DOCSLIB.ORG

Prenatal Management of Monoamniotic Twin Pregnancies

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Prenatal Management of Monoamniotic Twin Pregnancies Original Research Prenatal Management of Monoamniotic Twin Pregnancies Tim Van Mieghem, MD, PhD, Roel De Heus, MD, PhD, Liesbeth Lewi, MD, PhD, Philipp Klaritsch, MD, Martina Kollmann, MD, David Baud, MD, PhD, Yvan Vial, MD, Prakesh S. Shah, MD, Angela C. Ranzini, MD, Lauren Mason, MD, Luigi Raio, MD, Regine Lachat, MD, Jon Barrett, MD, MBBCh, Vesal Khorsand, MD, Rory Windrim, MB, and Greg Ryan, MB OBJECTIVE: To evaluate antenatal surveillance strategies major congenital anomalies. The prospective risk of and the optimal timing of delivery for monoamniotic a nonrespiratory neonatal complication was lower than twin pregnancies. the prospective risk of fetal death after 32 4/7 weeks of METHODS: Obstetric and perinatal outcomes were gestation (95% confidence interval 32 0/7–33 4/7). The retrospectively retrieved for 193 monoamniotic twin incidence of death or a nonrespiratory neonatal compli- pregnancies. Fetal and neonatal outcomes were com- cation was not significantly different between fetuses pared between fetuses followed in an inpatient setting managed as outpatients (14/106 [13.2%]) or inpatients and those undergoing intensive outpatient follow-up (15/142 [10.5%]; P5.55). Our statistical power to detect from 26 to 28 weeks of gestation until planned cesarean a difference in outcomes between these groups was low. delivery between 32 and 35 weeks of gestation. The risk of fetal death was compared with the risk of neonatal CONCLUSIONS: The in utero risk of a monoamniotic complications. twin fetus exceeds the risk of a postnatal nonrespiratory complication at 32 4/7 weeks of gestation. If close fetal RESULTS: Fetal deaths occurred in 18.1% of fetuses (70/ surveillance is instituted after 26–28 weeks of gestation 386). Two hundred ninety-five neonates from 153 preg- and delivery takes place at approximately 33 weeks of nancies were born alive after 23 weeks of gestation. gestation, the risk of fetal or neonatal death is low, no There were 17 neonatal deaths (5.8%), five of whom had matter the surveillance setting. (Obstet Gynecol 2014;124:498–506) From the Fetal Medicine Unit, Department of Obstetrics and Gynaecology, and DOI: 10.1097/AOG.0000000000000409 the Neonatal Intensive Care Unit, Department of Paediatrics, Mount Sinai Hospital, and the Department of Obstetrics and Gynaecology, Sunnybrook Health LEVEL OF EVIDENCE: II Sciences Centre, University of Toronto, University of Toronto, Toronto, Ontario, Canada; the Department of Woman and Baby, University Medical Centre, onoamniotic twins are at high risk of intrauter- Utrecht, The Netherlands; the Fetal Medicine Unit, Department of Obstetrics and M Gynaecology, University Hospitals Leuven, Leuven, Belgium; the Department of ine and neonatal death with perinatal mortality – Obstetrics and Gynaecology, Medical University Graz, Graz, Austria; the ranging between 10 and 40%.1 6 This high perinatal Ultrasound and Fetal Medicine Unit, Department of Obstetrics and Gynaecology, mortality rate is partially the result of an increased Centre Hospitalier Universitaire Vaudois and Swiss Laser Group, Lausanne, 1 Switzerland; Maternal Fetal Medicine, Department of Obstetrics and Gynecol- incidence in congenital anomalies (up to 26%) as well ogy, Saint Peter’s University Hospital, New Brunswick, New Jersey; and the as to twin-reversed-arterial-perfusion sequence and Department of Obstetrics and Gynaecology, Inselspital University of Bern and conjoined twinning.7 Another contributor to perinatal Swiss Laser Group, Bern, Switzerland. mortality in monoamniotic twins is the fact that two Presented at the Society for Maternal-Fetal Medicine Annual Meeting, February 3–8, 2014, New Orleans, Louisiana, and the abstract was published (Am J fetuses share a single placenta and a single amniotic Obstet Gynecol 2014;210:S55). cavity. This is invariably associated with umbilical cord 8,9 Corresponding author: Greg Ryan, MB, Fetal Medicine Unit, Mount Sinai entanglement and large vascular intertwin anastomo- Hospital, OPG 3-906, 600 University Avenue, ON M5G 1X5, Canada; ses at the placental level10 leading to cord accidents, e-mail: [email protected]. acute blood volume shifts from one fetus to the other, Financial Disclosure and, more rarely, twin–twin transfusion syndrome. The authors did not report any potential conflicts of interest. In an attempt to improve perinatal survival, mono- © 2014 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. amniotic pregnancies are monitored closely for fetal ISSN: 0029-7844/14 well-being. Typically, ultrasound scans are performed 498 VOL. 124, NO. 3, SEPTEMBER 2014 OBSTETRICS & GYNECOLOGY every 2 weeks from 16 weeks of gestation onward counseling. None of the centers changed its manage- through 