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Twin pregnancy and one dead fetus

Isaac Blickstein
Single fetal death in a monochorionic twin pregnancy is more frequent than in a dichorionic twin gestation. Due to inter-twin vascular anastomosis in the monochorionic common placenta, the death of one twin causes a drop in blood pressure due to a shift of blood from the survivor to the dead fetus. If the drop of blood pressure is abrupt and serious, the survivor will die soon after (as occurs in 15% of cases). If the drop is less serious, the survivor may sustain ischemic injury (in about 26% of the cases) and if the drop in blood pressure is subtle, the survivor will be intact...
June 2017: Harefuah
Fiona L Mackie, R Katie Morris, Mark D Kilby
Perinatal mortality is increased considerably in multiple pregnancies compared to singleton pregnancies, with single intrauterine fetal demise (sIUFD) presenting a rare but unique perinatal problem. Monochorionic pregnancies are at particular risk of sIUFD due to bidirectional inter-twin placental vascular anastomoses. The resulting inter-twin blood flow can become unbalanced, causing acute and chronic inter-twin transfusion and profound anemia secondary to fetal exsanguination into the low-pressure circulation of the dead fetus...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Divya Jain, R C Purohit
AIM: To study management and maternal and fetal outcome in single fetal death in twin pregnancies. MATERIALS AND METHODS: We studied 64 (1.37 %) twin deliveries out of a total of 4,655 deliveries in GMC, Haldwani (Uttrakhand). Out of them, 5 (7.81 %) were complicated with single fetal death in the second or third trimester. These cases were managed conservatively with regular monitoring of maternal coagulation profile along with intensive fetal surveillance for the surviving twin...
June 2014: Journal of Obstetrics and Gynaecology of India
Hiroshi Sato, Hiroko Murata, Kanae Sato, Kanako Kawaharamura, Shozo Hamanishi, Masaya Hirose
PATIENT: Female, 28 FINAL DIAGNOSIS: Single intrauterine fetal death Symptoms: - MEDICATION: - Clinical Procedure: - Specialty: Obstetrics and Gynecology. OBJECTIVE: Rare disease. BACKGROUND: Single fetal death in monochorionic twin pregnancy may result in poor perinatal outcome of the surviving twin, including neurologic sequelae, other organ injury, and death. In most reported cases of poor perinatal outcome in the surviving twin, monochorionic co-twin death occured after more than 20 weeks of gestation, while few with earlier occurrence have been presented...
2013: American Journal of Case Reports
Chih-Ping Chen, Schu-Rern Chern, Yi-Yung Chen, Pei-Chen Wu, Dai-Dyi Town, Wen-Lin Chen, Wayseen Wang
OBJECTIVE: To present prenatal diagnosis and molecular cytogenetic characterization of trisomy 18 in a monozygotic twin pregnancy, with one structurally abnormal living fetus and one intrauterine fetal demise. CASE REPORT: A 38-year-old woman was referred for amniocentesis at 16 weeks of gestation because of advanced maternal age. Prenatal ultrasound revealed a monozygotic twin pregnancy, with one structurally abnormal living fetus, and one fetal demise. The body structure details of the dead fetus could not be identified, whereas holoprosencephaly and omphalocele were identified in the living fetus on prenatal ultrasound...
September 2012: Taiwanese Journal of Obstetrics & Gynecology
María de la Calle Fernández-Miranda, Mireia Cruceyra Bertriu, Roberto Rodríuez-González, Fernando Magdaleno-Dans, Félix Omeñaca Teres, Antonio González González
BACKGROUND: happens in the womb when the death of one of the twins, it is necessary to consider the factors that influence the perinatal outcome of surviving fetus. OBJECTIVE: To review the outcome of twin pregnancies complicated by single fetal intrauterine death and how it can increase morbidity to its co-twin and its mother. MATERIAL AND METHODS: A retrospective analysis of the fifty one twin pregnancies complicated by single fetal intrauterine death in the second or third trimester in our centre from December 1999 to December 2010...
April 2012: Ginecología y Obstetricia de México
L M Harper, K A Roehl, A O Odibo, A G Cahill
OBJECTIVE: To evaluate the association between first-trimester growth discordance and adverse pregnancy outcome in dichorionic twin pregnancies. METHODS: This was a retrospective cohort study of consecutive women with dichorionic twin pregnancies undergoing an ultrasound scan at our institution between 7 and 14 weeks' gestation. Study groups were defined by the presence or absence of ≥ 11% crown-rump length (CRL) discordance. Pregnancies were excluded if one twin was dead on initial ultrasound or if a termination was performed...
