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Liu S, Xu Q, Liu D, Li Q, Qian J, Zhang B, Chen X. Pregnancy and obstetric outcomes of dichorionic triamniotic triplet pregnancies with selective foetal reduction after assisted reproductive technology. Reprod Biol Endocrinol 2024; 22:30. [PMID: 38491531 PMCID: PMC10941449 DOI: 10.1186/s12958-024-01199-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND It is generally beneficial and recommended that dichorionic triamniotic (DCTA) triplet pregnancies be reduced to monochorionic (MC) twin or singleton pregnancies after assisted reproductive technology (ART). However, some infertile couples still have a firm desire to retain twins. For this reason, the best foetal reduction strategies need to be available for infertile couples and clinicians. Given that data on the elective reduction of DCTA triplet pregnancies to twin pregnancies are scarce, we investigated the outcomes of elective reduction of DCTA triplet pregnancies through the retrospective analysis of previous data. METHOD Patients with DCTA triplet pregnancies who underwent elective foetal reduction between January 2012 and June 2020 were recruited. A total of 67 eligible patients with DCTA triplet pregnancies were divided into two groups: a DCTA-to-dichorionic diamniotic (DCDA) twin group (n = 38) and a DCTA-to-monochorionic diamniotic (MCDA) twin group (n = 29); the basic clinical data of the two groups were collected for comparison. RESULTS Compared with the DCDA-to-MCDA twin group, the DCTA-to-DCDA twin group had lower rates of complete miscarriage (7.89% versus 31.03%, p = 0.014), early complete miscarriage (5.26% versus 24.14%, p = 0.034), late preterm birth (25.71% versus 65.00%, p = 0.009) and very low birth weight (0 versus 11.11%, p = 0.025). In addition, the DCTA-to-DCDA twin group had higher rates of full-term delivery (65.71% versus 25.00%, p = 0.005), survival (92.11% versus 68.97%, p = 0.023), and taking the babies home (92.11% versus 68.97%, p = 0.023) than did the DCTA-to-MCDA twin group. In terms of neonatal outcomes, a significantly greater gestational age (38.06 ± 2.39 versus 36.28 ± 2.30, p = 0.009), average birth weight (3020.77 ± 497.33 versus 2401.39 ± 570.48, p < 0.001), weight of twins (2746.47 ± 339.64 versus 2251.56 ± 391.26, p < 0.001), weight of the larger neonate (2832.94 ± 320.58 versus 2376.25 ± 349.95, p < 0.001) and weight of the smaller neonate (2660.00 ± 345.34 versus 2126.88 ± 400.93, p < 0.001) was observed in the DCTA-to-DCDA twin group compared to the DCTA-to-MCDA twin group. CONCLUSION The DCTA-to-DCDA twin group had better pregnancy and neonatal outcomes than the DCTA-to-MCDA twin group. This reduction approach may be beneficial for patients with dichorionic triamniotic triplet pregnancies who have a strong desire to have DCDA twins.
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Affiliation(s)
- Shuhua Liu
- Department of Obstetrics and Gynecology, Hefei Maternity Child Health Hospital, Hefei, 230000, China.
- Department of Obstetrics and Gynecology, Anhui Women and Children's Medical Center, Hefei, 230000, China.
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China.
| | - Qianhua Xu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
| | - Dehong Liu
- Department of Obstetrics and Gynecology, Hefei Maternity Child Health Hospital, Hefei, 230000, China
- Department of Obstetrics and Gynecology, Anhui Women and Children's Medical Center, Hefei, 230000, China
| | - Qiuru Li
- Department of Obstetrics and Gynecology, Hefei Maternity Child Health Hospital, Hefei, 230000, China
- Department of Obstetrics and Gynecology, Anhui Women and Children's Medical Center, Hefei, 230000, China
| | - Jingyu Qian
- Department of Obstetrics and Gynecology, Hefei Maternity Child Health Hospital, Hefei, 230000, China
- Department of Obstetrics and Gynecology, Anhui Women and Children's Medical Center, Hefei, 230000, China
| | - Bin Zhang
- Department of Obstetrics and Gynecology, Hefei Maternity Child Health Hospital, Hefei, 230000, China.
- Department of Obstetrics and Gynecology, Anhui Women and Children's Medical Center, Hefei, 230000, China.
| | - Xianxia Chen
- Department of Obstetrics and Gynecology, Hefei Maternity Child Health Hospital, Hefei, 230000, China.
- Department of Obstetrics and Gynecology, Anhui Women and Children's Medical Center, Hefei, 230000, China.
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Getachew T, Negash A, Debella A, Yadeta E, Lemi M, Balis B, Balcha T, Bekele H, Abdurke M, Alemu A, Shiferaw K, Eyeberu A. Prevalence and adverse outcomes of twin pregnancy in Eastern Africa: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:169. [PMID: 38424482 PMCID: PMC10905881 DOI: 10.1186/s12884-024-06326-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Multiple pregnancies are much more common today than they were in the past. Twin pregnancies occur in about 4% of pregnancies in Africa. Adverse pregnancy outcome was more common in twin pregnancy than in singleton pregnancy. There is no pooled evidence on the burden and adverse pregnancy outcome of twin pregnancy in eastern Africa. Thus, this systematic review and meta-analysis were conducted to assess the prevalence and adverse pregnancy outcomes of twin pregnancies. METHODS This systematic review and meta-analysis covers published and unpublished studies searched from different databases (PubMed, CINAHL (EBSCO), EMBASE, DOAJ, Web of Sciences, MEDLINE, Cochrane Library, SCOPUS, Google Scholar, and Google search). Finally, 34 studies were included in this systematic review and meta-analysis. JBI checklist was used to assess the quality of included papers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Data synthesis and statistical analysis were conducted using STATA Version 14 software. Heterogeneity and publication bias were assessed. A forest plot was used to present the pooled prevalence using the random effect model. RESULTS The prevalence of twin pregnancy in eastern Africa was 3% [95% CI: 2, 3]. The adverse pregnancy outcomes like neonatal intensive care unit admission (78%), low birth weight (44%), low APGAR score (33%), prematurity (32%), stillbirth (30%), neonatal mortality (12%) and maternal complications like hypertensive disorder of pregnancy (25%), postpartum hemorrhage (7%), Cesarean section (37%), premature rupture of membrane (12%) and maternal mortality are more common among twin pregnancy than singleton pregnancy. CONCLUSION One in every 33 children born a twin in east Africa; admission to neonatal intensive care unit, low birth weight, low APGAR score, prematurity, stillbirth, neonatal mortality and maternal complications are its associated adverse birth outcomes. Since twin pregnancy is a high-risk pregnancy, special care is needed during pregnancy, labor and delivery to reduce adverse pregnancy outcomes.
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Affiliation(s)
- Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia
| | - Abraham Negash
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia.
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia
| | - Elias Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia
| | - Magersa Lemi
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia
| | - Bikila Balis
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia
| | - Tegenu Balcha
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia
| | - Habtamu Bekele
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia
| | - Mohammed Abdurke
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kasiye Shiferaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. BOX 138, Dire Dawa, Harar, Ethiopia
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Yisahak SF, Hinkle SN, Mumford SL, Grantz KL, Zhang C, Newman RB, Grobman WA, Albert PS, Sciscione A, Wing DA, Owen J, Chien EK, Buck Louis GM, Grewal J. Nutritional Intake in Dichorionic Twin Pregnancies: A Descriptive Analysis of a Multisite United States Cohort. Matern Child Health J 2024; 28:206-213. [PMID: 37934328 DOI: 10.1007/s10995-023-03802-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Twin gestations have greater nutritional demands than singleton gestations, yet dietary intakes of women with twin gestations have not been well described. METHODS In a prospective, multi-site US study of 148 women with dichorionic twin gestations (2012-2013), we examined longitudinal changes in diet across pregnancy. Women completed a food frequency questionnaire during each trimester of pregnancy. We examined changes in means of total energy and energy-adjusted dietary components using linear mixed effects models. RESULTS Mean energy intake (95% CI) across the three trimesters was 2010 kcal/day (1846, 2175), 2177 kcal/day (2005, 2349), 2253 kcal/day (2056, 2450), respectively (P = 0.01), whereas the Healthy Eating Index-2010 was 63.9 (62.1, 65.6), 64.5 (62.6, 66.3), 63.2 (61.1, 65.3), respectively (P = 0.53). DISCUSSION Women with twin gestations moderately increased total energy as pregnancy progressed, though dietary composition and quality remained unchanged. These findings highlight aspects of nutritional intake that may need to be improved among women carrying twins.
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Affiliation(s)
- Samrawit F Yisahak
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stefanie N Hinkle
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sunni L Mumford
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine L Grantz
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Cuilin Zhang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality, National University of Singapore, Singapore, Singapore
| | - Roger B Newman
- Division of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - William A Grobman
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul S Albert
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | | | - Deborah A Wing
- University of California, Irvine and Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - John Owen
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward K Chien
- Women and Infants Hospital of Rhode Island, Providence, RI, USA
| | | | - Jagteshwar Grewal
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
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Dhamrait G, O'Donnell M, Christian H, Taylor CL, Pereira G. Interpregnancy interval and adverse birth outcomes: a population-based cohort study of twins. BMC Pregnancy Childbirth 2024; 24:96. [PMID: 38297231 PMCID: PMC10832241 DOI: 10.1186/s12884-023-06119-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 11/10/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND To investigate associations between interpregnancy intervals (IPIs) and adverse birth outcomes in twin pregnancies. METHODS This retrospective cohort study of 9,867 twin pregnancies in Western Australia from 1980-2015. Relative Risks (RRs) were estimated for the interval prior to the pregnancy (IPI) as the exposure and after the pregnancy as a negative control exposure for preterm birth (< 37 weeks), early preterm birth (< 34 weeks), small for gestational age (SGA: < 10th percentile of birth weight by sex and gestational age) and low birth weight (LBW: birthweight < 2,500 g). RESULTS Relative to IPIs of 18-23 months, IPIs of < 6 months were associated with a higher risk of early preterm birth (aRR 1.41, 95% CI 1.08-1.83) and LBW for at least one twin (aRR 1.16, 95% CI 1.06-1.28). IPIs of 6-11 months were associated with a higher risk of SGA (aRR 1.24, 95% CI 1.01-1.54) and LBW for at least one twin (aRR 1.09, 95% CI 1.01-1.19). IPIs of 60-119 months and ≥ 120 months were associated with an increased risk of preterm birth (RR 1.12, 95% CI 1.03-1.22; and (aRR 1.25, 95% CI 1.10-1.41, respectively), and LBW for at least one twin (aRR 1.17, 95% CI 1.08-1.28; and aRR 1.20, 95% CI 1.05-1.36, respectively). IPIs of ≥ 120 months were also associated with an increased risk of early preterm birth (aRR 1.42, 95% CI 1.01-2.00). After negative control analysis, IPIs ≥ 120 months remained associated with early preterm birth and LBW. CONCLUSION Evidence for adverse associations with twin birth outcomes was strongest for long IPIs.
