Twin Deliveries Research Articles

Perinatal characteristics and neonatal outcomes of singletons and twins in Chinese very preterm infants: a cohort study

BackgroundThe prevalence of preterm birth has been rising, and there is a paucity of nationwide data on the perinatal characteristics and neonatal outcomes of twin deliveries of very preterm infants (VPIs) in China. This study compared the perinatal characteristics and outcomes of singletons and twins admitted to neonatal intensive care units (NICUs) in China.MethodsThe study population comprised all infants born before 32 weeks in the Chinese Neonatal Network (CHNN) between January 2019 and December 2019. Three-level and population-average generalized estimating equation (GEE)/alternating logistic regression (ALR) models were used to determine the association of twins with neonatal morbidities and the use of NICU resources.ResultsDuring the study period, there were 6634 (71.2%) singletons and 2680 (28.8%) twins, with mean birth weights of 1333.70 g and 1294.63 g, respectively. Twins were significantly more likely to be delivered by caesarean section (p < 0.01), have antenatal steroid usage (p = 0.048), have been conceived by assisted reproductive technology (ART) (p < 0.01), have a higher prevalence of maternal diabetes (p < 0.01) and be inborn (p < 0.01) than singletons. In addition, twins had a lower prevalence of small for gestational age, maternal hypertension, and primigravida mothers than singletons (all p < 0.01). After adjusting for potential confounders, twins had higher mortality rates (adjusted odds ratio [AOR] 1.28, 95% confidence interval [CI] 1.10–1.49), higher incidences of short-term composite outcomes (AOR 1.28, 95% CI 1.09–1.50), respiratory distress syndrome (RDS) (AOR 1.30, 95% CI 1.12–1.50), and bronchopulmonary dysplasia (BPD) (AOR 1.10, 95% CI 1.01–1.21), more surfactant usage (AOR 1.22, 95% CI 1.05–1.41) and prolonged hospital stays (adjusted mean ratio 1.03, 95% CI 1.00–1.06), compared to singletons.ConclusionOur work suggests that twins have a greater risk of mortality, a higher incidence of RDS and BPD, more surfactant usage, and longer NICU stays than singletons among VPIs in China.

Case Report- A challenging case of severe Asherman’s syndrome in Reproductive MedicineFollowed by twin delivery

Case Report- A challenging case of severe Asherman’s syndrome in Reproductive MedicineFollowed by twin delivery

Effects of parity on preterm delivery in twin gestations conceived with in vitro fertilization

To determine the relationship between prior obstetrical history and gestational age at delivery in a twin pregnancy. Retrospective cohort study using theUnited States Society for Assisted Reproductive Technology Clinic Outcomes Reporting System database. Clinic-based data. Patients undergoing invitro fertilization (IVF) in the United States with live delivery of twins. None. The main outcome measures are median gestational age at delivery and rate of preterm delivery (before 37 weeks). The median gestational age at delivery of IVF-conceived twins was 36.3 (interquartile rate 34.4, 37.6) weeks for nulliparous women, 35.9 (34.0, 37.1) weeks for parous women with a prior preterm birth, and 36.7 (35.1, 37.7) weeks for parous women without a prior preterm birth. The rate of preterm delivery was 61% for nulliparous women, 70% for parous women with a prior preterm birth, and 55% for parous women without a prior preterm birth. Parous women without a history of preterm delivery had lower rates of preterm delivery in a subsequent twin pregnancy than nulliparous women. Nulliparous women had lower rates of preterm delivery compared with parous women with a history of preterm delivery.

Histopathology of placenta in covid-19 infection and correlation with fetal outcome

Placental examination can yield valuable information that may be essential to enhance our understanding of disease pathogenesis and to identify underlying causes of adverse pregnancy outcomes. There is increasing evidence that COVID-19 infection leaves tell-tale signs of injuries in the placenta. To study histopathological features of placenta of covid 19 positive mothers. Prospective observational study. Out of fifteen placenta histopathological changes observed, intervillous fibrin deposition was most common finding that was present in 6 placenta (40%); calcifications, chorangiosis in 4 placenta(26.6%); deciduitis, thrombosis were present in 3 placentas(20%)respectively; increased fibrinoid material, decidual vasculopathy, chorioamnionitis were present in 1 placenta(6.6%)respectively. Out of fifteen infants, 13(86.6%) infants were term (&amp;#62;37weeks) and 2(13.3%) infants were preterm (&amp;#60;37 weeks) including one twin delivery. Two (13.3%) infants were IUGR and 3 (20%) infants were low birth weight and Small for gestational age. Six infants (40%) required admission in NICU of which 5 infants (33.3%) required respiratory support. Placenta histopathological findings were suggestive of maternal vascular malperfusion like increased intervillous fibrin deposition, chorangiosis, deciduitis, calcifications, thrombosis and the findings were correlated with fetal outcome like preterm deliveries, small for gestational age, IUGR, respiratory distress requiring respiratory support.

