Twin Birth Rate Research Articles

Secular Trend of Twin Birth Rate in Metropolitan Cities of Korea, 2000-2019

Objectives: To analyze the seven metropolitan cities of twin birth rate per 100 births (TBR) from 2000 to 2019 in Korea.Methods: We used the 2000-2019 birth certificated data (3,949,097 births) of seven metropolitan cities from Statistics Korea. The data of extra-marital birth and information missing cases (maternal and paternal age and triplet birth) were excluded. The odds ratio and 95% confidence intervals were calculated using logistic regression to describe the regional variance of TBR adjusted for maternal age, age difference between couple and maternal educational backgrounds.Results: During this period (2000-2019 years), the highest TBR by region was observed in Ulsan and Seoul metropolitan city (3.0), and the lowest TBR in Deagu metropolitan city (2.6). The TBR increased by 275 percent from 1.74 in 2000 to 4.79 in 2019. During the period from 2000-2004 to 2015-2019, there was the highest increment of TBR in Ulsan metropolitan city (odds ratio: 1.78; 95% confidence interval: 1.64-1.92) and Busan metropolitan city (1.74; 1.65-1.83), and the lowest increment in Daegu metropolitan city (1.24; 1.17-1.31), after adjustment by logistic regression for demographic variables. During the period 2015-2019 years, there was a significant increase the odds ratio of TBR in Ulsan metropolitan city (1.39), Busan metropolitan city (1.33), Seoul metropolitan city (1.25) and Incheon metropolitan city (1.23), as compared with the TBR of Deagu metropolitan city.Conclusions: Over the past two decades, TBR have risen dramatically in metropolitan cities of Korea. Regional variance of TBR was observed among metropolitan cities in Korea. There is a need for more research to understand the socio-demographic and medical factors associated with regional differences. The national birth registration system needs to be reformed to monitor whether twin births are spontaneous or assisted pregnancy.

Multifetal Gestations: Twin, Triplet, and Higher-Order Multifetal Pregnancies: ACOG Practice Bulletin, Number 231.

The incidence of multifetal gestations in the United States has increased dramatically over the past several decades. For example, the rate of twin births increased 76% between 1980 and 2009, from 18.9 to 33.3 per 1,000 births (1). However, after more than three decades of increases, the twin birth rate declined 4% during 2014-2018 to 32.6 twins per 1,000 total births in 2018 (2). The rate of triplet and higher-order multifetal gestations increased more than 400% during the 1980s and 1990s, peaking at 193.5 per 100,000 births in 1998, followed by a modest decrease to 153.4 per 100,000 births by 2009 (3). The triplet and higher-order multiple birth rate was 93.0 per 100,000 births for 2018, an 8% decline from 2017 (101.6) and a 52% decline from the 1998 peak (193.5) (4). The long-term changes in the incidence of multifetal gestations has been attributed to two main factors: 1) a shift toward an older maternal age at conception, when multifetal gestations are more likely to occur naturally, and 2) an increased use of assisted reproductive technology (ART), which is more likely to result in a multifetal gestation (5). A number of perinatal complications are increased with multiple gestations, including fetal anomalies, preeclampsia, and gestational diabetes. One of the most consequential complications encountered with multifetal gestations is preterm birth and the resultant infant morbidity and mortality. Although multiple interventions have been evaluated in the hope of prolonging these gestations and improving outcomes, none has had a substantial effect. The purpose of this document is to review the issues and complications associated with twin, triplet, and higher-order multifetal gestations and present an evidence-based approach to management.

A validated model for predicting live birth after embryo transfer

Accurately predicting the probability of live birth and multiple gestations is important for determining a safe number of embryos to transfer after in vitro fertilization. We developed a model that can be fit to individual clinic data for predicting singleton, twin, and total live birth rates after human embryo transfer. The predicted and observed rates of singleton and twin deliveries were compared in a tenfold cross-validation study using data from a single clinic. The model presented accounts for patient age, embryo stage (cleavage or blastocyst), type of transfer cycle (fresh or frozen) and uterine/universal factors. The standardized errors for rates of singleton and twin deliveries were normally distributed and the mean errors were not significantly different from zero (all p > 0.05). The live birth rates per embryo varied from as high as 43% for fresh blastocysts in the 35-year-old age group to as low as 1% for frozen cleavage stage embryos in the 43-year-old age group. This quantitative model or a simplified version can be used for clinics to generate and analyze their own data to guide the number of embryos to transfer to limit the risk of multiple gestations.

