Diagnosis Of Twin Pregnancy Research Articles

The effect of twin pregnancy in intrahepatic cholestasis of pregnancy: A case control study.

Intrahepatic cholestasis of pregnancy (ICP) is one of the most common hepatic disorders during pregnancy, and the etiology is thought to be multifactorial including both environmental and hormonal contributions. In twin pregnancies, the fetal and placental mass is generally greater than in singleton pregnancies, and is, theoretically, likely to have a greater influence upon the maternal hepatic metabolism compared to singleton pregnancy. The aim of this study was to compare ICP in twin and singleton pregnancies according to ICP characteristics, time of diagnosis, serum bile acid levels, pharmacological treatment, and pregnancy outcomes. This case control study was undertaken at Aarhus University Hospital, Denmark, from 2012 to 2019. The study comprised 51 women with twin pregnancies and ICP. These women were matched with 153 women with twin pregnancies without ICP and 153 women with singleton pregnancies with ICP, respectively. Three controls were matched per case, and data obtained from medical records and Danish obstetrical databases were compared. We found a significantly lower gestational age at ICP diagnosis in twin pregnancies (227 vs. 242 days for singleton pregnancies; p = 0.002). Bile acids reached significantly higher maximum blood levels in twin pregnancies (32.9 vs. 22.2 μmol/L; p = 0.012), and at a lower gestational age (gestational age maximum bile acids: 235 vs. 250 days; p < 0.001). No difference in pharmacological treatment was observed between the groups. Twin pregnancies with and without ICP had comparable pregnancy outcomes; however, ICP pregnancies had a higher incidence of gestational diabetes mellitus (15.7% vs. 5.2%; p = 0.03). In repeat pregnancies, ICP was diagnosed earlier in the twin pregnancy (p = 0.006). Compared to singleton pregnancies, twin pregnant women with ICP have an earlier diagnosis of ICP, and levels of bile acids are higher. Compared to twin pregnancies without ICP, the pregnancy outcomes are comparable.

Can maternal serum midkine level predict chorionicity in twin pregnancies?

Sometimes it can be difficult to chorionicity determination in twin pregnancies. This study aimed to compare maternal serum midkine levels between twin and singleton pregnancies. We also evaluated the relationship between chorionicity and maternal serum midkine level in twin pregnancies. The present prospective cohort study included 16 patients with monochorionic diamniotic twin pregnancies, 38 with dichorionic diamniotic twin pregnancies, and 66 healthy singleton pregnancies admitted to Ankara City Hospital Perinatology Clinic between June 2021 and June 2022. Demographic features, clinical characteristics, and serum midkine levels were compared between the groups. Additionally, a receiver operator characteristics (ROC) analysis was performed to assess the performance of midkine for detecting chorionicity. The median maternal serum midkine level was found to be 0.64 ng/ml in twin pregnancies and 0.26 ng/ml in singleton pregnancies (p < 0.001). When twin pregnancies were compared in terms of chorionicity, serum midkine level was determined as 1.20 ng/ml in the monochorionic diamniotic group and 0.50 ng/ml in the dichorionic diamniotic group (p = 0.034). An optimal cut-off value of 1.03 ng/ml was found for the determination of chorionicity (AUC: 0.68, p = 0.03, 95% CI: 0.53–0.83, %56.3 sensitivity, 76.3% specificity). In advanced weeks of pregnancy, biomarkers can be used as helpful parameters for ultrasonography in the diagnosis of twin pregnancies. Maternal serum midkine levels might be used to determine chorionicity in equivocal cases.

Locked twins\u2014remote from term: a case report

BackgroundLocked twins is a rare and hazardous obstetric complication, which occurs in approximately 1:1000 twin pregnancies. One of the known etiologic factors for locked twins is size of the twins. We report a case of chin-to-chin locked twins that occurred at gestational age of 30 weeks pus 6 days.Case summaryA 27 years-old primigravida Ethiopian mother presented with a history of pushing down pain and passage of liquor of 6 hours duration at gestational age of 30 weeks plus 6 days. With a diagnosis of twin pregnancy (first twin non-vertex), abdominal delivery was decided in latent first stage of labor but mother refused caesarian delivery and she was allowed to labor with the hope of achieving a vaginal delivery. In second stage, interlocking twin was encountered and a low vertical cesarean section was done to effect delivery of twins without the need to decapitate the first twin.ConclusionLocked twin is a rare obstetric complication. Whenever it is encountered, successful delivery can be achieved without the need to have decapitation of the first twin during caesarian section.