The impact of maternal ABO blood type on obstetric and perinatal outcomes after frozen embryo transfer

Research questionDoes the maternal ABO blood type affect obstetric and perinatal outcomes following frozen embryo transfer (FET)? DesignA retrospective study was performed at a university-affiliated fertility centre, involving women with singleton and twin deliveries conceived by FET. Subjects were divided into four groups based on ABO blood type. The primary end-points were obstetric and perinatal outcomes. ResultsA total of 20,981 women were involved, with 15,830 having singletons and 5151 delivering twins. In singleton pregnancies, women with blood group B had a slight but significantly increased risk of gestational diabetes mellitus compared to women with blood group O (adjusted odds ratio [aOR] 1.16; 95% confidence interval [CI] 1.01–1.34). Furthermore, singletons born to women with the B antigen (blood type B or AB) were more likely to be large for gestational age (LGA) and with macrosomia. In twin pregnancies, blood type AB was related to a decreased risk of hypertensive diseases of pregnancy (aOR 0.58; 95% CI 0.37–0.92), while blood type A was associated with a higher risk of placenta praevia (aOR 2.04; 95% CI 1.15–3.60). When compared with the O blood group, twins from the AB blood group had a lower risk of low birthweight (aOR 0.83; 95% CI 0.71–0.98) but a higher risk of LGA (aOR 1.26; 95% CI 1.05–1.52). ConclusionsThis study demonstrates that the ABO blood group may influence the obstetric and perinatal outcomes for both singletons and twins. These findings emphasize that patient characteristics could be, at least partly, responsible for adverse maternal and birth outcomes following IVF.

Previable Premature Rupture of Membranes in Dichorionic Diamniotic Twin Gestation, Loss of Leading Twin, Emergency Cervical Cerclage and Ceaserean Delivery at Term

Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G6P1+4 with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.

Development of Adaptive Sitting Cum Standing Positional Device - User's Centric Approach

Background As per India Census 2011 Cerebral palsy affects 3.8 of Indians or roughly 15-20 of physically challenged children. An estimated 31000 live births are affected in India. The most prevalent motor impairment in children is cerebral palsy. The adaptive devices need to accommodate different factors in terms of individual health condition body structure body function capacity gender age ethnicity and preference. In addition physical changes that occur in children as they grow and develop need to be accommodated. UNICEF stated that the frequency of changes to be made in an assistive product depends on how fast the child develops and grows which will vary over time as well as between children. This adds to the economic burden especially in families below the poverty line.Aim To build a device for dual usage seating cum standing for children with delayed milestones with versatile features to accommodate as they grow.Methods Anthropometric measurements of children with delayed milestones aged between 3-12 years were collected and assimilated in building the innovative twin device and its features. User satisfaction feedback was collected about the innovative twin device using Quebec User Evaluation of Satisfaction with Assistive Technology QUEST using a prospective qualitative study design. Simple random sampling methods were used to recruit 255 parents of children with delayed milestones from 2016 to 2019 across India and Bangladesh. They were prospectively observed and the perceived effectiveness usability and service delivery system of twin device was collected from parents mostly through telephonic and in-person interviews after three months. Results Around 121 usersparents gave their QUEST feedback. The mean satisfaction on the twin device was recorded as 4.16 Quite satisfied and the service delivery was rated 4.81 Very satisfied. Overall QUEST score was recorded as 4.48 Quite satisfied. The three most satisfying features of the device reported were safe and secure 61.16 easy to use 57.02 and comfortable 56.2.Conclusion Twin device and delivery services quality was measured through user satisfaction in terms of strength durability capacity safety and comfort. Provision of assistive technology includes the design production user satisfaction and quality of life.

Complications of Twin Delivery and Associated Factors: A Hospital-Based Cross-Sectional Analytical Study in Yaound&amp;#233;

Complications of Twin Delivery and Associated Factors: A Hospital-Based Cross-Sectional Analytical Study in Yaound&amp;#233;

Severe Maternal Morbidity in Twins.