Some reproductive, fattening and milk yield traits of South Karaman sheep

Aims: In this study, reproductive, lamb growing, fattening and milk yield characteristics of South Karaman ewes and lambs were investigated.Methods and Results: The animal material of the study consisted of South Karaman sheep raised in the nomadic system in Tarsus district of Mersin province. The flock was managed under breeders’ condition. In addition to the pasture, straw and concentrate feed were given to the animals during their stay in Tarsus. The feeding of animals was provided only by grazing in the pasture during the highland period. Lambing rate, number of lambs per ewe at mating period, number of lambs per ewe giving birth, survival rate and single and twin birth rates were calculated to determinate the reproductive characteristics. Fattening characteristics were determined by applying 60 days of fattening in 20 head male animals randomly selected from lambs of similar weight and three months old. Milk yield controls were made at 30 days interval. The Holland method was used for each lactation milk yield calculation. At the end of the study number of lambs per ewe at mating period, birth weight, weaning weight, daily weight gain and lactation milk yield were detected as 1.24, 3.4±0.07 kg, 16.7±0.18 kg, 232.8±10.24 g and 37.7 L, respectively.Conclusions: South Karaman sheep has low milk yield, fattening and reproductive characteristics similar to other fat-tailed native breeds under semi-intensive breeding conditions.Significance and Impact of the Study: At the end of the study, it can be stated that South Karaman sheep is an important breed to sustainable sheep production systems. The reproductive, fattening and milk yield characteristics of this breed are sufficient for sheep farmers, especially nomadic breeders.

Determining the factors affecting the gestational length in sheep.

This research aimed to determine the effects of body weight, the body condition score (BCS), body measurements, birth type (single offspring or twin birth), birth weight and sex on the gestational length in sheep (). Karayaka sheep raised on a private farm were used in the study. Progeny yield characteristics in sheep were also determined (). Estrus was monitored daily using teaser rams from August to September 2016. According to our findings, the pregnancy rate, infertility rate, fecundity, and twin and single birth rates were 93.52 %, 6.48 %, 93.52 %, 14.62 % and 85.38 % respectively. The effect of age on the BCS in sheep at mating was found to be significant (): BCS decreased as age increased. It was determined that there was a positive association between the BCS and live weight during the mating period (). The chest circumference, front shin circumference and body length were found to be higher in sheep with a BCS at mating time (). The middle rump width was significantly affected by the BCS (). In this study, the lowest and highest gestational lengths were found to be 148.90 and 151.41 d respectively. The gestational length in sheep was not found to be affected by age, the BCS, body measurements, sex or birth type (); however, it was observed that the gestational lengths for male offspring and single offspring (non-multiple births) were longer. In addition, it was detected that the gestational length was different in sheep with a BCS . The time spent in the womb is important with respect to obtaining a healthy lamb. For profitable production, a BCS of between 2.5 and 4 is recommended in sheep. It is thought that the use of body condition scoring, which is easy information for the breeder to utilize, will have a positive effect on determining the bodily reserves of sheep and the reproductive efficiency as well as on obtaining a healthy lamb. More studies on the gestational length in sheep are required.

Incidence of multiple births in relation to current regulations in Turkey regarding embryo transfer

BackgroundBefore 2010, there were no regulations in Turkey regarding the number of embryos to be transferred in one cycle. In March 2010, regulations restricting this number were implemented by the Turkish Ministry of Health. These specify the transfer of a maximum of one embryo in the first and second cycles and a maximum of two embryos in subsequent cycles in women aged < 35, and a maximum of two embryos in women aged ≥35 in any one cycle. Our study evaluates the effect of these regulations.MethodsThis large retrospective single center study first evaluates the incidence of multiple pregnancies before and after the implementation of the 2010 regulations. Secondly, it compares the clinical outcomes of double blastocyst transfer (DBT) and single blastocyst transfer (SBT) performed in compliance with these regulations from 2014 onwards.ResultsAfter the introduction of the 2010 regulations, the multiple pregnancy rate decreased significantly from 37.9 to 15.7%. The singleton live birth rate increased significantly, whereas multıiple live birth rates significantly decreased (p = < 0.001).When the clinical outcomes of SBT and DBT performed in compliance with regulations from 2014 onwards were evaluated, in patients < 35 years, the multiple pregnancy rate decreased from 47.2% in the DBT group to 1.7% in the SBT group (p = < 0.001). In patients ≥35 years, in the DBT group, the twin birth rate was again high at 28.4%, whereas in the SBT group, it was only 1.8% (p = < 0.001). Importantly, there was no statistically significant difference in clinical pregnancy rates between these two groups.ConclusionTurkish regulations have led to an encouragement of double embryo transfer (DET) as a routine practice, with many patients understanding it as an absolute right to have two embryos transferred. The results of our study suggest that, especially in the light of the success of blastocyst transfer, the Turkish regulations should be amended to limit the use of DET and encourage the use of single embryo transfer except in exceptional cases and particularly in women under 35 years old.

