Case Of Twin Pregnancy Research Articles

Diagnóstico prenatal de vasa previa

ObjectivePrenatal diagnosis of vasa previa in cord insertion anomalies Material and methodWe examined six cases of cord insertion anomalies or placentation anomalies ResultsThree cases were diagnosed of vessels previous the presentation and near the internal cervical orifice. Two cases of twin pregnancy with a cord velamentous insertion of the second twin on the partition membrane, the situation of the insertions showed a clinical vasa previa of the second twin after the potential birth of the first twin. The last case showed an interplacental vascular septum, in a bilobed placenta, that was previous to the presentation and near the internal cervical orifice ConclusionThe bidimensional ultrasounds, the pulsed and color Doppler studies allowed the prenatal diagnosis of the vasa previa in the asymptomatic pregnancies. Its diagnosis was based in its suspect in cases with a velamentous insertion or with a bilobed placenta. In these situations, a detailed evaluation of the relation of the amniotic umbilical vessels with the inferior uterine segment or with the uterine region previous to the fetus will allow the diagnosis of the vasa previa

Correlation of Doppler Velocimetry Findings in Twin Pregnancies Including Course of Pregnancy and Fetal Outcome

Objective: Subject of the study was the significance of umbilical artery Doppler velocimetry findings for the further course of pregnancy and fetal outcome in cases of twin pregnancies. Methods: In 206 cases of twin pregnancy, the umbilical artery was examined using Doppler velocimetry in the median 9 days prior to delivery, and the result was correlated with the further course of pregnancy and fetal outcome. 174 pregnancies showed normal Doppler findings of the umbilical artery (group A), 32 twin pregnancies showed pathological Doppler findings of at least one twin (group B). The median of the maternal age and the parity between the groups were not different. Results: In group B (pathological Doppler findings), intrauterine growth retardation and pre-eclampsia occurred 5 times more often than in group A (normal Doppler findings). The total rate of cesarean sections was not different between the study populations; the rate of deliveries by cesarean section in group B was significantly increased by a factor of 2.4 due to a pathological CTG. The median birth weight and the gestational age at birth were significantly lower in group B (1,660 g; 35 weeks) as compared to group A (2,460 g; 37 weeks; p < 0.001). In group B, the rate of premature deliveries up to reaching the 34th week of gestation was 3.4 times higher; the rate of SGA newborns was 6.3 times higher. Perinatal mortality was increased by a factor of 1.5 in group B compared to group A. Conclusion: The Doppler velocimetry findings have considerable effects on the further course of a multiple pregnancy. In case of pathological Doppler findings, early hospitalization and close monitoring of the pregnancy should be performed. In cases of additional pathological findings (maternal illness, pathological Doppler findings of fetal blood vessels), termination of the pregnancy has to be considered.

Complete Hydatidiform Mole and a Coexistent Viable Fetus: Report of Two Cases and Review of the Literature

Objective. The aim of this study was to report the clinical features, management, and outcome of two cases of complete hydatidiform mole with a coexisting viable fetus and to review the literature.Patients. In this article, we report on the well-documented follow-up of 2 cases of twin pregnancies with complete hydatidiform mole and a viable fetus, both of which ended with the delivery of a normal infant at 41 and 26 weeks of gestation. It is of interest that both pregnancies were achieved following induction of ovulation with hMG/hCG. Since 1977, the year in which complete and partial moles were characterized as distinct pathologic entities, 15 cases (including our 2) have been reported.Results. Persistent GTT developed in eight patients (53.3%) and four patients (27.7%) developed metastatic disease. Seventy-five percent patients with persistent GTT were treated with single-agent chemotherapy. The median gestational age of the patients with subsequent persistent GTT was 34.5 weeks compared to 38 weeks in the patients without persistent GTT.Conclusion. Complete hydatidiform mole and coexistent fetus is a rare occurrence and is associated with an increased risk of persistent gestational trophoblastic tumor. Based on currently available information, it seems that in the presence of a stable pregnancy, normal karyotype, and a normal sonogram it is reasonable to allow the pregnancy to continue.

Enhanced twin pregnancy detection within an open neural tube defect and Down syndrome screening protocol using free-beta hCG and AFP.

