Delivery In Twin Pregnancies Research Articles

OP19.07: Cervical length changes and the risk of preterm delivery in twin pregnancies

OP19.07: Cervical length changes and the risk of preterm delivery in twin pregnancies

The role of phosphorylated insulin-like growth factor binding protein-1 in predicting pre-term labour in twin pregnancies

This was a retrospective study, carried out at Yeovil District Hospital, UK, from January 2006 to December 2008, looking at 40 patients with twin pregnancies. The aim was to evaluate the role of phosphorylated insulin-like growth factor binding protein-1 (IGFBP-1) test in the prediction of pre-term delivery in twin pregnancies. All the patients had a transvaginal ultrasound scan for cervical length at 24 weeks, followed by a high vaginal swab for IGFBP-1 at 26 weeks. A total of 95% of women screened negative for the IGFBP-1 test. None of these women delivered before 30 weeks; 7.50% delivered between 30 and 33+6 weeks; 87.5% delivered after 34 weeks. Two women (5.00%) screened positive for phosphorylated insulin-like growth factor binding protein-1; one had a spontaneous pre-term delivery at 30 weeks, while the other patient delivered at 38 weeks. It was concluded that women with twin pregnancies that have negative phosphorylated insulin-like growth factor binding protein-1 have a low risk of delivery before 34 weeks in the absence of other obstetric complications.

Longitudinal changes in canal length at 16–35 weeks in normal twin pregnancies and twin pregnancies with preterm labor and delivery

To describe the longitudinal changes in canal length at 16-35 weeks' gestation in cases of twin pregnancy with preterm labor and delivery. We studied 22 cases of twin pregnancy that were delivered at < 36 weeks and/or that underwent preterm labor requiring tocolysis. We also studied 44 cases of twin pregnancy delivered at > or = 36 weeks without tocolysis (non-tocolysis twin pregnancy). Controls were 82 cases of normal singleton pregnancy. Canal length was longitudinally measured using transvaginal ultrasonography. The observational period of 16-35 weeks was divided into 4-week periods for analysis. From 28 to 31 weeks onwards the canal length of non-tocolysis twin pregnancies was shorter than that of normal singleton pregnancies (P < 0.05). The canal length of twin pregnancies with preterm labor and delivery was shorter than that of non-tocolysis twin pregnancies at 16-19 weeks and decreased rapidly until 24-27 weeks (P < 0.01). A short canal length at 16-19 weeks followed by rapid canal length shortening in the second trimester are specific characteristics in preterm labor and delivery of twin pregnancies. Sequential measurements of canal length in the second trimester starting at < 20 weeks may be a suitable parameter to predict preterm labor and delivery in twin pregnancies.

Twin pregnancy: controversies in management

Key content The management of twin pregnancy poses many difficult and controversial issues; questions about management remain unanswered. With the rising incidence of multiple pregnancies due to greater maternal age and advances in assisted conception, the obstetrician is increasingly faced with these issues. This article looks at the controversies and available evidence concerning management and delivery of twin pregnancy. Learning objectives To understand the issues surrounding screening for aneuploidy in twins and the role of invasive testing. To understand the complex issues involved in the management of single twin demise, twins discordant for fetal anomaly and twin‐to‐twin transfusion syndrome. To be aware of the evidence available regarding the timing and mode of delivery of twins. Ethical issues An obligatory single embryo transfer policy in assisted reproduction may be an option for women at high risk of twins, but will this be in conflict with client interests and wishes? Complex ethical issues surround multifetal pregnancy reduction and selective feticide among twins discordant for fetal anomaly; these are matters for continuing debate. Please cite this article as: Devaseelan P, Ong S. Twin pregnancy: controversies in management. The Obstetrician &amp; Gynaecologist 2010;12:179–185.