26–28 weeks of gestation to diagnose twin– ment protocol during the study period. Frequency of twin transfusion syndrome or discordant growth. monitoring was closely related to the surveillance set- Once viability is reached, surveillance is increased ting and varied between weekly ultrasound scans and even further.11 This often includes multiple ultrasound fetal heart rate monitoring (cardiotocogram) in an out- scans per week in addition to intermittent or continu- patient setting and ultrasound scans every 2 days in ous fetal heart rate monitoring.11,12 There is, however, combination with three cardiotocograms daily for in- little evidence supporting either the optimal intrauter- patients. In all units, glucocorticoids were adminis- ine surveillance strategy or its setting (inpatient com- tered for fetal lung maturation at approximately 26– pared with ambulatory outpatient), although some 28 weeks of gestation, irrespective of the mode of reports suggest that inpatient surveillance may be surveillance. Timing of delivery in otherwise uncom- associated with improved fetal outcomes.3,4,13 plicated monoamniotic twins varied between centers In uncomplicated monoamniotic twin pregnancies, from 32 0/7 to 34 6/7 weeks of gestation. delivery by cesarean is usually planned between 32 and For this study, we retrieved the following antenatal 34 weeks of gestation because, at that gestation, the variables: diagnosis of twin–twin transfusion syndrome prospective risk of intrauterine fetal death is felt to (defined as polyhydramnios in combination with poly- outweigh the risk of neonatal death.8 However, studies uria, evidenced by an enlarged bladder, in one fetus balancing detailed neonatal outcomes compared with and oliguria, evidenced by an empty bladder, in the intrauterine risks to help with determining the optimal other), occurrence of single or double intrauterine fetal timing of delivery are lacking. death, administration of glucocorticoids for pulmonary In the present study, we aim to identify the maturation, hospital admission during pregnancy, and optimal surveillance protocol and timing of delivery reason for admission (“elective” for fetal surveillance by analyzing results from different large referral compared with “indicated” for fetal or maternal obstet- centers that manage their monoamniotic twins accord- ric complications such as preterm labor, fetal growth ing to different protocols. restriction, or preeclampsia), number of ultrasound scans and cardiotocograms per week after viability, MATERIAL AND METHODS gestational age at delivery, reason for delivery (catego- We retrospectively reviewed all consecutive mono- rized as “elective,”“termination of pregnancy,” or amniotic twin pregnancies managed between January “indicated” such as for fetal distress or labor), and 2003 and December 2012 at eight university hospitals mode of delivery (vaginal compared with caesarean in this multicenter cohort study. All cases, irrespective delivery). Brief hospital admissions for delivery or glu- of gestational age at referral, were included in this cocorticoid administration were not recorded. analysis. The Research Ethics Board at each participat- At discharge from the NICU, the following ing center approved the study protocol. All centers characteristics were recorded for all liveborn neo- have extensive experience with the management of nates: congenital anomalies, birth weight, Apgar monoamniotic twins and all have a level 3 neonatal scores, gender, need for and duration of ventilation, intensive care unit (NICU) associated with their peri- mode of ventilation (intubation or continuous positive natal unit. In all cases, monoamnionicity was diagnosed airway pressure ), respiratory distress syndrome more on ultrasound scan and confirmed by examination of than grade I, death before discharge from the NICU, the placenta and membranes at the time of delivery. culture-proven sepsis, necrotizing enterocolitis, reti- Conjoined twins, pregnancies with twin-reversed- nopathy of prematurity more than grade II, intraven- arterial-perfusion sequence, and higher-order multiples tricular hemorrhage more than grade I, or cystic with monoamniotic pair were excluded. periventricular leukomalacia. Surveillance of monoamniotic twins after 26–28 The primary outcome of this study was the risk of weeks of gestation varied between hospitals, but all intrauterine fetal death or a composite adverse neo- followed the general principles for monoamniotic natal outcome defined as a nonrespiratory neonatal twin management as outlined in the introduction. In complication (death before discharge from the NICU, four units, patients were primarily admitted to the culture-proven sepsis, necrotizing enterocolitis, reti- hospital from 26 to 28 weeks of gestation
Load more

Recommended publications
  • Monoamniotic Twins: What Should Be the Optimal Antenatal Management?