We have applied our multimarker approach of maternal serum alpha-fetoprotein (AFP) and free-beta human chorionic gonadotropin (hCG) for Down syndrome screening to multiple gestations to assess its efficacy for improved detection of twin and triplet pregnancies. This study matched 225 cases of twin pregnancy and 39 cases of triplet pregnancy each with ten singleton pregnancies based on gestational week, race, time to receive sample, time of year of sample, and geographical area. The ratios of the MOM for each group at the tenth, 50th, and 90th percentiles were compared by the Wilcoxon test. Risks for twins were calculated using Bayes' rule, the age-related incidence of twins, and the levels of AFP and free-beta hCG. The tenth, 50th and 90th percentiles of free-beta hCG MOMs in twin and triplet cases were 0.85, 1.99, and 4.51, and 1.38, 2.78, and 4.07, respectively. For AFP, the MOMs at these percentiles were 1.26, 1.91, and 2.99, and 2.02, 2.68, and 5.30, respectively. The twin and triplet distributions for each marker were statistically significantly different from the singleton distributions (P < 0.0001) and from each other (P = 0.0012). At a twin risk cut-off of 1 in 50, 77.4 per cent of all twin gestations can be detected in a second-trimester AFP and free-beta hCG screening protocol with 5.1 per cent of singleton pregnancies falsely identified as at risk for twins. Our dual marker protocol for mid-trimester pregnancy screening combining AFP and free-beta hCG can identify over 77 per cent of twin pregnancies in women less than 35 years of age. This benefit may contribute to an improved outcome of pregnancy by early detection of multiple gestation.

Coexistent Complete and Partial Hydatidiform Moles in a Twin Pregnancy

A case of twin pregnancy with complete and partial molar disease is presented. Aspects of diagnosis, ploidy studies and management are discussed.

Neonatal limb ischemia following maternal indomethacin treatment in twin pregnancies.

The prenatal administration of indomethacin in obstetric management has been implicated as a cause of neonatal cardio-pulmonary, gastrointestinal and renal complications. The present report describes two cases of twin pregnancy resulting in premature delivery at the 33rd and 30th week following prolonged maternal indomethacin treatment for 9 and 4 weeks respectively. Neonatal cardiovascular and renal complications were observed and an unusual severe ischemia of a lower limb occured in each of the first twins following insertion of an umbilical arterial line. It is suggested that prolonged antenatal exposure to the drug may increase the systemic arterial constrictive reactivity in some newborn infants and that special caution should be exercised during arterial catheterization of susceptible cases.

Natural history of twin pregnancy with complete hydatidiform mole and coexisting fetus

To investigate the clinical features and natural history of twin conceptions consisting of complete hydatidiform mole and a coexisting fetus.Since 1973, eight well-documented cases of twin pregnancy with complete hydatidiform mole and coexisting fetus have been treated at the New England Trophoblastic Disease Center (NETDC). The clinical features of these eight patients were compared to 71 patients with singleton complete hydatidiform mole treated at the NETDC and with the published experience of other investigators. Flow cytometric analysis of DNA content was performed in addition to histologic inspection to assist in confirming the diagnosis of twin pregnancy with complete hydatidiform mole and coexisting fetus.Five of the eight patients in this series developed persistent gestational trophoblastic tumor requiring chemotherapy. Three of these five patients developed metastases requiring multi-agent chemotherapy to achieve remission. The presenting symptoms of twin pregnancy with complete hydatidiform mole and coexisting fetus were similar to those in patients with a singleton complete mole. However, compared to singleton complete molar gestation, a twin pregnancy with complete mole and coexisting fetus was diagnosed at a later gestational age, had higher preevacuation beta-hCG levels, and had a greater propensity to develop persistent gestational trophoblastic tumor.Our findings indicate that patients with complete hydatidiform mole and coexisting fetus are at high risk for developing persistent gestational trophoblastic tumor.