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Affiliation(s)
- Gursimran Dhamrait
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, PO Box 855, West Perth, Nedlands, Western Australia, 6872, Australia.
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia.
| | - Melissa O'Donnell
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, PO Box 855, West Perth, Nedlands, Western Australia, 6872, Australia
- Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
| | - Hayley Christian
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, PO Box 855, West Perth, Nedlands, Western Australia, 6872, Australia
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Catherine L Taylor
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, PO Box 855, West Perth, Nedlands, Western Australia, 6872, Australia
- Centre for Child Health Research, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Gavin Pereira
- Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, PO Box 855, West Perth, Nedlands, Western Australia, 6872, Australia
- Curtin School of Population Health, Curtin University, Perth, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
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Molin J, Paerregaard MM, Pihl C, Thygesen CB, Pietersen A, Dannesbo S, Norsk JB, Raja AA, Vøgg ROB, Sillesen AS, Iversen KK, Bundgaard H, Christensen AH. Cardiac findings in newborn twins. Acta Paediatr 2023; 112:2050-2059. [PMID: 36513612 DOI: 10.1111/apa.16626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
AIMS To evaluate cardiac findings in newborn twins from the general population and investigate if newborn twins may require systematic evaluation of cardiac parameters. METHODS Prospective cohort study of newborns with cardiac evaluation performed during the first month of life. Cardiac findings were compared 1:3 with matched singletons. RESULTS We included 412 newborn twins (16% monochorionic; 50% boys) and 1236 singletons. Comparing cardiac findings showed twins had an increased prevalence of non-severe structural heart disease (most common: ventricular septal defects in both groups), thinner left ventricular posterior wall in diastole (LVPWd; 1.82 vs. 1.87 mm, p = 0.02), smaller diameter of the left atrium (10.6 vs. 11.1 mm, p = 0.04), higher heart rate (148 vs. 144 bpm, p = 0.04), more left-shifted QRS axis (106 vs. 111°, p < 0.001), and lower maximum R-wave amplitude in V1 (927 vs. 1015 μV, p = 0.02) compared to singletons. After multifactorial adjustment for potential confounders, the effect of twinning on cardiac parameters persisted only for LVPWd (p < 0.05). CONCLUSION Despite contemporary surveillance, we found an increased prevalence of non-severe structural heart disease in a population-based cohort of newborn twins. However, the effect of twinning on cardiac parameters was modest and generally did not persist after correction for likely confounding factors.
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Affiliation(s)
- Julie Molin
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Munk Paerregaard
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Pihl
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Caroline Boye Thygesen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Adrian Pietersen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sofie Dannesbo
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jakob Boesgaard Norsk
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Axelsson Raja
- The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ruth Ottilia B Vøgg
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alex Hørby Christensen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Joya RM, Cottrell L, Kiefer A, Polak MJ. Diagnosis-Related Group Weight and Derived Case Mix Index to Assess the Complexity among Twins. Am J Perinatol 2022; 39:1223-1228. [PMID: 33378771 PMCID: PMC8385677 DOI: 10.1055/s-0040-1721847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Diagnosis-related groups (DRGs) are used to summarize hospital morbidity and mortality. Each DRG has a weight which is important in calculating the case mix index (CMI), a numeric summary of disease complexity in a population of patients. We utilized DRG weight and resultant CMI to compare postnatal outcomes among singletons versus monochorionic and monoamniotic, monochorionic diamniotic, and dichorionic diamniotic twins. STUDY DESIGN This single-center and retrospective cohort study evaluated DRGs assigned by the investigators, birth weight, gestational age, length of stay (LOS), NICU admission rate, and mortality in twin births between 2014 and 2016. Twins were analyzed depending on chorionicity and amnionicity. Overall, 3 months of singleton births served as the control. The CMI derived from DRG weights were compared across groups. RESULTS Twins (n = 288) had lower gestational ages and birth weights and higher mortality, LOS, NICU admission rates and DRG weights/CMI compared with singletons (n = 327; p < 0.001 for each). The LOS was no different between twin subtypes; monochorionic monoamniotic twins had the highest mortality and DRG weight (p < 0.001). CONCLUSION DRG weight and CMI values summarize in-hospital complexity and can be a useful tool to evaluate differences in care complexity among groups of patients. KEY POINTS · Using diagnosis-related group and case mix index to assess morbidities.. · Morbidities of twins are monochorionic-monoamniotic versus monochorionic-diamniotic versus dichorionic-diamniotic twins.. · Only seven diagnosis-related group in neonatology make it a valuable tool for clinicians..
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Affiliation(s)
- Rikizam M. Joya
- Departments of Neonatology and Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Autumn Kiefer
- Departments of Neonatology and Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Mark J. Polak
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
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Ercan I, Dincgez B, Uzunoglu A, Yenigul NN. Evaluation of the predictive role of anterior uterocervical angle in preterm labor in twin gestation through meta-analysis: anterior uterocervical angle and preterm labor in twin gestation. J Gynecol Obstet Hum Reprod 2022; 51:102397. [PMID: 35487404 DOI: 10.1016/j.jogoh.2022.102397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/24/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Ilker Ercan
- Uludag University, Faculty of Medicine, Department of Biostatistics, Bursa, Turkey
| | - Burcu Dincgez
- University of Health Sciences, Bursa Yuksek Ihtisas Research and Training Hospital, Department of Obstetrics and Gynecology, Bursa, Turkey.
| | - Arda Uzunoglu
- Uludag University, Faculty of Medicine, Department of Biostatistics, Bursa, Turkey
| | - Nefise Nazlı Yenigul
- University of Health Sciences, Bursa Yuksek Ihtisas Research and Training Hospital, Department of Obstetrics and Gynecology, Bursa, Turkey
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van Dongen J, Gordon SD, McRae AF, Odintsova VV, Mbarek H, Breeze CE, Sugden K, Lundgren S, Castillo-Fernandez JE, Hannon E, Moffitt TE, Hagenbeek FA, van Beijsterveldt CEM, Jan Hottenga J, Tsai PC, Min JL, Hemani G, Ehli EA, Paul F, Stern CD, Heijmans BT, Slagboom PE, Daxinger L, van der Maarel SM, de Geus EJC, Willemsen G, Montgomery GW, Reversade B, Ollikainen M, Kaprio J, Spector TD, Bell JT, Mill J, Caspi A, Martin NG, Boomsma DI. Identical twins carry a persistent epigenetic signature of early genome programming. Nat Commun 2021; 12:5618. [PMID: 34584077 PMCID: PMC8479069 DOI: 10.1038/s41467-021-25583-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/19/2021] [Indexed: 02/08/2023] Open
Abstract
Monozygotic (MZ) twins and higher-order multiples arise when a zygote splits during pre-implantation stages of development. The mechanisms underpinning this event have remained a mystery. Because MZ twinning rarely runs in families, the leading hypothesis is that it occurs at random. Here, we show that MZ twinning is strongly associated with a stable DNA methylation signature in adult somatic tissues. This signature spans regions near telomeres and centromeres, Polycomb-repressed regions and heterochromatin, genes involved in cell-adhesion, WNT signaling, cell fate, and putative human metastable epialleles. Our study also demonstrates a never-anticipated corollary: because identical twins keep a lifelong molecular signature, we can retrospectively diagnose if a person was conceived as monozygotic twin.
