Management Of Twin Pregnancies Research Articles

O589 INTRAPARTUM MANAGEMENT OF TWIN PREGNANCIES: IS THIS STILL A VIABLE OPTION?: A 10 YEAR EXPERIENCE AT A TERTIARY INSTITUTION IN LONDON

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S469-S469 Free communication (oral) presentations O589 INTRAPARTUM MANAGEMENT OF TWIN PREGNANCIES: IS THIS STILL A VIABLE OPTION?: A 10 YEAR EXPERIENCE AT A TERTIARY INSTITUTION IN LONDON E. Rzyska, E. RzyskaSearch for more papers by this authorB. Ajay, B. AjaySearch for more papers by this authorE. Chandraharan, E. ChandraharanSearch for more papers by this author E. Rzyska, E. RzyskaSearch for more papers by this authorB. Ajay, B. AjaySearch for more papers by this authorE. Chandraharan, E. ChandraharanSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61019-4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S469-S469 RelatedInformation

Umbilical Artery Doppler Ultrasound for the Determination of Chorionicity in Twin Pregnancies

Background: Maternal and perinatal complications are higher in twins than in singleton pregnancies. This complications rate is directly related to placental chorionicity in twin pregnancies. Early diagnosis of twins and their chorionicity is necessary to reduce the perinatal mortality. It can be determined by different methods in the first trimester. Ultrasonography is a valuable tool in management of twin pregnancy. Ultrasound in evaluation of the chorionicity decreases later in gestational weeks. The aim of this study is to determine the chorionicity by using Doppler ultrasonography in second and third trimesters. Methods: Patients were divided into two groups according to their chorionicity. Pregnancies with dichorionic placentas were included into group 1, while with monochorionic placentas were included into group 2. In both groups, PI, RI and S/D indices of umbilical artery were measured in each fetus. Whether there is a significant difference between the groups in the Doppler parameters was evaluated. Results: The PI, RI and S/D indices of umbilical artery doppler ultrasonography were different between the twins with dichorionic placentas (p < 0.05), but they were similar in twins with monochorionic placentas. Conclusions: Based on our study results, we suggest that the Doppler ultrasonography can be useful method for chorionicity determination of twin pregnancies at second and third trimesters, if chorionicity has not determined until the end of second trimester. doi:10.4021/ jcgo29w

Validity of Lamellar Body Count as a Fetal Lung Maturity Assessment in Twin Pregnancy

Fetal lung maturity assessment in twin pregnancy has been discussed, but is still controversial. The purpose of this study is to predict the occurrence of respiratory distress syndrome (RDS) using lamellar body count (LBC) and analyze the validity of LBC for fetal lung maturity assessment in twin pregnancy. Three-hundred two amniotic fluid samples were obtained at cesarean section from 29 to 38 weeks of gestation. Samples were analyzed immediately with no centrifugation and the number of lamellar bodies was counted using a platelet channel on the Sysmex SF-3000. There were 18 neonates (6.0%) suffering from RDS. An LBC cut-off value of 2.95×10⁴/μL resulted in 91.5% sensitivity and 83.3% specificity for predicting RDS. This cut-off value for predicting RDS was the same as that in singleton pregnancy. Moreover, the median LBC value in RDS cases was significantly lower than in non-RDS cases (1.50±1.1×10⁴/μL vs. 10.6±7.5×10⁴/μL; p<.001). This is the first report on the validity of LBC in twin pregnancy and also the largest study on fetal lung maturity assessment in twin pregnancy. An LBC value of >2.95×10⁴/μL means reassuring findings for RDS even in twin pregnancy. We believe the data in this study provide valuable, new information for the management of twin pregnancies.

