Diffusion-weighted magnetic resonance imaging of acute hypoxic-ischemic cerebral lesions in the survivor of a monochorionic twin pregnancy: case report.

Monochorionic twin pregnancies complicated by the death of one twin are associated with substantial morbidity in the survivor, with a high risk of developing hypoxic-ischemic brain damage. In this report, we demonstrate how prenatal diffusion-weighted magnetic resonance imaging detected focal ischemic lesions in the survivor of a monochorionic twin pregnancy within 1-2 days of cotwin death. A very early diagnosis of cerebral ischemic lesions might influence the management of the pregnancy. Published by John Wiley & Sons, Ltd.     

系统产前超声检查在双胎妊娠产前筛查中的应用价值

目的探讨系统产前超声检查在双胎妊娠产前筛查中的应用价值。 方法对2012年10月至2017年12月在咸阳市妇幼保健院进行系统产前超声检查的393例双胎妊娠资料进行回顾性分析,将其中27例双胎妊娠畸形病例纳入研究。通过将双胎妊娠畸形病例产前超声检查资料与随访及病理解剖结果进行对比,分析双胎妊娠系统产前超声检查胎儿畸形检出率及诊断符合率。 结果纳入研究的27例双胎妊娠畸形病例中19例为胎儿结构畸形,8例为双胎妊娠特有畸形。19例胎儿结构畸形均为双胎之一胎儿的单一畸形,8例双胎妊娠特有畸形多为两个胎儿同时受到累及。系统产前超声检查检出17例胎儿结构畸形和8例双胎妊娠特有畸形均与病理诊断符合,系统产前超声检查诊断符合率100%（25/25）;漏诊胎儿结构畸形2例,胎儿畸形检出率92.6%（25/27）。 结论系统产前超声检查应用于双胎妊娠产前筛查有较高的畸形检出率及诊断符合率,具有重要的临床应用价值。     

Sequencing circulating miRNA in maternal plasma with modified library preparation

Background and objectivesCirculating microRNAs in maternal plasma as one type of the cell free nucleotide acid revealed its potential for non-invasive prenatal diagnosis. The next generation sequencing technology provides promising approach detecting miRNA for such purpose.MethodIn this present study, a modified library preparation method for SOLiD sequencing technology was developed and maternal plasma miRNA from single and twin pregnancies was analyzed. Quantitative PCR was carried out for comparison.ResultsResults showed that the sequenced data was improved remarkably with this modified library preparation method; different types and levels of miRNA expression were found in twin pregnancy compared with control. Several miRNAs were validated that remarkably changed in twin pregnancy.Interpretation and conclusionIt is indicated that miRNAs might involve the process of pregnancy such as the generation of twin pregnancy, and it also suggested that the specific miRNAs could act as potential biomarkers for clinical diagnosis and therapy.     

Congenital myotonic dystrophy: prenatal ultrasound findings and pregnancy outcome.

OBJECTIVE: The objective of this study was to assess the maternal and prenatal ultrasound findings and outcome in pregnancies complicated by congenital myotonic dystrophy Type 1 (DM1). METHODS: A retrospective chart review of all patients with a diagnosis of DM1 and pregnancy presenting to the Oxford Radcliffe Hospital between 1990 and 2004 was undertaken. Obstetric case notes were reviewed and details of all pregnancies obtained. This included data on prenatal diagnostic tests and obstetric ultrasound scans performed as well as pregnancy complications and pregnancy outcome. Maternal and fetal CTG expansion size was also recorded where available. Maternal genetic case notes were reviewed for details of maternal grip myotonia. RESULTS: Sixty pregnancies among 26 couples in which one of the parents was a carrier of DM1 were identified during the study period. These resulted in 36 (60%) pregnancies affected by congenital DM1 and 19 (31.7%) unaffected pregnancies. There were four miscarriages and one termination of pregnancy for non-medical reasons.Nineteen of the 36 affected pregnancies ended in termination following the antenatal diagnosis of congenital DM1 by either chorionic villus sampling (CVS) or amniocentesis. In the remaining 17 affected pregnancies (16 singleton and one twin) there was one miscarriage of an affected fetus with co-existing Down syndrome and eight perinatal deaths. The principal cause of perinatal death was respiratory failure in the early neonatal period. Antenatally noted clinical/sonographic abnormalities in these pregnancies included polyhydramnios (100%), talipes (26.6%) and borderline ventriculomegaly (13.3%). Uni- or bilateral talipes was noted at delivery in 10 of 16 (62.5%) neonates. Maternal grip myotonia was present in all but one of these cases. CONCLUSION: The antenatal findings of polyhydramnios and talipes should prompt a search for maternal grip myotonia. If present, definitive testing for congenital DM1 should be considered.     

