scholarly journals Risks and challenges in multiple pregnancy

2021 ◽  
Vol 10 (12) ◽  
pp. 4578
Author(s):  
Aditi Agarwal ◽  
Arti Sharma ◽  
Neeta Bansal ◽  
Neha Panwar ◽  
Shweta Singh ◽  
...  
Keyword(s):  
Placenta Previa ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
Obstetric Care ◽  
Elevated Risk ◽  
Multiple Pregnancies ◽  
Triplet Pregnancy ◽  
Mother And Child ◽  
Fetal Complications ◽  
Fetal Malformations

Because of breakthroughs in reproductive medicine, multiple pregnancies have become more common in the industrialized world. As a result, obstetric care for women with multiple pregnancies and neonatal care for the same has become more demanding. Multifetal pregnancies are linked to an elevated risk for both the mother and child. There is increased incidence of obstetric complications such as spontaneous abortion, hypertensive disorders, placenta previa, and fetal malformations. Perinatal outcome is also affected which is attributable to increased incidence of fetal complications like prematurity, congenital malformations, growth discordance and cord accidents. We are presenting 2 cases, one of MCMA twin pregnancy with fetal congenital anomaly and another of a triplet pregnancy and their perinatal outcomes.

Dichorionic Triamniotic Triplet Pregnancy Complicated by Twin Anemia Polycythemia Sequence: The Place of Fetal Therapy

2014 ◽  
Vol 17 (6) ◽  
pp. 589-593 ◽  
Author(s):  
Thérèse H. Griersmith ◽  
Alison M. Fung ◽  
Susan P. Walker
Keyword(s):  
Preterm Labour ◽  
Multiple Pregnancy ◽  
Unintended Consequence ◽  
In Vitro Fertilisation ◽  
Multiple Pregnancies ◽  
Triplet Pregnancy ◽  
Monochorionic Twins ◽  
Common Presentation

Monochorionic twins as part of a high order multiple pregnancy can be an unintended consequence of the increasingly common practice of blastocyst transfer for couples requiring in vitro fertilisation (IVF) for infertility. Dichorionic triamniotic (DCTA) triplets is the most common presentation, and these pregnancies are particularly high risk because of the additional risks associated with monochorionicity. Surveillance for twin-to-twin transfusion syndrome, including twin anemia polycythemia sequence, may be more difficult, and any intervention to treat the monochorionic pair needs to balance the proposed benefits against the risks posed to the unaffected singleton. Counseling of families with DCTA triplets is therefore complex. Here, we report a case of DCTA triplets, where the pregnancy was complicated by threatened preterm labour, and twin anemia polycythemia sequence (TAPS) was later diagnosed at 28 weeks. The TAPS was managed with a single intraperitoneal transfusion, enabling safe prolongation of the pregnancy for over 2 weeks until recurrence of TAPS and preterm labour supervened. Postnatal TAPS was confirmed, and all three infants were later discharged home at term corrected age, and were normal at follow-up. This case highlights that in utero therapy has an important role in multiple pregnancies of mixed chorionicity, and can achieve safe prolongation of pregnancy at critical gestations.

scholarly journals MULTIPLE PREGNANCY, ANTENATAL CARE PROBLEMS AND THEIR SOLUTIONS RESULTS

2017 ◽  
Vol 1 ◽  
pp. 39-45
Author(s):  
Iryna Nikitina ◽  
Natalya Kalashnyk ◽  
Svitlana Smiian ◽  
Tatyana Babar ◽  
Alina Popova
Keyword(s):  
Transvaginal Ultrasound ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
Statistical Processing ◽  
Multiple Pregnancies ◽  
Perinatal Complications ◽  
Singleton Pregnancy ◽  
Monochorionic Twins ◽  
Pregnancy And Childbirth ◽  
Ultrasound Monitoring