Sivas İli Yetiştirici Koşullarındaki Kangal Akkaraman Koyunlarda Dölverimi Özellikleri

Hayvan yetiştiriciliğinde anaç sürüden elde edilen yavru sayısı veya oranı olarak ifade edilebilen dölverimi, başarılı bir yetiştiriciliğin ilk koşuludur. Bu araştırmada, Tarım ve Orman Bakanlığınca Halk Elinde Hayvan Islahı Ülkesel Projesi kapsamında yürütülen çalışmalara dâhil Sivas Merkez ve Yıldızeli ilçelerinde yer alan iki alt projenin (58KAK2012-06 ve 58KAK2012-07), 2013 ila 2018 yılları arası altı yıllık verilerinden yararlanılarak, Kangal Akkaraman ırkı koyunların dölverimi özelliklerinin belirlenmesi amaçlanmıştır. Çalışmada ilk yıl, projeye dahil her iki ilçeden toplam 48 köydeki 70 işletme, altıncı yılda 33 köyde 57 işletmeye düşmüştür. Altı yıllık süreçte, ıslah projesindeki tüm işletmelerdeki toplam 76383 anaç koyundan elde edilen 86116 kuzu kaydı değerlendirilmiştir. Alınan tüm verilere göre ortalama doğum oranı %92.7 olurken yıllar arası farklılıklar istatistiki olarak önemli, ilçeler arası farklılıklar ise önemsiz bulunmuştur. Çalışmada elde edilen veri sayısı çok fazla olduğundan, üçüz doğumlara da rastlanmış ancak çok düşük oranda (ortalama %0,1) kalmasından dolayı ayrıca değerlendirilmeyip, ikiz doğumlara dahil edilmiştir. Elde edilen tüm değerlere göre ortalama ikiz doğum oranı %22 olurken, yıllar arası, ilçeler arası ve koç katım dönemleri arası (ağustos-aralık ayları arası beş ay) farklılıklar önemli bulunmuştur. Yine dölverimi ölçütlerinden sütten kesilen kuzu oranı ya da sütten kesim dönemi yaşama gücüne ait genel ortalama %91,3 olurken, yıllara, ilçelere ve kuzu doğum zamanına (ocak-mayıs ayları arası beş ay) göre farklılıklar istatistiki olarak önemli bulunmuştur. Çalışmada ana yaşı bilinen, sadece 2013 yılına ait bir alt projedeki 4242 koyundan elde edilen 5147 kuzu kaydına göre, koyunların yaşı (1-10 arası) doğum tipi üzerinde etkili bulunurken, yaşama gücü üzerinde istatistiki olarak önemsiz bulunmuştur. Araştırma sonuçlarına göre çalışma bölgesinde ve benzer şartlara sahip işletmelerde karlılığı en üst düzeye çıkarmak için dölverimini artıran faktörlerin dikkate alınması yararlı olacaktır.