双胎妊娠胎儿异常的产前超声特征

目的探讨产前超声诊断双胎妊娠胎儿异常的价值。方法回顾性分析14对双胎妊娠胎儿异常的产前声像图特征及临床资料。结果超声诊断5对为双胎之一结构畸形,1对为双胎均结构畸形,1对为双胎输血综合征,2对为选择性胎儿宫内发育迟缓,1对为双胎之一死亡后孪生胎神经系统损伤,2对为联体双胎,2对为双胎反向动脉灌注序列症。结论超声有助于诊断多种双胎妊娠并发症和畸形,有重要临床指导意义。     

Pharmacokinetics of betamethasone in twin and singleton pregnancy

OBJECTIVE: The aims of the study were to compare the pharmacokinetics of betamethasone in singleton pregnancy with the pharmacokinetics in twin pregnancy and to assess the adrenal suppression produced by betamethasone. STUDY DESIGN: We measured serial betamethasone and cortisol levels in 30 singleton and 21 twin pregnancies after the first dose of betamethasone and calculated the pharmacokinetic parameters for betamethasone including volume of distribution, half-life, and clearance. We also measured cord and maternal blood levels of betamethasone at the birth of infants of 13 singleton and 9 twin pregnancies. RESULTS: The half-life of betamethasone in mothers with twin pregnancies was significantly shorter than that in mothers with singleton pregnancies (7.2 +/-2.4 versus 9.0 +/- 2.7 hours; P <.017). Clearance of betamethasone in the twin pregnancies appeared greater than in singleton pregnancies (8.4 +/- 6.4 versus 5.7+/- 3.1 L/h; P =.06) but did not reach statistical significance. Volume of distribution was similar in the two groups. Because the time between the last dose of betamethasone and birth varied widely (range, 2-158 hours), mothers with a longer interval after treatment tended to have a higher cord-to-maternal betamethasone ratio than did mothers with a shorter interval in both twin and singleton pregnancies. This finding indicated delayed fetal clearance, but the correlation was weak (R (2) = 0.29 for twins and 0.08 for singletons). CONCLUSION: The shorter half-life of betamethasone in twin pregnancy than in singleton pregnancy may cause the level of betamethasone to be subtherapeutic for lung maturation in twin pregnancy.     

Spontaneous unilateral dizygotic twin tubal pregnancy

Spontaneous dizygotic unilateral twin tubal pregnancy is an extremely rare occurrence with a high risk for pregnancy-related mortality, and a diagnostic challenge for obstetricians. We present a case of a 27-year-old woman with spontaneous twin tubal pregnancy. Transvaginal color Doppler sonography revealed 2 separate gestational sacs within the right adnexa, each containing an embryo. Cytogenetic examination of the trophoblastic tissues confirmed the diagnosis of dizygotic twin ectopic pregnancy. Clinical signs and symptoms together with imaging studies help in the diagnosis of this rare variant of ectopic pregnancies.     

产前超声检查在双胎输血综合征中的应用进展

双胎输血综合症（TTTS）是单绒毛膜双胎的一种严重并发症,其发病率较高,预后较差.超声作为产前检查的主要手段,能够早期发现、诊断,并及时治疗,从而提高围产儿的生存质量,本文就产前超声检查在TTTS的应用进展做一综述.     