Active Second-Stage Management in Twin Pregnancies Undergoing Planned Vaginal Delivery in a U.S. Population

To estimate neonatal morbidity and delivery outcomes according to planned mode of delivery in twin pregnancies with active second-stage management. This was an historic cohort of twin pregnancies delivered in one practice between June 2005 and September 2009 using a strict protocol of second-stage management, including breech extraction of a second noncephalic twin and internal version of a nonengaged cephalic second twin followed by breech extraction. Primary outcome was a 5-minute Apgar score less than 7 for twin B. Secondary outcomes were 5-minute Apgar score less than 7 for twin A and 1-minute Apgar score less than 7 and arterial cord pH below 7.20 for each twin. A total of 287 twin pregnancies were included. There were 157 patients (54.7%) in the planned cesarean group and 130 patients (45.3%) in the planned vaginal delivery group. There was no significant difference in the rates of twin B having a 5-minute Apgar score lower than 7 or an arterial cord pH below 7.20. Among the patients in the planned vaginal delivery group, the cesarean delivery rate was 15.4%. No patients had a vaginal delivery of twin A followed by cesarean delivery of twin B. Among the patients in the planned vaginal delivery group, patients who had a successful vaginal delivery were more likely to be younger (31.56+/-6.6 compared with 36.88+/-6.1 years, P=.001) and were more likely to have a prior vaginal delivery (47.3% compared with 15.0%, P=.007). Planned vaginal delivery of twin pregnancies seems to be associated with neonatal outcomes similar to those with planned cesarean delivery. Active second-stage management is associated with good neonatal outcomes and a low risk of combined vaginal-cesarean delivery. II.

Increased Rate of Elective Cesarean Delivery and Neonatal Respiratory Disorders in Twin Pregnancies

We examined whether the incidence of neonatal respiratory disorders has increased with the increased rate of elective cesarean delivery in twin pregnancies. We reviewed the obstetric records of 292 twin deliveries with vertex presentation of the first twin after 37 weeks' gestation at our hospital from 2000 through 2008. The study period was divided into 3 parts as follows: period 1: 2000 through 2002 (n=76); period 2: 2003 through 2005 (n=104); and period 3: 2006 through 2008 (n=112). We compared the rate of elective cesarean delivery due to maternal request and the incidence of transient tachypnea of the newborn (TTN). There has been a significant increase in rate of elective cesarean delivery (period 1: 18%; period 2: 25%; period 3: 48%) over the past several years. This increase was observed to be due to an increase in maternal requests for elective cesarean delivery. However, there were no significant differences in the incidence of TTN in the 3 periods [period 1: 7.2%; period 2: 6.7%; period 3: 8.0%]. The recent increase in the rate of cesarean delivery did not cause the increase in the incidence of neonatal respiratory disorders in twin pregnancies.

Grossesses gémellaires : où les suivre ? Où les faire accoucher ?

To define where should twin pregnancies be managed and delivered. A literature search was performed using the Pubmed and Cochrane database. Foreign societies guidelines were also consulted. There is little or no evidence to answer the question. Risk of premature labor and chorionicity are the two main factors involved in twin management. When there is a risk of prematurity, in utero transfer is recommended. Twin care must be performed by a team trained in the specificity of management according to chorionicity. There is not enough evidence to support specialized clinics. Labor and delivery need permanent and immediate disponibility of a perinatal team including an OB-gyn, an anesthesiologist and a pediatrician. Needs assessment and chorionicity are the best indicators to define the optimal place of care and delivery for twin pregnancies. More than a specific location, it seems more logical to define all necessary means to enforce an optimal management of these pregnancies.

60: Timing of delivery in twin pregnancies according to chorionicity

60: Timing of delivery in twin pregnancies according to chorionicity

444: Gestational age at cervical length measurement and preterm birth in twins

Objectives To estimate the risk of preterm delivery of twin pregnancies based upon sonographic cervical length measurement and gestational age at measurement. Methods Twin pregnancies that delivered between 1999 and 2005 and that underwent sonographic measurement of cervical length between 13 and 34 + 6 weeks’ gestation were identified and a retrospective review performed. Women with anomalous pregnancies, multifetal reduction, cerclage placement or medically indicated deliveries before 35 weeks were excluded. Logistic regression analysis was used to estimate the risk of preterm delivery before 35 weeks. Results A total of 561 women underwent 2975 sonographic cervical length measurements during the study period. The rate of preterm delivery before 35 weeks was 19.4%. The risk of delivery before 35 weeks decreased by approximately 5% for each additional mm of cervical length (odds ratio (OR) 0.95 (95% CI, 0.93–0.97); P < 0.001) and by approximately 6% for each additional week at which the cervical length was measured (OR 0.94 (95% CI, 0.92–0.96); P < 0.001). Conclusion The gestational age at which cervical length is measured is an important consideration when estimating the risk of spontaneous preterm birth in twins. The risk of preterm delivery is increased at earlier gestational ages and as cervical length decreases. Copyright  2012 ISUOG. Published by John Wiley & Sons, Ltd.

