Twin Fetuses Research Articles

The results of efferent therapy by woman with HIV infection, with amniotic fluid outflow at 23 weeks with growth retardation syndrome of 2 fetus

In the article presents data on the management of a 48-year-old patient with HIV infection, urogenital infection with pregnancy, which occurred as a result of IVF, with premature effusion of amniotic fluid at 23 weeks of pregnancy with the syndrome of growth retardation of 2 fetus in monochoric diamniotic twins. After the discharge of the amniotic fluid, the patient was treated for six days in an infectious hospital, then transferred to the perinatal center, where blood tests noted moderatemanifestations of endotoxicosis, increased levels of aminotransferases and an inflammatory reaction of the body. The course of treatment included detoxification methods (plasmapheresis, hemosorption, photomodification of blood with ultraviolet, laser rays), which contributed to the normalization of blood tests, prolongation of pregnancy for another three weeks in the absence of septic complications after operative childbirth in the mother and in newborn girls. At birth, 1 childs weight, body length and Apgar score were 750 g., 29 sm. and3/5points, respectively, in 2 children 590 g., 30 sm. and1/3points, respectively. The children required treatment from resuscitators, at the second stage of nursing, from rehabilitation specialists.

Changes in plasma biochemical parameters and hormones during transition period in Beetal goats carrying single and twin fetus.

Aim:The study was undertaken to find out the changes in biochemical and hormonal profile during transition period in single- and twin-bearing Beetal goats.Materials and Methods:Beetal goats are reared in North India for milk and meat purposes, popularly called poor man’s cow, serving as a source of livelihood. The present study was conducted on Beetal goats, maintained at a goat farm, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, for characterization of plasma biochemical and hormonal changes during transitional phase in pregnant goats carrying single and twin fetus. The animals selected were expected to have parturition at the same time, to avoid environmental variation effects, and divided into two groups: Group 1 (carrying single fetus, n=14) and Group 2 (twin fetus, n=6). Blood samples were collected from goats prepartum (−30 days and −15 days), 0 day, and postpartum +15 days and +30 days, and plasma was separated for the analysis of biochemical metabolites and hormones by commercially available kits.Results:Analysis of data revealed a significant decrease in triglyceride and cholesterol concentration during postpartum days. A significant increase in alanine aminotransferase (ALT) concentration was observed at the day of parturition. Furthermore, there was a significant (p≤0.05) decrease in ALT and aspartate aminotransferase concentration in goats at the 15th day and 30th day after parturition in both groups. A significant (p≤0.05) lower concentration of total protein and globulins was observed during late pregnancy and on the day of parturition, with a subsequent elevation during postpartum period (15 days and 30 days). Progesterone concentration was highest at −30 days prepartum and decreased sharply at parturition and thereafter postpartum, both in single- and twin-bearing goats. Progesterone level was lower in twin-bearing goats as compared to single-bearing goats at 0 day and postpartum days. No significant changes were observed in sodium, potassium, and chloride concentration during transitional period in goats.Conclusion:Transition period blood metabolite profile changes due to physiological need of mother and fetus were more prominent in metabolites regulating energy requirements and in goats bearing twin fetus.

Twin fetal facial expressions at 30-33+6 weeks of gestation.

Objective To assess the characteristics of twin fetal facial expressions at 30-33 + 6 weeks of gestation using four-dimensional (4D) ultrasound to clarify twin fetal brain development and maturation. Methods Frequencies of seven fetal facial expressions were studied using 4D ultrasound for 15 minutes in 30 singleton pregnancies and 18 twin pregnancies [four monochorionic diamniotic (MD) and 14 dichorionic diamniotic (DD) twins] at 30-33 + 6 weeks of gestation. Comparison of the frequency in each facial expression was performed between singleton and twin fetuses. Results Mouthing was the most frequent facial expression at 30-33 + 6 weeks of gestation, followed by blinking in twin and singleton fetuses. Both facial expressions were significantly more frequent than other expressions (P < 0.05). The frequencies of mouthing and scowling in twin fetuses were significantly lower than those in singleton fetuses, but there were no significant differences in the frequencies of the five other facial expressions between the fetal groups. Conclusion Our results suggest that restricted twin fetal behavior before 20 weeks of gestation may still affect the frequencies of twin facial expressions early in the third trimester of pregnancy. Moreover, the frequencies of facial expressions in twins are different from those of singleton fetuses.

