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Complications of twin pregnancies

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https://www.readbyqxmd.com/read/28100569/multiple-pregnancy-in-a-primigravida-with-uncorrected-pentalogy-of-fallot
#1
Pamela Partana, Jarrod Kah Hwee Tan, Ju Le Tan, Lay Kok Tan
Pentalogy of Fallot is a cyanotic congenital heart disease that has guarded prognosis without surgical intervention in infancy. Women with uncorrected defects rarely survive into childbearing age and pregnancy in this group is associated with a high rate of perinatal loss. Physiological cardiovascular changes in pregnancy can lead to maternal haemodynamic instability with subsequent adverse cardiac sequelae with or without fetal decompensation. Optimum management and pregnancy outcomes in mother with uncorrected Pentalogy of Fallot and twin pregnancy have not been described in the literature...
January 18, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28095812/maternal-sepsis-complicating-arabin-cervical-pessary-placement-for-the-prevention-of-preterm-birth-a-case-report
#2
Begoña Martinez de Tejada
BACKGROUND: Preterm delivery is a major health problem and contributes to more than 50% of all neonatal and infant deaths. Recently, there has been a renewed interest in the use of cervical pessaries as a safe and effective intervention with few maternal side-effects for the prevention of preterm birth in both single and twin pregnancies. CASE PRESENTATION: A 43-year-old gravida 5, para 1 (previous preterm birth at 24 weeks) patient with an in vitro fertilization twin pregnancy had an Arabin cervical pessary placed at 19 weeks of pregnancy due to the presence of cervical funneling identified by ultrasound screening...
January 17, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28089975/in-vitro-fertilization-in-37-women-with-systemic-lupus-erythematosus-or-antiphospholipid-syndrome-a-series-of-97-procedures
#3
Pauline Orquevaux, Agathe Masseau, Véronique Le Guern, Vanessa Gayet, Danièle Vauthier, Gaelle Guettrot-Imbert, Du Le Thi Huong, Bertrand Wechsler, Nathalie Morel, Patrice Cacoub, Jean-Loup Pennaforte, Jean-Charles Piette, Nathalie Costedoat-Chalumeau
OBJECTIVE: To compile and assess data about complication and success rates for in vitro fertilization (IVF) of women with systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). To date, such data are sparse. METHODS: This retrospective study described women with SLE and/or APS who have had at least 1 IVF cycle. RESULTS: Thirty-seven women with SLE (n = 23, including 8 with antiphospholipid antibodies), SLE with APS (n = 4), or primary APS (n = 10) underwent 97 IVF procedures...
January 15, 2017: Journal of Rheumatology
https://www.readbyqxmd.com/read/28079866/outcomes-of-twin-pregnancies-complicated-by-gestational-diabetes-a-meta-analysis-of-observational-studies
#4
R T McGrath, S L Hocking, E S Scott, S K Seeho, G R Fulcher, S J Glastras
OBJECTIVE: Gestational diabetes mellitus (GDM) in singleton pregnancy is associated with large for gestational age neonates and adverse perinatal outcomes; however, the impact of GDM in twin pregnancy is unclear. Thus, the aim of this study is to assess the perinatal outcomes of twin pregnancies complicated by GDM by performing a meta-analysis of observational studies. STUDY DESIGN: Studies investigating GDM in twin pregnancy were identified through an online search of three databases: Medline, Embase and Web of Science...
January 12, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28033658/multiple-exposures-to-environmental-pollutants-and-oxidative-stress-is-there-a-sex-specific-risk-of-developmental-complications-for-fetuses
#5
REVIEW
Kaïs H Al-Gubory
Medically assisted procreation significantly contributes to an increase in twin pregnancies. One of the major factors contributing to more twin births is the use of fertility treatments. Twin pregnancy is not without a risk for fetal organ development and the health outcome of new-borns, children, and adults. Multiple pregnancies are associated with an increased risk of developmental complications, such as perinatal mortality, premature births, and low birth weight. Oxidative stress is involved in pregnancy disorders such as abortion, intrauterine growth retardation, and prenatal mortality...