To the diagnosis of twin pregnancy

An absolutely correct diagnosis of twin pregnancy is not as easy as many people think, and this circumstance is especially evident when the doctor's course of action depends on the correct diagnosis.

Analysis of factors influencing the false-negative diagnosis of cervical/vaginal liquid based cytology

Objective: To investigate the possible influencing factors of false-negative diagnosis of cervical/vaginal liquid based cytology, and further improve the sensitivity of cervical/vaginal cytology. Methods: The results of cervical/vaginal cytology of outpatients and inpatients in Department of Obstetrics and Gynecology, Peking University First Hospital from July 2015 to December 2018 were analyzed retrospectively. Cytological false-negative cases were defined as the patients whose cytological results showed no intraepithelial neoplasia and malignant (NILM), but whose biopsy was diagnosed as cervical intraepithelial neoplasia (CIN) 2 or vaginal intraepithelial neoplasia (VAIN) 2 or above within 6 months of the diagnosis. The review of false-negative cytology smear was completed by two senior cytologists. Two-class logistic regression was used to evaluate the influence of age, location or number of lesion, and degree of lesion on the false-negative diagnosis of cytology. The reasons for the inconsistency of false-negative diagnosis were analyzed with the review results. Results: Among 1 009 cases of CIN2+ and VAIN2+ lesions, 180 cases (17.8%) showed NILM. After reviewing the smear, 123 cases (68.3%) were identified as NILM and 57 cases(31.7%) as abnormal. The false-negative rate was the highest (20.8%) in the patients with age≤30 years, and the risk was 8.85 times higher than the patients aged 31 to 60 years (P<0.001), 9.26 times than the patients aged≥60 years (P<0.001). The highest cytological false-negative rate was 50.0% for cervical polyps or intraductal lesions. The false-negative rate of vaginal wall or vaginal pedicle rupture was 13.0%; that of single cervical lesion was 22.3%; that of high-grade squamous intraepithelial lesion(HSIL) and adenocarcinoma in situ of cervix(AIS) was 13.7% and that of malignant lesions was 3.9%. The most common cell types in the reviewed abnormal cases were squamous cells in the middle surface layer (38.6%) and squamous cells in the outer bottom layer (24.6%). The abnormal cells in all smears was the most common distribution (59.7%), the number of abnormal cells in the smear was less than 10 (31.6%), nuclear enlargement and light staining were common (42.2%), and inflammatory lesions or keratotic changes in the background were most common (59.7%). Conclusions: Age of the patient, location or number of lesion, and degree of lesion are associated with false-negative diagnosis of cytology. Summarizing sampling experience and improving sampling skills will help reduce the occurrence of false-negative cases. Cytopathologists should examine slightly abnormal changes more carefully and learn how to further reduce the false-negative rate procactively.

Physical examination–indicated cerclage in twin pregnancy: a randomized controlled trial