P103 Timing of delivery in twin pregnancies complicated by intrauterine growth restriction – A cardiotocography-documented case report

P103 Timing of delivery in twin pregnancies complicated by intrauterine growth restriction – A cardiotocography-documented case report

Loop Electrosurgical Excision of the Cervix and Risk for Spontaneous Preterm Delivery in Twin Pregnancies

To investigate the association between three cervical procedures (biopsy with no treatment, ablation, and loop electrosurgical excision procedure [LEEP]) and subsequent spontaneous preterm delivery in twin pregnancies using population-based data from various nationwide registries. : The study population consisted of all twin deliveries in Denmark during a 9-year period, 1997-2005. Information on the deliveries, including cervical procedures, was obtained from various national registries. In all, 9,868 deliveries were eligible for analyses, of which 3,228 were delivered spontaneously preterm (32.7%). Preterm delivery was defined as gestational age between 21 weeks and 37 weeks. Logistic regression analyses were used to evaluate the association between cervical procedures and preterm delivery. Twin pregnancies subsequent to LEEP had a significantly increased risk of overall subsequent spontaneous preterm delivery (43.4%) with an adjusted odds ratio of 1.58 (95% confidence interval 1.16-2.14) compared with pregnancies with no prior LEEP (32.5%). The association was consistent in various secondary analyses and especially strong for the very preterm and extremely preterm groups. We found no increase in risk of preterm delivery subsequent to biopsy without treatment or ablation. Our study showed an overall significant increase in risk of preterm delivery in twin pregnancies subsequent to LEEP treatment, even after adjustment for several potential risk factors. II.

Severity of prematurity risk in spontaneous and in vitro fertilization twins: does conception mode serve as a risk factor?

Because assisted reproductive technology (ART) contributes to world-wide increases in twin pregnancies, we retrospectively evaluated whether preterm twin gestations after ART are at higher risk for delivery at earlier gestational ages compared with naturally conceived twins. The evaluation of 204 dichorial twin pregnancies, 102 after natural conception and 102 after ART, matched for maternal age, demonstrated comparable severity of prematurity risk in both groups.

Delivery of a Live Newborn in a Triplet Pregnancy Complicated by Preeclampsia after Intrauterine Demise of Two and Expulsion of One Triplet: A Case Report

Delayed interval delivery in twin pregnancies is an unusual occurrence, even more so in triplet pregnancies. We report on a delayed interval delivery in a dichorionic triamniotic triplet pregnancy after in vitro fertilization (IVF). Because of severe twin to twin transfusion syndrome (TTTS), two fetuses demised at 22 weeks of gestation. One of the two fetuses spontaneously aborted at 25 weeks of gestation. The remaining live fetus and the second demised fetus were delivered by cesarean section 9 weeks later because of the occurrence of preeclampsia. This case indicates that delayed interval delivery in triplets is possible and that preeclampsia can occur after intrauterine demise of two fetuses.

18th World Congress on Ultrasound in Obstetrics and Gynecology, 24–28 August 2008, Chicago, USA: presentations and awards

When asked to introduce Larry Platt as the 2008 Gold Medal recipient, I was more than delighted to do so. One might consider this to be a daunting task. However, since Larry’s career is so robust, it was actually easy to chronicle his contributions through the years. To me, the Ian Donald Gold Medal Award is the greatest honor that one can receive in our field of obstetric and gynecological ultrasonography. Since it carries so much respect, when I heard that Larry Platt was this year’s recipient I thought to myself, ‘it’s about time’. Why? Firstly, Larry has been a prolific contributor to the literature. Secondly, he has been a tenacious supporter of ultrasound education. And thirdly, aside from Stuart Campbell, I can think of no one who has been a greater advocate for ISUOG. He has served as President of the Society, Associate Editor of Ultrasound in Obstetrics and Gynecology, and has been on the Board for many years; he has simply put ISUOG first, ahead of his many other responsibilities. When I recently thumbed through my most recent book on ultrasound, I found that I had cited Larry’s work in five different chapters. First and foremost, one cannot mention his name without connecting it to the wonderful contribution that he and Frank Manning made in designing the biophysical profile. It is hard to believe that this was published 28 years ago, and is still being used in its original form by virtually everyone managing