Variations in serum metabolites in response to season, cyclicity, and pregnancy in estrus-synchronized Damascus goats.

The current study was carried out to determine the changes in serum electrolytes, liver enzymes, and hormones during breeding and non-breeding seasons in estrus-synchronized goats. Forty goats (n= 40) were synchronized by inserting the sponges intravaginally for 12days; PMSG and PGF2α were injected on day of sponge removal. Blood samples were collected from the goats at the time of sponges insertion (day -12), estrus day (day 0), and at 15day after sponge withdrawal (day 15). The blood samples were analyzed for glucose, cholesterol (CHO), aspartate aminotransferase (AST), alanine aminotransferase (ALT), thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4) and progesterone (P4), calcium (Ca), phosphate (PO4), magnesium (Mg), sodium (Na), potassium (K), and chlorine (Cl) levels. Repeated measurements ANOVA of general linear model were used as statistical model. The results showed that seasons have an effect (p< 0.05) on glucose, Ca, Na, K, Cl, CHO, T3, and T4 levels. There was an effect (p< 0.05) of cyclicity only on P4 level. Whereas, nonpregnant, or goats carrying singlet and twin fetuses have shown variation (p< 0.05) in glucose, Ca, and P4 levels. Although, the correlations existed between different serum metabolites but strong correlations (p< 0.05) were observed either between Ca and Na or T3 and T4. In conclusion, the serum electrolytes and liver enzymes are correlated with hormones during the different seasons, pregnancy status, and fecundity. In recommendation, the results of the study could be as managemental tool to monitor the reproductive activity across seasons and to maintain pregnancy carrying twining in goat breeds.

Consideration of breed specific fetal trunk diameter for the estimation of gestation age using trans-abdominal ultrasonography in sheep

The study aim was to estimate gestational age (GA), expected parturition date (EPD) and growth rate by determining fetal trunk diameter (TD). Effects of fetal-dam pelvis alignment and in utero fetal position at time of ultrasonography (UG) on fetal numbers and sex determination were also studied. Trans-abdominal UG (3–6.5 MHz) was conducted on 37 ewes with known breeding dates from Days 25–120 of pregnancy. Errors in GA and EPD were studied using an equation in the same ewes at their successive breeding when date of breeding was unknown. There were four equations, Y = 1.28861X+32.656 (R2 = 0.92), for Indigenous; Y = 1.2603X+38.075 (R2 = 0.85), for Indigenous × Garole; and Y = 0.8932X+45.916 (R² = 0.99), for Garole fetuses; and the equation, Y = 1.3565X + 32.604 (R2 = 0.94), independent of breed were computed to estimate GA and the relationship between GA and TD of different breeds. The error in estimated GA and EPD using these four equations was determined and there was comparison with the data collected using US and the previously described equations. Results indicate there was the greatest (P < 0.01) error for GA and EPD values using the US TD equation for all breeds. There was the least error in estimated EPD using the breed specific equations. Error in the sex determination was 4.8 % and fetal number determination was 16.7 % with singleton and 7.7 % twin fetuses. The results indicate there is a breed specific fetal TD that is useful for predicting GA in sheep.

Twin Pregnancy with Hydatidiform Mole

Twin pregnancy with Hydatidiform Mole is a rare case, only about 1 in 22.000 to 100.000 pregnancies. Molar pregnancy with triplet pregnancy is even rarer, which is only 6 cases reported and mostly occurred in women who received therapy for infertility. Management in cases of twin pregnancy with hydatidiform mole is dilemmatic both for the patient and physician. We present a case of 29 years old woman with her first pregnancy of twin fetuses complicated with hydatidiform mole. Diagnostic approaches were made mainly by ultrasound examination, continued with laboratory and radiology examinations which some did not performed due to worsened vaginal bleeding. This case ended with premature labor with the result of delivery of two babies and placenta with vesicles which is a characteristic of hydatidiform mole.

Feasibility of Non-invasive Fetal Electrocardiographic Interval Measurement in the Outpatient Clinical Setting.