Women with twin pregnancies and a dilated cervix in the second trimester are at increased risk of pregnancy loss and early preterm birth; there is currently no proven therapy to prevent preterm birth in this group of women. This study aimed to determine whether physical examination-indicated cerclage reduces the incidence of preterm birth in women with a diagnosis of twin pregnancies and asymptomatic cervical dilation before 24 weeks of gestation. Multicenter, parallel group, open-label, randomized controlled trial of women with twin pregnancies and asymptomatic cervical dilation of 1 to 5 cm between 16 weeks 0/7 days of gestation and 23 weeks 6/7 days of gestation were enrolled from July 2015 to July 2019 in 8 centers. Eligible women were randomized in a 1:1 ratio into either cerclage or no cerclage groups. We excluded women with monochorionic-monoamniotic twin pregnancy, selective fetal growth restriction, twin-twin transfusion syndrome, major fetal malformation, known genetic anomaly, placenta previa, signs of labor, or clinical chorioamnionitis. The primary outcome was the incidence of preterm birth at <34 weeks of gestation. Secondary outcomes were preterm births at <32, <28, and <24 weeks of gestation, interval from diagnosis to delivery, and perinatal mortality. Data were analyzed by intention-to-treat methods. After an interim analysis was performed, the Data and Safety Monitoring Board recommended stopping the trial because of a significant decrease in perinatal mortality in the cerclage group. We randomized 34 women, with 4 women being excluded because of expired informed consent. A total of 17 women were randomized to physical examination-indicated cerclage and 13 women to no cerclage. Whereas 4 women randomized to cerclage did not receive the surgical procedure, no women in the no cerclage group received cerclage. Maternal demographics were not significantly different. All women in the cerclage group also received indomethacin and antibiotics. When comparing the cerclage group vs the no cerclage group, the incidence of preterm birth was significantly decreased as follows: preterm birth at <34 weeks of gestation, 12 of 17 women (70%) vs 13 of 13 women (100%) (risk ratio, 0.71; 95% confidence interval, 0.52-0.96); preterm birth at <32 weeks of gestation, 11 of 17 women (64.7%) vs 13 of 13 women (100%) (risk ratio, 0.65; 95% confidence interval, 0.46-0.92); preterm birth at <28 weeks of gestation, 7 of 17 women (41%) vs 11 of 13 women (84%) (risk ratio, 0.49; 95% confidence interval, 0.26-0.89); and preterm birth at <24 weeks of gestation, 5 of 17 women (30%) vs 11 of 13 women (84%) (risk ratio, 0.35; 95% confidence interval, 0.16-0.75). The mean gestational age at delivery was 29.05±1.7 vs 22.5±3.9 weeks (P<.01), respectively; the mean interval from diagnosis of cervical dilation to delivery was 8.3±5.8 vs 2.9±3.0 weeks (P=.02), respectively. Perinatal mortality was also significantly reduced in the cerclage group compared with the no cerclage group as follows: 6 of 34 women (17.6%) vs 20 of 26 women (77%) (risk ratio, 0.22; 95% confidence interval, 0.1-0.5), respectively. In women with twin pregnancies and asymptomatic cervical dilation before 24 weeks of gestation, a combination of physical examination-indicated cerclage, indomethacin, and antibiotics significantly decreased preterm birth at all evaluated gestational ages. Most importantly, cerclage in this population was associated with a 50% decrease in early preterm birth at <28 weeks of gestation and with a 78% decrease in perinatal mortality.

Comparison of electrolyte and acid-base balances of Dorper breed ewes between single and twin pregnancies

ABSTRACT: During pregnancy there are modifications in the metabolic profile of sheep that may predispose to the occurrence of metabolic disorders, of which pregnancy toxaemia (PT) is highlighted. Blood gas analysis is detects changes in acid-base and electrolyte balance effectively. The objectives of this study were to study the acid-base and electrolyte balance of sheep during gestation and in the immediate peripartum (up to 48 hours postpartum), comparing single gestation with twins. Sixty healthy sheep of Dorper breed, two to five years old were raised in a semi-intensive system and were divided in two experimental groups: Group 1: 30 ewes, with ultrasonographic diagnosis of single fetus gestation; Group 2: 30 ewes, with ultrasonographic diagnosis of twin pregnancy. The experimental moments were defined as: MI-immediately after artificial insemination (control); MG30 - 30 days of gestation; MG90 - 90 days of gestation; MG120 - 120 days of gestation; MG130 - 130 days of gestation; MG140 - 140 days of gestation; MP - lambing; MPP1 - 24h postpartum; MPP2 - 48h postpartum. At all times 1mL of blood was collected per jugular vein puncture for blood gas evaluation in a portable equipament (I-Stat®). The pH, carbon dioxide pressure (PCO2), bicarbonate (HCO3-), base excess (BE), sodium (Na+), potassium (K+), chloride (Cl-), ionized calcium (Ca+2), lactate, anion gap (AG) were mensured and strong ion difference (SID) were calculed. This work showed that there were changes in acid-base and electrolyte balance in pregnant ewes, due to the decrease in BE, HCO3-, TCO2 and increase of lactate and AG during gestation, but the pH remained normal and did not present any difference among moments in both groups. Comparing the groups, single-gestation ewes presented higher alkaline expenditure at delivery than twin-gestation, evidenced by lower levels of BE and HCO3-. Lower Na+ levels were observed in prepartum; drop in K+ values with advancing gestation; hyperchloremia and hypocalcemia during gestation according to the reference standards for species; decreased iCa+2 levels in the final third of gestation in both groups. It was concluded that the ewes of this study were healthy until the last moment analyzed (48h postpartum), although have shown greater consumption of the alkaline reserve in the peripartum, being more explicit in the single gestation animals. In addition, this situation can be physiological and result in increased energy demand during gestation, more exacerbated by peripartum.