Early pregnancy prenatal diagnostic testing: risks associated with chorionic villus sampling and early amniocentesis and screening options

Routine amniocentesis is an established test for the prenatal diagnosis of chromosome abnormalities and many single-gene conditions. Chorionic villus sampling and early amniocentesis, which are available in some centers, enable families to receive prenatal test results earlier in the pregnancy. There are concerns regarding the safety of early pregnancy testing because of increased risks for pregnancy loss and possible risks for birth defects. The use of first trimester testing has changed because of these concerns, and alternative methods of screening pregnancies at risk for a chromosome abnormality are being investigated.     

Thrombin-antithrombin complex and alpha-plasmin inhibitor-plasmin complex levels in singleton and twin pregnancies

Thrombin-antithrombin complex (TAT) is a sensitive marker for thrombin formation, and alpha2-plasmin inhibitor-plasmin complex (PIC) is a marker for fibrinolysis. Previous studies have shown that blood coagulation and fibrinolysis are activated in normal pregnancies. Thus, the present study examined changes in TAT and PIC levels during the course of singleton and twin pregnancies and compared these markers between the two pregnant groups. The subjects were 148 pregnant women, of whom 84 were women carrying single fetuses and 64 were women with twin fetuses. Their average gestational age at entry was 10, 20, 30 and 38 weeks of gestation in singleton pregnancies and 10, 20, 30 and 35 weeks in twin pregnancies. Peripheral blood was collected, and plasma was separated after centrifugation and then stored at -20 degrees C. The TAT levels increased significantly with the progression of pregnancy in both pregnant groups, whereas the PIC levels increased significantly only in singleton pregnancies between 30 and 38 weeks of gestation. The TAT levels were significantly higher in twin pregnancies than in singleton pregnancies. The PIC levels were significantly lower in twin pregnancies than in singleton pregnancies at 35-38 weeks. Thrombin formation might be enhanced with the progression of pregnancy in both pregnant groups. This enhancement might be more intensified in twin pregnancies. Fibrinolysis might increase only in singleton pregnancies from 30 to 38 weeks of gestation. Fibrinolysis might be less intensified in twin pregnancies than in singleton pregnancies only at 35-38 weeks.     

规范化早孕期超声筛查在双胎异常妊娠中的临床价值

目的 通过规范妊娠早期超声检查双胎的时间、内容和方法,探讨早孕期规范化产前超声筛查在双胎妊娠诊断中的临床应用价值.方法 前瞻性分析2009年5月至2011年6月在江苏省产前诊断中心超声室受检的655例双胎妊娠孕妇,于妊娠11～13+6周行早孕期胎儿结构超声筛查,并追踪妊娠过程和临床结局.结果 655例受检双胎妊娠孕妇,早孕期发现28例孕妇的29个疑似胎儿超声异常,其中1例为两个胎儿均异常,其余为单个胎儿异常.疑似胎儿异常包括11例单纯解剖结构异常(颈部淋巴水囊瘤、无脑儿、脐膨出、腹部囊性包块和胎盘水泡样变性)以及17例早孕期超声指标异常(NT增厚、鼻骨缺失、巨膀胱和单脐动脉),其中共有17例最后经临床证实.其余早孕期正常孕妇中,共漏诊3例,失访62例,漏诊率为0.51%(3/593),实际双胎异常妊娠发生率为3.37%(20/593),早孕期超声筛查临床符合率为60.71%(17/28).结论 统一规范化进行早孕期产前超声筛查可有效地提高双胎异常检出的准确率,尽可能地检出胎儿异常、减少漏诊率以及早期干预具有重要的临床价值.     