    Monoamniotic Twins: What Should Be the Optimal Antenatal Management? Ashis K. Sau1, Kate Langford1, Catherine Elliott1, Lin L. Su2, and Darryl J. Maxwell1 1Fetal Medicine Unit, St.Thomas’ Hospital, London, UK 2National University Hospital, Singapore onoamniotic twinning is a rare event with an incidence of London with a high proportion of socially deprived and M1% of all monozygotic twins and associated with a high black, Asian or mixed race peoples. Management protocols fetal morbidity and mortality. Confident early diagnosis is possi- ble, but optimal management is not yet established. This article employed were those of early detection of chorionicity and presents the experience of a single centre in managing all amnionicity, 2-weekly serial ultrasound surveillance and monoamniotic twins diagnosed during 1994–2000. Seven pairs early delivery by elective cesarean section at around 32 of monoamniotic twins were identified for analysis. All were weeks gestation. From 1997, a formal twin ultrasound sur- managed in accord with a unit protocol that involved early diag- veillance clinic was established and first trimester nuchal nosis, serial ultrasound examination and elective early delivery. In four cases, the detection of monoamnionicity was made translucency screening was performed. The same fetal med- during a first trimester nuchal scan. Discordance for structural icine consultant had clinical input into the management of abnormality was found in three cases where the co-twin was all cases. A summary of the cases can be seen in Table 1. normal. Cord entanglement was detected antenatally in four cases. Two pairs of twins died before 20 weeks. One of these Case 1 had early onset twin–twin transfusion syndrome.
    [Show full text]
  • The Natural History of Monoamniotic Twin Pregnancies: a Case Series and Systematic Review of the Literature
    DOI: 10.1002/pd.4538 ORIGINAL ARTICLE The natural history of monoamniotic twin pregnancies: a case series and systematic review of the literature Federico Prefumo1*, Anna Fichera1, Giorgio Pagani1, Daria Marella1, Adriana Valcamonico1 and Tiziana Frusca1,2 1Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy 2Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy *Correspondence to: Federico Prefumo. E-mail: [email protected] ABSTRACT Objective To describe the natural history of monoamniotic twin pregnancies in contemporary practice. Method Cohort study of monochorionic monoamniotic twin pregnancies with two live fetuses diagnosed at less than 16 weeks and prospectively followed up between 2004 and 2013. A systematic review of the literature using Medline, Embase and Scopus to determine the perinatal mortality rate after 24 weeks of gestation in monoamniotic twins was also performed. Results Twenty pregnancies were analyzed. Four were terminated (in three cases as a result of fetal abnormalities). Another six miscarried spontaneously. Among ten pregnancies reaching viability, there was double intrauterine death in one, and both fetuses were alive at delivery in the other nine. There were no neonatal deaths. Overall survival for fetuses alive at the initial scan was 18/40 (45%; 95% CI 29 to 62%). At meta-analysis of 13 studies (including the current series), the perinatal mortality rate after 24 weeks was 4.5% (95% CI 3.3 to 5.8%). Conclusions Despite early diagnosis and intensive monitoring, of those fetuses alive before 16 weeks less than half survive until the neonatal period. Most losses are attributable to fetal abnormalities and spontaneous miscarriage and are therefore unlikely to be reduced by further improvements in fetal assessment and monitoring.