Detection of twin pregnancies in ewes by pregnancy-associated glycoprotein assay and transabdominal ultrasonography

The objectives of the present study were to evaluate and compare the accuracy of transabdominal ultrasonography and pregnancy-associated glycoprotein (PAG) assay in the diagnosis of twin pregnancies in ewes and to evaluate the utility of the PAG assay for predicting fetal gender in singleton pregnancies. The animals in the study consisted of 179 pregnant ewes. The number of fetuses in the ewe was determined using transabdominal ultrasonography between days 40 and 60 (on days 40, 45, 50, 55, and 60). Blood samples were collected from all the ewes on the same day to determine the PAG concentrations. The results found were highly sensitive for the detection of twin pregnancies by transabdominal ultrasonography. The accuracy of transabdominal ultrasonography in detecting twin pregnancies was found to be higher on day 60 than on other days (P < 0.05). The sensitivities of PAG assay in detecting twin pregnancies on days 40, 45, 50, 55, and 60 were 91.67%, 66.67%, 81.82%, 88.89%, and 33.33%, respectively. The accuracies of the PAG assay in detecting twin pregnancies on days 40, 45, and 50 were found to be statistically significant higher than other days (P < 0.05). The PAG assay had low sensitivity and specificity for predicting fetal gender. It was concluded that twin pregnancies in ewes can be diagnosed with high accuracy using transabdominal ultrasonography on day 60 of pregnancy and as well as using the PAG assay during the early days of pregnancy (on days 40, 45, and 50). The PAG assay is not useful for predicting fetal gender.

Is twin pregnancy, calving and pregnancy loss predictable by serum pregnancy-specific protein b (pspb) concentration 28-35 days after ai in dairy cows?

Double ovulation occurs more frequently in multiparous cows with high milk production than in primiparous cows and the rate of twin pregnancy/calving is increasing worldwide. Diagnosis of twin pregnancy is possible by ultrasound at the time of early pregnancy examination [28-34 days after artificial insemination (AI)]. Pregnancy proteins are also well-known indicators of gestation. The risk of pregnancy loss during the first trimester of gestation for cows carrying twins is three to nine times higher than for cows carrying singletons. Pregnancy-specific protein B (PSPB) is a good indicator not only of pregnancy but also of pregnancy loss. The aims of this study were (a) to collect calving data in some Hungarian Holstein-Friesian herds (n = 7,300) to compare PSPB serum concentrations (measured 29-35 days post insemination) in twin- and singleton-calving cows (Trial 1), and (b) to check the predictive value of PSPB serum concentration for twin pregnancy and pregnancy loss in high-producing Spanish Holstein-Friesian cows (n = 98; Trial 2). Our results showed almost 7% twin calving rate. Although hormonal treatments are commonly believed to be major causes of twin pregnancies, our data do not support this hypothesis. The only exception is the single PGF injection, which significantly increased twin calving. No effect of milk production on the risk of twin pregnancy was found, and twin pregnancy increased with parity. The AI bull, the bull's sire, the bull's grandfather and the cow's father also affected twin calving (P ≤ 0.02). We found much higher frequency of twin calving in cows diagnosed pregnant with higher than 3 ng/ml serum PSPB concentrations at 29-35 days after insemination. In Trial 2, non-significant but well-marked differences were found in PSPB serum concentration between singleton- and twin-pregnant cow samples (2.1 and 2.9 ng/ml) at different bleeding times. Probably the small size of the study population and the effects of milk production on PSPB values may explain this lack of significance.

No. 262-Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies.