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Affiliation(s)
- Jenny van Dongen
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development (AR&D) Research Institute, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Scott D Gordon
- Queensland Institute of Medical Research Berghofer, Brisbane, QLD, Australia
| | - Allan F McRae
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Veronika V Odintsova
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development (AR&D) Research Institute, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hamdi Mbarek
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development (AR&D) Research Institute, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Karen Sugden
- Department of Psychology and Neuroscience and Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
| | - Sara Lundgren
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | | | - Eilis Hannon
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Terrie E Moffitt
- Department of Psychology and Neuroscience and Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fiona A Hagenbeek
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Catharina E M van Beijsterveldt
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jouke Jan Hottenga
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Pei-Chien Tsai
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - Josine L Min
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gibran Hemani
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Erik A Ehli
- Avera Institute for Human Genetics, Sioux Falls, SD, USA
| | - Franziska Paul
- Institute of Molecular and Cellular Biology, A*STAR, Singapore, Singapore
| | - Claudio D Stern
- Department of Cell and Developmental Biology, University College London, London, UK
| | - Bastiaan T Heijmans
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - P Eline Slagboom
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Lucia Daxinger
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Eco J C de Geus
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Gonneke Willemsen
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Grant W Montgomery
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Bruno Reversade
- Institute of Molecular and Cellular Biology, A*STAR, Singapore, Singapore
- Genome Institute of Singapore, A*STAR, Singapore, Singapore
- Medical Genetics Department, KOC University, School of Medicine, Istanbul, Turkey
| | - Miina Ollikainen
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - Jordana T Bell
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - Jonathan Mill
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Avshalom Caspi
- Department of Psychology and Neuroscience and Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nicholas G Martin
- Queensland Institute of Medical Research Berghofer, Brisbane, QLD, Australia
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development (AR&D) Research Institute, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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9
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Wertheimer A, Decter D, Borovich A, Trigerman S, Bardin R, Hadar E, Krispin E. Amniocentesis in twin gestation: the association between gestational age at procedure and complications. Arch Gynecol Obstet 2021; 305:1169-1175. [DOI: 10.1007/s00404-021-06242-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
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10
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Yeaton‐Massey A, Sparks TN, Norton ME, Jelliffe‐Pawlowski L, Currier RJ. Twin chorionicity and zygosity both vary with maternal age. Prenat Diagn 2021; 41:1074-1079. [DOI: 10.1002/pd.5997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Amanda Yeaton‐Massey
- Department of Obstetrics, Gynecology & Reproductive Sciences University of California San Francisco California USA
| | - Teresa N. Sparks
- Department of Obstetrics, Gynecology & Reproductive Sciences University of California San Francisco California USA
| | - Mary E. Norton
- Department of Obstetrics, Gynecology & Reproductive Sciences University of California San Francisco California USA
| | - Laura Jelliffe‐Pawlowski
- Preterm Birth Initiative ‐ California University of California San Francisco School of Medicine San Francisco California USA
- Department of Epidemiology and Biostatistics University of California San Francisco School of Medicine San Francisco California USA
| | - Robert J. Currier
- Department of Pediatrics University of California San Francisco School of Medicine San Francisco California USA
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11
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Yu FNY, Mak ASL, Chan NM, Siu KL, Ma TWL, Leung KY. Prospective risk of stillbirth and neonatal complications for monochorionic diamniotic and dichorionic diamniotic twins after 24 weeks of gestation. J Obstet Gynaecol Res 2021; 47:3127-3135. [PMID: 34137119 DOI: 10.1111/jog.14866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our study compared the prospective risks of intrauterine fetal death (IUFD), neonatal death (NND), perinatal death (PND), and neonatal morbidities in monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies. METHODS This retrospective cohort study included twin pregnancies who had antenatal care and delivery in a public hospital from 2011 to 2018. Exclusion criteria included monoamnionicity, one/both twin miscarriage, twin-twin transfusion syndrome, or lethal congenital abnormalities. All twins were managed in multiple pregnancy clinic with standardized protocols. Gestational age-specific IUFD, NND, PND, and neonatal morbidity rates were compared according to chorionicity. RESULTS Three hundred seventy-eight MCDA and 1282 DCDA twins were included. MCDA twins had higher risks of PND (1.9% vs. 0.7% in DCDA twins, p = 0.05), composite neonatal morbidity (p = 0.01), preterm delivery (p < 0.01), and low birth weight (p < 0.01). The prospective risk of IUFD was 0.6% and 0.4% for MCDA and DCDA twins, respectively after 34 weeks' gestation. No NND occurred among deliveries after 30 weeks. The risk of neonatal morbidity of MCDA twins fell from 22.7% at 34 weeks to 2.7% at 37 weeks (p < 0.01). For DCDA twins, the risk of morbidity fell insignificantly from 36 to 38 weeks (4.0% vs. 3.4%, p = 0.60). Logistic regression analysis suggested that the increased risk of perinatal morbidities was related to the higher rate of preterm delivery in MCDA twins rather than chorionicity. CONCLUSION With close fetal monitoring, the risk of late IUFD in twin pregnancies without major complications is low. Perinatal morbidity can be minimized by avoiding late preterm deliveries in twin pregnancies.
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Affiliation(s)
- Florrie Nga Yui Yu
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Annisa Shui Lam Mak
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Ngai Man Chan
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Kiu Lok Siu
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Teresa Wei Ling Ma
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Kwok Yin Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China.,Gleneagles Hong Kong, Hong kong Special Administrative Region, China
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12
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Vajda FJE, O'Brien TJ, Graham JE, Hitchcock AA, Perucca P, Lander CM, Eadie MJ. Twin pregnancy in women with epilepsy. Epilepsia 2020; 61:2748-2753. [PMID: 33140408 DOI: 10.1111/epi.16727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We report data from the Raoul Wallenberg Australian Register of Antiepileptic Drugs in Pregnancy (APR) to see if there are significant differences in relation to the courses and outcomes of the twin pregnancies contained in the register, as compared with the singleton ones. METHODS The APR has been under the oversight of Melbourne institutional Human Ethics Research Committees; all women enrolled in the APR have provided written informed consent. Data from the APR were transferred to a spreadsheet and then analyzed using simple statistical techniques including logistic regression. RESULTS The population studied comprised 44 twin and 2261 singleton pregnancies; thus, twin pregnancies accounted for 1.91% of all pregnancies studied. The women carrying twins tended to be older than the women with singleton pregnancies to a statistically significant extent, their pregnancies more often originated from assisted fertilization techniques, and their babies were more often delivered by cesarean section. There were no statistically significant differences in relation to antiepileptic drug (AED) therapy. Individual twins had statistically significantly lower mean birthweights than singleton babies and they were statistically significantly more often involved structurally malformed foetuses. In the first year of life, the twin pregnancies statistically significantly more often produced offspring that were affected by seizures in infancy. SIGNIFICANCE The data suggest that there may be an increased hazard of fetal malformation in the offspring of twin pregnancy in women with epilepsy, but that with contemporary standards of management of epilepsy and pregnancy, there is unlikely to be an increased hazard of seizure-affected pregnancy.
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Affiliation(s)
- Frank J E Vajda
- Department of Medicine and Neurosciences, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic, Australia.,Department of Neurology, Alfred Hospital, Melbourne, Vic, Australia.,Department of Neuroscience, Monash University, Clayton, Vic, Australia
| | - Terence J O'Brien
- Department of Neurology, Alfred Hospital, Melbourne, Vic, Australia.,Department of Neuroscience, Monash University, Clayton, Vic, Australia
| | - Janet E Graham
- Department of Medicine and Neurosciences, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic, Australia
| | - Alison A Hitchcock
- Department of Medicine and Neurosciences, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic, Australia
| | - Piero Perucca
- Department of Medicine and Neurosciences, Royal Melbourne Hospital and University of Melbourne, Parkville, Vic, Australia.,Department of Neurology, Alfred Hospital, Melbourne, Vic, Australia.,Department of Neuroscience, Monash University, Clayton, Vic, Australia
| | - Cecilie M Lander
- Royal Brisbane and Women's Hospital and School of Medicine and Biomedical Science, University of Queensland, Brisbane, Qld, Australia
| | - Mervyn J Eadie
- Royal Brisbane and Women's Hospital and School of Medicine and Biomedical Science, University of Queensland, Brisbane, Qld, Australia
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13
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Springer S, Polterauer M, Stammler-Safar M, Zeisler H, Leipold H, Worda C, Worda K. Notching and Pulsatility Index of the Uterine Arteries and Preeclampsia in Twin Pregnancies. J Clin Med 2020; 9:jcm9082653. [PMID: 32824222 PMCID: PMC7465290 DOI: 10.3390/jcm9082653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 12/02/2022] Open
Abstract
Increased uterine artery Doppler indices have been shown to be associated with preeclampsia and adverse pregnancy outcomes in singleton and twin pregnancies. At 20–22 weeks of gestation, we assessed the use of notching, the highest, lowest, and mean pulsatility index (PI), and the combination of notching and PI of the uterine arteries to screen for preeclampsia. This was done in a cohort of 380 twin pregnancies. The results showed that the combination of notching and the highest PI above the 95th centile of the uterine arteries gives the best screening characteristics for preeclampsia in twin pregnancies. We calculated sensitivities for preeclampsia for notching, highest PI, and the combination of notching and the highest PI of 50%, 45% and 91%, with specificities of 96%, 96% and 93%, respectively. The present findings demonstrate that notching, increased highest PI, and the combination of notching and the highest PI of the uterine arteries is associated with an increased risk of preeclampsia in twin pregnancies. We observed the highest sensitivity and specificity by using the combination of notching and the highest PI of the uterine arteries.
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Affiliation(s)
- Stephanie Springer
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (S.S.); (M.P.); (M.S.-S.); (H.Z.); (K.W.)
| | - Mariella Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (S.S.); (M.P.); (M.S.-S.); (H.Z.); (K.W.)
| | - Maria Stammler-Safar
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (S.S.); (M.P.); (M.S.-S.); (H.Z.); (K.W.)
| | - Harald Zeisler
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (S.S.); (M.P.); (M.S.-S.); (H.Z.); (K.W.)
| | - Heinz Leipold
- Department of Obstetrics and Gynecology, Landeskrankenhaus Klagenfurt, 9020 Klagenfurt am Wörthersee, Austria;
| | - Christof Worda
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (S.S.); (M.P.); (M.S.-S.); (H.Z.); (K.W.)
- Correspondence: ; Tel.: +43-1-40400-28220
| | - Katharina Worda
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (S.S.); (M.P.); (M.S.-S.); (H.Z.); (K.W.)
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14
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Valenzuela I, van der Merwe J, De Catte L, Devlieger R, Deprest J, Lewi L. Foetal therapies and their influence on preterm birth. Semin Immunopathol 2020; 42:501-514. [PMID: 32785752 DOI: 10.1007/s00281-020-00811-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/26/2020] [Indexed: 12/12/2022]
Abstract
Foetal therapy aims to improve perinatal survival or to prevent severe long-term handicap. Foetal medicine opens a new territory by treating the foetus as a patient. The mother has nothing to gain in terms of health benefits, yet she is inherently also undergoing treatment. In utero foetal interventions can be divided into ultrasound-guided minimally invasive procedures, fetoscopic procedures and open hysterotomy procedures, which carry an inherent risk of ruptured membranes and preterm birth. In this review, we summarise the conditions that may benefit from foetal therapy and review the current therapies on offer, each with their associated risk of ruptured membrane and preterm birth. We also look into some risk limiting and preventative strategies to mitigate these complications.
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Affiliation(s)
- Ignacio Valenzuela
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium
| | - Johannes van der Merwe
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - Luc De Catte
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - Roland Devlieger
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, United Kingdom
| | - Liesbeth Lewi
- Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium. .,Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium.