December 2016: Birth Defects Research. Part C, Embryo Today: Reviews
https://www.readbyqxmd.com/read/28029461/-prevention-of-preterm-birth-by-uterine-cervical-cerclage
#6
L Marcellin
OBJECTIVE: To review the scientific literature on cervical insufficiency and indications of cervical cerclage cervix. MATERIALS AND METHODS: The PubMed database, the Cochrane Library and the recommendations from the French and international obstetrical societies between 1972 and June 2016 have been consulted. RESULTS: Cervical insufficiency is a pathophysiological concept and to date no consensual definition is available: the diagnosis is clinical and discussed retrospectively in case of patients with a history of late miscarriages and/or spontaneous preterm delivery, with asymptomatic dilatation of the cervix (professional consensus)...
October 29, 2016: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
https://www.readbyqxmd.com/read/28017976/acute-abdomen-in-the-17th-week-of-twin-pregnancy-due-to-ovarian-torsion-a-late-complication-of-ivf
#7
D Habek, R Bauman, L Rukavina Kralj, T Hafner, T Turudic, S Vujisic
Background: A 32-year-old woman with tubal factor infertility due to bilateral laparoscopic salpingectomy conceived twins with in vitro fertilization (IVF). She developed moderate ovarian hyperstimulation syndrome which was treated with anticoagulant therapy. The subsequent course of the twin pregnancy was normal until the 17th week of gestation when she presented to hospital because of a sharp pain in the right lower abdomen which ceased after admission. Case: Except for a single incident of vomiting, patient had no other subjective symptoms...
December 2016: Geburtshilfe und Frauenheilkunde
https://www.readbyqxmd.com/read/28009308/-twin-to-twin-transfusion-syndrome-the-possibility-of-latent-flow-case-report
#8
E Kamyshanskiy, O Kostyleva, S Musabekova, M Tussupbekova, I Kopobaeva
The early diagnosis of the Twin-To-Twin transfusion syndrome (TTTS) carries benefits of the better survivor for the fetus-donor; but at the same time there are obvious practical impediments to diagnose the condition earlier in the course of a pregnancy. That's why this particular problem in practical medicine requires in depth investigation to clarify casual factors, and specify tactical approach to the prospective patients which in turn will lead to prevention of the fetal death and damage and improvement of fetal survivor in any form of TTTS...
November 2016: Georgian Medical News
https://www.readbyqxmd.com/read/28003676/a-case-of-refractory-systemic-capillary-leak-syndrome-clarkson-s-disease-during-pregnancy
#9
Yukiko Hikasa, Masao Hayashi, Satoshi Suzuki, Hiroshi Morimatsu
A 32-year-old woman, pregnant with twins, presented with a chief complaint of general fatigue. Her general condition had rapidly deteriorated since her last visit to the primary obstetrician; the patient was then referred to our hospital because of suspected fetal death. She underwent emergency cesarean section because fetal death had indeed occurred, and she was then admitted to the intensive care unit (ICU). On ICU admission, she was found to be in shock. Laboratory analysis revealed extreme hemoconcentration and a low albumin level, and initially, septic shock with obstetric complications was suspected...
December 2016: Acta Medica Okayama
https://www.readbyqxmd.com/read/27994991/dynamics-of-a-pregnancy-when-two-become-four-a-case-report-and-literature-review
#10
Murid Javed, Nareman Altorairi, Hamad Alsufyan
The incidence of pregnancies with multiple gestational sacs has increased with the use of assisted reproductive technology because more than one embryo is frequently transferred. The splitting of one or more embryos further complicates the pregnancy. Some of these complications include intrauterine fetal death, growth restriction, discordant birth weight, and preterm delivery. Monozygotic twins suffer from a few unique complications including twin-twin transfusion syndrome, twin reversed arterial perfusion sequence, and twin anemia-polycythemia sequence...
November 11, 2016: Curēus
https://www.readbyqxmd.com/read/27958258/case-of-twin-pregnancy-complicated-by-idiopathic-thrombocytopenic-purpura-treated-with-intravenous-immunoglobulin-review-of-the-literature
#11
W X Zhao, X F Yang, J H Lin
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 by recurrent very low platelets, and gave birth to preterm twins. This patient received multiple courses of intravenous immunoglobulin (IVIG) and showed a significant platelet count improvement with IVIG therapy...
January 2017: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/27926655/maternal-morbidity-after-previable-prelabor-rupture-of-membranes
#12
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...
January 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27907899/reducing-the-number-of-fetuses-in-a-pregnancy-providers-and-patients-views-of-challenges
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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