Twin pregnancy involving complete hydatidiform mole and partial mole after five years of amenorrhoea

A case of twin pregnancy involving a single fetus and complete hydatidiform mole in a 56-year-old woman after 5 years of amenorrhoea is reported. The patient presented with threatened abortion and was managed with bed rest and blood transfusion. Six weeks after admission and at 20 weeks gestation, she had a spontaneous vaginal delivery of a molar pregnancy and a fresh stillbirth with molar degeneration of the placenta. The uterine cavity was evacuated by suction curettage after delivery and plasma, BHCG was negative 4 weeks subsequently. In a case of pregnancy after a long period of amenorrhoea in the older woman, molar degeneration is a strong probability.

Gemini-Gravidität bei Uterus didelphys

A case of twin pregnancy in uterus didelphys is reported. This rare event is discussed from obstetric aspects as well as that of dizygotic twins.

Differentiation of Monochorionic and Dichorionic Twin Placentas by Antenatal Ultrasonic Evaluation

The prenatal identification of various types of placentation is important for the antenatal management of twin pregnancies. Such classification can be achieved with the use of ultrasound examination. In 32 cases of twin pregnancy the intervening septum was classified as either a thick (dichorionic) or thin (monochorionic) type. Macroscopic and microscopic examination of the placenta after delivery confirmed the ultrasound diagnosis in 24 of the 30 cases, an accuracy of 80%.

A Case of Twin Pregnancy in a Woman with Uterus Bicornis Unicollis in Which Both Infants were Successfully Delivered after Two Episodes of Uterine Rupture

A Case of Twin Pregnancy in a Woman with Uterus Bicornis Unicollis in Which Both Infants were Successfully Delivered after Two Episodes of Uterine Rupture

Simultaneous pregnancy in each cavity of a double uterus. A case report

A case of twin pregnancy in an anovulatory woman with uterus didelphys who conceived after ovulation induction is described. The management and possible complications of such cases are discussed.

The concentration of serum unconjugated estradiol, estriol and estetrol in pregnant women, and the significance of these hormones in pregnancy (author's transl)

Simultaneous determinations of unconjugated estradiol (E2), estriol (E3) and 15 alpha-hydroxyestriol (E4) levels in maternal serum were studied serially to ascertain the significance of these estrogens in the feto-placental unit. The samples of serum were collected serially from 25 normal and 44 abnormal pregnancies. In normal pregnancy, these estrogen levels increased throughout pregnancy, especially E3 and E4 nearing the term. In 15 cases of IUGR pregnancy (including 4 cases of perinatal death), E2 levels were mostly low (less than M -- S.D.), E3 was within normal limits (M +/- S.D.) or low, and E4 was either high (greater than M + S.D.) or relatively low, and normal. In 9 cases of twin pregnancy, most E2 levels were within normal limits, while E3 and E4 were remarkedly high. The results signified that E2 indicated placental function, that E3 indicated placental and fetal function, and that E4 indicated fetal function.

Maternal plasma unconjugated oestrogens in early human pregnancy.

SummaryThe plasma levels of unconjugated oestrone (El), oestradiol (E2) and oestriol (E3) were determined by radioimmunoassay, twice weekly in 21 subjects from the earliest detection of pregnancy up to 16 weeks gestation where possible. Normal ranges for the three oestrogens were established using data from 15 subjects who had a normal pregnancy, including one sampled throughout the cycle of conception. The six other subjects comprised a twin pregnancy, two who aborted and three who received progestogen therapy, and their oestrogen levels were compared with the normal ranges. El and E2 levels showed a steady increase over the period of study with E2 levels exceeding those of El. E3 levels remained low (in many cases less than 50 pg/ml) until week 13 when levels began to rise steadily. In a caseof twin pregnancy, El and E2 levels only became significantly elevated when compared with single pregnancies from week 15. There were differing oestrogen trends in two patients who aborted. In a patient with an incomplete abortion, levels only dropped significantly after abortion had occurred, whereas, in a patient with a complete abortion, a gradual and progressive fall in El and E2 levels was observed. The levels of El and E2 for the three subjects receiving progestogen therapy did not differ significantly from those of the normal subjects.