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15
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Vaughan DA, Seidler EA, Murphy LA, Cleary EG, Penzias A, Norwitz ER, Sakkas D. Double trouble? Clinic-specific risk factors for monozygotic twinning. Fertil Steril 2020; 114:587-594. [PMID: 32622657 DOI: 10.1016/j.fertnstert.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate clinic-specific risk factors for monozygotic twinning (MZT) using a large, electronic database. DESIGN Retrospective case-control study. SETTING Infertility clinics. PATIENT(S) Using an electronic medical record system, viable clinical pregnancy (confirmation of a gestational sac(s) and presence of at least one fetal pole with a heartbeat on first trimester ultrasound), data were obtained from homologous in vitro fertilization (IVF) cycles after single ET from June 1, 2004, to December 31, 2016. Monozygotic twinning was defined as a pregnancy with two fetal heartbeats on ultrasound with sex concordance at birth. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Risk factors for MZT including cycle type, method of insemination, and method of cryopreservation. RESULT(S) Of the 28,265 IVF cycles that met inclusion criteria over the study period, 8,749 (31.0%) resulted in a viable intrauterine clinical pregnancy. There were 102 (2.7%) MZT in the fresh cycle cohort and 133 (2.7%) in the frozen cycle cohort. Neither cryopreservation nor the method of cryopreservation was a significant risk factor for MZT. However, the use of sequential media was an independent risk factor for MZT in fresh, but not frozen, ETs (odds ratio = 1.72, 95% confidence interval, 1.10-2.68). Significant differences were seen in the incidence of MZT between clinics, and this difference persisted after controlling for known risk factors (clinic 0, reference; clinic 2, odds ratio = 2.22; 95% confidence interval, 1.48-3.32; clinic 3, odds ratio = 1.93; 95% confidence interval, 1.30-2.87). CONCLUSION(S) Differences in MZT rates exist between individual IVF clinics, suggesting that variations in practice patterns may contribute to this event. The present study noted the use of sequential media was an independent risk factor for fresh but not frozen cycles.
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Affiliation(s)
- Denis A Vaughan
- Boston IVF, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Emily A Seidler
- Boston IVF, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lauren A Murphy
- Boston IVF, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ekaterina G Cleary
- Center for Integration of Science and Industry, Bentley University, Waltham, Massachusetts
| | - Alan Penzias
- Boston IVF, Waltham, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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16
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Birth weight percentiles by sex and gestational age for twins born in southern China. Sci Rep 2019; 9:757. [PMID: 30679504 PMCID: PMC6345857 DOI: 10.1038/s41598-018-36758-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/22/2018] [Indexed: 11/17/2022] Open
Abstract
Mean birth weight of twins is known to be lower than that of singletons, however, southern China lacks a twin-specific birth weight reference. In this paper, we use data from the Birth Certificate System in southern China, collected between January 1st 2014 and December 31st 2017 and including 161,076 twins, to calculate sex- and gestational week-specific birth weight percentiles (the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th). We applied generalized additive models for location, scale and shape (GAMLSS) when calculating the birth weight percentiles, and calculated percentiles for monochorionic and dichorionic twins separately. We next used data collected between Jan 1st 2018 and Apr 30th 2018, encompassing 12,371 live births, to calculate the SGA and LGA ratios using birth weight references in Australia, South Korea and China (based on birth defects surveillance system) and birth weight percentiles calculated in this study. Compared to dichorionic twins, monochorionic twins had lower birth weights at 25 to 42 weeks of gestation. The calculated SGA and LGA ratios were relatively stable compared to the other references.
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17
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Kilby MD, Gibson JL, Ville Y. Falling perinatal mortality in twins in the UK: organisational success or chance? BJOG 2018; 126:341-347. [PMID: 30358075 DOI: 10.1111/1471-0528.15517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 11/28/2022]
Abstract
In June 2018, Mothers and Babies Reducing Risks through Audits and Confidential Enquiries across the UK (MBRRACE-UK) published a Perinatal Surveillance report of an audit between 2013-2016. This noted that the stillbirth rate for twins nearly halved between 2014-2016; whereas the stillbirth rate for singletons remained static. There was a statistically significant reduction in the rate of stillbirth in twins over this period from 11.07 (95% CI, 9.78-12.47) to 6.16 (95% CI, 5.20-7.24) per 1000 total births. This commentary discusses these observations, the effects of twin chorionicity, and the potential obstetric and neonatal interventions, as well as public health improvements, that may have influenced these findings.
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Affiliation(s)
- M D Kilby
- Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J L Gibson
- Maternal and Fetal Medicine, Ian Donald Fetal Medicine Centre, Queen Elizabeth University Hospital, Glasgow, UK
| | - Y Ville
- Department of Obstetrics and Gynaecology, Paris Descartes University, Paris, France.,Department of Obstetrics and Fetal Medicine, Necker-Enfants-Malades Hospital, Paris, France
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18
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Birth management and fetal outcome in multiple gestation: analysis of 1.444 births. Arch Gynecol Obstet 2017; 297:61-69. [PMID: 29018972 DOI: 10.1007/s00404-017-4559-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Since the late 1990s, controversies came up concerning the mode of delivery for multiples births. The twin birth study indicated no difference in maternal and fetal outcome between planned vaginal delivery and planned caesarean section, but did not analyze the influence of maternal and fetal characteristics or the obstetric management in vaginal birth. The purpose of this study is to analyze these parameters regarding fetal outcome. METHODS A large-scale retrospective analysis of twin births (n = 1.444) was performed at a university medical center. The analysis included pregnancy, delivery, and maternal and fetal parameters, including pH and base excess (BE) differences between the first- and second-born twin (delta pH, delta BE). RESULTS Delta pH correlated significantly with the birth interval for various positions of twins in the womb (p < 0.05). The longer the birth interval, the greater the delta pH with a lower pH of the second twin. Delta BE values were significantly correlated with the birth interval for a combination of twins in cephalic and breech presentation. Furthermore, it could be shown that higher differences in birth weight between the first/second twin are associated with higher delta pH, higher delta BE values (all p < 0.05). We found significantly decreasing delta pH values in vaginal deliveries over secondary and, finally, primary caesarean sections (p < 0.001). CONCLUSION We conclude a vaginal delivery of twin appears safe if experienced staff monitor birth weight discrepancies, birth interval, and blood values consequently. A good outcome also for the second twin delivered spontaneously is nevertheless feasible if experienced staff is available.
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19
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Vasak B, Verhagen JJ, Koenen SV, Koster MP, de Reu PA, Franx A, Nijhuis JG, Bonsel GJ, Visser GH. Lower perinatal mortality in preterm born twins than in singletons: a nationwide study from The Netherlands. Am J Obstet Gynecol 2017; 216:161.e1-161.e9. [PMID: 27729252 DOI: 10.1016/j.ajog.2016.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/16/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Twin pregnancies are at increased risk for perinatal morbidity and death because of many factors that include a high incidence of preterm delivery. Compared with singleton pregnancies, overall perinatal risk of death is higher in twin pregnancies; however, for the preterm period, the perinatal mortality rate has been reported to be lower in twins. OBJECTIVE The purpose of this study was to compare perinatal mortality rates in relation to gestational age at birth between singleton and twin pregnancies, taking into account socioeconomic status, fetal sex, and parity. STUDY DESIGN We studied perinatal mortality rates according to gestational age at birth in 1,502,120 singletons pregnancies and 51,658 twin pregnancies without congenital malformations who were delivered between 2002 and 2010 after 28 weeks of gestation. Data were collected from the nationwide Netherlands Perinatal Registry. RESULTS Overall the perinatal mortality rate in twin pregnancies (6.6/1000 infants) was higher than in singleton pregnancies (4.1/1000 infants). However, in the preterm period, the perinatal mortality rate in twin pregnancies was substantially lower than in singleton pregnancies (10.4 per 1000 infants as compared with 34.5 per 1000 infants, respectively) for infants who were born at <37 weeks of gestation; this held especially for antepartum deaths. After 39 weeks of gestation, the perinatal mortality rate was higher in twin pregnancies. Differences in parity, fetal sex, and socioeconomic status did not explain the observed differences in outcome. CONCLUSION Overall the perinatal mortality rate was higher in twin pregnancies than in singleton pregnancies, which is most likely caused by the high preterm birth rate in twins and not by a higher mortality rate for gestation, apart from term pregnancies. During the preterm period, the antepartum mortality rate was much lower in twin pregnancies than in singleton pregnancies. We suggest that this might be partially due to a closer monitoring of twin pregnancies, which indirectly suggests a need for closer surveillance of singleton pregnancies.
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20
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Long L, Yan J, Li Q, Zhou Z, Deng H, Wang C, Zou Y, Cai J. Intrauterine fetal death in triplet gestation caused by feto-fetal transfusion syndrome - a case report. Forensic Sci Res 2016; 2:213-217. [PMID: 30483645 PMCID: PMC6197143 DOI: 10.1080/20961790.2016.1264915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/21/2016] [Indexed: 10/24/2022] Open
Abstract
Feto-fetal transfusion syndrome (FFTS) severely affects monochorionic (MC) multiple pregnancies and affects 1 in 1600 pregnancies overall. The number of increasing disputed obstetrics cases in China is related to unavailability of prompt diagnosis of FFTS. We present here a woman with a MC triplet pregnancy with intrauterine fetal death at 33 weeks of gestation due to FFTS. Subsequent pathological anatomy showed that the MC placenta contained vascular anastomoses, including arterio-arterial anastomosis and arterio-venous anastomosis. These anastomoses led to unidirectional blood flow with the absence of adequate compensatory counter-transfusion and bi-directional flow. When encountering such challenging conditions, medical practitioners should discreetly compare the fetuses' characteristics with features of placental blood vessels and consult morphological and pathological findings. Furthermore, they should perform ultrasound examinations, particularly focussing on fetal size differences and the maximum vertical pocket in the diagnosis of FFTS, especially in MC multiple pregnancies with abdominal symptoms.