INCIDENCE OF MULTIPLE BIRTHS IN RELATION TO CURRENT REGULATIONS IN TURKEY REGARDING EMBRYO TRANSFER

The aim of our study is to evaluate the 2010 regulations in Turkey regarding the number of embryos which can be transferred. This retrospective single center study evaluated single versus multiple births before and after the introduction of 2010 Turkish regulations. The study is based on data from Istanbul Memorial Hospital, ART and Genetics Center used to evaluate the 2010 regulations, which restricts the number of embryos to be transferred. According to the regulation; double embryo transfer (DET) is allowable after two unsuccessful attempts in cases up to maternal age of 35 and in any one cycle in cases ≥35. For the period from March 2003 to June 2019, a total of 31,459 cycles were analyzed to evaluate the overall effect of 2010 regulations. For the period from January 2014 to July 2019, a total of 4450 cycles were evaluated according to two different ages groups, patients <35 and patients from 35-42 years of age with single or double blastocyst transfer performed in compliance with current regulations. First the overall effect of the introduction of the regulations on multiple births was evaluated regardless of previous ART attempts and maternal age. Secondly, the clinical results of fresh and frozen-thawed single or double blastocyst transfer in patients <35 years with a history of 2 or 3 previous unsuccessful ART attempts and in patients ≥ 35 (35-42) years with a history of either no previous attempts or 1,2 or 3 attempts were evaluated. In the first study groups (March 2003 to July 2019), the parameter most significantly affected by the introduction of the regulations was the number of the embryos transferred. The percentage of single embryo transfer (SET ) cycle increased dramatically from 14% to 56.6%. However, despite a fall from 32.4%, the incidence of twin births remained high at 15.5%. In the second study groups from January 2014 to July 2019, in young patients <35 years with 2 or 3 previous cycles, the twin birth rate was very high at 47.26 % in the double blastocyst group whereas it was only 1.75% when a single blastocyst was transferred (p=0.0001). In patients ≥ 35 years (35-42) with zero,1,2 and 3 previous cycles, in the double blastocyst transfer group, the twin birth rate was again high at 28.4% whereas in the single blastocyst transfer group it was only 1.8% (p=0.0001). Importantly, there was no statistically significant difference in clinical pregnancy rates between these two groups (67.4% vs 67.5% in the <35 group, and 59.1% vs 54.1% in the ≥ 35 year group) (p=0.846 and p=0.055). Thus, in DET, there was a high risk of twin births and no advantage in terms of pregnancy rates. As a result of the wording of the current regulations, there has been a high demand for DET in both young and older patients. Our study strongly suggests that, especially in the light of the success of blastocyst transfer, the Turkish regulations should be amended to limit the use of DET and encourage the use of SET apart from in exceptional cases and particularly in women under 35 years old.

An elective single cleavage embryo transfer strategy to minimize twin live birth rate based on a prediction model from double cleavage embryos transfer patients

Objective To minimize twin birth rate by establishing an elective single cleavage embryo transfer strategy based on a twin live birth prediction model from fresh double cleavage embryos transfer (cleavage DET) patients. Methods A total of 2478 patients underwent fresh cleavage DET in Nanjing Tower Hospital were enrolled to establish the twin live birth prediction model by logistic regression analysis and the cutoff value was calculated by ROC curve. Another 300 fresh cleavage DET patients and 550 cleavage single-embryo transfer (SET) patients were selected to testify the sensitivity, specificity and usefulness of this model. Results The twin live birth probability (TLBP) = eX /(eX + 1), e is a natural logarithm, X = −1.763 – (0.319 × female age) + (0.329 × endometrial thickness) + (0.282 × the number of transferred top embryos) – (0.314 × previous transfer times), and the cutoff value of TLBP was 24.2%. The sensitivity of this model for predicting twin live birth was 75.6%, while the specificity was 52.5% in the external validation of 300 DET patients. Furthermore, the validation of 550 SET patients showed that the live birth rate of TLBP value positive patients was significantly higher than that in negative patients (54.3% vs. 35.5%, p < .001). When adopted an elective single cleavage embryo transfer strategy, the patients with a positive TLBP value choose SET, while still undergo DET who with a negative TLBP value, the live birth rate would maintain as 56.7%; however, the twin birth rate would significantly decline to 7.4%. Conclusion Female age, endometrial thickness, the number of transferred top embryos and previous embryo transfer times were critical variables for the twin live birth prediction model. An elective single cleavage embryo transfer strategy according to this model can maintain the relatively high live birth rate, meanwhile get the acceptable low twin birth rate.

Is transferring a lower-quality embryo with a good-quality blastocyst detrimental to the likelihood of live birth?