June 2013: Ultrasound in Obstetrics & Gynecology
Bao-sheng Zhu, Jie Su, Xiao-hong Lu, Jing He, Shu Zhu, Cun-xian Jiao, Jin-man Zhang, Xin-hua Tang, Ying Tao, Ke-Ping Lin, Hong Chen, Su-Yun Li
OBJECTIVE: To investigate key techniques and intervention in reducing birth defects. METHOD: Down's syndrome (DS), trisomy-18 (Edwards syndrome, ES), neural tube defects (NTD), Duchenne muscular dystrophy (DMD), spinal muscular atrophy (SMA), thalassemia, and glucose-6-phosphate dehydrogenase deficiency (G6PD) were chosen as target disease. From Jan. 2007 to Dec. 2009, the condition of intake folic acid were investigated in 5004 pregnant women in Panlong District and Wuhua District of Kunming City...
September 2011: Zhonghua Fu Chan Ke za Zhi
Shi-lin Zhong, Qun Fang, Bao-jiang Chen, Zhen-yan Han, Yan-min Luo, Jian-sheng Chen, Ying-jun Xie
OBJECTIVE: To investigate the clinical features of the abnormal chromosome karyotypes in twin pregnancies complicated with fetal malformations. METHODS: Totally 181 twin pregnancies (362 fetuses) in which one or two fetuses had abnormalities diagnosed by ultrasound were referred to the First Affiliated Hospital of Sun Yat-Sen University from January, 2000 to September, 2010. They were divided into different groups according to (1) maternal age: the cases with maternal age ≥ 35 were divided into advanced pregnancy group (105 fetuses), and those with maternal age < 35 were divided into young pregnancy group (203 fetuses); (2) conceived method: those conceived by assisted reproductive technology were divided into assisted reproductive group (81 fetuses), and the natural conception pregnancies were divided into natural conception group (227 fetuses); (3) chorionicity: the monochorionic twin (MCT) pregnancies were divided into MCT group (123 fetuses), and the dichorionic twin (DCT) pregnancies were divided into DCT group (185 fetuses); (4) structural abnormalities: 205 fetuses with structural abnormalities were divided into the abnormal fetal group, and 103 fetuses without structural abnormalities were divided into the normal fetal group...
September 2011: Zhonghua Fu Chan Ke za Zhi
A Daniilidis, C Sardeli, T Tantanasis, K Dinas, M Mavromichali, J Tzafettas
BACKGROUND: Intrauterine death of one twin in the second or third trimester occurs in about 1% of all twin pregnancies. The retention in utero of the dead fetus may be associated with maternal disseminated intravascular coagulation. CASE: We present the case of a diamniotic monochorionic pregnancy with intrauterine death of the first twin at 24 weeks. The pregnancy reached 33 weeks. In our case although all coagulation factors were within normal limits, D-dimer levels were significantly high, without any evidence though of any clotting problems to the mother...
2010: Clinical and Experimental Obstetrics & Gynecology
N N Mahajan, N L Gaikwad, M V Solomon, K N Mahajan, N P Kothari
In modern obstetrics, the role of internal podalic version (IPV) is limited to delivery of the second twin. A retrospective study was conducted to assess the efficacy of IPV in singleton neglected shoulder presentation with fetal demise. Women with live fetuses, previous CS or contracted pelvis were excluded. The procedure involved repositioning the prolapsed hand under anaesthetic followed by breech extraction. 12 women were identified over a 19 month period and all underwent successful IPV. One woman had a postpartum haemorrhage...
December 2009: BJOG: An International Journal of Obstetrics and Gynaecology
Waldo Sepulveda, Amy E Wong, Juan C Bustos, Ximena Flores, Juan L Alcalde
OBJECTIVE: To report our experience with the management of triplet pregnancies complicated by an acardiac fetus. METHODS: During the 5-year period from 2003 to 2008, five cases were identified. The prenatal sonographic findings, antepartum course, antenatal intervention if performed, and perinatal outcome of each case were reviewed. RESULTS: Four pregnancies were spontaneously conceived and one was achieved by in vitro fertilization. Three pregnancies were dichorionic and two were monochorionic, and two acardiac fetuses were part of a monoamniotic set...
August 2009: Prenatal Diagnosis
W Jia, W Yang, A Lei, Z Gao, C Yang, J Hua, W Huang, X Ma, H Wang, Z Dou
This report details a chimeric goat derived by injecting caprine embryonic germ (EG) cells into a host blastocyst. The EG cells, isolated from the primordial genital ridge of white Guanzhong goat fetuses (28-42 days of pregnancy), had alkaline phosphatase activity and several stem cell markers, including SSEA-1, c-kit, and Nanog. Ten to 20EG cells were microinjected into the blastocoelic cavity of a host blastocyst collected from a black goat following natural service. Twenty-nine injected blastocysts were transferred into nine white surrogate goats...