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Affiliation(s)
- Lingling Long
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, China
| | - Jie Yan
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, China.,Department of Forensic Pathology, Hunan Xiangya Judicial Identification Center, Changsha, China
| | - Qiyan Li
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, China
| | - Ziqi Zhou
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, China
| | - Haixiao Deng
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, China
| | - Chudong Wang
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, China
| | - Ying Zou
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, China.,Department of Forensic Pathology, Hunan Xiangya Judicial Identification Center, Changsha, China
| | - Jifeng Cai
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, China.,Department of Forensic Pathology, Hunan Xiangya Judicial Identification Center, Changsha, China
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21
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Coutinho Nunes F, Domingues AP, Vide Tavares M, Belo A, Ferreira C, Fonseca E, Moura P. Monochorionic versus dichorionic twins: Are obstetric outcomes always different? J OBSTET GYNAECOL 2016; 36:598-601. [DOI: 10.3109/01443615.2015.1116501] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Filipa Coutinho Nunes
- Obstetrics A Unit, Daniel De Matos Maternity, Coimbra Hospital and University Centre, Coimbra, Portugal,
| | - Ana Patrícia Domingues
- Obstetrics A Unit, Daniel De Matos Maternity, Coimbra Hospital and University Centre, Coimbra, Portugal,
| | - Mariana Vide Tavares
- Obstetrics A Unit, Daniel De Matos Maternity, Coimbra Hospital and University Centre, Coimbra, Portugal,
| | | | - Cristina Ferreira
- Obstetrics A Unit, Daniel De Matos Maternity, Coimbra Hospital and University Centre, Coimbra, Portugal,
| | - Etelvina Fonseca
- Obstetrics A Unit, Daniel De Matos Maternity, Coimbra Hospital and University Centre, Coimbra, Portugal,
| | - Paulo Moura
- Obstetrics A Unit, Daniel De Matos Maternity, Coimbra Hospital and University Centre, Coimbra, Portugal,
- Obstetrics Clinic, Faculty of Medicine, Coimbra University, Coimbra, Portugal
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Premkumar P, Antonisamy B, Mathews J, Benjamin S, Regi A, Jose R, Kuruvilla A, Mathai M. Birth weight centiles by gestational age for twins born in south India. BMC Pregnancy Childbirth 2016; 16:64. [PMID: 27012538 PMCID: PMC4806424 DOI: 10.1186/s12884-016-0850-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 03/16/2016] [Indexed: 11/23/2022] Open
Abstract
Background Birth weight centile curves are commonly used as a screening tool and to assess the position of a newborn on a given reference distribution. Birth weight of twins are known to be less than those of comparable singletons and twin-specific birth weight centile curves are recommended for use. In this study, we aim to construct gestational age specific birth weight centile curves for twins born in south India. Methods The study was conducted at the Christian Medical College, Vellore, south India. The birth records of all consecutive pregnancies resulting in twin births between 1991 and 2005 were reviewed. Only live twin births between 24 and 42 weeks of gestation were included. Birth weight centiles for gestational age were obtained using the methodology of generalized additive models for location, scale and shape (GAMLSS). Centiles curves were obtained separately for monochorionic and dichorionic twins. Results Of 1530 twin pregnancies delivered during the study period (1991–2005), 1304 were included in the analysis. The median gestational age at birth was 36 weeks (1st quartile 34, 3rd quartile 38 weeks). Smoothed percentile curves for birth weight by gestational age increased progressively till 38 weeks and levels off thereafter. Compared with dichorionic twins, monochorionic twins had lower birth weight for gestational age from after 27 weeks. Conclusions We provide centile values of birth weight at 24 to 42 completed weeks of gestation for twins born in south India. These charts could be used both in routine clinical assessments and epidemiological studies.
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Affiliation(s)
- Prasanna Premkumar
- Departments of Biostatistics, Christian Medical College, Vellore, 632 002, India.
| | | | - Jiji Mathews
- Obstetrics and Gynaecology, Christian Medical College, Vellore, 632 002, India
| | - Santhosh Benjamin
- Obstetrics and Gynaecology, Christian Medical College, Vellore, 632 002, India
| | - Annie Regi
- Obstetrics and Gynaecology, Christian Medical College, Vellore, 632 002, India
| | - Ruby Jose
- Obstetrics and Gynaecology, Christian Medical College, Vellore, 632 002, India
| | - Anil Kuruvilla
- Neonatology, Christian Medical College, Vellore, 632 002, India
| | - Mathews Mathai
- Making Pregnancy Safer Department, World Health Organization, Geneva, Switzerland
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Soong S, Greer RM, Gardener G, Flenady V, Kumar S. Impact of mode of delivery after 32 weeks’ gestation on neonatal outcome in dichorionic diamniotic twins. J Obstet Gynaecol Res 2015; 42:392-8. [DOI: 10.1111/jog.12918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/02/2015] [Accepted: 10/31/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Stephen Soong
- Mater Mothers’ Hospital; South Brisbane Queensland Australia
| | - Ristan M. Greer
- Mater Research Institute; University of Queensland; South Brisbane Queensland Australia
| | - Glenn Gardener
- Mater Research Institute; University of Queensland; South Brisbane Queensland Australia
- Mater Mothers’ Hospital; South Brisbane Queensland Australia
| | - Vicki Flenady
- Mater Research Institute; University of Queensland; South Brisbane Queensland Australia
| | - Sailesh Kumar
- Mater Research Institute; University of Queensland; South Brisbane Queensland Australia
- Mater Mothers’ Hospital; South Brisbane Queensland Australia
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Carter EB, Bishop KC, Goetzinger KR, Tuuli MG, Cahill AG. The impact of chorionicity on maternal pregnancy outcomes. Am J Obstet Gynecol 2015; 213:390.e1-7. [PMID: 25986034 DOI: 10.1016/j.ajog.2015.05.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/27/2015] [Accepted: 05/13/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Women carrying twin pregnancies often receive similar counseling, regardless of chorionicity, with the notable exception of twin-twin transfusion syndrome (TTTS); however, little is known about whether the presence of 1 vs 2 placentas confers dissimilar maternal risks. We sought to determine differences in maternal and neonatal outcomes based on chorionicity. STUDY DESIGN This was a retrospective cohort study of all twin pregnancies at our institution undergoing routine second-trimester ultrasound for anatomic survey from 1990 through 2010. Secondary outcomes included other adverse maternal and neonatal outcomes. Relative risks and adjusted odds ratios (aORs) were calculated. Cluster analysis was used to account for nonindependence of twin pairs. RESULTS Of 2301 pregnancies, 1747 (75.9%) were dichorionic and 554 (24.1%) were monochorionic. Rates of preeclampsia, gestational diabetes, placental abruption, placenta previa, preterm labor, and preterm premature rupture of membranes (PPROM) were not significantly different in dichorionic vs monochorionic pregnancies. Early preterm delivery less than 34 weeks (aOR, 1.47; 95% confidence interval [CI], 1.17-1.86) and less than 28 weeks (aOR, 2.58; 95% CI, 1.58-4.20) were more likely in monochorionic twins, as was neonatal intensive care unit admission (aOR, 1.41; 95% CI, 1.12-1.78). Monochorionic twins delivered earlier at a mean gestational age of 34.2 weeks vs 35.0 weeks for dichorionic twins (P < .001). Hospital length of stay was significantly longer for monochorionic twins with a mean of 13.7 days vs 10.8 days for dichorionic twins (P = .01). CONCLUSION There are no significant differences in maternal outcomes by chorionicity; however, monochorionicity is associated with increased fetal risks. This information may be helpful in guiding more targeted counseling to expectant parents of twins that, although the presence of an additional placenta does not confer additional maternal risks, monochorionic infants tend to deliver earlier and require longer hospital stays.
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Affiliation(s)
- Ebony B Carter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO.
| | - Katherine C Bishop
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| | - Katherine R Goetzinger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| | - Methodius G Tuuli
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| | - Alison G Cahill
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
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Paternal Factors Associated with Neonatal Deaths and Births with Low Weight: Evidence from Pakistan Demographic and Health Survey 2006–2007. Matern Child Health J 2015; 19:1634-42. [DOI: 10.1007/s10995-015-1674-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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26
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Argoti PS, Papanna R, Bebbington MW, Kahlek N, Baschat A, Johnson A, Moise KJ. Outcome of fetoscopic laser ablation for twin-to-twin transfusion syndrome in dichorionic-triamniotic triplets compared with monochorionic-diamniotic twins. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:545-549. [PMID: 24659447 DOI: 10.1002/uog.13369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/23/2013] [Accepted: 01/10/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare outcome of dichorionic-triamniotic (DCTA) triplet gestations with that of a paired cohort of monochorionic-diamniotic (MCDA) twin gestations undergoing laser therapy for treatment of twin-to-twin transfusion syndrome (TTTS). METHODS All DCTA triplets treated at four referral centers between specified dates were included. A matched cohort group of MCDA twin gestations affected by TTTS was used for comparison. RESULTS Sixteen sets of DCTA triplets treated with laser photocoagulation of placental anastomoses were compared with 32 matched sets of MCDA twins. All of the 'singleton' fetuses in the triplet gestations survived to birth and to the end of the neonatal period. There were no differences in single or double survival or the rate of non-survivors to birth and at age 28 days. A mean 3-week difference was found in the procedure-to-delivery interval in DCTA triplets vs MCDA twins (60 ± 35.8 days vs 83.6 ± 33.2 days; P = 0.029). A mean difference of 3 weeks was also found in the gestational age at delivery in DCTA triplets vs MCDA twins (28.5 ± 3.5 weeks vs 31.9 ± 5 weeks; P = 0.024). A similar post-laser fetal growth pattern in donors and recipients of both groups was noted. CONCLUSIONS DCTA triplet gestations with TTTS have a similar rate of post-laser survival but deliver earlier than can be expected for twins treated with laser. These findings have potential implications for the risk of prematurity and long-term outcomes.
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Affiliation(s)
- P S Argoti
- Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Maternal-Fetal Medicine, UT Health - School of Medicine at Houston, The Texas Fetal Center, Children's Memorial Hermann Hospital, Houston, TX, USA
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Mulcahy C, McAuliffe FM, Breathnach F, Geary M, Daly S, Higgins J, Hunter A, Morrison J, Burke G, Higgins S, Dicker P, Mahony R, Tully E, Malone F. Umbilical and fetal middle cerebral artery Doppler reference ranges in a twin population followed longitudinally from 24 to 38 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:461-467. [PMID: 24407772 DOI: 10.1002/uog.13302] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 12/23/2013] [Accepted: 12/30/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To construct monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin reference ranges for umbilical artery (UA) pulsatility index (PI), UA resistance index (RI), fetal middle cerebral artery (MCA) PI and peak systolic velocity (PSV) and cerebroplacental ratio (CPR) from 24 weeks' to 38 weeks' gestation and compare these with published normal values for singleton pregnancies. METHODS This prospective multicenter cohort study included 1028 unselected twin pairs recruited over a 2-year period. Participants with dichorionic twins underwent fortnightly ultrasound surveillance from 24 weeks' gestation, with monochorionic twins being followed every 2 weeks from 16 weeks until delivery. A total of 7536 fetal Doppler examinations in 618 twin pregnancies were included in the analysis, with reference ranges for MCDA and DCDA pregnancies constructed for each of the Doppler indices using multilevel modeling. RESULTS UA-PI and UA-RI appear to be higher in twins than in singletons, and MCA-PI and MCA-PSV appear to be lower. The CPR also appears to be lower in twins than in singletons. Similar MCA indices were observed in MCDA and DCDA twins. CONCLUSION We have established longitudinal reference ranges for UA-PI and UA-RI, MCA-PI and MCA-PSV and CPR in twin pregnancies, which appear to differ from those in singleton pregnancies. The derived twin-specific reference ranges may be more appropriate in the surveillance of these high-risk pregnancies. Applying the singleton CPR cut-off of ≤ 1.0 may lead to a large number of false-positive diagnoses of cerebral redistribution in twin fetuses.