Aim of the work. The aim of our study is to summarize the course of pregnancy and delivery in multiple pregnancies in modern conditions. Materials and methods. The analysis of the pregnancy course, labor and perinatal outcomes was carried out in 182 women with diochorionic and 86 patients with monochorionic twins and 40 women with a singleton pregnancy. Multiple pregnancies were proved to be a monochorionic (MH) and diochorionic (DH) that is a high risk factor for perinatal complications. The research included clinical and laboratory examination metods, study of hormonal function of fetoplacental complex (FPC), transvaginal ultrasound examination. Statistical processing of data was carried out using the package of applied programs Microsoft Office Excel 2010 and StatSoft Statistica 6.1. Results and discussion. In the analysis of pregnancy the abortion threat was detected in 51 (59.3%) women with monochorionic and 34 (62%) women with diochorionic twins. Preeclampsia during pregnancy complicated in 26 (30.2%) and 43 (23.6%) patients, with monochorionic and diochorionic placentation type, respectively. A frequent complication of both the MH and DH twins was anemia, which was found in more than half of the surveyed (56.9 and 51%, respectively). Delivery in the case of multiple pregnancies is also much more complicated and is terminated surgically three times more often than in singleton births. The most frequent indications for operative delivery were first breech fetus, fetal distress during pregnancy and childbirth, FGR, severe preeclampsia, premature detachment of normally situated placenta, anomalies of labor activity. These perinatal losses were equally observed both after cesarean section and after spontaneous labor and amounted to 4% at monochorionic and 1.7% at diochorionic twins. The frequency dependence of identified lesions at pregnancy with twins was established by chorionic. Careful observation of the patients with multiple pregnancies in the antenatal period, the prevention of the most frequent complications, ultrasound monitoring of early pregnancy allows a differentiated approach to the management of pregnancy and childbirth, helping to reduce perinatal morbidity and mortality. Conclusions. Multiple pregnancies occur with a large number of complications compared with singletons. Thus, the increase of frequency of multiple pregnancy influences the obstetric and perinatal indicators, pushing this issue in a number of the most pressing issues of modern obstetrics and perinatology.

scholarly journals The Desire for Multiple Pregnancy among Patients with Infertility and Their Partners

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Ida Lilywaty Md Latar ◽  
Nuguelis Razali
Keyword(s):  
Multiple Pregnancy ◽  
Previous Treatment ◽  
Multiple Pregnancies ◽  
Singleton Pregnancy ◽  
Increased Risk ◽  
Fetal Complications

Objective. To study the predictors for desire for multiple pregnancies and the influence of providing information regarding the maternal and fetal complications associated with multiple pregnancies on their preference for multiple pregnancies.Methods. Couples attending an infertility clinic were offered to fill up a questionnaire separately. Following this, they were handed a pamphlet with information regarding the risks associated with multiple pregnancies. The patients will then be required to answer the question on the number of pregnancies desired again.Results. Two hundred fifty three out of 300 respondents completed the questionnaires adequately. A higher proportion of respondents, 60.3% of females and 57.9% of males, prefer singleton pregnancy. Patients who are younger than 35 years, with preexisting knowledge of risks associated with multiple pregnancies and previous treatment for infertility, have decreased desire for multiple pregnancies. However, for patients who are older than 35, with longer duration of infertility, and those patients who have preexisting knowledge of the increased risk, providing further information regarding the risks did not change their initial preferences.Conclusion. Providing and reinforcing knowledge on the risks to mother and fetus associated with multiple pregnancies did not decrease the preference for multiple pregnancies in patients.

scholarly journals Recovery of second trimester pre-eclampsia after fetal reduction of a triplet

2019 ◽  
Vol 12 (9) ◽  
pp. e227667
Author(s):  
Jeske M bij de Weg ◽  
Christianne J de Groot ◽  
Eva Pajkrt ◽  
Marjon A de Boer
Keyword(s):  
Severe Hypertension ◽  
Multiple Pregnancy ◽  
Second Trimester ◽  
Multiple Pregnancies ◽  
Review Of The Literature ◽  
Hypertensive Disorders Of Pregnancy ◽  
Triplet Pregnancy ◽  
Increased Risk ◽  
Multifetal Pregnancy ◽  
Multifetal Pregnancy Reduction

