Unilateral Twin Research Articles

Twin Pregnancy in the Martina Franca Donkey Breed Managed by Natural Reduction and Post-Fixation Manual Crushing.

Twenty-five twin pregnancies were detected at 11-13 days after ovulation. At 16 days after ovulation, twin pregnancies were classified as unilateral or bilateral and left untreated. The occurrence of natural reduction of one embryo was assessed at 20-21 days after ovulation, and post-fixation manual crushing of one embryo was performed in those cases in which natural reduction did not occur. The pregnancy rate at 28 days after ovulation and live foal rate were recorded. Sixteen out of 25 twin pregnancies were unilateral and nine bilateral. At 20-21 days after ovulation, the natural reduction of one embryo occurred in 87.5% of the unilateral and in none of the bilateral twin pregnancies. The remaining twin pregnancies were treated by post-fixation manual crushing of one embryo. The 28-days-after-ovulation single embryo pregnancy rate was 93.8% for unilateral twin pregnancies and 88.9% for bilateral twin pregnancies, with an overall pregnancy rate of 92%. The live foal rate was 87%. The success rate of natural reduction within 20-21 days after ovulation, the 28-days-after-ovulation pregnancy rate, and the live foal rate suggest that waiting for the natural reduction of one embryo and choosing the post-fixation manual crushing of one embryo could be considered as an alternative to traditional early pre-fixation manual crushing in the Martina Franca donkey breed.

Characteristics of unilateral and bilateral bovine twin foetuses

AbstractTwin pregnancy in cattle is undesirable for a number of reasons, including a higher abortion risk compared to pregnancies with a single foetus. Yet, the abortion risk is significantly influenced by the intrauterine location of the foetuses, that is, the abortion risk is several times higher if they are implanted in the same uterine horn (unilateral twin pregnancy) than if they are implanted with one foetus in each uterine horn (bilateral twin pregnancy). The reason for the higher abortion risk in unilateral twin pregnancies is unknown, but it may be related to malnutrition of the outermost foetus due to a limited placental capacity, as is the case for equine twin foetuses. A slaughterhouse study was performed and the foetuses of cattle pregnant with twins were measured. We identified 65 cases of twin pregnancies, of which 35 were unilateral twin pregnancies and 30 were bilateral twin pregnancies. There was no significant difference between the outermost and the more centrally located foetus in unilateral twin pregnancies in terms of body weight and length of the metacarpal diaphysis. Growth retardation of the outermost foetus could therefore not be confirmed as the cause of the higher abortion risk in unilateral bovine twin pregnancies. Four cases of pre‐slaughter foetal mortality were identified. In three of these cases, both twins were dead, of equal size and at a comparable level of degradation. In the fourth case, with approximately 40‐day‐old twin foetuses of equal size, only one of the foetuses showed signs of pre‐slaughter death.

Double trouble: Implications and management of twinning in lactating dairy cows

Over the past 4 decades, twinning increased concurrently with milk production in dairy cattle, but recently appears to have plateaued, likely from the adoption of hormonal synchroniza­tion protocols. Approximately 95% of Holstein twins are dizy­gotic, making double ovulations the primary mechanism for twinning. Decreased progesterone (P4) concentrations dur­ing preovulatory follicle growth increases double ovulations. Increased hepatic catabolism of P4 because of increased feed intake associated with increased milk production provides a physiological mechanism for decreased P4 concentrations and increased double ovulations. Cows with unilateral twins have more pregnancy losses than cows with bilateral twins which were similar to cows with singletons. Selective embryo reduction followed by P4 treatment did not increase the risk of pregnancy loss for cows with unilateral twins, but increased the risk of loss for cows with bilateral twins. Twinning will likely increase concurrently with milk production over time but can be decreased using 2 approaches: 1) submitting cows to hormonal synchronization protocols that increase P4 dur­ing growth of the preovulatory follicle before timed AI; and 2) identifying twins by laterality and allowing cows with bilateral twins to continue through gestation with extra assistance at calving, while selective reduction can be attempted for cows with unilateral twins.