    [Show full text]
  • Fetal Distress Condition Twin-To-Twin Transfusion Syndrome (TTTS)
    Fetal Distress Condition Twin-to-Twin Transfusion Syndrome (TTTS) Twice as many babies Description die from TTTS and TTTS or Twin-to-Twin Transfusion Syndrome is a disease of the placenta. It affects other fetal syndromes pregnancies with monochorionic (shared placenta) multiples when blood passes than from SIDS disproportionately from one baby to the other through connecting blood vessels within (Sudden Infant Death their shared placenta. One baby, the recipient twin, gets too much blood overloading his or Syndrome) each year; her cardiovascular system, and may die from heart failure. The other baby, the donor twin yet more people are or stuck twin, does not get enough blood and may die from severe anemia. Left untreated, mortality rates near 100%. aware of SIDS. The cause of TTTS is attributed to unbalanced flow of blood through vascular channels that connect the circulatory systems of each twin via the common placenta. The shunting of blood through the vascular communications leads to a net flow of blood from one twin (the donor) to the other twin (the recipient). The donor twin develops oligohydramnios (low amniotic fluid) and poor fetal growth, while the recipient twin develops polyhydramnios (excess amniotic fluid), heart failure, and hydrops. If left untreated, the pregnancy may be lost due to lack of blood getting to the smaller twin, fluid overload and heart failure in the larger twin, and/or preterm (early) labor leading to miscarriage of the entire pregnancy. Some general treatment approaches consist of using laser energy to seal off the blood vessels that shunt blood between the fetuses.
    [Show full text]
  • Monoamniotic Twins - Management
    LOCAL OPERATING PROCEDURE – CLINICAL Approved Safety & Quality Committee May 2021 Review May 2026 MONOAMNIOTIC TWINS - MANAGEMENT This LOP is developed to guide clinical practice at the Royal Hospital for Women. Individual patient circumstances may mean that practice diverges from this LOP. 1. AIM • Diagnosis of monoamniotic twin pregnancy • Regular antenatal review, fetal welfare scanning and preterm birth plan • Preparation for parenting twins and preterm birth 2. PATIENT • Woman suspected of having a monoamniotic (MA) twin pregnancy 3. STAFF • Medical and midwifery staff • Sonographers • Neonatologists 4. EQUIPMENT • Ultrasound machine 5. CLINICAL PRACTICE • Diagnose the MA twin pregnancy by identifying two fetal poles with no separating membrane. The presence of one or two yolk sacs is no longer considered necessary for the diagnosis 1 • Arrange referral to Maternal fetal medicine (MFM) clinic whenever MA twins diagnosed • Discuss the need for increased antenatal surveillance with the woman, explain the increased incidence of unexpected stillbirth due to cord entanglement, fetal anomalies and preterm birth • Discuss screening for aneuploidy and fetal anomalies with first trimester screening or non- invasive prenatal screening plus structural ultrasound scan • Recommend fortnightly ultrasound from 16 weeks gestation and one to two weekly antenatal ultrasound from 24 weeks gestation to monitor: o Position of fetuses o Cord entanglement o Amniotic fluid volume o Umbilical artery Doppler blood flow o Middle cerebral artery Doppler waveforms (from 20 weeks gestation) o Growth (on a fortnightly basis) o Fetal bladder volume • Discuss options of frequency of ultrasound and cardiotocograph (CTG) monitoring, including inpatient and outpatient monitoring • Recommend outpatient management from 26 weeks if Monochorionic Monoamniotic (MCMA) twins are uncomplicated • Consider CTG monitoring from 26 weeks gestation as part of outpatient management (see educational notes), particularly if there is significant estimated fetal weight discordance …./2 2.