Reproduction performance of cows with single, twin and triplet calves

The aim of this study was to analyse data on 74,081 calvings, subsequent lactation performance and culling of 23,588 Black-and-White cows improved with Holstein-Friesians. The animals represented the active population in Pomerania and Kujavia, first calved in 2000 and 2001, and were culled before the end of 2008. Frequency of calvings, which averaged 1.5% for twin births and just 0.02% for triplet births, increased with age of cow and also with increasing milk yield in the preceding lactation. Performance results showed that mothers of twins were superior to mothers of single calves in terms of milk yield (1.3 kg milk/day milking). Despite the greater perinatal mortality of twins and triplets, multiple pregnancies gave rise to a greater number of calves compared to single pregnancies. However, multiple pregnancies were accompanied by adverse effects such as increased proportion of complications requiring human assistance, mechanical assistance and veterinary intervention (1.2 × more). Fertility of the cows deteriorated after multiple pregnancies, with particularly unfavourable indicators of fertility found for triplet births, decreased chance of survival to the next calving, and increased culling rates in cows, especially due to udder diseases, infertility, reproductive diseases, old age, metabolic and gastrointestinal diseases, and locomotor system diseases. It was found that the increasing milk yield was paralleled by the increasing proportion of multiple pregnancies. This has highlighted the need for early and reliable diagnosis and management of twin pregnancies, which is supposed to facilitate parturition and ensure survival of calves.

Conjoined twins pregnancies: experience with 36 cases from a single center

To review a single center's experience in the management of twin pregnancies with conjoined fetuses. Retrospective study describing prenatal findings, delivery details, surgical treatment and perinatal outcome. The study included 36 twin pregnancies with conjoined twins seen over a period of 12 years in a single tertiary hospital: 69.4% were thoracopagus, 13.9% parapagus, 8.3% omphaloischiopagus 5.6% omphalopagus and 2.8% cephalopagus. Cardiac defects were present in 91.6% of twin pairs and associated malformations were present in 61.8% of the cases: limb abnormalities in 36.1%, abdominal wall defects in 25.0%, cleft lip and/or palate in 13.9% and congenital diaphragmatic hernia in 5.5%. Surgical separation was considered not feasible and prognosis lethal in 30 (83.3%) cases. Termination of pregnancy was performed in 12 pregnancies of poor prognosis. Cesarean section was performed in all remaining cases. Five sets of twins underwent surgical separation and six children survived. Overall survival in our series was 8.3% and, among the livebirths, 13.6%. Conjoined twin pregnancies should be referred to tertiary centers for detailed fetal anomaly and echocardiographic assessment to evaluate prognosis and determine the possibility of postnatal surgical separation.

Ultrasound in Twin Pregnancies

ObjectiveTo review the literature with respect to the use of diagnostic ultrasound in the management of twin pregnancies. To make recommendations for the best use of ultrasound in twin pregnancies OutcomesReduction in perinatal mortality and morbidity and short- and long-term neonatal morbidity in twin pregnancies. Optimization of ultrasound use in twin pregnancies. EvidencePublished literature was retrieved through searches of PubMed and the Cochrane Library in 2008 and 2009 using appropriate controlled vocabulary (e. g., twin, ultrasound, cervix, prematurity) and key words (e. g., acardiac, twin, reversed arterial perfusion, twin-to-twin transfusion syndrome, amniotic fluid). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date restrictions. Studies were restricted to those with available English or French abstracts or text. Searches were updated on a regular basis and incorporated into the guideline to September 2009. 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. ValuesThe evidence collected was reviewed by the Diagnostic Imaging Committee of the Society of Obstetricians and Gynaecologists of Canada, with input from members of the Maternal Fetal Medicine Committee and the Genetics Committee of the SOGC. The recommendations were made according to the guidelines developed by The Canadian Task Force on Preventive Health Care (Table 1). Benefits, harms, and costsThe benefit expected from this guideline is facilitation and optimization of the use of ultrasound in twin pregnancy.

Active Second-stage Management in Twin Pregnancies Undergoing Planned Vaginal Delivery in a US Population

Active Second-stage Management in Twin Pregnancies Undergoing Planned Vaginal Delivery in a US Population

Antenatal and intra-partum management of twins – a DGH experience

AimTo examine antenatal and intra-partum management of twin pregnancies, review the available guidelines and compare the current practice in our unit with recommendations.Methods3 year retrospective audit from 1 April 2007...