Unilateral double maxillary paramolars in a non-syndromic child – a rare case report

Introduction and aim. Extra teeth are the teeth which are more than the normal number of teeth in jaws. They can be present on a single side or both sides, singular or many, maxillary or mandibular. Paramolars are uncommon supernumerary molars which can be present on buccal or palatal side of molars. Very few reports of supernumerary teeth in maxilla or mandible being paramolars has been stated. No literature on unilateral twin paramolars in maxilla has been reported in literature yet. This is a first case report of unilateral twin paramolars in maxilla in a child. Description of the case. This case report describes the presence of unilateral double maxillary paramolars and their handling in a thirteen-year-old boy, whose primary concern was that of severe pain in maxilla on both sides. After an identification of double maxillary paramolars was put forward and established by cone beam computer tomography, both the paramolars were extracted. Conclusion. Supernumerary teeth have to be removed as soon as detected otherwise they can lead to malocclusion and pain due to caries after pulp involvement.

A Rare Case of a Twin Tubal Stump Pregnancy Postunilateral Salpingectomy

Twin ectopic pregnancy is an extremely rare occurrence with an estimated incidence of 1 in 20 000 to 250 000 spontaneous pregnancies [1]. Tubal stump pregnancies account for only 1.16% of all ectopic pregnancies [2]. Here, we show sonographic and laparoscopic images of a spontaneous, unilateral twin ectopic pregnancy in a fallopian tube remnant after previous ipsilateral salpingectomy.

Twin reduction in the late embryonic period prevents the condition of freemartin in dairy cattle.

The condition of freemartinism occurs in the bovine heterosexual twin foetuses and refers to the resulting infertile female. Vascular anastomoses of the foetal membranes are the major reason of this anomaly. This study examines whether single born heifers following induced twin reduction at 28-34 days of pregnancy could develop normal reproductive functions. The study population derived from 367 lactating dairy cows carrying: unilateral twins (n=178), bilateral twins (n=174) or triplets (n=15), in which manual embryo reduction was performed. The final study population was constituted of 95 single born twin females that reached 12months of life and entered into the AI period. Of these heifers, 40 have had one unilateral co-twin, 49 one bilateral co-twin, and 6 two contralateral co-twins. A total of 1688 heifers inseminated during the same period were used as controls to compare the rates of pregnancy at 15months of age, culling due to infertility and birth before the age of 24months. No differences were detected between groups. With an accepted incidence rate of 50% heterosexuality for all twin sets, we should assume that half of our study population had a male co-twin. Our results indicate lack of effect of the male co-twin on normal development of the gonads and genital tract of his female partner during the late embryonic period.

Live Unilateral Monochorionic Diamniotic Twin Ectopic Gestations At The Lekma Hospital, Teshie. Accra Ghana – A Case Report

Live unilateral twin ectopic gestations are a rare ultrasound finding with only 12 previous cases documented, none in Africa. This 13th case highlights a 30 year old primigravida who presented with abdominal pain. Transabdominal ultrasound found live rightadnexal monochorionic diamniotic twin ectopic gestations and 200 mls of free fluid in the pouch of Douglas. Laparotomy showed two gestational sacs within the right fimbria and a right Salpingectomy was performed with good maternal outcome. This case is different from most previous cases in having previous appendectomy as a risk factor and also for its use of transabdominal ultrasound. Duringtransabdominal ultrasound, Sonologists must carefully evaluate any surgical scars and other risk factors, as these may raise the index of suspicion and lead to a prompt diagnosis of live unilateral monochorionic diamniotic twin ectopic gestations.

Spontaneous Unilateral Triplet Interstitial Ectopic Gestation: A Case Report

Unilateral multiple ectopic gestations are very rare, and usually associated with <em>in vitro</em> fertilization as has been reported in studies. Unilateral twin ectopic gestation occurs in about 1 in 200 ectopic gestations. Unilateral triplet ectopic gestation is even more rare.

A retrospective study of twin pregnancy management in mares

The aim of the study was to compare three methods of reducing twin pregnancy in mares to maintain a single pregnancy. As multiple pregnancies in mare are always undesirable, early ultrasound diagnosis makes possible management of twin pregnancies and extra embryo removal. In years 2010–2018, 16494 mares were sonographically tested for early pregnancy, finding 868 cases of twins (471 bilateral and 397 unilateral). 260 mares with a confirmed bilateral tween pregnancy were subjected to manual crushing of one embryo and administration of flunixin at a dose of 1.1 mg/kg BW. 186 mares were subjected only to the embryo crushing procedure. 25 mares from this group were on a restrictive diet. In the unilateral twin pregnancy mare group, 62 were subjected to manual embryo reduction with simultaneous treatment with flunixin, 60 had only manual embryonic vesicle crush and 210 had a restrictive diet. Determination of success, measured as the development of a single pregnancy, were monitored 2 weeks after the procedure, between the 50th and 60th day of pregnancy and after the 90th day of pregnancy. In general, warm-blooded mares were more prone to a twin pregnancy, and at the same time, all the procedures used to reduce it to a single pregnancy caused a greater risk of losing both embryos than in the case of cold-blooded mares. The beneficial effect of administering flunixin after manual removal of one embryo on the maintenance of the other has been experimentally proven in both unilateral and bilateral twin pregnancy.