    [Show full text]
  • Multiple Pregnancies
    Learning Objectives Using Ultrasound to Manage Twins After this presentation, the learner will be able to discuss: • Diagnosis and dating in twin pregnancies • Sonographic characteristics that distinguish dichorionic from monochorionic twins • Prenatal ultrasound screening in twins • Complications unique to monochorionic twins Lynn L. Simpson, MD Chief, Division of Maternal Fetal Medicine • Ultrasound surveillance recommendations for twins Columbia University Medical Center, New York Diagnosis and Dating of Twins Importance of Pregnancy Dating • Diagnosis best in the first trimester and dating optimal using crown-rump length • Timing for screening − 20% of first trimester twin pregnancies result in singleton live births and diagnostic testing − “Vanishing twin” is associated with favorable prognosis of surviving twin if dichorionic • Accurate interpretation of twin growth • If discrepancy in dates between the twins, date using the larger twin • Scheduling of twin deliveries − Avoids missing diagnosis of IUGR Types of Twins Determination of Chorionicity • All dizygotic twins are dichorionic • All monochorionic twins are monozygotic • Not all monozygotic twins are monochorionic • Optimal in first trimester − close to 100% accuracy • Incorrect assignment in up to 10% of cases when chorionicity determined in second trimester 2-3 days 3-8 days 8-13 days (28%) (70%) (1%) Lee et al, 2006 Blumenfeld et al, 2014 1 Determination of Chorionicity Intertwin Membrane • Gestational sacs • Amniotic sacs • Placenta number • Intertwin membrane • Gender
    [Show full text]
  • Management of Twin Pregnancy
    DOI: 10.1002/ijgo.12742 FIGO COMMITTEE REPORT Good clinical practice advice: Management of twin pregnancy FIGO Working Group on Good Clinical Practice in Maternal–Fetal Medicine*,a *Correspondence: Gian Carlo Di Renzo, Department of Obstetrics and Gynecology, University of Perugia, Santa Maria della Misericordia University Hospital, Perugia, Italy. Email: [email protected] Endorsed in March 2017 and April 2018 by the FIGO Executive Board. This advice should not be considered as standards of care or legal standards in clinical practice. aWorking Group members and expert contributors are listed at the end of the paper. PREMISE pregnancies presenting later than 14 weeks’ gestation should be dated according to the head circumference of the larger twin.6 Twin pregnancy is associated with a high risk of perinatal, as well as maternal, mortality and morbidity.1–3 Intensive antenatal fetal surveil- Determining chorionicity and amnionicity of lance is associated with a lower risk of stillbirth.4 The excess perinatal twin pregnancies mortality and morbidity is higher in monochorionic than dichorionic twin pregnancy due to the placental anastomoses invariably present The chorionicity and amnionicity should be determined in the first in the monochorionic placenta.5 This guideline will cover the care of trimester. The chorionicity is determined by examining the mem- both uncomplicated and complicated twin pregnancies. brane thickness at the site of their insertion into the placenta; a T sign indicates monochorionicity, while a lambda (λ) sign
    [Show full text]
  • Multiple Pregnancy: Having More Than One Baby About This Information a Multiple Pregnancy Means You Are Having More Than One Baby at the Same Time
    Information for you Published in September 2021 Multiple pregnancy: having more than one baby About this information A multiple pregnancy means you are having more than one baby at the same time. This is most commonly twins but may include triplets or, rarely, more. This information is for you if you are having a multiple pregnancy. It may also be helpful for your partner, family or friends. It focuses on twin and triplet pregnancies. If you are having more babies you can still use this information but you will have an individualised plan of care for your pregnancy depending on your circumstances. The information here aims to help you better understand your pregnancy and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions. 1 A glossary of medical terms is available on the RCOG website at: www.rcog.org.uk/en/patients/medical-terms. Key Points • Multiple pregnancy happens in about one in 60 pregnancies. • Most women with a multiple pregnancy will have a healthy pregnancy and will give birth to healthy babies, however complications are more common. • You will be offered extra antenatal checks and ultrasound scans to make sure that you are well and to monitor your babies closely. • If you have a multiple pregnancy you are more likely to give birth to your babies prematurely. • You will be advised to give birth in hospital. What is a multiple pregnancy? A multiple pregnancy is the term used when you are expecting two or more babies at the same time (twins, triplets or more).