To provide a Canadian consensus document with recommendations on prenatal screening for and diagnosis of fetal aneuploidy (e.g., Down syndrome and trisomy 18) in twin pregnancies. The process of prenatal screening and diagnosis in twin pregnancies is complex. This document reviews the options available to pregnant women and the challenges specific to screening and diagnosis in a twin pregnancy. Clinicians will be better informed about the accuracy of different screening options in twin pregnancies and about techniques of invasive prenatal diagnosis in twins. PubMed and Cochrane Database were searched for relevant English and French language articles published between 1985 and 2010, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, prenatal screening, genetic health risk, genetic health surveillance, prenatal diagnosis, twin gestation). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding prenatal screening were also reviewed in developing this clinical practice guideline. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table1). There is a need for specific guidelines for prenatal screening and diagnosis in twins. These guidelines should assist health care providers in the approach to this aspect of prenatal care of women with twin pregnancies. RECOMMENDATIONS.

Non-Invasive Prenatal Diagnosis in Twin Pregnancies: Current Status

The objective of this review is to assess the evidence which supports the use of non-invasive prenatal diagnosis (NIPD) in twin pregnancies. Through the years, we have witnessed the technological developments in non-invasive prenatal diagnosis attained new heights, but those studies were usually limited in singleton pregnancies. As we known, twin pregnancies are at higher risk in both aneuploidy and structural abnormalities. The first- and second- trimester aneuploidy screening in twin gestations are less accurate than in singleton gestations. And the invasive prenatal diagnosis in twin pregnancies is associated with a high risk of pregnancy loss. So, it is urgent to develop accurate non-invasive prenatal diagnosis in twin pregnancies. Recent studies about different terminology and methods in NIPD of twin pregnancies have been reported, suggesting that non-invasive prenatal testing can be feasibly and reliably used in twin pregnancies. In this article, we summarized the published literature on non-invasive prenatal diagnosis in twin pregnancies in order to benefit our clinical practice.

Twinning in Holstein-Friesian Dairy Cows: Proportion Carried to Term and Calf Sex Ratios.

The purpose of this study was to investigate the proportion of twins carried to term and the sex ratio of twin calves at birth in Holstein-Friesian dairy cattle kept on commercial farms in Devon and Cornwall, England. Ten farms were used in the study. Fifty four cows with twin pregnancies were identified using trans-rectal ultra-sonographic examination between 30 and 70 days of gestation. The farm records were subsequently used to derive the number of calves born. Farm records of 66 additional sets of twin births with the sex of the calves recorded were also identified. Of the 54 cows diagnosed with twin pregnancies, 16 cows (29.6%) aborted or absorbed both fetuses, 11 cows (20.4%) carried one calf to term and 27 cows (50%) carried both calves to term. In the calf sex analysis of the additional 66 sets of twins: 13♂♂ calves (19.7%), 18 ♀♀ calves (27.3%) and 35 ♂♀ calves (53.0%). There was no statistically significant difference from an expected ratio of 1♂♂:2♂♀:1♀♀ (p = 0.61). This study provides bench marks for the expected abortion/absorption rates following the early ultra-sonographic diagnosis of twin pregnancies in comparable populations and supports earlier observations that the expected sex ratio for twinning approximates to1♂♂:2♂♀:1♀♀.

Pregnancy and perinatal outcomes in women with polycystic ovary syndrome and twin births: a population-based cohort study.

To investigate pregnancy and perinatal outcomes in twin births among women with and without polycystic ovary syndrome (PCOS) diagnosis. Population-based cohort study. Sweden. We identified 20,965 women with twin births between 1995 and 2009 of whom 226 had a PCOS diagnosis through linkage between the Swedish Medical Birth Register and the Swedish National Patient Register. Calculating risk ratios (RR) with 95% confidence intervals (CI) using a log-binomial regression model and hazard ratios (HR) with 95% CI for preterm birth. Preterm birth, low birthweight, caesarean section, pre-eclampsia, Apgar score <7 at 5 minutes and perinatal mortality. PCOS diagnosis in twin pregnancy was associated with increased risk of preterm delivery (51% versus 43%, RR 1.18 [95% CI 1.03-1.37]), particularly spontaneous preterm delivery (37% versus 28%; RR 1.30 [95% CI 1.09-1.55]) and very preterm birth (<32 weeks) (14% versus 8%, RR 1.62 [95% CI 1.10-2.37]). Twins of PCOS mothers had more often low birthweight (48% versus 39%, adjusted RR 1.40 [95% CI 1.09-1.80]). This difference disappeared when adjusting for gestational age. No risk difference was found for caesarean section, pre-eclampsia, low 5-minute Apgar score or perinatal mortality. The risk of preterm delivery in twin pregnancies is increased by having a PCOS diagnosis. This should be considered in risk estimation and antenatal follow-up of twin pregnancies.