Women with a multiple pregnancy are at increased risk of developing hypertensive disorders of pregnancy. We describe a case of a dichorionic triamniotic triplet pregnancy complicated by severe hypertension, proteinuria and maternal symptoms, fitting with the diagnosis of pre-eclampsia, apart from the early gestational age of only 16 weeks. After reduction of the monochorionic pair, the disease resolved and pre-eclampsia was diagnosed again at 30 weeks of gestation, resulting in a delivery on maternal indication at 33 weeks of gestation. In a review of the literature, we found six papers including eight cases on multifetal pregnancy reduction on maternal indication. Multifetal pregnancy reduction resulted in a prolongation of pregnancy of two to 21 weeks and may be considered in extreme early onset pre-eclampsia in dichorionic multiple pregnancies.

scholarly journals Role of Ultrasound in Diagnosis of Fetus Acardius Acephalus in Multiple Pregnancies

2018 ◽  
Vol 4 (02) ◽  
pp. 085-087
Author(s):  
Ruby Yadav ◽  
Nishi Choudhary
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Gestational Age ◽  
Preterm Labor ◽  
Perinatal Outcomes ◽  
Therapeutic Interventions ◽  
Multiple Pregnancies ◽  
Triplet Pregnancy ◽  
Gestational Age At Delivery

AbstractThis case report describes an acardiac fetus of the acephalus phenotype in a triplet pregnancy. The diagnosis was confirmed at 13 weeks. In the absence of signs of heart failure in the co-fetus, the pregnancy was managed conservatively. The pregnancy was complicated by preterm labor and the fetuses were delivered at 23 + 4 weeks. Also, the perinatal outcomes of triplet pregnancies complicated by an acardiac fetus, where the median gestational age at delivery is 23 to 24 weeks, are summarized, and the possible therapeutic interventions have been discussed.

scholarly journals Obstetric and perinatal aspects of multiple pregnancy

2021 ◽  
Vol 6 ◽  
pp. 7-18
Author(s):  
V.G. Siusiuka ◽  
A.D. Kyryliuk ◽  
О.V. Babinchuk ◽  
N.Y. Boguslavska ◽  
O.I. Bachurina ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Perinatal Care ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
Breech Presentation ◽  
Epidemiological Data ◽  
Conjoined Twins ◽  
Multiple Pregnancies ◽  
Maternal Condition ◽  
Unsuccessful Attempt

The article presents epidemiological data, modern terminology, features of the course of gestation, as well as obstetric and perinatal outcomes of childbirth in women with multiple pregnancy. The relevance of study this problem is due to the fact that the course of multiple pregnancy in almost all patients is accompanied by various complications, and their prognosis and prevention are of paramount importance. Despite the attention paid to multiple pregnancy, the complication rate remains high. Their treatment should be carried out in III level of perinatal care facilities. Attention is focused on the features of childbirth of pregnant women in accordance with the procedure for providing medical care to women with multiple pregnancies. An important issue remains to determine the time and tactic of delivery in multiple pregnancy. The choice of childbirth method depends on the obstetric anamnesis, gestational age, position and presentation of fetuses, estimated weight and size of fetuses, chorionicity, fetal and maternal condition, and the presence/absence of indications for caesarean section also matters. The optimal delivery time for uncomplicated twins is 37 weeks of pregnancy (monochorionic diamniotic twins — 36–37 weeks, dichorionic — 37–38 weeks), since in this period of pregnancy, the risks of antenatal fetal death and early neonatal death are minimal. Delivery of women with monochorionic monoamniotic twins is performed at the full 32 weeks of pregnancy by caesarean section. Among other indications for caesarean section are triplets and a larger number of fetuses, as well as conjoined twins, transverse or breech presentation of the first fetus, twins in combination with a scar on the uterus, an unsuccessful attempt of external-internal rotation of the second fetus in a transverse position after the birth of the first fetus, and others. An analysis of domestic and foreign publications was carried out in the article, which indicates the need for in-depth research in this direction, namely the elucidation of new pathogenetic links in multiple pregnancies, depending on the type of placentation, the search for new ways of management and the development of diagnostic criteria for the childbirth of this contingent of women.