Heterotopic pregnancy: report of three cases

OBJECTIVE: Heterotopic pregnancy, defined as concomitant intrauterine and ectopic pregnancy, is a rare event. Assisted reproductive technologies have led to an increase in the number of heterotopic pregnancies. MATERIALS AND METHOD: From 1997 to 1999 three cases of heterotopic pregnancies were referred to the gynecological unit of the hospital of St. P?lten. The condition was diagnosed at 7, 8 and 12 weeks of gestation, respectively. Two patients had undergone assisted reproductive technologies and former pelvic surgery for tubal pregnancy. Two patients had intrauterine singleton pregnancies and one patient had an intrauterine twin pregnancy. In all cases the ectopic site presented as a ruptured tubal pregnancy and the treatment consisted of laparoscopic salpingectomy. RESULTS: In all patients the postoperative course was uneventful and the intrauterine pregnancy progressed. In one case recurrent preterm labor led to vaginal delivery at 33 weeks of pregnancy. In the case of twin pregnancy, a planned cesarean section was performed at 37 weeks of gestation. One patient delivered at term. All newborns were healthy. CONCLUSION: Knowledge of heterotopic pregnancy and understanding the epidemiological risk factors underlying this condition are important for early diagnosis with the aim of improving therapy and clinical outcome.     

Detection of twin reversed arterial perfusion sequence at the time of first-trimester screening: the added value of 3-dimensional volume and color Doppler sonography

Twin reversed arterial perfusion (TRAP) sequence, also known as acardiac malformation, is a rare complication unique to monozygotic multiple gestations. It occurs in approximately 1 per 35,000 pregnancies and in 0.3% of all monozygotic twin gestations. The malformation is characterized by the lack of a well-defined cardiac structure in one twin (acardiac), which acts as a parasite that is hemodynamically dependent on the normal (pump) twin. The malformation in the acardiac twin is always incompatible with survival regardless of its extent, whereas the prognosis of the pump twin may vary considerably. Common complications that affect the prognosis of the pump twin include complications of prematurity secondary to preterm delivery and polyhydramnios as well as congestive heart failure due to the expended cardiac demand. Without prompt detection, follow-up, and treatment, mortality rates for pump twins have been noted to be as high as 50% to 70%. Early sonographic diagnosis, appropriate follow-up, and intervention via cord occlusion when indicated are the mainstays of prenatal care in cases of TRAP sequence and have been associated with substantial improvements in survival. We report a case that emphasizes the added value of 3-dimensional (3D) and color Doppler techniques for both diagnosis of TRAP sequence and detection of poor prognostic features in the first or early second trimester.     

Insulin Requirements in Type 1 Diabetic Pregnancy: Do twin pregnant women require twice as much insulin as singleton pregnant women?

OBJECTIVE

To evaluate the insulin requirements in women with type 1 diabetes during twin pregnancy compared with singleton pregnancy.

RESEARCH DESIGN AND METHODS

At 8, 14, 21, 27, and 33 gestational weeks, insulin requirements and HbA_1c were compared between 15 twin pregnant women from 2000 to 2011 and 108 singleton pregnant women from 2004 to 2006.

RESULTS

In twin pregnancies, the weekly increase in daily insulin dose between 14 and 27 weeks was higher than in singleton pregnancies (median 3.0 international units [IU] [range 0.9–4.9] versus 1.5 IU [−1.5 to 5.9]; P = 0.008) and remained stable from 27 to 33 weeks. The increment in total insulin requirement from before pregnancy until 33 weeks tended to be higher in twin pregnancies (103% [36–257%] versus 71% [−20 to 276%]; P = 0.07). Throughout pregnancy, HbA_1c was similar in twin and singleton pregnancies.

CONCLUSIONS

In twin pregnancies, the weekly increase in insulin dose between 14 and 27 weeks was doubled compared with singleton pregnancies.Based on clinical experience, some clinicians expect a doubling of insulin requirement in third trimester of twin pregnancies compared with singleton pregnancies in women with type 1 diabetes. As no studies have investigated the insulin requirement during twin pregnancy, we investigated this in women with type 1 diabetes during twin pregnancy compared with that in singleton pregnancies.     

Assessment of endothelial function in normal twin pregnancy.