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Affiliation(s)
- C Mulcahy
- National Maternity Hospital, Dublin, Ireland
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Legendre G, Moulin J, Vialard J, Ziegler DD, Fanchin R, Pouly JL, Watrelot A, BELAISCH Allart J, Massin N, Fernandez H. Proximal occlusion of hydrosalpinges by Essure® before assisted reproduction techniques: a French survey. Eur J Obstet Gynecol Reprod Biol 2014; 181:300-4. [DOI: 10.1016/j.ejogrb.2014.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/15/2014] [Accepted: 07/20/2014] [Indexed: 01/18/2023]
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Masheer S, Maheen H, Munim S. Perinatal outcome of twin pregnancies according to chorionicity: an observational study from tertiary care hospital. J Matern Fetal Neonatal Med 2014; 28:23-5. [DOI: 10.3109/14767058.2014.899576] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Petousis S, Margioula-Siarkou C, Kalogiannidis I, Prapas N. Twin Pregnancy and Antenatal Examination: An Overview. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-013-0057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hughes TE, Townsend GC, Pinkerton SK, Bockmann MR, Seow WK, Brook AH, Richards LC, Mihailidis S, Ranjitkar S, Lekkas D. The teeth and faces of twins: providing insights into dentofacial development and oral health for practising oral health professionals. Aust Dent J 2013; 59 Suppl 1:101-16. [DOI: 10.1111/adj.12101] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- TE Hughes
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - GC Townsend
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - SK Pinkerton
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - MR Bockmann
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - WK Seow
- School of Dentistry; The University of Queensland; Brisbane Australia
| | - AH Brook
- School of Dentistry; The University of Adelaide; South Australia Australia
- Institute of Dentistry; Queen Mary University of London; United Kingdom
| | - LC Richards
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - S Mihailidis
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - S Ranjitkar
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - D Lekkas
- School of Dentistry; The University of Adelaide; South Australia Australia
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[Perinatal outcome of monochorionic and dichorionic twin gestations: a study of 775 pregnancies at Reunion Island]. ACTA ACUST UNITED AC 2013; 42:655-61. [PMID: 23562794 DOI: 10.1016/j.jgyn.2013.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 02/09/2013] [Accepted: 02/28/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To compare the perinatal mortality and morbidity of infants born from monochorionic versus dichorionic twin pregnancies (TP). PATIENTS AND METHODS Retrospective, comparative study of monochorionic and dichorionic TP over 10 years in the south of Reunion Island. Information regarding demographic, gestational and perinatal variables of mothers and infants was collected from the hospital perinatal database. RESULTS Six hundred and twenty dichorionic and 155 monochorionic TP were analyzed. In case of monochorionic TP, mothers had higher rates of pregnancy-related hypertension (OR=1.82, 95%CI=[1.02-3.29] ; P=0.03) and hospitalization (OR=1.48, 95%CI=[1.02-2.16]; P=0.03). Newborns from monochorionic TP had higher morbidity for : very preterm birth (birth before 33 weeks gestation) (OR=1.65, 95%CI=[1.02-2.66]; P=0.02), very low birth weight (birth weight<1500g) (OR=1.73, 95%CI=[1.57-3.13]; P<0.001), Apgar<7 at 1 minute (OR=1.76, 95%CI=[1.18-2.61]; P<0.01) and hospitalization (OR=2.08, 95%CI=[1.58-2.73]; P<0.001). Perinatal mortality was also significantly higher (OR=2.47, 95%CI=[1.54-3.94]; P<0.001), as well intrauterine fetal death (OR=3.96, 95%CI=[1.95-8.05]; P<0.001) CONCLUSION: This study confirms that few differences exist among dichorionic and monochorionic TP with regard to maternal morbidity, while neonatal morbidity and mortality are higher in twins born from monochorionic pregnancies.
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Sparks TN, Cheng YW, Phan N, Caughey AB. Does risk of preeclampsia differ by twin chorionicity? J Matern Fetal Neonatal Med 2013; 26:1273-7. [PMID: 23425367 DOI: 10.3109/14767058.2013.777701] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Examine whether dichorionic (DC) and monochorionic (MC) twins exhibit different rates and severity of preeclampsia. METHODS Retrospective cohort study of 695 twin pregnancies from 2002 to 2007. DC pregnancies were compared to MC pregnancies, with the primary outcome of interest being development of preeclampsia, and the secondary outcome being severity of preeclampsia. Chi square test compared proportions and multivariable analyses controlled for potential confounders. RESULTS Any preeclampsia developed in 21.1% (104/492) of DC and 10.8% (22/203) of MC pregnancies (p = 0.001), mild preeclampsia in 13.8% (68/492) of DC and 4.9% (10/203) of MC pregnancies (p = 0.001) and severe preeclampsia in 7.3% (36/492) of DC and 5.9% (12/203) of MC pregnancies (p = 0.506). DC pregnancies showed higher odds of mild preeclampsia compared to MC pregnancies (aOR 5.85, 95% CI 1.31-26.13) after controlling for several potential confounders including gestational age at delivery. CONCLUSIONS A statistically significant larger proportion of women with DC twins developed any preeclampsia, and specifically mild preeclampsia, compared to those with MC twins. Additionally, after controlling for several potential confounders, women with DC pregnancies demonstrated higher odds of developing mild preeclampsia compared to those with MC pregnancies. Mechanisms of preeclampsia development may differ by twin chorionicity.
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Affiliation(s)
- Teresa N Sparks
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital/Massachusetts General Hospital , Boston, MA 02115, USA.
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Piccoli GB, Arduino S, Attini R, Parisi S, Fassio F, Biolcati M, Pagano A, Bossotti C, Vasario E, Borgarello V, Daidola G, Ferraresi M, Gaglioti P, Todros T. Multiple pregnancies in CKD patients: an explosive mix. Clin J Am Soc Nephrol 2012; 8:41-50. [PMID: 23124785 DOI: 10.2215/cjn.02550312] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES CKD and multiple pregnancies bear important risks for pregnancy outcomes. The aim of the study was to define the risk for adverse pregnancy-related outcomes in multiple pregnancies in CKD patients in comparison with a control group of "low-risk" multiple pregnancies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The study was performed in the Maternal Hospital of the University of Turin, Italy. Of 314 pregnancies referred in CKD (2000-2011), 20 were multiple (15 twin deliveries). Control groups consisted of 379 low-risk multiple pregnancies (314 twin deliveries) and 19 (15 twin deliveries) cases with hypertension-collagen diseases. Baseline data and outcomes were compared by univariate and logistic regression analyses. RESULTS The prevalence of multiple pregnancies was relatively high in the CKD population (6.4%); all referred cases were in early CKD stages (I-II); both creatinine (0.68 to 0.79 mg/dl; P=0.010) and proteinuria (0.81 to 3.42 g/d; P=0.041) significantly increased from referral to delivery. No significant difference in demographic data at baseline was found between cases and low-risk controls. CKD was associated with higher risk of adverse pregnancy outcomes versus low-risk twin pregnancies. Statistical significance was reached for preterm delivery (<34 weeks: 60% vs 26.4%; P=0.005; <32 weeks: 53.3% vs 12.7%; P<0.001), small for gestational age babies (28.6% vs 8.1%; P<0.001), need for Neonatal Intensive Care Unit (60% vs 12.7%; P<0.001), weight discordance between twins (40% vs 17.8%; P=0.032), and neonatal and perinatal mortality (6.6% vs 0.8%; P=0.032). CONCLUSION This study suggests that maternal-fetal risks are increased in multiple pregnancies in the early CKD stages.
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Clinicians learn less and less about more and more until they know nothing about everything; researchers learn more and more about less and less until they know everything about nothing: discuss. Behav Brain Sci 2012; 35:358-9. [PMID: 23095379 DOI: 10.1017/s0140525x12001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A number of recent developments in our understanding of the biology of heritability question commonly held views on the immutability of genetic factors. These have numerous potential implications for improving understanding and practice in pre- and postconceptional care and for infant and child mental health, and they carry a cautionary message against overgeneralization.
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Giannantonio C, Semeraro CM, Fioretti M, Molisso A, Lio A, Gallini F, Papacci P, Romagnoli C. Renal failure of the surviving fetus after intrauterine death of the co-twin. Fetal Pediatr Pathol 2012; 31:336-9. [PMID: 22443167 DOI: 10.3109/15513815.2012.659399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Twin pregnancies are considered at a higher risk for fetal mortality than singleton pregnancies. The antenatal death of one of the twins is associated with an increasing rate of cerebral impairment and lesions in other organs in the surviving fetus, especially if the pregnancy is monochorionic. We describe a case of isolate renal failure becoming evident gradually after birth in a surviving twin after the antenatal death of the co-twin. Considering the deleterious effects of vascular disruption in a surviving twin, our findings suggest careful investigation of renal function, even if no intrauterine signs of diminished renal function were previously detected.
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Affiliation(s)
- Carmen Giannantonio
- Department of Paediatrics, Catholic University, Division of Neonatology, Rome, Italy
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Abstract
Twin gestations are fascinating and are also high-risk pregnancies. They account for approximately 3% of all pregnancies in the United States. Major obstetrical complications associated with twin pregnancies include hypertensive disorders of pregnancy, gestational diabetes, and preterm delivery. In addition, the death rate for twins and the rate of severe handicap in very low birth weight survivors of twin pregnancies is greater than that for singleton pregnancies. Ultrasound allows for stepwise evaluations at any time during a twin gestation. Current evidence suggests that uncomplicated diamniotic twins with concordant and appropriate growth beyond 24 weeks' gestation should be managed conservatively and the time and mode of delivery should be determined on the basis of obstetrical history and fetal presentations. Perinatal management of the remaining twin pregnancies depends on good clinical judgment, which is improved by the use of ultrasound imaging.