Circulating maternal serum progesterone in high-risk pregnancies

Serum progesterone was measured by competitive protein-binding assay in 331 cases of normal pregnancy ranging from 6 to 42 weeks. Serial estimations of serum progesterone were performed in nine cases of severe hypertensive disorder of pregnancy, eight cases of twin pregnancy, three cases of twin pregnancy complicated by severe hypertensive disorder of pregnancy, three cases of triplet pregnancy, three cases of previous bad obstetric history, one case of anencephaly, and seven cases of intrauterine fetal death. Serum progesterone remained within normal range in severe hypertensive disorder of pregnancy and the levels were indistinguishable in cases of fetal growth retardation from those without growth retardation. In twin and triplet pregnancies, serum progesterone was within normal range or elevated and was usually higher than normal in twin pregnancies after weeks 33 to 34. Serum progesterone levels were normal in anencephalic pregnancy and in most cases of intrauterine fetal death. The findings are discussed with reference to placental hormonal activity. It is concluded that serum progesterone is a poor index of placental function.

Twin Pregnancy in Singapore

Summary:Two hundred and thirty‐four cases of twin pregnancy seen between January, 1970 and December, 1972 were analysed. The incidence of twin pregnancy was 1 in 133 pregnancies and occurred proportionately in Chinese, Malays, and Indians according to population numbers. Parity did not significantly affect the incidence of twin pregnancy. Common antenatal complications included anaemia, hypertensive disorders of pregnancy, and haemorrhage. Hospitalised bed rest did not significantly alter the perinatal mortality. Premature labour occurred in 20% of patients and only 10.8% went beyond 40 weeks of gestation. The incidence of depressed second twin increased slightly after a time‐interval of more than 10 minutes between the delivery of the first twin and the second twin, but increased significantly when the time‐interval was more than 30 minutes. The first twin tended to be larger than the second twin. The sex ratio was 100 females to 134.5 males. The overall perinatal mortality was 76.4 per 1,000, with a perinatal mortality of 64.4 per 1,000 for the first twin and 93.6 per 1,000 for the second twin.

Placental Development in the Sheep and its Relation to Fetal Development

A quantitative macroscopic and microscopic investigation was performed upon the placenta of the sheep. Macroscopic data were obtained from 235 cases of single pregnancy, 285 cases of twin pregnancy, 45 cases of triplet pregnancy, and from one case of quadrulet pregnancy. Macroscopic data obtained include: weight of the uterine horns, weight of the fetal membranes, weight of the total cotyledonary mass, and weight of the fetus. Microscopic data were mainly obtained from twin pregnancies (about 30 placentas in each of the nine age groups, group I being excluded from this investigation). The following microscopic data were calculated: vascularization of the caruncles (being the maternal component), degree of branching of the villi, total villous surface, vascularization of the villi, and total villous blood volume.

Two cases of continuous fetal heart rate monitoring in twins.

This report describes two cases of twin pregnancy in which continuous heart rate monitoring of both twins was successfully carried out during labour. In both cases monitoring permitted early diagnosis of fetal distress and both mothers were delivered by caesarean section. Continuous fetal heart rate monitoring permits diagnosis of fetal distress in the second twin much earlier than conventional methods.

A Successful Outcome of Twin Pregnancy in Patient with Systemic Lupus Erythematosus - A Case Report

A 28 years old lady was admitted in BSMMU with 4th gravida 33 wks. twin pregnancy with preeclampsia and anasarca. She is a known case of SLE for 4 years and was diagnosed at her 3rd pregnancy. At that time her antids DNA titre was 1100IU/ml. She was in prednisolone and aspirin. She was in remission phase and with advice of physician she got pregnancy. She was diagnosed as a case of twin pregnancy at 12 weeks of pregnancy. DOI: 10.3329/bmj.v38i1.3585 Bangladesh Medical Journal 38(1) 2009 35-36

The efficacy of folic acid in preventing megaloblastic anaemia in twin pregnancy.

The incidence of megaloblastic anaemia in 41 cases of twin pregnancy receiving prophylactic folic acid, delivered at the Rotunda Hospital from November, 1960, to November, 1961, is compared with the incidence of megaloblastic anaemia in 42 cases not receiving prophylactic folic acid delivered during the same period. There were no cases of megaloblastic anaemia in the former group, while 7 cases were diagnosed in the latter group. The use of prophylactic folic acid, 5 mg. daily following 32 weeks gestation, is recommended, at any rate in twin pregnancy.