Stillbirth Associated With Birth Weight Discordance in Twin Gestations

Objective

Stillbirth is an important adverse outcome associated with twin pregnancy. We aimed at investigating the association between birth weight discordance (BWD) and stillbirth.

Twin Delivery After a Previous Caesarean: A Twelve-Year Experience

Objectives: To compare maternal and neonatal morbidities between trial of labour (TOL) and elective Caesarean section in women with twin pregnancies who have had a prior Caesarean.Methods: An observational study was conducted of women with a prior Caesarean who delivered twins at 28 weeks’ gestation or greater in Ste-Justine Hospital between 1988 and 2001. Maternal and neonatal outcomes were compared between women who had a TOL (group I) and those who had an elective Caesarean delivery (group 2).Results: Twenty-six women and 52 fetuses were included in group 1 and compared to the 71 women and 142 fetuses in group 2. Maternal age, gestational age, and birth weight were comparable in both groups. In group 1, 22 (85%) out of 26 women delivered twin A vaginally and 19 (73%) delivered both vaginally. There was no significant difference in the umbilical artery cord pH, Apgar score, ventilatory support, and admission to the neonatal intensive care unit between the 2 groups. There was also no significant difference in the rate of postpartum maternal fever or decrease of serum hemoglobin between the 2 groups, but the median hospital stay was higher in the group with elective Caesarean (5.0 vs. 3.0 days, p <0.001). There were no uterine ruptures or other major complications in either group.Conclusion: There were no significant differences in maternal and neonatal morbidity outcomes between births by trial of labour and by elective Caesarean, in twin pregnancies after a prior Caesarean section. A trial of labour is associated with a shorter hospital stay.     

Trial of Labour Compared to Elective Caesarean in Twin Gestations with a Previous Caesarian Delivery

Objective: To compare maternal and neonatal outcomes in twin gestations with a vertex presenting first twin undergoing either an elective repeat Caesarean section or a trial of labour subsequent to having had a Caesarean delivery in a prior pregnancy.Methods: Maternal and newborn data from 1980 to 1999 in twin gestations, having I or more previous lower-segment Caesarean section(s) and a vertex presentation of the first twin, were analyzed from the Nova Scotia Atlee Perinatal Database. Categorical data were compared using chi-square or Fisher exact tests and continuous data by the Student t test. Logistic regression was used to control for covariates.Results: Of the 121 women eligible for the data analysis, 38 chose to have a trial of labour, and 28 delivered vaginally with no uterine ruptures, scar dehiscences, maternal deaths, or increase in neonatal morbidity or mortality reported. Two Caesareans in the trial-of-labour group were for the delivery of the second twin. Women choosing elective Caesarean section had a higher incidence of infectious morbidity (p = 0.04).Conclusion: In twin pregnancies with twin A presenting as a vertex, a cautious trial of labour may be an effective and safe alternative to elective repeat Caesarean section. Further research on a trial of labour after previous Caesarean section in twin gestations is warranted, as the studies published to date do not have sufficiently large numbers to detect adverse maternal and neonatal outcomes.     

Twin pregnancies in Cardiff and Vale of Glamorgan over four decades: natural twinning is on the increase

Objective

To assess trends in twinning over four decades using a population-based registry.

Design

Ecological study to conduct trend analysis of twin pregnancies in a geographically defined area over 40 years.

Setting

All pregnancies in the Cardiff and Vale of Glamorgan area of South Wales from 1965 to 2004, as recorded in the Cardiff Birth Survey (CBS) database.

Methods

Trends of the incidence of all twin pregnancies (≥18 weeks of gestation) were calculated in 5-year increments, beginning with 1965–1969 and ending in 2000–2004. Natural twinning rates could only be calculated for the terminal five time periods (i.e., 1980–1984, 1985–1989, 1990–1994, 1995–1999, and 2000–2004), when information regarding non-spontaneous (iatrogenic) twinning was first collected in the database. All results were adjusted for maternal age.