    [Show full text]
  • ACR Appropriateness Criteria® Multiple Gestations
    Revised 2017 American College of Radiology ACR Appropriateness Criteria® Multiple Gestations Variant 1: Known or suspected multiple gestations. Monochorionic or dichorionic. First trimester US. Procedure Appropriateness Category Relative Radiation Level US pregnant uterus transvaginal Usually Appropriate O US pregnant uterus transabdominal Usually Appropriate O US cervix transvaginal Usually Not Appropriate O US duplex Doppler pelvis Usually Not Appropriate O US assessment for TTTS Usually Not Appropriate O US pregnant uterus biophysical profile Usually Not Appropriate O US echocardiography fetal Usually Not Appropriate O Variant 2: Multiple gestations. Dichorionic. Second trimester US. Anatomy scan. Procedure Appropriateness Category Relative Radiation Level US pregnant uterus transabdominal Usually Appropriate O US cervix transvaginal Usually Appropriate O US echocardiography fetal May Be Appropriate O US duplex Doppler pelvis Usually Not Appropriate O US pregnant uterus transvaginal Usually Not Appropriate O US pregnant uterus biophysical profile Usually Not Appropriate O US assessment for TTTS Usually Not Appropriate O Variant 3: Multiple gestations. Monochorionic. Second trimester US. Anatomy scan. Procedure Appropriateness Category Relative Radiation Level US pregnant uterus transabdominal Usually Appropriate O US assessment for TTTS Usually Appropriate O US echocardiography fetal Usually Appropriate O US cervix transvaginal Usually Appropriate O US duplex Doppler pelvis Usually Appropriate O US pregnant uterus biophysical profile
    [Show full text]
  • Monochorionic Monoamniotic Twins: Neonatal Outcome
    Journal of Perinatology (2006) 26, 170–175 r 2006 Nature Publishing Group All rights reserved. 0743-8346/06 $30 www.nature.com/jp ORIGINAL ARTICLE Monochorionic monoamniotic twins: neonatal outcome L Cordero1, A Franco2 and SD Joy2 1Department of Pediatrics and Obstetrics, Division of Neonatal-Perinatal Medicine, College of Medicine and Public Health, The Ohio State University Medical Center, The Ohio State University, Columbus, OH, USA and 2Department of Obstetrics and Gynecology, College of Medicine and Public Health, The Ohio State University, Columbus, OH, USA Introduction Background: Monochorionic monoamniotic twins (MoMo) occur in one Every year 4 million infants are born in the United States and of 10 000 pregnancies. Cord entanglement, malformations, twin-to-twin approximately 130 000 of them are twins.1 The prevalence of twin transfusion syndrome (TTS) and prematurity are responsible for their high deliveries has increased 48% between 1990 and 1998.1 Of great perinatal morbidity and mortality. concern is that although twins represented only 2.5% of the entire Objective: To report our experience with 36 sets of MoMo twins (1990 to group, they accounted for 12.6% of the total perinatal mortality.2 2005) and to provide updated information for counseling. Only one-third of all twins are monozygotic, but 75% of the Methods: Chorionicity was determined by placental examination, monozygotic twins are monochorionic. Among monochorionic gestational age and TTS clinically and by sonography. Intrauterine twins, about 2% are monochorionic monoamniotic (MoMo), 18% growth restriction (IUGR) was diagnosed with a twin-specific nomogram. monochorionic diamniotic (MoDi) with twin-to-twin transfusion syndrome (TTS) and 80% MoDi without TTS.3 Monochorionic Results: Cord entanglement was observed in 15 pregnancies, but only monoamniotic twins have the highest incidence of perinatal losses, one twin with entanglement and a true knot, experienced related congenital malformations, perinatal mortality and perinatal morbidity.
    [Show full text]
  • Monoamniotic Twins
    Information for Women Bogulkunta, Hyderabad - 500 001 Ph : 040 - 40222300 Fax : 040 - 24753482 Email : [email protected] Web : www.fernandezhospital.com What is a Multiple Pregnancy? A multiple pregnancy is a pregnancy with two or more babies. The different terms used depend on the number of babies: Two : Twin Three : Triplets Four : Quadruplets Five : Quintuplets Six : Sextuplets Seven : Septuplets Multiples account for only a small percentage (3%) of all births, but the multiple pregnancy rate is rising. Why are Multiple Pregnancies Increasing? The reason why a woman has a multiple pregnancy may be due to many factors. A few important ones are : Hereditary : A family history increases the chance of having a multiple pregnancy. Maternal Age : About one-third of the increase in multiple pregnancies is due to the fact that more women over age 30 are having babies. Women in this age group are more likely than younger women to conceive multiples. Assisted Reproduction : Medicines that stimulate ovulation help produce many eggs, which if fertilized can result in a multiple pregnancy. In-vitro fertilization, during which eggs are removed from the mother, fertilized in the lab and then transferred to the uterus, result in the transfer of many fertilized eggs into the uterus, thus resulting in a multiple pregnancy. 2 Types of Twin Pregnancy There are two kinds of twins. Non-identical (dizygotic) : Eighty percent of all twins are non-identical. That means they come from two eggs with two sperms fertilizing them. These twins are as similar as siblings can be, of the same or different sex. They have their own placenta (dichorionic) and pregnancy sacs (diamniotic) and are called Dichorionic Diamniotic (DCDA ) twins.