Précision de l’estimation du poids fœtal par l’échographie dans les grossesses gémellaires

Objectives Ultrasonography is an essential tool in the management of twin pregnancies. Fetal weight estimation is useful to anticipate neonatal care in case of prematurity, growth restriction or growth discordance. The aim of this study was to evaluate the accuracy of ultrasound fetal weight prediction in twin pregnancies. Patients and methods Two hundred and twenty-four patients with an ultrasonography within 7 days before birth were retrospectively studied. Estimated fetal weight (EFW) was calculated with the Hadlock's formula and was compared with birth weight (BW). Growth restriction and growth discordance superior or equal to 25% between the first (T1) and the second twin (T2) were recorded. Results Absolute differences between EFW and BW were similar for both twins (127 g [56.25–210] for T1 and 110 g [50–206.25] for T2). Mean absolute percentage error was 5.41% (2.32–9.65) for T1 and 5.64% (2.46–10.37) for T2 and was superior to 10% for 24% of T1 and 27% of T2. Gestational age inferior to 32 weeks, obesity and oligoamnios were associated with a better accuracy of ultrasonography. Chorionicity as well as fetal presentation did not influence fetal weight estimation. Ultrasonography in the diagnosis of growth restriction had a sensitivity of 82%, a specificity of 76%, a positive predictive value (PPV) of 22% and a negative predictive value (NPV) of 98%. For diagnosis of growth discordance, sensitivity was 72%, specificity 95%, PPV 72% and NPV 95%. Conclusion Fetal weight can be accurately predicted in twin pregnancies. The contribution of ultrasonography in the diagnosis of growth restriction and growth discordance is mainly due to a high NPV.

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.

Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): a randomised, double-blind, placebo-controlled study and meta-analysis

Women with twin pregnancy are at high risk for spontaneous preterm delivery. Progesterone seems to be effective in reducing preterm birth in selected high-risk singleton pregnancies, albeit with no significant reduction in perinatal mortality and little evidence of neonatal benefit. We investigated the use of progesterone for prevention of preterm birth in twin pregnancy. In this double-blind, placebo-controlled trial, 500 women with twin pregnancy were recruited from nine UK National Health Service clinics specialising in the management of twin pregnancy. Women were randomised, by permuted blocks of randomly mixed sizes, either to daily vaginal progesterone gel 90 mg (n=250) or to placebo gel (n=250) for 10 weeks from 24 weeks' gestation. All study personnel and participants were masked to treatment assignment for the duration of the study. The primary outcome was delivery or intrauterine death before 34 weeks' gestation. Analysis was by intention to treat. Additionally we undertook a meta-analysis of published and unpublished data to establish the efficacy of progesterone in prevention of early (<34 weeks' gestation) preterm birth or intrauterine death in women with twin pregnancy. This study is registered, number ISRCTN35782581. Three participants in each group were lost to follow-up, leaving 247 analysed per group. The combined proportion of intrauterine death or delivery before 34 weeks of pregnancy was 24.7% (61/247) in the progesterone group and 19.4% (48/247) in the placebo group (odds ratio [OR] 1.36, 95% CI 0.89-2.09; p=0.16). The rate of adverse events did not differ between the two groups. The meta-analysis confirmed that progesterone does not prevent early preterm birth in women with twin pregnancy (pooled OR 1.16, 95% CI 0.89-1.51). Progesterone, administered vaginally, does not prevent preterm birth in women with twin pregnancy. Chief Scientist Office of the Scottish Government Health Directorate.

379: Management of twin pregnancies at term: What is the optimal gestational age at which all twin pregnancies should be delivered?

379: Management of twin pregnancies at term: What is the optimal gestational age at which all twin pregnancies should be delivered?

Current methods for the diagnosis and management of twin pregnancy in the mare

SummaryHistorically, twin pregnancy has been one of the leading causes of pregnancy loss in the mare. Numerous studies have identified factors that increase the incidence of twinning. The identification and management of twins during the mobility phase remains the most effective method to control the potentially detrimental effects of twin pregnancy. Options exist for post fixation management of twins, although these methods are generally less successful than management during the mobility phase.