Results

The total twinning rate was 13.1 per 1000 pregnancies in the 1st time period (1965–1969). Subsequently, there was a gradual reduction in twinning, reaching a nadir of 10.3 per 1000 for the time period 1980–1985 (Z = 3.15, P value < 0.001). This was followed by a gradual increase in twinning, reaching a maximum of 15.7 per 1000 for both 1995–1999 and 2000–2004 (Z = −5.18, P value < 0.0001). After exclusion of the cases of iatrogenic pregnancies, the natural twinning rate showed a continuous and gradual increase from 10 per 1000 spontaneous pregnancies in 1980–1984 to 13.3 per 1000 in 2000–2004 (Z = −5.08, P value < 0.0001).

Conclusion

The data showed a gradual, continuous increase in natural twinning rates over the last two decades. Such an increase cannot be attributed to the rise in maternal age alone.     

双胎妊娠孕期不同阶段体质量增长速度与母婴结局的关系

目的:分析双胎妊娠孕期不同阶段体质量增长情况与母婴结局的关系。方法:对2013年1月至2015年10月在上海交通大学医学院附属国际和平妇幼保健院住院分娩的472例双胎妊娠产妇的临床资料进行回顾性分析,比较不同孕前BMI孕妇孕期体质量增长情况,在校正年龄和孕前BMI后,使用二元Logistic回归分析孕期不同阶段体质量增长速度与孕期并发症、早产、胎膜早破和新生儿出生体质量的关系。结果:(1)孕早中期平均体质量增长速度0.41±0.15 kg/w,孕晚期平均体质量增长速度0.64±0.30 kg/w,整个孕期平均体质量增长速度0.49±0.15 kg/w。(2)孕晚期和整个孕期体质量增长过快是妊娠期高血压疾病和发生早产的高危因素(P0.05),孕早中期、孕晚期及整个孕期体质量增长过快是发生胎膜早破的高危因素(P0.05),孕早中期及整个孕期的体质量增长过慢是新生儿低出生体质量的高危因素(P0.05)。(3)在校正年龄、孕前BMI、孕周等因素后,孕期体质量每增加1 kg,双胎出生体质量之和增加25.21 g(P0.001);孕早中期每增加1 kg,双胎出生体质量之和增加30.89 g(P0.001);孕晚期每增加1 kg,双胎出生体质量之和增加21.46 g(P=0.001)。结论:双胎妊娠孕期体质量增长与母婴不良结局密切相关,妊娠不同阶段的体质量增长速度对母婴结局有一定的预测价值,应进一步探讨适合中国人群的双胎妊娠孕期体质量增长适宜范围。     

阿托西班、利托君治疗双胎晚期流产和早产的临床分析

目的：探讨阿托西班及利托君在双胎妊娠晚期流产和早产治疗中的临床价值。方法：回顾性分析郑州大学第二附属医院2015年1月-2017年1月收治的85例晚期流产及先兆早产的双胎妊娠孕妇,根据产妇使用宫缩抑制剂的情况分为阿托西班组20例,利托君组25例,利托君联合阿托西班组（联合用药组）40例。观察3组患者的保胎成功率、延长妊娠时间、新生儿情况、产后出血率及药物不良反应。结果：阿托西班组药物起效时间短,与其他两组比较差异有统计学意义（均P＜0.05）。3组孕妇抑制宫缩总有效率比较差异无统计学意义（χ2=0.30,P=0.86）。3组新生儿出生体质量、新生儿窒息率比较差异均无统计学意义（均P＞0.05）。3组患者无一例发生产后出血。白蛋白水平≤30 g/L、血红蛋白水平≤100 g/L、基础心率≥100次/min的患者出现利托君药物不良反应的风险大。结论：针对宫缩强、白蛋白水平≤30 g/L、血红蛋白水平≤100 g/L、基础心率≥100次/min的双胎孕妇可考虑阿托西班作为一线药物治疗。     

An Unusual Complication in a Twin Pregnancy — Umbilical Cord of Twin 2 Around the Neck of Twin 1

Summary: A case of uniovular twin pregnancy is described in which the cord of twin 2 around the neck of twin 1 was clamped and cut soon after delivery of the head of twin 1, thereby creating an unusual obstetric emergency.     

An Unusual Complication in a Binovular Twin Pregnancy — Umbilical Cord of Twin 2 Around the Neck of Twin 1

Summary: A case of cord entanglement involving the cord of twin 2 being around the neck of twin 1 is presented. The unusual feature of this case is that the twins were binovular, being male and female, refuting previous statements that for this complication to occur, the twins must be monoamniotic.     