scholarly journals Challenges and prospects of preterm birth prediction in multiple pregnancies

2018 ◽  
Vol 67 (4) ◽  
pp. 48-59 ◽  
Author(s):  
Olga V Kosyakova ◽  
Olesya N Bespalova
Keyword(s):  
Preterm Birth ◽  
Metabolic Disorders ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
High Rate ◽  
Premature Births ◽  
Multiple Pregnancies ◽  
Priority Task ◽  
Adverse Perinatal Outcomes ◽  
High Level

For today, twins make up about 1.5% of the population of our planet. It is more than one hundred million people, which in number corresponds to the population of two Frances. The number of twins born relative to the total number of newborns in different countries and on different continents is different, but the overall trend is that it continues to grow. In recent years, the percentage of multiple pregnancy has increased almost 2.5 times, which is associated with the widespread use of assisted reproductive technologies.At the same time, pregnancy in multiple births is an extremely important problem in modern obstetrics, as it is accompanied by a high level of complications for both the mother and the fetuses. Multiple pregnancy contributes significantly to the formation of adverse perinatal outcomes, which is primarily due to the high rate of preterm birth. Premature twins are at high risk of neurological and neuropsychiatric disorders, respiratory distress, endocrine and metabolic disorders, which subsequently become the cause of disability and social maladaptation of children. In this regard, the reduction in the number of premature births is today a priority task, the solution of which is possible only through timely and correct forecasting. The multifactority of pathogenic mechanisms determines the necessity of diagnostic search strategies that can identify markers of various pathogenetic ways of preterm birth. (For citation: Kosyakova OV, Bespalova ОN. Challenges and prospects of preterm birth prediction in multiple pregnancies. Journal of Obstetrics and Women’s Diseases. 2018;67(4):48-59. doi: 10.17816/JOWD67448-59).

scholarly journals Effect of single and multiple pregnancies on performance of primiparous and multiparous cows

2015 ◽  
Vol 58 (1) ◽  
pp. 43-48 ◽  
Author(s):  
A. Sawa ◽  
M. Bogucki ◽  
M. Głowska
Keyword(s):  
Milk Yield ◽  
Multiple Pregnancy ◽  
Rest Period ◽  
Production Cycle ◽  
Multiple Pregnancies ◽  
Triplet Pregnancy ◽  
Yield Increase ◽  
Active Population ◽  
Significant Difference ◽  
Negative Effect

Abstract. Data on 393 002 parturitions and performance in the following production cycle were collected from the SYMLEK database for 145 457 Polish Holstein-Friesian cows representing the active population in the Pomorze and Kujawy regions. The animals first calved during 2000–2012 and were used or culled by the end of 2013. GLM and FREQ procedures of the SAS package were used for the statistical calculations. The frequency of twin and triplet births depended on the cow's age (0.64% in primiparous and 2.88% in multiparous cows), calving season (1.79% in winter, 2.41% in summer), previous lactation milk yield (increase of 2.15 to 3.73% with increasing milk production level), and year of calving of primiparous cows (increase from 0.43% during 2000–2003 to 0.78% during 2010–2012). Dams of twins were superior to dams of singles in terms of milk yield, but a significant difference was manifest only in multiparous cows. Despite the higher perinatal mortality of the twins and triplets (especially those born to primiparous cows), multiple pregnancy resulted in a greater number of calves born compared to single pregnancy. A negative effect of multiple pregnancies was a decrease in fertility, especially in multiparous cows (e.g. calving interval was longer by 18 days, reproductive rest period by 9 days, and service period by 10 days, while services per conception increased by 0.15). In addition, twin pregnancy (especially in heifers) and triplet pregnancy (especially in cows) considerably decreased chance of survival until the next calving.