Unilateral twin pregnancy: A non-infectious factor required for the etiological diagnosis of abortion in dairy herds.

Twin pregnancies are classified into bilateral (one fetus in each uterine horn: 44%) and unilateral (both fetuses in the same uterine horn, right or left: 56%). The incidence of abortion during mid- to late gestation is approximately 1% in cows carrying bilateral twins and more than 40% in cows carrying unilateral twins. In this period, abortion seems most commonly associated with infectious agents. However, although this imbalanced abortion rate may imply that unilateral twin pregnancy is a non-infectious abortion factor, few available data can describe the cause of abortions in twin pregnancies. The current findings suggest that unilateral twin pregnancy is a non-infectious factor required for the etiological diagnosis of abortion in dairy herds.

144 Proof of concept for bilateral twin pregnancies in Trio allele carriers

Abstract Bovine twin birth is associated with detriments including increased embryo/fetal losses, malpresentation and dystocia. Incidence of these is lessened in bilateral versus unilateral twin pregnancy. This study was undertaken to assess use of follicular ablation by aspiration to create bilateral twin pregnancies in females with genetic potential for ~3.5 ovulations per cycle (Trio allele carriers). In Experiment 1, carriers (n = 30) and non-carriers (n = 10) were synchronized for ovulation and timed artificial insemination (TAI). Follicles (&amp;gt; 5 mm) in excess of one per ovary were aspirated ~16h preceding TAI. Follicle count for females with follicles on only one ovary was reduced to two. Blood was sampled 2 weeks post-TAI to assess progesterone (P4) concentrations; fetal count was determined by ultrasound 6 weeks post-TAI. P4 concentration post-TAI was significantly (P &amp;lt; 0.001) associated with both genotype and subsequent pregnancy status (pregnant non-carriers, 7.06 ± 0.68 ng/mL; pregnant carriers, 5.54 ± 0.55 ng/mL; non-pregnant non-carriers, 5.22 ± 1.05 ng/mL; non-pregnant carriers, 3.13 ± 0.42 ng/mL). Experiment 2 was undertaken to offset negative effects of follicular aspiration on subsequent P4 concentration observed in Experiment 1. Carriers (n = 38) and non-carriers (n = 32) were submitted to fixed-TAI and follicle ablation as described. Additionally, accessory corpora lutea were induced by administration of hCG (carriers) at d6 post-TAI. Consequently, P4 concentration post-TAI was significantly (P &amp;lt; 0.05) associated with subsequent pregnancy status (pregnant, 8.48 ± 0.61 ng/mL; non-pregnant, 6.70 ± 0.63 ng/mL) but not with genotype (carrier, 8.01 ± 0.59 ng/mL; non-carrier, 7.17 ± 0.64 ng/mL). Fetus number was greater in carriers (Exp1, 1.64 ± 0.81; Exp2, 1.45 ± 0.09) versus non-carriers (1.00 ± 0.00, both Experiments). Singles, twins, and triplets occurred in carriers in Experiment 1, whereas multiples in Experiment 2 were limited to twins. Genotype effects on pregnancy rate were not significant (P &amp;gt; 0.10) in either experiment. Results suggest follicular ablation to create bilateral twin pregnancies in Trio carriers is feasible but requires induction of accessory corpora lutea to offset the negative effects of follicular aspiration on subsequent P4 concentration.

Ruptured Unilateral Twin Tubal Ectopic Pregnancy. Case Report of an oddity &amp; Literature Review

Background: An ectopic pregnancy (EP) is a type of conception in which, the fertilized egg is lodged outside the uterine cavity. Twin ectopic pregnancies are a rarity, and the reported cases of twin tubal pregnancies are a handful to date.Case Report: We report a case of a 35 years old patient who presented to the emergency with the complaint of lower abdominal pain and intermittent vaginal discharge. She was diagnosed with twin tubal alive gestation, underwent exploratory laparotomy and right salpingectomy.Conclusion: Ectopic pregnancy can occur even in the absence of known risk factors. Its incidence is on the rise. It is a leading cause of first-trimester maternal deaths and can be easily diagnosed with Beta HCG levels and transvaginal ultrasound.

