy complications and monitoring high-risk pregnancies...
November 2016: Prenatal Diagnosis
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