Accuracy of diagnosing double corpora lutea and twin pregnancy by measuring serum progesterone and bovine pregnancy-associated glycoprotein 1 in the first trimester of gestation in dairy cows

Progesterone (P4) and bovine pregnancy-associated glycoprotein 1 (bPAG-1) concentrations during gestation are dependent on the number of CL and fetuses, respectively. The objective of this present study was to measure and evaluate the usefulness of measuring the P4 and bPAG-1 concentrations in cases of single versus twin pregnancies and one versus two CL at the first 4 months of gestation. We hypothesized that both the number of the CL and the number of fetus might have an effect on P4 and pregnancy protein concentrations, and we can set up clinically useful threshold levels to predict twin gestations. Eighty-four Holstein-Friesian dairy cows were enrolled in this prospective observational clinical trial. Blood was collected at time point 1: between Days 29 and 42, time point 2: between Days 57 and 70, time point 3: between Days 85 and 98, and time point 4: between Days 113 and 126 of gestation, and bPAG-1 and P4 concentrations were measured. Binary logistic regression analyzing serum P4 concentrations differed at time point 2 compared with baseline level, but the area under the curve (AUC) had low sensitivity. The bPAG-1 concentrations were statistically different at each time point of gestation. The AUC cutoff values of serum bPAG-1 concentrations were sufficiently sensitive to differentiate between twin gestations from singleton ones. At time points 3 (cutoff value of 3.4 ng/mL) and 4 (cutoff value of 56.5 ng/mL), statistically significant differences with low sensitivity, high specificity, and a high AUC were found. On the basis of these results, the diagnosis of twin pregnancy using pregnancy protein measurements is clinically insufficient before Day 85 of gestation; however, the ability to confirm the early twin pregnancy diagnosis with bPAG-1 measurements appears to be promising. To achieve high sensitivity, further studies are required.

Incidence and Risk Factors of Twin Pregnancy at Jimma University Specialized Hospital, Southwest Ethiopia

Background: The incidence of twin pregnancy is increasing all over the world because of assisted reproductive technology or spontaneously as a result of numerous risk factors. It is associated with increased risk of maternal and neonatal complications both in the developed and developing countries, which in turn increase financial, emotional, personal and social costs to the twins themselves and their families. Thus, determining its magnitude and identifying the risk factors are crucial for possible prevention and better interventions. Method: Hospital-based prospective and case-control studies were conducted. To determine the incidence of twin pregnancy, all the 3812 deliveries conducted from December 01, 2012 to November 30, 2013 at Jimma University Specialized Hospital were followed from the time of admission to labor ward to the expulsion of fetus. To identify the risk factors for twin pregnancies, all 144 twin deliveries happened were taken as cases and 288 controls were randomly selected from the 3668 single ton-deliveries happened, with the ratio of 1:2. All the necessary data were collected by interviewing mothers, for both the cases and controls, by using structured questionnaire. The data were analyzed by using SPSS for windows version 20.0. Multivariate logistic regression analysis was done to identify risk factors for twin pregnancy. Odds ratios with 95% confidence intervals were used as measure of associations. Results: From 3812 deliveries conducted in the year period, 144 were twins making an incidence of 37.7 per 1000 deliveries. Family history of twinning (OR=9.16, 95% CI: 4.73, 17.74), oral contraceptive pill use prior to pregnancy (OR=2.14, 95% CI: 1.12, 4.08), household monthly income of 50-100 USD (OR=1.94, 95% CI: 1.08, 3.50) and >100 USD (OR=2.18, 95% CI: 1.10, 4.33) were found to increase the risk of twin pregnancy significantly. Conclusion: The study found high incidence of twin pregnancy. Family history of twinning, household income of ≥50 USD and oral contraceptive use prior to pregnancy were identified as risk factors for twin pregnancy. Mothers with identified risk factors should be targeted by nearby health facility in order to make the diagnosis of twin pregnancy earlier so that complications can be picked earlier and managed.

