辅助生育技术受孕双胎与自然受孕双胎妊娠结局的分析

目的　探讨辅助生育技术受孕 (助孕 )双胎与自然受孕双胎围产期的结局。方法　选择 10 4例助孕双胎孕妇 (助孕组 )和 173例自然受孕双胎孕妇 (自然受孕组 ) ,比较两组孕妇一般情况、妊娠合并症、分娩情况和新生儿预后等方面的差异。结果　 (1)助孕组孕妇平均年龄 (31 2± 3 7)岁 ,自然受孕组孕妇为 (2 7 8± 3 5 )岁 ,两组比较 ,差异有显著性 (P <0 0 5 )。 (2 )助孕组孕妇早产 70例(6 7 3% ) ,自然受孕组孕妇早产 78例 (45 1% ) ,两组比较 ,差异有极显著性 (P <0 0 1)。助孕组孕妇患妊娠期糖尿病或糖耐量异常 16例 (15 4 % ) ,自然受孕组孕妇仅 4例 (2 3% ) ,两组比较 ,差异有极显著性 (P <0 0 1)。(3)助孕组孕妇剖宫产率为 76 0 % (79/10 4 ) ,明显高于自然受孕组的 6 5 3% (113/173)。(4)两组围产儿死亡率、畸形发生率和新生儿窒息率等比较 ,差异无显著性 (P <0 0 5 )。结论　助孕双胎孕妇年龄较大 ,早产率及妊娠期糖尿病或糖耐量异常发生率高 ;分娩方式以剖宫产为主。助孕双胎孕妇的围产儿结局与自然受孕双胎相似     

Perinatal outcome of twin pregnancies after in vitro fertilization

BACKGROUND: There are conflicting data concerning perinatal outcome of twin, in vitro fertilization (IVF) pregnancies. The aim of this study was to evaluate and compare perinatal and neonatal outcomes in twin IVF pregnancies to those of spontaneously conceived twin gestations. METHODS: The medical files of 73 IVF and 148 naturally conceived twin pregnancies were studied retrospectively. Data concerning maternal characteristics, obstetric complications, and neonatal outcome were recorded and compared by chi2 test. The one-way analysis of variance (anova) was used to compare the means of groups. RESULTS: Mean maternal age, the proportion of nulliparous women, and the incidence of premature rupture of membranes, cesarean section, and premature delivery were significantly higher in the study group. The mean birthweight was significantly lower, the frequency of admission to the intensive care unit and the duration of hospitalization were significantly higher in the study group. The incidence of intraventricular hemorrhage was significantly higher in the IVF group. The number of perinatal deaths was similar. CONCLUSION: IVF twin pregnancies are at greater risk for obstetric complications and adverse neonatal outcome in comparison with naturally conceived twin gestations.     

Morphologic and histopathologic characteristics of placentas from twin pregnancies spontaneously conceived and from reduced and nonreduced assisted reproductive technologies

OBJECTIVE: To prospectively evaluate morphologic and histopathologic characteristics of placentas from twin pregnancies obtained by assisted reproductive technologies (ART) and non-ART and to evaluate the influence of previous fetal reduction on placental features. STUDY DESIGN: Fifty-five placentas from consecutive deliveries of ART-obtained and 50 placentas from consecutive deliveries of non-ART-conceived twin pregnancies were investigated by one pathologist, who was blinded to specimen origins. The patients' demographic and clinical data were also recorded. RESULTS: The mean maternal and gestational ages were similar in both groups. ART-obtained pregnancies were associated with an increased incidence of pregnancy complications and lower mean birth weight. Placentas from ART-obtained pregnancies were mostly of the dichorionic type and were thinner, weighed less and had more infarctions as compared to non-ART-conceived pregnancies. Placental characteristics of reduced ART-obtained twin pregnancies were comparable to those of nonreduced ones. The second twin's placenta in all groups weighed less and had a higher incidence of anomalous umbilical cord insertion. CONCLUSION: Placentas from ART-obtained twin pregnancies appear to have more pathologic features as compared to those of non-ART-conceived ones. Fetal reduction does not significantly affect the remaining placentas.     