368: The mode of delivery in twin pregnancies

368: The mode of delivery in twin pregnancies

Prediction of Spontaneous Preterm Delivery in Twin Pregnancies By Cervical Length at Mid-Gestation

The objective of our study was to evaluate the correlation of the cervical length at 20-25 weeks of gestation with the incidence of spontaneous preterm delivery in twins in a country with a high incidence of preterm delivery compared to other European countries. Cervical length was measured in 262 consecutive patients. Previous preterm delivery before 34 weeks of gestation, chorionicity, maternal age, body-mass-index, smoking habit and parity were recorded as risk factors for preterm delivery. Women who were symptomatic at 20-25 weeks and who delivered because of other reasons than spontaneous labour and preterm rupture of membranes or at term were excluded. The primary outcome was incidence of preterm birth before 34 weeks. Two hundred and twenty-three patients were analyzed. Thirty-two (14%) delivered before 34 weeks. There was a significant correlation between cervical length of less than 25 mm and spontaneous delivery before 34 weeks (50% vs. 13%, p = .007). In addition, logistic regression analysis found cervical length to be the only significant predictor of spontaneous delivery before 34 weeks (OR 1.084; 95% CI 1.015; 1.159; p = .017). We conclude that the risk of severe preterm delivery in twins is high. Cervical length at mid-gestation was the only predictor of delivery before 34 weeks.

OP10.02: Cervical shortening rate as a predictor for preterm delivery in twin pregnancies

OP10.02: Cervical shortening rate as a predictor for preterm delivery in twin pregnancies

P37.03: Clinical, sonographic and psychosomatic aspects of delayed‐interval delivery in twin pregnancy

P37.03: Clinical, sonographic and psychosomatic aspects of delayed‐interval delivery in twin pregnancy

OC141: Prediction of spontaneous preterm delivery in twin pregnancies by cervical length at mid‐gestation

OC141: Prediction of spontaneous preterm delivery in twin pregnancies by cervical length at mid‐gestation

Achieving maternal BMI-specific weight gain goals improves birthweight and gestational age at delivery in twin pregnancies

BIRTHWEIGHT AND GESTATIONAL AGE AT DELIVERY IN TWIN PREGNANCIES WILLIAM GOODNIGHT, ELIZABETH HILL, ROGER NEWMAN, AMELIA ROWLAND, Medical University of South Carolina, Obstetrics and Gynecology, Charleston, South Carolina, Medical University of South Carolina, Biometry and Epidemiology, Charleston, South Carolina OBJECTIVE: To validate improved obstetrical outcomes associated with maternal achievement of BMI-specific weight gain goals recommended for twin pregnancies. STUDY DESIGN: A retrospective review of all twin deliveries between 2002 2006 at the Medical University of South Carolina was conducted. Maternal BMI-specific weight gain goals recommended by Luke, et al, JRM 2003 were established prospectively for each patient at presentation. ANOVA and repeated measures analysis were performed to evaluate birthweight and gestational age at delivery by maternal achievement of their BMIand gestational age-specific weight gain goals. Analysis was performed with SAS 9.1 (SAS Institute, Cary, NC). RESULTS: 151 twin gestations (300 neonates) were analyzed; 57.8%, 18.6%, and 23.5% were under, within, or over weight gain goals at 20-22 weeks, while 55.0%, 17.9% and 27.2% were under, within, or over goals at delivery. Achievement of maternal weight gain goals at 20-22 weeks and at delivery was significantly associated with increased birthweight (p!0.0076 and p!0.001 respectively). After adjustment for gestational age, BMI, maternal age, and chorionicity, lower birthweights were associated with a weight gain under goal both at delivery ( 245 gram 95% CI 359.4, 131.1 p ! 0.0001) and at 20-22 weeks ( 148.1 gram 95% CI 277, 18 p =0.03). Achievement of weight gain goals was also associated with a nonsignificant increase in GA at delivery. CONCLUSION: Failure to achieve recently recommended BMI and gestational age specific weight gain goals for twin pregnancies was associated with a significant reduction in birthweight at delivery and shortened length of gestation. No benefit was associated with exceeding these weight gain goals.