Non-invasive fetal electrocardiography (ECG) is a promising method for evaluating fetal cardiac electrical activity. Despite advances in fetal ECG technology, its ability to provide reliable, interpretable results in a typical outpatient fetal cardiology setting remains unclear. We sought to determine the feasibility of measuring standard ECG intervals in an outpatient fetal cardiology practice using an abdominal fetal ECG device that employs blind source separation with reference, an innovative signal-processing technique for fetal ECG extraction. Women scheduled for clinically indicated outpatient fetal echocardiogram underwent 10min of fetal ECG acquisition from the maternal abdomen using specialized gel electrodes. A bedside laptop computer performed fetal ECG extraction, allowing real-time visualization of fetal and maternal ECG signals. Offline post-processing of 1min of recorded data yielded fetal P-wave duration, PR interval, QRS duration, RR interval, QT interval, and QTc. Fifty-five fetuses were studied with gestational age 18-37weeks, including 13 with abnormal fetal echocardiogram findings and three sets of twins. Interpretable results were obtained in 91% of fetuses, including 85% during the vernix period and 100% of twin fetuses. PR interval and RR interval of 18-24week gestation fetuses were significantly shorter than those with gestational age 25-31 and 32-37weeks. Of the six fetuses with abnormal rhythms on fetal echocardiogram, fetal ECG tracing was interpretable in five and matched the rhythm noted on fetal echocardiogram. Abdominal fetal ECG acquisition is feasible for arrhythmia detection and ECG interval calculation in a routine clinical setting.

Reference values for fetal heart rate in cattle in the first trimester of pregnancy.

The aim of this study was to create a fetal heart rate (FHR) reference curve for singleton bovine fetuses in the first trimester of gestation and to determine its possible relationship with the outcome of pregnancy. Forty-eight Holstein-Friesian cows with one fetus and five cows with twins were used. Fetal heart beatings were recorded on videotape during transrectal scanning with a 5 and/or 7.5 MHz linear array transducer on a weekly basis between Days 40 and 95 of gestation. FHR was calculated by averaging the results of five counts of the same record by the same observer. For singleton pregnancies, a reference curve was created using the mean, the standard deviation (SD) and the 5th and 95th percentiles. The FHR increased from Days 40-46 (173 beats/min) to Days 61-67 (183 beats/min). After a peak, the FHR decreased slowly until Days 89-95 (175 beats/min), while the SD increased. There was no significant difference between singleton and twin fetuses. in the aborted and lost fetuses in twin gestation due to fetal reduction, both bradycardia and tachycardia were detected compared to the singleton pregnancy reference curve.

Developmental trajectories of general and breathing movements in fetal twins.

This study examined the developmental trajectories of general and breathing movements in fetal twins. Fetal movement patterns were assessed from real-time ultrasound recordings performed at 12-15, 20-23, and 28-32weeks of gestation in 42 twin pairs. Results indicated that both general movements and breathing movements followed a curvilinear, inverted U-shaped curve. Developmental trajectories were unrelated within pairs of twins and were not associated with gestational age at birth and birth weight. However, sex differences were found for general movements with males displaying more time making general movements at 21weeks and a steeper decline in time spent making general movements during the second half of pregnancy than females. These age-related changes in fetal movements may reflect CNS development. These findings also suggest that twins' behavioral development is largely independent of co-twin development, gestational age at birth, and birth weight, but not of fetal sex.

Intestinal volvulus without malrotation in a dichorionic diamniotic twin: case report and review of literature

Volvulus is a condition in which the small bowel and proximal colon twist around the superior mesenteric artery, and a surgical emergency associated with high intrauterine morbidity and mortality. Intestinal volvulus can occur at any age, but most cases of volvulus occur in infants with anomalies of intestinal rotation and fixation. Intestinal volvulus without malrotation is a rare condition, as only normal intestinal rotation and fixation are present. The authors report a case of intestinal volvulus without malrotation in one fetus of twins.