While twin gestations are at increased risk of severe maternal morbidity (SMM), there is limited information about timing and causes of SMM in twins. Furthermore, existing data rely on screening definitions of SMM because a gold standard approach requires chart review. We sought to determine the timing and cause of SMM in twins using a gold standard definition outlined by the American College of Obstetricians and Gynecologists (ACOG). We used a perinatal database to identify all twin deliveries from 1998 to 2013 at a single academic medical center (n = 2,367). Deliveries were classified as screen positive for SMM if they met any of the following criteria: (1) one of the Centers for Disease Control and Prevention (CDC) International Classification of Diseases Ninth Revision diagnosis and procedure codes for SMM; (2) a prolonged postpartum length of stay (>3 standard deviations beyond mean length of stay by mode of delivery); or (3) maternal intensive care unit admission. We identified true cases of SMM through medical record review of all screen-positive deliveries using the definition of SMM outlined in the ACOG Obstetric Care Consensus. We also determined cause and timing of SMM. A total of 165 (7%) of twin deliveries screened positive for SMM. After chart review of all screen-positive cases, 2.4% (n = 56) were classified as a true case of SMM using the ACOG definition for a positive predictive value of 34%. The majority of SMM occurred postpartum (65%). Hemorrhage was the most common cause of SMM, followed by hypertensive and pulmonary etiologies. Commonly used approaches to screen for SMM perform poorly in twins. This has important implications for quality initiatives and epidemiologic studies that rely on screening definitions of maternal morbidity. Our study demonstrates that the immediate postpartum period is a critical time for maternal health among women with twin pregnancies. · Screening approaches for SMM have low positive predictive value in twins.. · Hemorrhage, hypertensive, and pulmonary complications were the most common morbidities.. · SMM was most common postpartum..

Vaginal birth as compared with cesarean section in preterm twins-Experience from a tertiary center of a middle-income country.

To evaluate the mode of birth in early-preterm, late-preterm, and near-term twins as well as to compare the maternal and neonatal outcomes of each group following vaginal birth (VB) and lower-segment cesarean section (LSCS). A prospective cohort study was conducted of 100 twin pregnancies in a tertiary center between 2018 and 2019. Deliveries were allocated into the following three gestational age groups (weeks ± days) and compared: (1) early-preterm (28 to 31 ± 6), (2) late-preterm (32 to 35 ± 6), and (3) near-term (≥36 weeks). The proportion of VB and LSCS were similar when early-preterm twins (P= 0.766; relative risk [RR], 1.08) and late-preterm twins (P= 0.071; RR, 1.21) were compared separately with near-term twins. Perinatal outcomes did not differ between VB and LSCS within each gestational age group. When compared with the near-term group, the early-preterm group had more hypoglycemia (P< 0.001), hyperbilirubinemia (P< 0.001), respiratory distress (P< 0.001), low APGAR scores (P< 0.001), and death (P< 0.001) irrespective of the mode of birth. The late-preterm group had lower morbidity and mortality (P= 0.227). Postpartum hemorrhage and blood transfusion were similar between the groups. The proportion of VB and LSCS and associated maternal and neonatal outcomes did not differ in twins of different gestational ages. The data provide reassurance to practitioners to perform vaginal delivery in preterm twins.

Placenta percreta invading left broad ligament in a woman with twin pregnancy: A case report

and importance: Placenta percreta is an abnormal of placentation disorder that causes firm and deep attachment of placenta into myometrium due to absent decidua basalis and leads to significant morbidity and mortality due to severe hemorrhage. A 28-year, old women gravida 2 para 1+0 with previous one Lower segment caesarean section (LSCS), presented to emergency department of HFH with complaint of per vaginal bleeding. It was a twin pregnancy and was a rare case of complex placenta percreta with invasion into left broad ligament and urinary bladder in a woman having twin pregnancy. Placental invasion into bladder was diagnosed pre-operatively on USG scan, however; the broad ligament involvement was diagnosed intraoperatively. Patient underwent hysterectomy and internal iliac artery ligation to control hemorrhage soon after delivery of twins with T2 being IUD and patient shifted to ventilatory support but unfortunately due to massive hemorrhage and hemodynamic instability patient did not survive. Placenta percreta is a subtype of placenta accreta spectrum disorder that is associated with significant morbidity and mortality depending upon nature and extent of placental invasion. Preoperative diagnosis and management can be of significant value in preventing obstetrics related morbidity. A multidisciplinary approach is required in management of such cases and due to involvement of surrounding structures including urinary bladder. Placenta percreta is a rare disorder of placentation that poses significant life-threatening risk of bleeding and maternal mortality and multidisciplinary approach can be of benefit in such cases.