    [Show full text]
  • A Monoamniotic Pregnancy Discordant for Limb Body Wall Complex and Complicated by Acute TTTS
    Academic Journal of Pediatrics and Neonatology ISSN: 2474-7521 Case Report Acad J Ped Neonatol Volume 1 Issue 1 - January 2016 Copyright © All rights are reserved by Pace Carlotta DOI: 10.19080/AJPN.2016.01.555553 A Monoamniotic Pregnancy Discordant for Limb Body Wall Complex and Complicated by Acute TTTS Pace Carlotta1*, Masturzo Bianca1, Gaglioti Pietro1, Viora Elsa2, Sciarrone Andrea2, Botta Giovanni3, Todros Tullia1 12U Gynecology and Obstetrics Unit, Sant’Anna Hospital, Italy 2Ultrasound and Prenatal Diagnosis Unit, Sant’Anna Hospital, Italy 3Gynecological and Obstetrical Pathology Unit, Sant’Anna Hospital, Italy Submission: November 24, 2015; Published: January 05, 2016 *Corresponding author: Pace Carlotta, Sant’Anna Hospital, Città della Salute e della Scienza, Via Ventimiglia 3, 10126, Turin, Italy, E-mail: Abstract We are reporting a case of monoamniotic twin pregnancy discordant for Limb Body Wall Complex (LBWC), complicated by acute twin- to-twin transfusion syndrome. The twins were delivered by an emergency cesarean section at 29+6 weeks’ gestation because of persistent fetal tachycardia of the unaffected twin. The phenotipically normal twin was anemic at birth (donor twin), while postmortem examination in a monoamniotic pregnancy reported in Literature. In monoamniotic pregnancies discordant for LBWC careful fetal monitoring should be granted,revealed asa condition the presence of overloaded of the malformation fetal circulation masks of the the classic LBWC signs twin of (recipient twin-to-twin twin). transfusion This is,
    [Show full text]
  • Multiple Pregnancy
    AQ FREQUENTLY ASKED QUESTIONS FAQ188 fPREGNANCY Multiple Pregnancy • How does multiple pregnancy occur? • What are some causes of multiple pregnancy? • What are some symptoms of multiple pregnancy? • Do I need to gain extra weight if I am pregnant with multiples? • Should I exercise if I am pregnant with multiples? • Is the risk of complications higher if I am pregnant with multiples? • What is the most common complication of multiple pregnancy? • What are chorionicity and amnionicity? • What are the risks associated with monochorionic babies? • How can multiple pregnancy affect my risk of preeclampsia? • How can multiple pregnancy affect my risk of gestational diabetes? • How can multiple pregnancy affect fetal growth? • Are tests for genetic disorders as accurate in multiple pregnancies? • How can multiple pregnancy affect delivery? • Can multiple pregnancy affect my risk of postpartum depression? • Can I breastfeed if I have multiples? • Glossary How does multiple pregnancy occur? A twin, triplet, or higher-order pregnancy (four or more babies) is called multiple pregnancy. If more than one egg is released during the menstrual cycle and each is fertilized by a sperm, more than one embryo may implant and grow in your uterus. This type of pregnancy results in fraternal twins (or more). When a single fertilized egg splits, it results in multiple identical embryos. This type of pregnancy results in identical twins (or more). Identical twins are less common than fraternal twins. What are some causes of multiple pregnancy? The use of fertility drugs to induce ovulation often causes more than one egg to be released from the ovaries and can result in twins, triplets, or more.
    [Show full text]