Differences in fetal growth patterns between twins and singletons*

Objective: Twin fetus growth is delayed during the third trimester compared to singletons. Whether this phenomenon should be considered a normal physiologic characteristic of twins or a pathologic process inherent to twin pregnancies is currently unclear. Information on the growth rate of the individual fetal biometric indices may provide more insight into the mechanisms underlying these differences between twins and singletons. Our aim was to compare fetal growth pattern between twin and singleton fetuses.Methods: This was a retrospective study of women with an uncomplicated twin pregnancy who underwent sonographic fetal weight estimation between 16 and 38 weeks’ gestation in a single referral center. Twins-specific regression models were generated for biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL) and fetal weight as a function of gestational age and were compared to published singletons-based curves.Results: Overall 543 women were eligible for the study and underwent a total of 3401 sonographic weight estimations. Estimated weight of twin fetus emerged as lower than that of singletons starting at 26 weeks of gestation, and these differences increased with gestational age, reaching a mean difference of 300–350 g or of ∼10% at term. The growth of all four biometric indices was slower in twins compared to singletons, but the differences were most pronounced for AC which had the largest relative contribution to the lower fetal weight in twins (51.7 ± 7.3%), while the relative contribution of FL, HC, and BPD was smaller (26.4 ± 10.7, 15.5 ± 3.0, and 6.4%±5.7%, respectively). This was also reflected by a higher HC/AC ratio in twins compared with singletons starting at 22 weeks of gestation. The likelihood of a twin fetus being diagnosed as small for gestational age (fetal weight <10th percentile) was significantly lower when the newly developed twins-based curves (rather than singletons-based curves) were used (OR: 0.39, 95%-CI: 0.34–0.44).Conclusion: Twin fetus experience slowing of growth beginning at ∼26 weeks of gestation and a greater degree of asymmetric growth pattern compared with singletons. These findings suggest that the slower growth of twins may reflect a state of “relative growth restriction” compared with singleton gestations.

Placental Growth Factor and Endothelial Cell-Specific Molecule 1 Levels in Discordant and Concordant Twins and Their Effects on Fetal Growth

Objective: We explored whether fetal twin growth was related to the levels of placental growth factor (PGF) and endothelial cell-specific molecule 1 (ESM-1) and sought correlations between cord blood PGF and ESM1 levels and birth weight discordance. Methods: This was a prospective study. We evaluated 79 pairs of twins, thus 158 infants. Twenty-nine (37%) twins were naturally conceived; the remaining 50 (63%) resulted from assisted reproduction. Results: Nine (11%) sets of twins were monochorionic. Eighteen of the 79 twin sets (22%) were discordant. We found a positive correlation between PGF and ESM-1 levels (r = 0.51, p = 0.001) and between discordance and PGF level (r = 0.430, p = 0.001). Conclusion: The growth discordance may not be attributable to the different PGF levels, but the difference in PGF level may be a consequence.

Development of the central nervous system in equine twin fetuses derived by somatic cell nuclear transfer.

Because of the growing importance of horses in leisure and several sports, somatic cell nuclear transfer (SCNT) is being used more frequently for cloning animals for performance and reproductive purposes. However, because of the need to perforate the zona pellucida during microsurgical reconstruction of the oocyte, it is possible that SCNT-derived embryos undergo premature hatching, resulting in embryo bisection and twinning. Therefore, because equine twin pregnancies often lead to abnormal embryo development and pregnancy failure, we performed a detailed comparative assessment of equine twin fetuses derived by SCNT with particular attention on the development of the central nervous system at 40 and 60 days gestation. The results of this study indicate that although cloned twin embryos show small differences in size, they do not exhibit apparent macro- or microscopic developmental discrepancies in the central nervous system, suggesting that the twining phenomenon resulting from SCNT does not affect fetal differentiation.

416: Rate of Doppler abnormalities in small for gestational age twin and singleton fetuses

416: Rate of Doppler abnormalities in small for gestational age twin and singleton fetuses

Three-dimensional power Doppler ultrasound evaluation of placental blood flow in normal monochorionic diamniotic twin pregnancies