Twin pregnancy

Twins account for 2–3% of all births. They carry significant risks to both mothers and babies. These risks include preterm delivery, intrauterine growth restriction, and pre-eclampsia. In addition, monochorionic gestations confer an even higher rate of perinatal morbidity and mortality arising from a shared placenta due to placental anastomoses, which may lead to twin-to-twin transfusion syndrome (TTTS) or twin anaemia-polycythaemia sequence (TAPS). It is essential that chorionicity is established in the first trimester in order to initiate the appropriate antenatal management and surveillance. In view of the high risk of both maternal and fetal complications, twin pregnancies are ideally managed in a dedicated clinic according to agreed protocols with both obstetric and midwifery input.     

Twin pregnancy

Twins account for 2–3% of all births. They carry significant risks to both mothers and babies. These risks include preterm delivery, intrauterine growth restriction and pre-eclampsia. In addition, monochorionic gestations confer an even higher rate of perinatal morbidity and mortality arising from a shared placenta due to placental anastomoses, which may lead to twin to twin transfusion syndrome (TTTS). It is essential that chorionicity is established in the first trimester in order to initiate the appropriate antenatal management and surveillance. In view of the high risk of both maternal and fetal complications, twin pregnancies are ideally managed in a dedicated clinic according to agreed protocols.     

Twin pregnancy

Recent advances regarding twin pregnancies have focused on several problems, including the detection and definition of risk in relation to chorionicity, the management of a pregnancy with a single anomalous fetus, the prediction of prognosis and the management of twin-twin transfusion syndrome, and the detection of preterm labor. These questions will be considered in this review.     

Twin delivery

The incidence of twin pregnancy has increased worldwide over the past 10 years largely as a consequence of the assisted reproductive technologies. Issues such as intrapartum monitoring and operative interventions, especially with regard to the second twin, provide a unique challenge in labour and delivery. Epidemiological data suggest that the term twin has a threefold higher mortality rate than the singleton. It is the authors' view that many aspects of twin delivery deserve as much import as those features of twin gestations such as pre-term birth and intrauterine growth restriction that, to date, have received much of the research and clinical interest in this area.Indications for elective Caesarean section are presented, incorporating new data derived from the delivery of the term singleton breech, and implications on the timing thereof are discussed.Vaginal delivery of both twins presenting by the vertex is recommended as safe as long as guidelines for the conduct of such delivery are followed. The recommended time interval between twins as well as the use of epidural, fetal monitoring and ultrasound in the delivery room are discussed.The second twin presenting as a non-vertex presents an urgent dilemma for accoucheurs. Data suggest that internal version and breech extractions are safer than external cephalic version provided that the appropriate techniques are applied. It is revealed, however, that the use of elective Caesarean section in this group of babies has not been subject to randomized controlled studies of sufficient power to determine the best method of delivery of the second twin - particularly in the low-birth-weight baby.     

Twin pregnancy

Twins account for 2–3% of all births. They carry significant risks to both mothers and babies. These risks include preterm delivery, intrauterine growth restriction and pre-eclampsia. In addition, monochorionic gestations confer an even higher rate of perinatal morbidity and mortality arising from a shared placenta due to placental anastamoses, which may lead to twin-to-twin transfusion syndrome (TTTS). It is essential that chorionicity is established in the first trimester in order to initiate the appropriate antenatal management and surveillance. In view of the high risk of both maternal and fetal complications, twin pregnancies are ideally managed in a dedicated clinic according to agreed protocols.     

Endocrinology of Twin Pregnancy

Summary: Plasma oestradiol 17β, plasma oestriol and plasma progesterone were estimated in 10 twin pregnancies from 30 to 40 weeks. Plasma oestradiol and plasma oestriol rose gradually, reaching their highest levels around 36 weeks. Plasma progesterone levels were very high and showed little variation in the last 10 weeks of gestation. Plasma seroids were twice levels described for singleton pregnancies.     

Twin Transfusion Syndrome

Twin transfusion syndrome (TTS) is a rare, yet frequently fatal, complication of twin gestations. Recently published data demonstrate a reduction in the perinatal mortality rate associated with TTS from nearly 100% to 20-40%. This article explains the pathophysiology of TTS, newly described treatments, complications, and specific aspects of nursing care for patients with this complication of multiple gestation.