To determine if transferring a lower-quality embryo with a good-quality blastocyst is detrimental, given that evidence suggests that embryos can signal the endometrium and that embryo quality may affect negatively endometrial receptivity. Retrospective cohort study. Invitro fertilization center. Single- versus double-embryo transfer. Patients with a double-embryo transfer of a good-quality blastocyst plus a lower-quality blastocyst, early blastocyst, or morula were compared with patients receiving a single good-quality blastocyst. Live birth, multiple gestation. In this study, 4,640 invitro fertilization cycles were analyzed. In none of the analyses did transferring a second lower-quality embryo negatively affect birth rate. In the primary analysis, transferring a second lower-quality embryo increased live birth by 10% and the multiple birth rate by 15%. The addition of a fair- or poor-quality blastocyst or early blastocyst markedly increased the twin birth rate by 22%-27% with an 8%-12% increase in live birth. The addition of a morula did not increase live birth but resulted in 12% more multiples. In women younger than 38 years, adding a lower-quality embryo increased the birth rate by 7% but resulted in 18% increase in multiples. In women 38 years or older, adding a lower-quality embryo increased the live birth rate by 9% with a 15% increase in multiples. Addition of a lower-quality embryo does not have a detrimental effect on a good-quality blastocyst and results in a small increase in live births. However, this is at the expense of a marked increase in the likelihood of multiple gestations.

Do state insurance mandates alter ICSI utilization?

BackgroundAssisted reproductive technology (ART) insurance mandates resulted in improved access to infertility treatments like intracytoplasmic sperm injection (ICSI). Our objective was to examine whether ART insurance mandates demonstrate an increased association with ICSI use.MethodsIn this retrospective cohort study, clinic-specific data for 2000–2016 from the Centers for Disease Control (CDC) were grouped by state and subgrouped by the presence and extent of ART state insurance mandates. Mandated (n = 8) and non-mandated (n = 22) states were compared for ICSI use and male factor (MF) infertility in fresh non-donor ART cycles with a transfer in women < 35 years. Clinical pregnancy (CPR), live birth (LBR) rates, preimplantation genetic testing (PGT), elective single-embryo transfer (eSET) and twin birth rates per clinic were evaluated utilizing Welch’s t-test. Pearson correlation was used to measure the strength of association between MF and ICSI; ICSI and CPR, and ICSI and LBR over time. Results were considered statistically significant at a p-value of < 0.05, with Bonferroni correction used for multiple comparisons.ResultsFrom 2000 to 2016, ICSI use per clinic increased in both mandated and non-mandated states. ICSI use per clinic in non-mandated states was significantly greater from 2011 to 2016 (p < 0.05, all years) than in mandated states. Clinics in mandated states had less MF (30.5 ± 15% vs 36.7 ± 15%; p < 0.001), lower CPR (39.8 ± 4% vs 43.4 ± 4%; p = 0.02) and lower LBR (33.9 ± 3.5% vs 37.9 ± 3.5%; p < 0.05). PGT rates were not significantly different. ICSI use in non-mandated states correlated with MF rates (r = 0.524, p = 0.03). A significant correlation between ICSI and CPR (r = 0.8, p < 0.001) and LBR (r = 0.7, p < 0.001) was noted in mandated states only. eSET rates were greater and twin rates were lower in mandated compared with non-mandated states.ConclusionsThere was greater use of ICSI per clinic in non-mandated states, which correlated with an increased frequency of MF. In mandated states, lower ICSI rates per clinic were accompanied by a positive correlation with CPR and LBR, as well as a trend for greater eSET rates and lower twin rates, suggesting that state mandates for ART coverage may encourage more selective utilization of laboratory resources.

Reproductive performance and kid growth until weaning in Hair goat reared on-farm conditions in Turkey

This study was conducted to determine the growth traits, survival rates, and some reproductive traits of Hair kids reared onfarm in Antalya province of Turkey. The data concerning the birth weights of totally 22,817 kids and the 90th day live weights of totally 21643 kids were taken for a 5-year period within the scope of this study. In 37 flocks, the mean birth weights of the kids born in 2012, 2013, 2014, 2015, and 2016 were determined as 3.38, 3.41, 3.26, 3.32, and 3.26 kg, and also the mean live weights of 90th day weaning were found as 16.96 kg, 18.33 kg, 17.43 kg, 17.47 kg, and 17.53 by the years, respectively. The differences between the birth year, sex, type of birth, and the dam?s age groups were statistically significant in terms of birth weight and 90th day live weight P < 0.05 . The survival rates of the kids on the 90th day were 96.44%, 92.70%, 94.06%, 94.31%, and 97.02% by the years P < 0.05 . In the study, the twin birth rate was 5.1% in general. It was revealed based on five-year data that Hair goats had adaptation to the region and breeding system with their survival rate exceeding 90%.

The contribution of twins conceived by in vitro fertilization to preterm birth rate: observations from a quarter of century.