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Oldenburg A, Rode L, Bødker B, Ersbak V, Holmskov A, Jørgensen FS, Larsen H, Larsen T, Laursen L, Mogensen H, Petersen OB, Rasmussen S, Skibsted L, Sperling L, Stornes I, Zingenberg H, Tabor A. Influence of chorionicity on perinatal outcome in a large cohort of Danish twin pregnancies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:69-74. [PMID: 21830245 DOI: 10.1002/uog.10057] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess outcome in twin pregnancies according to chorionicity. METHODS A cohort was retrieved from local ultrasound databases at 14 obstetric departments in Denmark, comprising all twin pregnancies with two live fetuses scanned between weeks 11 and 14 in the period 1 January 2004 to 31 December 2006. Outcome data were retrieved from the National Board of Health. RESULTS Among 2038 twin pregnancies, 1757 (86.2%) were dichorionic (DC) and 281 (13.8%) were monochorionic diamniotic (MC). In MC pregnancies, the rate of spontaneous fetal loss in both second and third trimesters was more than threefold higher than the comparable rate in DC pregnancies: 6.0% vs. 1.9% for at least one fetus in the second trimester (P < 0.001) and 2.1% vs. 0.7% in the third trimester (P = 0.03). In 98.4% of DC pregnancies and in 91.1% of MC pregnancies, at least one infant was liveborn. Amongst pregnancies with two live fetuses at 24 weeks, the proportion with two live infants at 28 days after delivery was 97.5% and 95.1%, respectively. CONCLUSIONS The increased incidence of fetal loss in MC pregnancies compared with DC pregnancies predominantly occurs before 24 weeks' gestation. After this stage, although the risk of intrauterine fetal death is still higher in MC than in DC pregnancies, if both fetuses are alive at 24 weeks, the chance of a woman having two live infants 1 month after delivery is similar in MC and DC pregnancies.
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Affiliation(s)
- A Oldenburg
- Department of Fetal Medicine, Copenhagen University Hospital, Copenhagen, Denmark.
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Mean, lowest, and highest pulsatility index of the uterine artery and adverse pregnancy outcome in twin pregnancies. Am J Obstet Gynecol 2011; 205:549.e1-7. [PMID: 21889764 DOI: 10.1016/j.ajog.2011.06.103] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 06/07/2011] [Accepted: 06/28/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of the study was to assess the use of mean, lowest, and highest pulsatility index (PI) of the uterine arteries to screen for adverse pregnany outcome in twin pregnancies. STUDY DESIGN This was a screening study of 423 twin pregnancies. Relationship between PI at 20-22 weeks and adverse pregnancy outcome was evaluated. RESULTS Mean, lowest, and highest PI above the 95th centile were significant risk factors for preeclampsia and adverse pregnancy outcome in monochorionic and dichorionic twins. We calculated a sensitivity for preeclampsia for mean, highest, and lowest PI of 35%, 29%, and 27%, respectively. CONCLUSION Increased mean, lowest, and highest PI is associated with a higher risk of preeclampsia and adverse pregnancy outcome in twins. We observed the highest sensitivity and specificity by using highest PI. The high incidence of preeclampsia in twins makes it attractive to use the PI of the uterine artery for risk stratification in twins.
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Mahony R, Mulcahy C, McAuliffe F, Herlihy CO, Carroll S, Foley ME. Fetal death in twins. Acta Obstet Gynecol Scand 2011; 90:1274-80. [PMID: 21762113 DOI: 10.1111/j.1600-0412.2011.01239.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the pattern and prospective risk of intrauterine fetal death (IUFD) in twin pregnancy by chorionicity. DESIGN Retrospective cohort analysis. SETTING Large national tertiary referral center. POPULATION All consecutive twin deliveries (1997-2006) ≥24 weeks. METHODS Retrospective review of all consecutive twin deliveries over 10 years to identify patterns of IUFD in twins and calculate gestation-specific prospective risks of IUFD. Fetal death was defined as intrauterine demise of a fetus ≥24weeks, intertwin birthweight discordance as ≥20% difference and growth restriction as birthweight <5(th) centile. Chorionicity was confirmed by postnatal placental examination. MAIN OUTCOME MEASURES Fetal death. RESULTS 1094 twin pairs including 276 monochorionic-diamniotic (MCDA) (25.3%) and 818 dichorionic-diamniotic (DCDA) twin pregnancies (74.7%) were studied. Twenty-nine fetal deaths occurred affecting 22 twin pregnancies. The incidence of IUFD (death of one or both fetuses) in MCDA twin pregnancies was three times that in DCDA pregnancies [11/276 (3.9)% vs. 11/818 (1.3%) p<0.001]. The majority of deaths in MCDA twins were associated with twin-twin transfusion syndrome (TTTS) prior to 30 weeks. In normally grown twins the prospective risk of IUFD was similarly low in MCDA and DCDA pregnancies after 34 weeks but in pregnancies complicated by abnormal growth, the prospective risk of IUFD was 3.4 in MCDA and 2.0 in DCDA pregnancies. CONCLUSION Twin pregnancies complicated by growth restriction or growth discordance were associated with a high risk of IUFD, particularly in affected MCDA twins. Conversely, in normally grown twins the risk was similarly low in MCDA and DCDA pregnancies after 34 weeks.
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Affiliation(s)
- Rhona Mahony
- Department of Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin, Dublin, Ireland.
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Arpino C, Compagnone E, Cacciatore D, Coniglio A, Castorina M, Curatolo P. MTHFR C677T and A1298C polymorphisms and cerebral stroke in two twin gestations. Childs Nerv Syst 2011; 27:665-9. [PMID: 21113717 DOI: 10.1007/s00381-010-1340-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 11/09/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Stroke in pediatric age is a rare event with a multifactorial genesis which could involve genetic factors as methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphism. At the same time, twin gestation with co-twin demise is an important potential risk factor for premature brain damage. PATIENTS AND METHODS We describe two children presenting with presumed cerebral stroke born from two MC twin pregnancies in which the other co-twin had died in utero associated to maternal and fetal homozygosity for MTHFR C677T and MTHFR A1298C, respectively. Brain damage was diagnosed immediately before the delivery. CONCLUSION Our observations underline the necessity to make a thrombophilia workup in women before or during pregnancy and, above all, in twin pregnancy. Data of literature are not clear about what kind of genetic polymorphism is prominent in the genesis of cerebral stroke (factor V leiden, MTHFR, activated protein C resistance, factor II G20210A). A multifactorial genesis for severe fetal and perinatal cerebral vascular alterations has been supposed; for this reason an early folate supplementation both to mother and infant could reduce the risk of brain damage due to fetal/perinatal stroke and eventual recurrence of thrombotic events.
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Affiliation(s)
- Carla Arpino
- Department of Neuroscience, Pediatric Neurology Unit Tor Vergata University of Rome, Rome, Italy
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Abstract
There have been significant advances in our understanding of the aetiology and management of disorders specific to Monochorionic Diamniotic (MCDA) twin pregnancies like Twin-Twin Transfusion Syndrome (TTTS) and Twin Reversed Arterial Perfusion (TRAP) but there is paucity of data about the management of uncomplicated MCDA twins pregnancies. It is accepted that even in the absence of specific complications, these pregnancies are associated with increased perinatal morbidity & mortality. The aim of this review is to gather evidence regarding the management of seemingly uncomplicated monochorionic diamniotic pregnancies.
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Affiliation(s)
- M Nair
- Department of Obstetrics and Gynaecology, Wythenshawe Hospital, South Manchester University Hospitals, UK.
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Kapoor M, Pal L. Epidemic of plurality and contributions of assisted reproductive technology therein. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2009; 151C:128-135. [PMID: 19378330 DOI: 10.1002/ajmg.c.30205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A commentary on contributions of ART to the pandemic of multiple gestations is presented and mechanistic aspects therein are explored.
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Affiliation(s)
- Monica Kapoor
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, Connecticut, USA
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Hack KEA, Kaandorp JJ, Derks JB, Elias SG, Pistorius L, Visser GHA. The value of umbilical artery Doppler velocimetry in the antenatal surveillance of uncomplicated monochorionic twin pregnancies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:662-668. [PMID: 18504772 DOI: 10.1002/uog.5363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To investigate the predictive value of abnormal umbilical artery Doppler findings on outcome in uncomplicated monochorionic (MC) twin pregnancies. METHODS Sixty-seven MC twin pregnancies, with antenatal care and delivery at the University Medical Center, Utrecht, The Netherlands, between 1999 and 2004, were studied. Pregnancies with antenatal signs of twin-to-twin transfusion syndrome were excluded. We analyzed the data according to both the last Doppler measurement of the umbilical artery before delivery and the presence of any abnormal Doppler measurement during the course of pregnancy. Risks of mortality and total neonatal morbidity were stratified according to the Doppler findings in one or both fetuses at the time of each standard ultrasound assessment in order to estimate the risk associated with an abnormal Doppler finding at or before that specific gestational age. RESULTS Mortality rates were similar in the normal and abnormal Doppler groups. Using both group definitions, total neonatal morbidity was higher in the abnormal Doppler group; this was significant at > 32 weeks' gestation, and was due to lower birth weight and earlier gestational age at delivery. There was no mortality at > or = 36 weeks in the abnormal Doppler group, but there were four perinatal deaths in the normal Doppler group. Gestational age at delivery was significantly lower when one or more abnormal Doppler findings had been present (median, 34 + 1 weeks vs. 36 + 3 weeks) and infants with abnormal Doppler findings weighed on average 261 g (95% CI, 21-502 g) less than those with normal findings. CONCLUSIONS In MC twins, abnormal Doppler flow of the umbilical artery identifies a subgroup at risk for preterm delivery, low birth weight and neonatal morbidity, but with a similar mortality risk to those with normal Doppler flow. At term, mortality occurred only in the group with normal Doppler findings, suggesting that fetal surveillance is insufficient in uncomplicated term MC twin pregnancies.