Prenatal diagnosis and management of twin pregnancies complicated by a co‐existing molar pregnancy

Prenatal diagnosis and management of twin pregnancies complicated by a co‐existing molar pregnancy

Prenatal diagnosis and management of twin pregnancies complicated by a co‐existing molar pregnancy

Recent advances in ultrasound and molecular genetics have increased our understanding and hence enhanced the perinatal management of complete and partial hydatidiform mole. By contrast, the management of a twin pregnancy combining a normal pregnancy with a normal fetus and a complete hydatidiform mole (CHM) remains complex and controversial due to conflicting data from different parts of the world. The aim of this review is to analyse the international literature on twin pregnancies that include a mole, present the complications and outcome of pregnancy and to discuss the perinatal management. Management is complicated and women should be counselled about the maternal and fetal complications, and the pregnancy monitored carefully by a perinatal team with experience in high-risk obstetrics and access to neonatal care. The data reviewed here suggest that a woman who decides to continue with the pregnancy including a CHM must be aware that, overall, she only has a one in four chance of live birth and in around 35% of cases she will develop persistent trophoblastic disease (PTD) after delivery. In ongoing pregnancies, there will be, in at least 20% of the cases, an early onset of pre-eclampsia (PET) and a 29% risk of fetal loss due to late miscarriage, intrauterine death and neonatal death. Maternal serum human chorionic gonadotrophin (MShCG) could be useful in predicting outcome in twin pregnancy combining normal pregnancy and CHM, but this needs to be investigated prospectively.

Reduction of Twin Pregnancy in the Mare by Transvaginal Ultrasound‐Guided Aspiration

Diagnosis and management of twin pregnancies in the mare are an ongoing challenge in equine reproduction. Early detection of twin and manual crush of one vesicle are the main steps in the management of twins. Few studies were carried out about the use of transvaginal ultrasound-guided aspiration (TUGA) for reduction of twins in the mare. In this study, the efficiency of TUGA for management of twin pregnancies was investigated. Reduction of unicornuate twins between 16 and 25 days of gestation gave a success rate of 70.0% (14 viable foals/20 twin pregnancies); when reduction was performed after day 40 of gestation, all mares (one unicornuate; three bicornuate) lost both. For those cases in which the window for early crush of a twin vesicle has been missed, TUGA can be successfully used to reduce twin pregnancy between 16 and 25 days of gestation.

Quality of routine ultrasound in twin pregnancy in a Swiss Canton

Optimal prenatal management of twin pregnancies requires diligent sonographical evaluation. In Switzerland the efficiency of routine ultrasound during pregnancy has recently become a point of debate. Aim of this study was to evaluate the quality of routine ultrasound of twin pregnancies in Kanton Aargau. Standardised prospective postal interview of each practitioner caring for twin pregnancies during the time period of August 1st, 1998 to July 30th, 1999 in Kanton of Aargau. We chose the Aargau Kanton as being representative of the Swiss population in general on the basis of its average demographic and geographical condition. In addition, evaluating an entire Kanton allows the comparison of data with the official data of the Federal Statistical Office. 81 twin pregnancy cases were delivered during this time period. 65 interviews could be analysed which provided full information. The first sonographic diagnosis of twin pregnancy was confirmed at a mean of 11 (5 - 32) weeks gestation. All twin pregnancies were diagnosed before the onset of labour. 2/65 of the twin pregnancies remained undiagnosed until the 3rd trimester. In one of these cases the patient had refused an ultrasound examination. In 57/65 cases clear information about amnionicity, but in only 53/65 cases additional information about chorionicity was gained. All twin pregnancies were detected sonographically before delivery. Determinations of amnionicity and chorionicity were possible in 87 % and 81 %, respectively, which could be improved.

Clinical management of twin pregnancy (1987-2003)

Clinical management of twin pregnancy (1987-2003)

Clinical management of twin pregnancy by Osaka Medical College

Clinical management of twin pregnancy by Osaka Medical College