February 2008: Theriogenology
T F Crosby, A O'Donnell, J V O'Doherty, P J Quinn, A C O Evans
Twin bearing mature ewes (n=40) were treated with exogenous progesterone (100mg daily in oil) or vehicle (oil control) from Day 143 of gestation until lambing to investigate the effects on gestation length, foetal survival and colostrum yield and composition. Compared to control ewes, progesterone treated ewes had increased (P<0.05) serum progesterone concentrations (by 4.3 ng/ml) before lambing and in the first day post-partum (by 10 ng/ml). Progesterone treatment increased gestation length (150.4+/-0.6 days versus 147...
September 15, 2005: Theriogenology
Andreas Zankl, Daniela Brooks, Eugen Boltshauser, Remo Largo, Albert Schinzel
Intrauterine death of one fetus in a monochorionic twin pregnancy is associated with high morbidity and mortality in the surviving co-twin. Thromoboplastic material from the dead twin may pass to the circulation of the living twin via placental anastomoses and cause tissue necrosis by direct embolization or by activating intravascular coagulation. Alternatively, acute blood loss into the dying twin through placental anastomoses may result in hypotension and hypoxic-ischemic damage to cerebral and visceral tissue in the surviving twin...
June 1, 2004: American Journal of Medical Genetics. Part A
R Ali, F Ozkalemkaş, T Ozçelik, V Ozkocaman, U Ozan, Y Kimya, N Köksal, E Bülbül-Başkan, O Develioğlu, M Tüfekçi, A Tunali
We observed 13 pregnant women of 70 females with idiopathic thrombocytopenic purpura (ITP) from January 1992 through September 2002. Thirteen mothers with ITP gave birth to twelve babies and two fetuses died. One of the pregnancies produced twins. Seven of the cases were diagnosed with ITP before pregnancy and six during pregnancy. One of the thirteen pregnancies was complicated by preeclampsia, one by ablatio placentae, and one by intrauterine death. Seven mothers received corticosteroid treatment, four high-dose immunoglobulin therapies, and one underwent splenectomy in the second trimester of gestation...
June 2003: Annals of Hematology
T Fischer, G Wallukat, M P Schneider, D Schlembach, W Munz, V Homuth
We present a 24-year-old woman with a twin pregnancy who was with a typical HELLP syndrome at the 18th week of pregnancy. One fetus was dead, while the other was severely growth retarded. Our patient had agonistic autoantibodies directed at the angiotensin AT(1)-receptor. Termination of the pregnancy proved necessary. This report is the first to our knowledge associating HELLP syndrome with angiotensin AT(1)-receptor antibodies. Since the antibodies may have a pathogenic significance, their removal could permit the prolongation of pregnancy in preeclamptic and HELLP syndrome patients...
August 2001: European Journal of Obstetrics, Gynecology, and Reproductive Biology
T B Song, J Jeong, Y H Kim, E K Kim
Two multiple pregnancies with delayed delivery after expulsion of dead fetus are presented. Case 1: A woman with a twin pregnancy and one intrauterine fetal death at 20 weeks' gestation delivered a dead fetus at 27 weeks' gestation. She delivered a healthy male infant weighing 2430 g at 33 weeks' gestation (42 d after the delivery of the first twin). Case 2: A woman with quadruplets pregnancy (2 live fetuses, one empty sac, and one fetocide at 7 weeks' gestation) got a intrauterine fetal death at 21 weeks' gestation at one fetus among 2 live fetuses and delivered a dead fetus at 24 weeks' gestation...
April 2000: Archives of Gynecology and Obstetrics
J B Lopoo, B W Paek, G A Maichin, G S Lipshutz, R W Jennings, D L Farmer, P L Sandberg, V A Feldstein, R A Filly, J A Farrell, M R Harrison, C T Albanese
Placental vascular communications can present a life-threatening problem in monochorionic twins when one fetus has a lethal anomaly. Although selective feticide is the best option for salvaging the normal twin, techniques normally employed (i.e. intracardiac potassium, air embolism) are not prudent given the common circulatory system. Furthermore, in monoamniotic, monochorionic twin gestations it is important to transect the umbilical cord completely to prevent entanglement of the dead fetus around the cord of the normal twin...
May 2000: Fetal Diagnosis and Therapy
N Carrasquero, M Prieto-Carrasquero, C Paz
Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare cardiac congenital malformation involving the right ventricle (RV) in which the communication through pulmonary valve, is absent. A case of a congenital heart disease (CHD) consisting of pulmonary atresia with intact ventricular septum (PA/IVS) and small right ventricle (RV) or type I of Greenwold, coming from a twin pregnancy in which the other was an inutero dead fetus, is reported. Although the case was referred after the death of one of the fetuses, the prenatal diagnosis was made by the use of echocardiographic studies and confirmed by anatomopathology of the still-born fetus with the CHD...
September 1999: Investigación Clínica
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