Complete hydatidiform mole with a healthy fetus, a twin pregnancy following intrauterine insemination: A case report

Hydatidiform mole (molar pregnancy) is characterized by abnormal fetoplacental development and trophoblastic hyperplasia. We report an unusual case of a 26 year old woman with the diagnosis of twin pregnancy with a healthy fetus and complete mol hydatidiform following an ovulation induction and subsequent intrauterine insemination (IUI). On 14th weeks of gestation, a fetus with a positive fetal cardiac activity and a second intrauterine ex fetus with a hydropic placenta was seen on ultrasound. A chorionic villus sampling and an amniosynthesis were performed. After the diagnosis of complete mole which was confirmed by histopathology; the pregnancy was terminated with the patient’s will on the 17th week of gestation. Keywords: Intrauterine insemination (IUI); infertility; complete hydatidiform mole; twin pregnancy DOI: 10.12973/ejms.2014.133p

OC09.02: Complications and outcome of invasive prenatal diagnosis in twin pregnancies

OC09.02: Complications and outcome of invasive prenatal diagnosis in twin pregnancies

Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies

ObjectiveTo provide a Canadian consensus document with recommendations on prenatal screening for and diagnosis of fetal aneuploidy (e.g., Down syndrome and trisomy 18) in twin pregnancies. OptionsThe process of prenatal screening and diagnosis in twin pregnancies is complex. This document reviews the options available to pregnant women and the challenges specific to screening and diagnosis in a twin pregnancy OutcomesClinicians will be better informed about the accuracy of different screening options in twin pregnancies and about techniques of invasive prenatal diagnosis in twins. EvidencePubMed and Cochrane Database were searched for relevant English and French language articles published between 1985 and 2010, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, prenatal screening, genetic health risk, genetic health surveillance, prenatal diagnosis, twin gestation). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding prenatal screening were also reviewed in developing this clinical practice guideline. ValuesThe quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Benefits, harms, and costsThere is a need for specific guidelines for prenatal screening and diagnosis in twins These guidelines should assist health care providers in the approach to this aspect of prenatal care of women with twin pregnancies. Summary StatementsFetal nuchal translucency combined with maternal age is an acceptable first trimester screening test for aneuploidies in twin pregnancies. (II-2)First trimester serum screening combined with nuchal translucency may be considered in twin pregnancies It provides some improvement over the performance of screening by nuchal translucency and maternal age by decreasing the false-positive rate. (II-3)Integrated screening with nuchal translucency plus first and second trimester serum screening is an option in twin pregnancies. Further prospective studies are required in this area, since it has not been validated in prospective studies in twins (III)Non-directive counselling is essential when invasive testing is offered (III)When chorionic villus sampling is performed in non-monochorionic multiple pregnancies, a combination of transabdominal and transcervical approaches or a transabdominal only approach appears to provide the best results to minimize the likelihood of sampling errors. (II-2) RecommendationsAll pregnant women in Canada, regardless of age, should be offered, through an informed counselling process, the option of a prenatal screening test for the most common clinically significant fetal aneuploidies. In addition, they should be offered a second trimester ultrasound for dating, assessment of fetal anatomy, and detection of multiples. (I-A)Counselling must be non-directive and must respect a woman's right to accept or decline any or all of the testing or options offered at any point in the process. (III-A)When non-invasive prenatal screening for aneuploidy is available, maternal age alone should not be an indication for invasive prenatal diagnosis in a twin pregnancy. (II-2A) If non-invasive prenatal screening is not available, invasive prenatal diagnosis in twins should be offered to women aged 35 and over. (II-2B)Chorionicity has a major impact on the prenatal screening process and should be determined by ultrasound in the first trimester of all twin pregnancies (II-2A)

Noninvasive prenatal tests for Down syndrome are near

Noninvasive prenatal tests for Down syndrome are near

Diagnosing twins in early pregnancy

Multiple pregnancy has increased in frequency as a result of the ageing maternal population as well as the advent and wider availability of assisted reproductive technologies. Higher-order pregnancies are associated with increased morbidity and mortality for both the foetuses and mother. The introduction of transvaginal ultrasound has made accurate diagnosis of twin pregnancy, determination of chorionicity and subsequent planning of these high-risk pregnancies a common part of obstetric care. In this article, we critically evaluate the role of transvaginal ultrasound in the diagnosis of twin pregnancies.