Objective Little information exists related to the contribution of assisted reproductive technology (ART) twins to the preterm and very preterm birth rate. We sought to examine this contribution over a period of more than two decades in a tertiary perinatal center. Methods We identified all preterm births from 1993 to 2017, born at <37 or <32 weeks' gestation, by mode of conception [in vitro fertilization (IVF) vs. non-IVF pregnancies]. We generated trend lines of the annual change of the dependent variable (% preterm birth). Results We evaluated 74,299 births, including 3934 (5.3%) preterm births at <37 and 826 (1.1%) at <32 weeks' gestation. In this period, 1019 (1.4%) twin pairs were born including 475 (46.6%) and 80 (7.8%) at <37 and <32 weeks, respectively. There were 213 (5.4%) IVF pregnancies among the preterm births at <37 weeks, including 88 (41.3%) twins. Fifteen (1.8%) births of all IVF gestations were at <32 weeks, and all were twins. Whereas the annual rate of spontaneous twins did not change, a significant increase over time exists for IVF twins (P < 0.05, R2 = 0.6). We demonstrated an increase in IVF twin births at <37 weeks but not for spontaneously conceived twins. Whereas the twin birth rate at <32 weeks did not change over time, all preterm births at <32 weeks following IVF were twins. Conclusions The risk of twins after ART increasingly contributes to preterm births at <37 weeks and ART twins are at significant risk for preterm births at <32 weeks.

Changes in the perinatal outcomes of twin pregnancies delivered at a tertiary referral center in Korea during a 24-year period from 1995 to 2018.

ObjectiveTo analyze the changes in the clinical characteristics and perinatal outcomes of twin pregnancies delivered at a tertiary referral center in Korea during a 24-year period.MethodsThis was a retrospective cohort study of twin pregnancies delivered at 24–40 weeks of gestation, from 1995 to 2018. The subjects were divided into 4 groups according to the year of delivery: 1995–2000, 2001–2006, 2007–2012, and 2013–2018. The trends in the changes in the twin birth rate, maternal age, assisted reproductive technology (ART) pregnancy rate, chorionicity, obstetric complications, delivery outcomes, and neonatal outcomes over the periods were analyzed.ResultsA total of 2,133 twin pregnancies were included in the study. The twin birth rate increased from 16.7/1,000 in 1995–2000 to 42.2/1,000 in 2001–2006, 49.5/1,000 in 2007–2012, and 61.8/1,000 in 2013–2018. The maternal age and ART pregnancy and dichorionic twin rates increased, while the monochorionic twin rate decreased over the periods. The incidence of fetal congenital anomalies, cervical incompetence, gestational diabetes mellitus, preeclampsia, and placental abruption increased over the periods. The preterm birth (PTB) rate significantly decreased owing to the decreasing elective late-PTB rate; however, the early-PTB rate significantly increased.ConclusionThis study found that twin pregnancies increased steadily over the last 24 years and that the increase was related to increased maternal age and ART pregnancy rate. The incidence of obstetric complications increased over the periods; however, the neonatal intensive care unit admission rate decreased, along with decreases in the elective late-PTB rate.

Twin Births and Their Survival under Age Five: Evidence from Bangladesh Demographic and Health Survey 2014

Background &amp; Aim: Little is known about twinning in developing countries due to lack of reliable data. However, the large data set from the national level Demographic and Health Surveys (DHSs) in developing countries can fill this gap. This paper examines the level, trends and determinants of twin births, and their risk of survival until age five relative to singletons in Bangladesh. Methods &amp; Materials: The data for the study were obtained from the 2014 Bangladesh DHS. The analysis was based on birth histories of 43,842 live births, experienced by the 17,863 women between 1978 and until survey date November 2014. Frequency distribution, cross tabulation, univariate and multivariate logistic regression models, and demographic methods such as conventional life table approach were used for data analysis. Results: About 1.52% of the total live births in Bangladesh were found found to be twins. The twin birth rate has increased by 13.4% over the last 20 years in Bangladesh. Maternal age, parity, region of residence, economic status, father’s education, contraceptive use status and religion were identified as significant predictors of twin births. Twinning appeared as a significant predictor of high childhood mortality. Twins were found to have more than eight times higher risk of death during neonatal period than that of singletons. Conclusion: The increasing trends in twin births in Bangladesh and the associated higher risk of childhood mortality among twins underscores the need for more focused care strategy during pregnancy and after birth. Further studies are needed to identify the reasons for exceptionally high childhood mortality among twins in Bangladesh.