OBJECTIVE: To assess the maternal endothelial function in normal twin pregnancy. DESIGN: Cross-sectional study. SUBJECTS: Endothelial function was investigated in 74 women with normal twin pregnancy at 11-30 weeks of gestation and the results were compared to previous reported findings in 98 women with normal singleton pregnancy and 19 non-pregnant controls. METHODS: Endothelial function was assessed by measuring the changes of the brachial artery diameter in response to reactive hyperemia (flow-mediated dilatation) using external high resolution ultrasound. RESULTS: Flow-mediated dilatation of the brachial artery in both twin and singleton pregnancies was significantly higher than in non-pregnant women (P = 0.002 and P = 0.02, respectively). However, there was no significant difference in flow-mediated dilatation between women with twin and singleton pregnancy (9.61 +/- 4.36 vs. 8.84 +/- 3.18, P = 0.38). Resting vessel size, baseline flow and reactive hyperemia did not change significantly with gestation in twin pregnancy and were similar to values in singleton pregnancies and controls. CONCLUSION: Our findings indicate that although in pregnancy endothelial function is enhanced, this change may not be affected by the number of fetoplacental units present.     

Antenatal ultrasonic evaluation of acardiac monsters

Acardiac monster represents a rare but serious complication of monozygotic twin pregnancy. Antenatal recognition is important because of accompanying obstetrical problems, including polyhydramnios, dystocia, and uterine rupture. While pathologic findings are varied, characteristic sonographic findings allow accurate prenatal diagnosis. Acardia must be distinguished from sacrococcygeal teratoma, omphalocele and macerated fetus.     

Is twin pregnancy a risk factor for devolopmental dysplasia of the hip - retrospective analysis using ultrasonography

Background. Disorders in development of the hip in the uterus are caused mainly by mechanical factors. Their influence has been established on the basis of the results of examinations of newborns from singleton pregancies. Malposition of the fetus and the lack of space in the uterus are present in higher frequency in twin pregnancies. Thus, it is probable, that twin pregnacy may be a risk factor in developmental dysplasia of the hip.
Material and methods. We examined clinically and ultrasonographically 308 hip joints of 154 newborn twins and compare the values of the alpha related to different position in uterus, birthweight, gender, length of gestation and mode of delivery. The only pathological position of the fetus in the uterus is the tranverse one.
Results and Conclusions. The results of ultrasound examinations reveal that in the cramped space inside the uterus in twin pregnancies hip joints develop in different conditions than in singleton pregnancies and the twin pregnancy cannot be regarded as a risk factor which may cause developmental dysplasia of the hip.     

产前双胎输血综合征超声诊断的临床价值

目的探讨产前超声在双胎输血综合征(TTTS)预测、诊断、预后等方面的临床价值。方法对1250例双胎进行系统产前超声检查,其中单绒毛膜双胎265例在16～18孕周后每2～4周作1次检查,对TTTS进行预测、诊断及分期;根据超声分期及孕龄对TTTS进行预后评估及宫内治疗方法的选择。结果产前超声诊断TTTS31例,占11.2%;通过宫内治疗,存活21例,存活率67.7%,死亡率32.3%。结论产前TTTS超声诊断及分期,对TTTS及时、有效的宫内治疗,改善预后,具有重要的临床价值。     

173例双胎妊娠的妊娠结局

目的对双胎妊娠合并症积极防治,降低围产儿死亡率,提高产科质量。方法选择173例双胎妊娠,从双胎妊娠孕妇的一般情况,合并症,分娩情况,新生儿预后做回顾性的分析探讨。结果进行系统产前检查109例,发生早产11例,占10.9%;围产儿死亡4例,占3.6%;未进行系统产前检查64例,发生早产42例,占21.3%;围产儿死亡6例,占9.3%,孕妇合并症以早产、妊娠高血压疾病、胎膜早破、产前或产后贫血占的比例较多,其余的如妊娠期糖耐量异常、前置胎盘、羊水过多、胎盘早剥等占的例数差异不大。常见的剖宫产指征为重度妊娠高血压疾病、胎位异常、胎儿窘迫或产程停滞、前置胎盘等,新生儿合并症中,硬肿症、高胆红素血症发生率较高。结论做到早期诊断,加强双胎妊娠的孕期保健及产期的处理,防治各种并发症至关重要,建议对先露异常者,大胆地使用剖宫产,适当放宽双胎中有一胎方位异常的剖宫产者,监测双胎儿的生长发育,对双胎输血综合症的处理。