BackgroundMonochorionic diamniotic (MCDA) twin pregnancies are at higher risk of adverse outcomes and complications, which are attributed to the influence of placental morphology in MCDA twins. Monitoring of placental function is an important index for clinical decisions. The aim of our study was to evaluate the placental blood flow estimated using three-dimensional power Doppler (3D-PD) ultrasound and the vascular indices distribution with gestational age (GA) in normal MCDA twin pregnancies.MethodsOne hundred four MCDA twin pregnancies and 106 singleton pregnancies (GA range, 14–32 weeks) were included in this prospective study. 3D-PD volume data of each fetus was obtained separately from the placenta at the site of umbilical cord insertion. We analyzed the volume data using sonobiopsy technique. The placental vascularization index (VI), flow index (FI) and vascularizationflow index (VFI), were auto-calculated. The means and standard deviation values of three vascular indices per fetus were calculated and regression analysis of the vascular indices as a function of GA was performed in twin pregnancies. The vascular indices of twin and singleton pregnancies were compared using independent t-test.ResultsThere were no significant differences in VI, FI or VFI among the fetuses of twins (p > 0.05). These vascular indices increased over the course of pregnancy (p < 0.05). We obtained the regression equations for the indices as a function of GA in days: VI = exp. (4.369–28.533/GA) (R2 = 0.699, p < 0.05), FI = exp. (3.916–13.003/GA) (R2 = 0.511, p < 0.05), and VFI = exp. (3.577–37.468/GA) (R2 = 0.675, p < 0.05). There were no significant differences in three vascular indices between MCDA twin and singleton groups (p > 0.05).Conclusions3D-PD placental data using sonobiopsy technique could reflect the placental blood flow of each twin, which could be applied to the study of placental perfusion in MCDA twin pregnancies. This study also presented the vascular indices distribution with GA in normal twin pregnancies, which might be useful for early detection of MCDA complications.

New features of aplasia cutis congenita type 5 – Skin atrophy associated with respiratory insufficiency and multiple intestinal atresia caused by the early death of twin fetus

New features of aplasia cutis congenita type 5 – Skin atrophy associated with respiratory insufficiency and multiple intestinal atresia caused by the early death of twin fetus

Placental erythropoietin expression is upregulated in growth-restricted fetuses with abnormal umbilical artery Doppler findings: a case\u2013control study of monochorionic twins

BackgroundWe previously reported that fetal plasma erythropoietin (EPO) concentrations are significantly increased in growth-restricted fetuses with abnormal umbilical artery (UA) Doppler. During hypoxia in an ovine model, the primary site of fetal EPO synthesis was switched from the kidneys to the placenta. Therefore, we designed this study to evaluate human placental EPO gene expression and the correlation to fetal serum EPO concentration in growth-restricted fetuses in a monochorionic (MC) twin model.MethodsIn MC twin pairs, selective intrauterine growth restriction (sIUGR) was defined as the presence of (i) birth weight discordance of > 20% and (ii) a smaller twin with a birth weight less than the 10th percentile. Fetal UA and middle cerebral artery (MCA) Doppler were checked within 1 week before delivery. An abnormal UA Doppler was defined as persistently absent or reverse end-diastolic flow. Cerebroplacental ratio (CPR) was defined as MCA-pulsatility index (PI)/UA-PI. Fetal plasma EPO concentrations were measured in cord blood, and EPO gene expression was assayed in each twin’s placental territory. The intertwin plasma EPO ratio was calculated as the cord plasma EPO level of the smaller (or sIUGR) twin divided by the EPO concentration of the larger (or appropriate-for-gestational-age (AGA)) twin, and the intertwin placental EPO gene expression ratio was calculated similarly.ResultsTwenty-six MC twins were analyzed, including normal twins (Group 1, n = 9), twins with sIUGR without UA Doppler abnormalities (Group 2, n = 9), and twins with sIUGR and UA Doppler abnormalities (Group 3, n = 8). The CPRs of smaller (sIUGR) fetuses were significantly decreased in Group 3 MC twins (p < 0.001), but not significantly different between Group 1 and Group 2. The highest fetal plasma EPO ratio and placental EPO gene expression ratio were identified in Group 3 MC twins (p < 0.001). The placental EPO gene expression ratios were significantly correlated with the fetal plasma EPO ratios (Pearson’s correlation test, p = 0.004).ConclusionThis study provides evidence of increased placental EPO expression in MC twin fetuses with sIUGR and abnormal UA Doppler. Future studies are needed to confirm the similar role of placental EPO in severe IUGR singletons.