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Affiliation(s)
- K E A Hack
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Hack KEA, Derks JB, Elias SG, Franx A, Roos EJ, Voerman SK, Bode CL, Koopman-Esseboom C, Visser GHA. Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study. BJOG 2007; 115:58-67. [PMID: 17999692 DOI: 10.1111/j.1471-0528.2007.01556.x] [Citation(s) in RCA: 254] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate mortality and morbidity in a large cohort of twin pregnancies according to chorionicity. We aimed to estimate the optimal time of delivery. DESIGN Historical cohort design. Setting Two teaching hospitals. POPULATION Twin pregnancies delivered in the University Medical Centre, Utrecht, and the St Elisabeth Hospital, Tilburg (1995-2004), The Netherlands (n = 1407). METHODS Pregnancy outcomes were documented according to chorionicity. Mortality >/=32 weeks was reviewed carefully with special attention to antenatal fetal monitoring, autopsy and placental histopathology to find an explanation for adverse outcome. MAIN OUTCOME MEASURES Perinatal mortality and morbidity in monochorionic (MC) and dichorionic (DC) twins. RESULTS Perinatal mortality was 11.6% in MC twin pregnancies and 5.0% in DC twin pregnancies. After 32 weeks, the risk of intrauterine death (IUD) was significantly higher in MC twins than in DC twins (hazard ratio 8.8, 95% CI 2.7-28.9). In most of these cases of IUD, no antenatal signs of impaired fetal condition had been present. Median gestational age was 1 week longer in DC twins than in MC twins, and the mean birthweight was 221 g higher. Severe birthweight discordancy (>20%) occurred more often in MC twins than in DC twins (OR 1.23, 95% CI 0.97-1.55). The incidence of necrotising enterocolitis (NEC) was higher in MC twins, after adjustment for age and weight at birth (OR 4.05, 95% CI 1.97-8.35). There was a trend towards higher neuromorbidity in MC twins. CONCLUSIONS This is the largest cohort study of twin pregnancies evaluating outcome according to chorionicity thus far. MC twins are at increased risk for fetal death (even at term), NEC and neuromorbidity. Current antenatal care is insufficient to predict and prevent this excess perinatal mortality and morbidity. Planned delivery at or even before 37 weeks of gestation seems to be justified for MC twins.
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Affiliation(s)
- K E A Hack
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Previc FH. Prenatal influences on brain dopamine and their relevance to the rising incidence of autism. Med Hypotheses 2006; 68:46-60. [PMID: 16959433 DOI: 10.1016/j.mehy.2006.06.041] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 06/17/2006] [Accepted: 06/19/2006] [Indexed: 10/24/2022]
Abstract
The incidence of autism has risen 10-fold since the early 1980s, with most of this rise not explainable by changing diagnostic criteria. The rise in autism is paradoxical in that autism is considered to be one of the most genetically determined of the major neurodevelopmental disorders and should accordingly either be stable or even declining. Because a variety of epigenetic influences, particularly those occurring during the prenatal period, can override or masquerade as genetic influences, these should be considered as prime contributors to the recent increase of autism. Prenatal influences on dopamine activity are especially well-documented, including the effects of maternal psychosocial stress, maternal fever, maternal genetic and hormonal status, use of certain medications, urban birth, and fetal hypoxia. All of these factors have been implicated in the genesis of autism, which is characterized by a "hyperdopaminergic" state based on evidence from monkey and human behavioral studies, pharmacological studies in humans, and a left-hemispheric predominance of both dopamine and autistic-like symptoms. Chronically high maternal levels of dopamine caused by the pressures of increasingly urbanized societies and by changing maternal demographics such as increased workforce participation, educational achievement level, and age at first birth, may be especially significant epigenetic contributors to the recent autism rise.
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Cordero L, Franco A, Joy SD, O'shaughnessy RW. Monochorionic diamniotic infants without twin-to-twin transfusion syndrome. J Perinatol 2005; 25:753-8. [PMID: 16281049 DOI: 10.1038/sj.jp.7211405] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Monochorionic-diamniotic twins (MoDi) occur in 0.3% of all pregnancies. Twin-to-twin transfusion syndrome (TTS) that occurs in 20% of MoDi pregnancies is associated with high perinatal morbidity and mortality. MoDi twins without TTS are more frequent (80%) but have been scarcely reported. OBJECTIVE To study perinatal morbidity and mortality of 74 MoDi twin sets without TTS and to compare it to that of 38 sets of MoDi twins with TTS. METHODS Chorionicity was determined by gender and placental examination. Gestational age (GA) was set by sonography and pediatric examination. TTS was diagnosed clinically and by sonography, discordance was defined by twins birth weight difference > or =20%, and fetal growth restriction was determined by using a twin-specific nomogram. RESULTS MoDi twin pregnancies without and with TTS were similar in demographics, live births, history of preeclampsia, fetal distress and cesarean delivery. They were different (p<0.01) in discordant pregnancies (36 and 79%), GA at delivery (32 and 29 weeks) intrauterine growth restriction (39 and 89%) and neonatal mortality (12 and 36%). Concordant (47 sets) and discordant (27 sets) MoDi twins without TTS were clinically similar. CONCLUSIONS MoDi twins without TTS have high rates of birth weight discordance, fetal growth restriction, fetal distress, prematurity and cesarean delivery. Although their perinatal mortality is low, the reported occurrence and the short- and long-term impacts of fetal and neonatal morbidities warrants attention.
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MESH Headings
- Amnion/diagnostic imaging
- Amnion/pathology
- Cause of Death
- Chorion/diagnostic imaging
- Chorion/pathology
- Diseases in Twins/diagnostic imaging
- Diseases in Twins/mortality
- Diseases in Twins/pathology
- Female
- Fetal Distress/diagnostic imaging
- Fetal Distress/mortality
- Fetal Distress/pathology
- Fetal Growth Retardation/diagnostic imaging
- Fetal Growth Retardation/mortality
- Fetal Growth Retardation/pathology
- Fetofetal Transfusion/diagnostic imaging
- Fetofetal Transfusion/mortality
- Fetofetal Transfusion/pathology
- Gestational Age
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature, Diseases/diagnostic imaging
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/pathology
- Male
- Placenta/diagnostic imaging
- Placenta/pathology
- Pregnancy
- Risk
- Survival Analysis
- Twins, Dizygotic
- Twins, Monozygotic
- Ultrasonography, Prenatal
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Affiliation(s)
- Leandro Cordero
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and Obstetrics, College of Medicine and Public Health, The Ohio State University, Columbus, OH 43210-1228, USA
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Penava D, Natale R. An association of chorionicity with preterm twin birth. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2005; 26:571-4. [PMID: 15193202 DOI: 10.1016/s1701-2163(16)30375-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the risk factors for preterm birth in twin pregnancies, particularly monochorionicity. METHODS A cohort study of 767 sets of twins, each twin weighing more than 500 g, born between January 1, 1992, and December 31, 2001, at St. Joseph's Health Care in London, Ontario. Statistical analysis was performed using forward stepwise logistic regression models, with gestational age at birth less than 28 or 32 weeks as the outcome. RESULTS Polyhydramnios and chorioamnionitis were significant risk factors for preterm birth prior to 28 or 32 weeks' gestation. Monochorionicity was a risk factor for preterm birth prior to 32 weeks' gestation. Past term birth and maternal age over 30 years were associated with reduced risk for preterm birth. CONCLUSION Monochorionic placentation is a significant risk factor for preterm twin birth.
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Affiliation(s)
- Debora Penava
- Department of Obstetrics and Gynaecology, The University of Western Ontario, London ON
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Cordero L, Giannone PJ, Ramirez NC, Joy SD. Mean arterial pressure in concordant and discordant triplets during the first week of life. J Perinatol 2005; 25:198-204. [PMID: 15578030 DOI: 10.1038/sj.jp.7211232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To retrospectively determine mean arterial pressure (MAP) for stable concordant and discordant triplets during the first 7 days of life. BACKGROUND Morbidity and mortality for prematurely born triplets is high, therefore, MAP monitoring during the first day of life is important for their clinical management. MAP reference values for special populations such as triplets have not been published. Recently, we reported that in stable discordant twins MAP values during the first day of life were significantly lower in the smaller than in their larger siblings. Comparable information for triplets is not available. DESIGN Retrospective cohort study. METHODS We studied 30 sets of concordant and 29 sets of discordant (birth weight difference > or =20%) consecutively born triplets. Stable patients were defined as those having umbilical cord hemoglobin > or =13 g/dl, normal blood gases, who were never treated for hypotension, and survived at least 7 days. MAP (torr) were measured by oscillometry in 3410, and by transducer via an umbilical arterial catheter in 1251 instances. RESULTS Concordant and discordant triplets were similar in demographics, history of preterm labor (63 and 63%), chorioamnionitis (10 and 10%), pre-eclampsia (53 and 48%), cesarean delivery (100 and 100%), antenatal steroids (77 and 73%), cord hemoglobin (16 and 16 g/dl), combined triplets birth weight (4922 and 4732 g), gestational age (32 and 33 weeks), normal head ultrasounds or Grade I intracranial hemorrhage (96 and 100%) and neonatal mortality (2 and 1%), but were different in the number of infants requiring mechanical ventilation (57 and 31%). A total of 80 (89%) concordant triplets and 77 (88%) discordant triplets were stable according to our definition. Concordant stable triplets, whether small, medium or large, had similar MAP at birth. Their MAP values increased noticeably from birth to 24 hours and more subtlely to 7 days. Triplets of < or =32 weeks GA had lower MAP throughout than those of > or =33 weeks GA. Discordant stable triplets were divided into 27 small (1382 g), 26 medium (1683 g) and 27 large (1969 g); during the first 24 hours, medium and smaller triplets had MAP values that were lower than those of their larger siblings. From the second to the seventh day of life, all MAP values and trends were similar. Among discordant triplets, 86% of the smallest, 13% of the medium and 13% of the largest infants had asymmetrical intrauterine growth restriction. CONCLUSION In stable concordant and stable discordant triplets, MAP correlates with birth weight, gestational age and postnatal age. MAP values increase noticeably during the first 24 hours and more subtlely during the next 7 days. Concordant or discordant, small, medium, and large triplets have similar MAP values and trends to that of their siblings. Small and medium discordant triplets have lower MAP values during the first day of life than their larger siblings but by the second day there MAP trends and values were no longer different.
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Affiliation(s)
- Leandro Cordero
- Division of Neonatal-Perinatal Medicine, Pediatrics and Obstetrics, The Ohio State University Medical Center, Columbus, OH 43210-1228, USA
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