Twin gestation and the burden of adult cardio-renal disease.

The rate of twin births has increased by nearly 80% in recent decades largely due to advanced reproductive technologies. Twins are often born preterm and/or growth restricted which are independently associated with impaired renal and vascular development. Many preterm and twin infants are surviving into adulthood, albeit with an increased burden of chronic health conditions. Twinning as a research tool offers the unique opportunity to investigate the impact of genetics versus the environment on clinical outcomes. This educational review will focus on delineating our current understanding of the renal and cardiovascular development and long-term outcomes among twin born individuals. Specifically, existing literature regarding how twins differ in kidney size and function as well as vascular stiffness and hypertension profiles from singletons will be discussed. The unique situation of twin-twin transfusion syndrome which is associated with distinct short- and long-term cardio-renal disease will be highlighted. Ultimately, the ability to stratify risk of future cardio-renal disease at birth for infants born preterm and/or growth restricted, including twins, is important to guide clinical follow up. In addition, this early risk stratification could direct research efforts to better understand the mechanisms driving impaired organogenesis and allow for discovery of therapeutic interventions aimed at modifying disease progression and improving longevity in the most vulnerable infant subgroups.

The Nigerian Twin and Sibling Registry: An Update.

Here we provide an update of the 2013 report on the Nigerian Twin and Sibling Registry (NTSR). The major aim of the NTSR is to understand genetic and environmental influences and their interplay in psychological and mental health development in Nigerian children and adolescents. Africans have the highest twin birth rates among all human populations, and Nigeria is the most populous country in Africa. Due to its combination of large population and high twin birth rates, Nigeria has one of the largest twin populations in the world. In this article, we provide current updates on the NTSR samples recruited, recruitment procedures, zygosity assessment and findings emerging from the NTSR.

Some Reproductive Characteristics of Honamlı Goats

This study was carried out to investigate the some reroduction chareacteristics of Honamli goat breed which are rearing commonly in Taurus mountains in the Mediterranean region of Turkey. The materials of the study was formed with the five years records from 2011 to 2016 of 27 flocks (average 220 bucks and 4400 does) chosen from 36 flocks with in the scope of National Public Small Ruminant Improvement Project, which was raised under extensive conditions in Beysehir and Derebucak districts of Konya. At the end of the research; kidding rate, survival rate, twin birth rate, fecundity, litter size and the averages for birth weight, weaning weight and daily weight gains for the five consecutive years were found as 85%,87%,15%,0.94,1.10,3.64 kg,19.14 kg,0.180 kg respectively. Effects of farm, birth type and gender on live weights and daily weight gains were found to be statistically significant (P<0.01).

US Evaluation of Twin Pregnancies: Importance of Chorionicity and Amnionicity.

The twin birth rate is increasing in the United States. Twin pregnancies can be dichorionic or monochorionic (MC). MC twins account for 20% of twin pregnancies but 30% of all-cause pregnancy-related complications. This article describes the imaging findings that establish chorionicity and amnionicity. Ideally, these are established in the first trimester when accuracy is high, but they can also be determined later in pregnancy. Complications unique to MC twin pregnancy include twin-twin transfusion syndrome, twin anemia polycythemia sequence, twin reversed arterial perfusion sequence, and selective fetal growth restriction. The US features, staging systems, and management of these complications are reviewed, and the consequences of MC twin demise are illustrated. Ongoing surveillance for these conditions starts at 16 weeks gestation. Monoamniotic (MA) twins are a small subset of MC twins. In addition to all of the MC complications, specific MA complications include cord entanglement and conjoined twinning. Radiologists must be able to determine chorionicity and amnionicity and should be aware of potential complications so that patients may be referred to appropriate regional specialized centers. A proposed algorithm for referral to specialized fetal treatment centers is outlined. Online supplemental material is available for this article. ©RSNA, 2019.

Cerclage for Women With Twin Pregnancies: A Systematic Review and Meta-analysis

(Abstracted from Am J Obstet Gynecol 2019;220(6):543–557) The use of assisted-reproductive technique has led to an increase in the twin birth rate over the last 30 years, and these pregnancies are at an increased risk for preterm birth (PTB). Reportedly, approximately 50% of twin pregnancies deliver at &lt;37 weeks of gestation and 14% are delivered at &lt;33 weeks.