Preoperative diagnosis of unilateral twin tubal pregnancy by enhanced magnetic resonance imaging

Preoperative diagnosis of unilateral twin tubal pregnancy by enhanced magnetic resonance imaging

Abortion in dairy cattle with advanced twin pregnancies: Incidence and timing.

This study examines incidences and timing of abortion in Holstein Friesian dairy cows with advanced twin pregnancies in north-eastern Spain. The study population consisted of 1,194 twin pregnancies in two herds recorded from 2010 to 2015: 522 bilateral and 672 unilateral. The presence of live twins was determined by transrectal ultrasonography between 55 and 61 days post-AI and pregnancy confirmed 60 days later. Abortion was recorded in 278 (23.3%) cows before Day 260 of pregnancy: 7 (1.3%) in bilateral and 271 (40.3%) in unilateral twin pregnancies. Using binary logistic regression procedures the following were excluded as risk factors for abortion: herd, year, heat stress (temperature-humidity index values >72), lactation number and right versus left side for unilateral twins. Based on odds ratios, cows carrying unilateral twins were 49.9 (right unilateral twins) and 49.3 (left unilateral twins) times more likely to suffer abortion than cows with bilateral twins. The average time of abortion for unilateral twins was 173±32 days and ranged from 135 to 249days, 43% of abortions occurring between 135 and 154 days of gestation. The authors suggest prevention or reduction of unilateral twin pregnancies by follicular puncture and drainage of subordinate follicles at AI or manual rupture of the amniotic vesicle of one of the two twins at the time of pregnancy diagnosis.

202 Factors influencing pregnancy loss in lactating dairy cows

Abstract Pregnancy loss in high producing dairy cows is significant and negatively affects profitability of dairy farms. It is not clear the extent of pregnancy loss prior to a subsequent estrus or first pregnancy diagnosis. It is clear that percent of cows losing pregnancies are greatest following 1st pregnancy diagnoses then decrease in a time-related fashion throughout gestation. Non-disease related factors that are associated with pregnancy losses in dairy cows include parity, timing of AI relative to ovulation, circulating concentrations of progesterone during growth of the ovulatory follicle(s), double ovulations, unilateral twins, service sire, extent of change in body condition during early lactation, and serum levels of pregnancy associated glycoproteins at 24 or 28 d post-AI. Metabolic changes related to high milk production resulted in a greater chance for double ovulations. A growing body of literature indicates that cows with unilateral double ovulations and unilateral twins have a greater chance for pregnancy loss during the 1st 90 d of pregnancy compared to cows with single ovulations or bilateral twins. It also appears there is a preferential timing of loss in cows with double vs. single ovulations. Levels of circulating concentrations of progesterone during follicular wave development affect follicular development of cows. In a study that controlled progesterone during follicular development, low levels of progesterone caused a greater percentage of cows to have double ovulations and increased chances for pregnancy loss after 35 d post-AI. Lastly, it appears that cows that lose body condition during the 1st 30 DIM have a greater chance of pregnancy loss between 35 and 69 d post-AI compared with cows that maintained or gained body condition during that period. These data lead towards a greater understanding of the potential causes of pregnancy loss in dairy cows and can be instrumental in the development of reproductive technologies to reduce these losses.

Spontaneous unilateral twin tubal ectopic pregnancy: A case report

Unilateral tubal twin pregnancy is rare with an incidence of 1: 125,000 spontaneous pregnancies. Majority of cases that occur follow ovulation induction and assisted reproductive technology. A 38-year-old single primipara with a 9-week history of amenorrhea, 2-week history of lower abdominal pain, and a 3-day history of vaginal bleeding. Previous history of ectopic gestation with surgery, as well as repeated elective abortions and pelvic infections, was elicited. She was hemodynamically unstable with features of an acute abdomen. Pelvic examination revealed features suggestive of ectopic gestation. Spot serum pregnancy test was positive and the pelvic ultrasound revealed left tubal twin ectopic gestation with the significant peritoneal fluid collection. An emergency laparotomy with left salpingectomy was performed, with an un-complicated post operation course. The diagnosis was confirmed with histology. A high index of suspicion is required in the diagnosis of ectopic gestation in order to reduce the morbidity associated with it. Unilateral twin tubal ectopic gestation, although rare, has been reported with higher frequencies, and as such, the occurrence should be carefully sought on ultrasound in order to reduce its potential morbidity and mortality.