Delivery of the Second Twin, 115 Days After the Birth of the First: Case Report of a Rare

Delivery of the Second Twin, 115 Days After the Birth of the First: Case Report of a Rare

Molar Twin Deliveries with Coexisting Fetus at Term: Concerning Two Uncomplicated Cases of Gestational Trophoblastic Tumor, From 2015-2021, In Conakry, Guinea

The coexistence of a molar pregnancy with a live fetus is a rare entity of difficult diagnosis and treatment. Continuation of the pregnancy until full-term delivery is possible. We report two cases of twin molar deliveries observed empirically from 2015-2021, in the gynecology-obstetrics department of the Donka national hospital and in the maternity ward of the Jean Paul II hospital in Conakry. The discovery was made on ultrasound of the first trimester of pregnancy and macroscopic examination of the placenta. One of the neonates was alive, a healthy female and the other was polymal formed with facial dysmorphism, omphalocele and sexual ambiguity, fresh stillborn. There was no maternal complication towards a gestational trophoblastic tumor (T.T.G) in both cases. Efforts must be made in the prevention of T.T.G. by screening for twin molar pregnancies with healthy fetuses on transvaginal ultrasound in the first trimester, the dosage of HCG in the face of unexplained metrorrhagia, macroscopic observation of the placenta after each delivery and biopsy sampling of any suspicious placenta.

Delayed-interval delivery in twin pregnancies: 12 years' experience in one perinatal center.

Delayed-interval delivery in twin pregnancies: 12 years' experience in one perinatal center.

Perinatal outcomes of twin pregnancies complicated with preeclampsia at a tertiary hospital in Ethiopia: A case‐control study

AbstractBackgroundPreeclampsia accounts for 10–15% maternal deaths globally, corresponding to 50,000 annual maternal deaths. Twin pregnancy is a known risk factor for preeclampsia; however, there is inadequate data on the clinical characteristics and perinatal outcomes of twin pregnancies complicated with preeclampsia. This paper studied the perinatal outcomes of twin pregnancies complicated with preeclampsia at a tertiary hospital in Ethiopia.MethodsA case‐control study was conducted at St. Paul's Hospital Millennium Medical College (Addis Ababa, Ethiopia) from September 1, 2016 till August 31, 2018. A total of 173 twin deliveries (63 preeclampsia cases and 110 normotensive controls) were included in the study and the primary outcome was the frequency of preterm delivery. Data were analyzed using SPSS version 23 and statistical test of association was done using chi‐square test for categorical data. Variables with p value of &lt;0.2 on bivariate analysis were entered into multivariable logistic regression analysis. p value &lt;0.05 were considered significant.ResultsThe frequency of preterm birth was 61.9% in the preeclampsia group and 33.6% in the normotensive group, p &lt; 0.001. Preeclampsia group were 2.58 times more likely to have preterm delivery compared to matched normotensive controls [adjusted OR = 2.58, 95% CI (1.24 – 5.35), p = 0.01]. There was no difference in the rate of adverse neonatal outcome (respiratory distress syndrome, early neonatal death, and Low Apgar score) between the groups.ConclusionsIn this study, twin pregnancies complicated with preeclampsia were found to have an increased rate of preterm birth compared to matched controls without hypertension.

Risk of Severe Postpartum Hemorrhage in Twin Pregnancies According to the Sum of Birth Weights.

To characterize the strength and patterns of association between birth weights and severe postpartum hemorrhage in twin pregnancies. This was a secondary analysis of the JUMODA (JUmeaux Mode d'Accouchement) cohort, a national, prospective, population-based study of twin deliveries, conducted from February 2014 to March 2015 in France. We excluded patients with a fetal death, medically indicated termination of pregnancy, antepartum hemorrhage, placenta previa, placental abruption, or missing birth weight. The primary outcome was severe postpartum hemorrhage , defined as a postpartum hemorrhage requiring at least one of the following: transfusion of 4 or more units of red blood cells, uterine artery embolization, uterine balloon tamponade, vascular ligation, uterine suture, emergency hysterectomy, admission to an intensive care unit, or postpartum hemorrhage considered severe by the obstetrician or leading to maternal death. The exposure was the sum of the birth weights of the two twins. To assess the association between the sum of twins' birth weights and severe postpartum hemorrhage, we used multilevel multivariable modified Poisson regression modeling. Analyses were conducted for the overall population and by planned and actual mode of delivery. A total of 8,373 patients were analyzed. Severe postpartum hemorrhage occurred in 4.5% (379/8,372, 95% CI 4.1-5.0), from 2.1% (15/722) for a sum of twins' birth weights less than 3,000 g up to 8.8% (12/136) for a sum exceeding 6,500 g. In the multivariable analysis, the association between the sum of the twins' birth weights and severe postpartum hemorrhage was linear, with an adjusted relative risk of severe postpartum hemorrhage of 1.36 (95% CI 1.24-1.49) for each 500-g increase in the sum of twins' birth weights. In twin pregnancies, the risk of severe postpartum hemorrhage increased linearly with the sum of the twins' birth weights.