Effect of abnormal GpG methylation in the second trimester of pregnancy on adverse health risk of offspring.

Effect of abnormal GpG methylation in amniotic fluid cells during the second trimester of pregnancy on adverse health risk of offspring was investigated. In total, 237 sets of amniotic fluid cells were collected from patients who received prenatal diagnosis in the Third Affiliated Hospital of Guangzhou Medical University (Guangzhou, China) from April 2010 to October 2011. Among them, 156 sets were from singleton and 81 sets were from twins. H19 gene was amplified by PCR, and the product was purified and pyrosequencing was used to detect the DNA methylation level of GapG. Follow-up records of the birth outcomes of pregnant women's offspring were collected. Positive rate of DNA amplification in 200 cases of amniotic fluid cells was 84.4% (200/237). Average age of singleton pregnancies was higher than that of twins (P<0.05), and no significant differences were found in gestational age and PCR amplification rate (P>0.05). There was no difference in the methylation level of GapG between singleton and twins (P>0.05), but the abnormal methylation rate of GapG1 in twin fetuses was significantly higher than that of singleton (20.3 vs. 3.6%, χ2=8.364, P=0.004). Offspring sex, singleton or twins, mode of delivery, time of pregnancy, and low birth weight showed no significant effect on GapG methylation level of H19 in the second trimester of pregnancy. No offspring deformities were found regardless of the increased or decreased degree of methylation (P>0.05). The number of fetuses born may cause abnormal GapG1 methylation, but no effect of GapG methylation on the adverse health risk of offspring was found.

Steroid hormones and energetic metabolites profiles in ewes raised under arid and semi-arid climates of Algeria

ABSTRACTSerum progesterone, estradiol 17-β and energetic metabolites profiles were investigated during the spring breeding season in non-pregnant and pregnant “Ouled Djellal” ewes bearing singleton or twin fetuses in arid and semi-arid climates of Algeria. Twenty and thirty ewes aged 1 to 4 years from semi-arid and arid zones, respectively, were used. In semi-arid zone, 15 ewes were pregnant (eight carrying one fetus and seven carrying twins). In arid zone, from 24 pregnant ewes, 14 carried singleton and 10 carried twins. Blood sampling were collected before mating, in the first and the last month of pregnancy and after lambing. Significant effect (p < 0.05) of litter size was found during early gestation on progesteronemia in arid region and on estradiolemia (p < 0.05) in both regions. During late pregnancy significant effect of fetal number was observed in semi-arid (p < 0.05) and arid (p < 0.001) area for progesterone and only in arid zone (p < 0.05) for estradiol. In the present study, no significant effect of litter size was found on serum glucose, cholesterol and triglycerides in both regions. Reproductive hormones profiles and energetic metabolism in pregnant ewes raised in arid zone are more altered than those in semi-arid zone.

The rate of neonatal respiratory distress syndrome/transient tachypnea in the newborn and the amniotic lamellar body count in twin pregnancies compared with singleton pregnancies

BackgroundWhether or not the period of fetal lung maturity differs between twin and singleton pregnancies has not been clarified. We examined whether or not fetal lung maturity and fetal lung absorption are achieved earlier in twin fetuses than in singleton fetuses. MethodsWe registered 454 singleton pregnancies and 398 twin pregnancies with no congenital abnormalities affecting the respiratory function or neonatal deaths. All patients were delivered by Caesarean section without labor between 24 and 38 gestational weeks. The amniotic fluid samples were analyzed immediately without centrifugation. A multiple logistic regression analysis was performed to explore the relationship between twin pregnancy and neonatal respiratory distress syndrome and transient tachypnea of the newborn (RDS/TTN). ResultsThe rate of RDS/TTN in infants was significantly higher and the lamellar body counts (LBCs) significantly lower in singleton pregnancies than that in twin pregnancies (P < .001). According to a multivariate logistic regression analysis, twin pregnancy (odds ratio, 0.34; 95% confidence interval, 0.22–0.55) was a significant preventive factor for neonatal RDS/TTN. ConclusionsWe showed that twin fetuses experience more rapid lung maturation and lung fluid absorption than singleton fetuses, as confirmed by the higher LBC values in twin fetuses.