Maternal physiology and complications of multiple pregnancy.

Growth of ‘small-for-dates’ babies

Monochorionic (MC) twins account for about 20-30% of all twins, but contribute disproportionately to mortality, intrauterine growth restriction, and preterm delivery compared with dichorionic (DC) twins. This higher mortality in MC twins is likely due to the effects of placental morphologic characteristics, which include complex vascular communications between the twins associated with twin-twin transfusion syndrome (TTTS), and the tendency for the common placenta to be shared either symmetrically or asymmetrically. In assessment of clinical outcomes for TTTS, artery to vein anastomoses in the absence of artery to artery or vein to vein, especially if present with placental asymmetry, carry the worse prognosis. Chorion status in twins forms the basis for clinical risk assessment and can be determined by 7 menstrual weeks using transvaginal sonography. The variable results reported in the literature for intertwin umbilical artery Doppler findings in MC twins may be explained by differences between sonograp...

Diamnionic Monochorionic Twin Gestations: An Overview

The perinatal outcome of pregnancies (both single and multiple) established after in-vitro fertilization (IVF)-surrogacy was evaluated and compared to the outcome of pregnancies that resulted from standard IVF Analysis of medical records and a telephone interview with physicians, IVF-surrogates, and commissioning mothers were conducted to assess prenatal follow up and delivery care in several hospitals 95 IVF-surrogates delivered 128 liveborn (65 singletons, 27 sets of twins and two sets of triplets) The commissioning mothers and the IVF-surrogates average ages were 377 +/- 50 and 304 +/- 47 years old respectively IVF-surrogates carrying twin and triplet gestations delivered substantially earlier than those who gestated singleton pregnancies (362 +/- 04 versus 355 versus 387 +/- 03 weeks gestation respectively; P < 0001) Twin newborns were significantly lighter than singleton infants born through IVF-surrogacy (27 +/- 006 versus 35 +/- 007 kg; P < 0001) The incidence of low birth weight infants rose from 33% in the single births to 296% (P < 001) in the twins and to 333% in the triplets born through IVF-surrogacy The incidence of prematurity was significantly greater in both twins delivered by IVF-surrogates (204%) and infertile IVF patients (58%) The occurrence of pregnancy-induced hypertension and bleeding in the third trimester was four to five times lower in the IVF-surrogates, independently of whether they were carrying multiples The incidence of Caesarean section was 213% for singleton gestations, while two times higher in the IVF-surrogates carrying multiples (563%) Postpartum complications occurred in 63% of patients and the incidence of malformation was similar to those reported for the general population The results provide general reassurance regarding perinatal outcome to couples who wish to pursue IVF-surrogacy

/pdf/perinatal-outcome-after-in-vitro-fertilization-surrogacy-3nu4nag5ho.pdf

Perinatal outcome after in-vitro fertilization-surrogacy

Perinatal deaths in twin pregnancy. A five-year analysis of statewide statistics in Missouri.

A survey of factors associated with perinatal mortality in 511 twins and fetal growth retardation and its reversal in 262 twins is presented. The incidence of stillbirth was almost 50% higher in twins than in singletons and the neonatal mortality was six times as high. Eighty percent of the neonatal deaths occurred in infants born prior to or at 30 weeks of gestation; 93% of the deaths were in infants weighing less than 1500 g and 75% occurred within 48 hours of birth. Fetal malnutrition was the main cause of stillbirth, and respiratory distress syndrome and asphyxia neonatorum were the main causes of neonatal death. One quarter of the twins had fetal growth retardation, a prevalence 10 times that in singletons. In almost all, the growth retardation was reversed by high-energy feedings. Although twins represented only 1% of all pregnancies and 2% of live births, they composed 12% of infants with early neonatal death and 17% of growth-retarded infants. A program is suggested for reduction of twin mortality and morbidity.

Contribution of twin pregnancy to perinatal mortality and fetal growth retardation; reversal of growth retardation after birth

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Contribution of twin pregnancy to perinatal mortality and fetal growth retardation; reversal of growth retardation after birth