Mode of delivery of twins at term.

Observational epidemiological analyses demonstrated a decreased risk of death and severe morbidity associated with caesarean delivery at term but an increased risk at preterm gestational age. A multicentre international randomized controlled compared planned caesarean section with vaginal birth and observed no difference in outcome; however, the trial included preterm and term births in approximately similar proportions. A subsequent re-analysis of the trial demonstrated that planned caesarean section was associated with an increased risk of adverse neonatal outcome at preterm gestational ages, but reduced the risk of perinatal complications at term, consistent with the epidemiological studies. Hence, decision-making around mode of delivery for twins should recommend against routine caesarean delivery preterm. At term, the balance of risks and benefits will vary according to the mother's prioritization of avoiding intervention, her attitude to managing the risks of uncommon but potentially severe adverse events, and her plans and potential for future pregnancies.

Obstetric and fetal short- and long-term outcomes of delayed-interval delivery in multiple pregnancies

IntroductionMultiple pregnancies are at higher risk of preterm birth. However, both children do not necessarily have to be born and exposed to the morbidity of prematurity. One option is a delayed-interval delivery with reduction of morbidity and mortality for the second twin. The present case series demonstrates the feasibility and safety of this procedure including the long-term outcome of the surviving children compared to the overall outcome of premature born children at the same perinatal center. MaterialRetrospective evaluation of all cases of delayed-interval deliveries in multiple pregnancies from 2003 to 2020 at the Women's and Children's Hospital of the University Hospital Ulm. ResultsIn 17 cases, the delivery of the second twin could be delayed, on average by 36 days. Pregnancies with delivery of the first twin before 22 weeks of gestation had a longer prolongation than pregnancies with delivery of the first twin after 22 weeks (53 vs. 22 days). If a cerclage was placed after the delivery of the first twin a longer prolongation interval could be achieved (45 vs. 19 days). No severe maternal morbidity occurred, and the short- and long-term outcome of the second twin did not differ from age-matched controls. ConclusionsIn multiple pregnancies with extremely preterm birth of the first twin, delivery of the second twin can in some cases be successfully postponed without serious maternal morbidity or additional fetal complications. Delivery of the first twin before 22 weeks of gestation and placement of a cerclage is associated with a longer prolongation interval.

Term delivery of dicavity twins in a uterus didelphys by bilateral caesarian section

Twin pregnancy continuing up to term in a uterus didelphys is an extremely rare occurrence. The following is a case report of such an event at District Base Hospital, Dambulla, Sri Lanka.

Outcome of preterm twins compared to preterm singleton neonates, a multicenter prospective observational study in Ethiopia

Background: In recent decades there has been a major increase in multiple birth rates, and the rate of twining vary from 6-9 per thousand life births to 20 per thousand live births across differ-ent areas of the world. Many studies have demonstrated higher neonatal and perinatal mortality and morbidity rates in twin deliveries compared to singleton births. This study was aimed to com-pare the outcomes of preterm twins and preterm singletons.Methods: A prospective, observational multicenter study was conducted from July 2016 to May 2018 in five tertiary hospitals in Ethiopia. All preterm, liveborn infants born at or transferred at less than 7 days of life to one of the study hospitals with an estimated gestational age below 37 weeks were included.Results: A total of 3,703 preterm neonates admitted to participating neonatal intensive care units were included in the study, of which 1171(31.6%) were twins. After adjusting for birth weight and gestational age, the mortality rate for preterm singletons of 31.0% was higher than the mortality rate for preterm twins of 24.8%, which was statistically significant (p-value = 0.001), OR of 1.37 (95% CI: 1.15 to 1.64). The study also identified an inverse relationship between birth weight and gestational age, and mortality. Male singletons were more likely to die than male twins (440 (32.4%) vs. 141 (23.4%); AOR 1.56 (95% CI: 1.22, 1.99); p=0.001)Conclusion: Our study showed that the mortality of a singleton preterm infant was significantly higher than the mortality of a preterm twin infant