scholarly journals Prevention and therapy of threatened preterm birth in multiple pregnancy

2019 ◽  
Vol 68 (4) ◽  
pp. 55-70
Author(s):  
Olga V. Kosyakova ◽  
Olesya N. Bespalova
Keyword(s):  
Preterm Birth ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
Bed Rest ◽  
Good Evidence ◽  
Therapeutic Interventions ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Multiple Pregnancies ◽  
Adequate Treatment

Preterm birth in multiple pregnancy is an important medical, economic and social problem. Currently, more than half of twins are born prematurely, which puts them at high risk of developing neonatal diseases causing lifelong disability and social maladjustment. In this regard, reducing the frequency of preterm multiple births is an important task of modern obstetrics. Improving perinatal outcomes of multiple pregnancies can only be achieved using the most effective measures that have a good evidence base. At the same time, numerous studies on the effectiveness of therapeutic interventions aimed at prolonging multiple pregnancies have reported contradictory results. This review included most of the randomized controlled trials of methods for the prevention and treatment of threatening preterm birth in multiple pregnancies, as available in PubMed, Google Academy, Elibrary, and the Cochrane Central Register of Controlled Trials. Thus far, studies on the use of bed rest, prophylactic tocolysis, most of the progestins, and cervical cerclage in multiple pregnancy have shown no efficacy in reducing the risk of premature birth. However, encouraging data were obtained on improving neonatal outcomes of multiple pregnancies using vaginal progesterone and an obstetric pessary, but these results require additional confirmation in larger multicenter randomized studies. Further clinical trials are needed to develop algorithms for timely diagnosis and adequate treatment of threatened preterm birth in case of multiple pregnancy, including the use of the most rational preventive and therapeutic methods that have a high evidence level.

Delayed interval delivery of the second and third fetuses in multiple pregnancy triplet (Сase report)

2016 ◽  
pp. 148-152
Author(s):  
Y. Dubossarskaya ◽  
◽  
L. Padalko ◽  
L. Zakharchenko ◽  
E. Savel’eva ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Multiple Pregnancy ◽  
Bed Rest ◽  
Perinatal Morbidity ◽  
Perinatal Complications ◽  
Triplet Pregnancy ◽  
Satisfactory Condition ◽  
Nulliparous Women ◽  
Perinatal Center ◽  
Delayed Interval Delivery

This article describes a clinical case of vaginal delivery in nulliparous women 24 years old delayed interval delivery of the second and third fetuses in spontaneous multiple pregnancy dichorionic triamniotic triplet in a tertiary perinatal center. After preterm delivery in 27+5 weeks of gestation the first fetus to reduce perinatal morbidity and mortality of two fetuses that are left in the uterus, with informed consent of the woman preterm delivery the second and third fetuses occurred at intervals of 38 days, in 33+1 weeks of gestation. Careful monitoring of the state of the mother and fetuses was conducted. To increase the interval between the birth of the first fetus and the second and the third fetuses, prevention of obstetric and perinatal complications used tocolysis, antibiotics, progesterone, the prevention of respiratory distress syndrome of the newborn by corticosteroids and bed rest. Three girls were born alive with a weight of 980, 1800 and 1950 grams correspondingly. Childbirth complicated second degree perineal laceration and retained portions of placenta and membranes, puerperal period was uneventful. After 1.5 months, all infants discharged with her mother in a satisfactory condition with a weight of more than 3000 grams. Key words: multiple pregnancy, triplet pregnancy, delayed interval delivery in triplet pregnancy, preterm delivery.

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