Tubal Twin Ectopic Gestation Report of Three Different Cases

Gestation outside the uterine cavity in which the implantation occurs in any tissue other than the endometrium is referred as ectopic pregnancy. The most place for occurring ectopic pregnancy (97% of cases) is the fallopian tubes including ampulla (55%), isthmus (25%), and fimbria (17%), and in 3% of patients ectopic pregnancy occurs in the abdominal cavity, ovary, or cervix.[1]The tubal twin ectopic pregnancy is a rare condition, and the first unilateral tubal twin was reported by De Ott in 1891, and the first live twin tubal ectopic pregnancy was reported in 1944 [2].A live tubal twin ectopic pregnancy is a very rare condition and among &gt;100 reports of tubal twin pregnancies, till now, only 8 cases were live [3]. Early diagnosis and treatment of women with tubal twin ectopic pregnancy is very important and may decrease the risk of tubal rupture.. I present three cases of tubal twin ectopic gestation. In the first case, spontaneous unilateral live tubal twin ectopic gestation .The second and third cases spontaneous ruptured twin ectopic gestation .All three cases were successfully managed and there was no history of assisted reproductive techninique fertilization or pelvic inflammatory disease .

The effects of a single or double GnRH dose on pregnancy survival in high producing dairy cows carrying singletons or twins.

Pregnancy loss during the late embryonic and early fetal periods influences dairy herd economy. The objectives of this study were to (1) investigate the effects of a single or double GnRH dose administered at the time of pregnancy diagnosis (28–34 days post-AI) on the pregnancy survival of cows in their third lactation or further carrying live singletons or unilateral twins, and (2) examine the impacts of GnRH treatment on subsequent twin reduction in twin pregnancies. Cows carrying singletons (n = 1,054) or unilateral twins (n = 379) were assigned at the time of pregnancy diagnosis to the following groups: control (no treatment), GnRH (100 μg GnRH), and 2GnRH (200 μg GnRH). Pregnancy loss was recorded in 180 of the 1,433 cows (12.6%) at 58–64 days post-AI. Based on the odds ratios, there was a significant (P < 0.0001) interaction between the treatment group and twin pregnancy. This interaction implies that control cows carrying twins were 3.2 times more likely to suffer pregnancy loss than the other cows, whereas the GnRH and 2GnRH treatment groups cows carrying singletons or twins had pregnancy loss rates similar to the control cows carrying singletons. Twin reduction was observed in 35 twin pregnancies (9.2%). Cows in the GnRH and 2 GnRH groups were seven times more likely to show twin reduction than control cows. Our results indicate that GnRH administered at the time of pregnancy diagnosis had no beneficial effects in cows carrying singletons. In contrast, for twin pregnancies, the treatment increased the rate of pregnancy survival and was accompanied by an increase in the twin reduction rate.

Unilateral twin tubal pregnancy: a case report and review of the literature.

Background:Unilateral twin tubal pregnancy is an extremely rare condition, occurring in 1/20.000-250.000 pregnancies and represents a major health risk for reproductive-aged women, leading to even life-threatening complications. Aim:We present a case of a 31-year-old woman with unilateral twin tubal pregnancy, treated with methotrexate and then surgically because of failure, followed by review of the literature. Methods: Researches for relevant data were conducted utilizing multiple databases, including PubMed and Ovid. Results: The most common type of twin ectopic pregnancy is the heterotopic (1/7000 pregnancies) in which in which both ectopic and intrauterine pregnancy occur simultaneously. Expectant, medical and surgical therapy have similar success rates in correctly selected patients. Two prospective randomized trials did not identify any statistically significant differences between groups receiving MTX as a single dose or in multiple doses. Among the 106 cases reported in literature, methotrexate was tried just in 4 patients (3 unilateral and 1 bilateral) before ours. Details are reported in the table 1. Conclusion: The recent shift in the treatment of singleton ectopic pregnancies to the less invasive medical therapy might apply even in the case of twin implants. (www.actabiomedica.it)

Bilateral fetal lobulated kidney with unilateral twin renal artery

Primary intracranial malignant melanomas are rarely reported tumors of the central nervous system that are highly malignant with a poor prognosis, accounting for 0.1% of intracranial neoplasms. Given the location of the tumor, preoperative diagnosis by imaging study is difficult. Typically, mainstream therapy involves total excision of the tumor followed by radiation therapy. We present a case of primary intracranial melanoma arising from convexity of the left frontal lobe in a 49-year-old male who presented with headache and progressive mentality change for one month. After total tumor excision and whole brain radiation therapy, the patient has experienced tumor-free survival extending through 47 months of follow-up. Herein we have reported the patient's MRI findings, pathological examination, treatment and outcome.