Frequency and significance of preterm delivery in twin pregnancies.

OBJECTIVE: We investigated the frequency of preterm delivery and its influence on the neonatal outcome in twin pregnancies at a perinatal center. Are there differences in the course of twin pregnancies with preterm or term delivery? METHOD: A retrospective investigation was carried out at the Department of Obstetrics on 502 twin pregnancies and deliveries between 1978 and 1993. Pregnancy history and clinical parameters were compared among preterm (<37+0 weeks) and term deliveries. RESULT: Median duration of all twin pregnancies was 36+3 weeks of gestation. In the preterm group, preterm labor was more frequent, both, the first and the second neonate had lower birth weight and were more often admitted to the neonatal intensive care unit (NICU) where they stayed longer than full-term neonates needing intensive care. Perinatal deaths occurred only in the preterm group. CONCLUSIONS: The incidence of preterm delivery is significantly elevated in twin pregnancies and consequently the incidence of low- and very-low-birth-weight-infants and perinatal mortality. Preterm delivery is the main reason why twin pregnancies are at a higher risk for an adverse neonatal outcome and thereby cause considerable costs.     

Obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproductive technology compared with twin pregnancies conceived spontaneously: a prospective follow-up study

Objective

To compare the obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproduction technology (ART) with spontaneously conceived (SC) twin pregnancies.

Study design

A prospective cohort study compared all dichorionic twin pregnancies in nulliparous women following fresh in vitro fertilization/intra-cytoplasmic sperm injection (ICSI) or ICSI cycles at Royan Institute (n = 320) with SC dichorionic twin pregnancies in nulliparous women at Arash Women's hospital (n = 170) from January 2008 to October 2010. These pregnancies were followed-up until hospital discharge following delivery. Obstetric and neonatal outcomes of SC and ART twin pregnancies were compared.

Results

Multivariate analysis, adjusted for maternal age and body mass index, revealed that the obstetric outcomes were similar in both groups. However, the risks of very preterm birth [odds ratio (OR) 5.2, 95% confidence interval (CI) 2.1–12.9], extremely low birth weight (OR 2.2, 95% CI 1.0–3.9), admission to a neonatal intensive care unit (OR 2.0, 95% CI 1.2–3.2) and perinatal mortality (OR 2.3, 95% CI 1.2–4.0) were higher in the ART group.

Conclusions

The maternal outcomes of ART dichorionic twins were comparable with those of SC twins. However, despite the same obstetric management, the rates of very preterm birth, extremely low birth weight, admission to a neonatal intensive care unit and perinatal mortality were significantly higher in the ART group.     

Elective hospitalization in the management of twin pregnancies

We sought to evaluate the effectiveness of a policy of early elective hospitalization on the outcomes of 522 consecutive twin gestations delivered at our institution between 1983-1987. During the first 2 years (1983-1985), 237 twin pregnancies were delivered with a policy of elective hospitalization when twin pregnancy was diagnosed between 24-32 weeks' gestation. When possible, elective hospitalization started at 24 weeks' gestation. Electively admitted women remained hospitalized until 34 weeks' gestation, at which time they were discharged unless complications developed requiring continued hospitalization. During 1985-1987, 285 women with twin gestations were intentionally managed as outpatients unless intercurrent complications required hospitalization. A total of 211 twin pregnancies was excluded from analysis because the women did not present for prenatal care (19%) or were undiagnosed until delivery (22%). Of the remaining 311 pregnancies available for study, 134 were managed when the elective admission policy prevailed and 177 when this policy was not in effect. Although the elective admission policy did result in a small reduction in the incidence of low birth weight among the 58 pregnancies hospitalized electively (mean [+/- SEM] gestational age at elective hospitalization 27.7 +/- 0.3 weeks) compared with outpatient management, this policy did not result in an improvement in prematurity (32 versus 36%; P greater than .05) or perinatal morbidity as reflected by requirement for neonatal intensive care (12 versus 11%; P greater than .05) and mechanical ventilation (8 versus 9%; P greater than .05). Moreover, perinatal mortality was actually higher in the electively hospitalized pregnancies (8 versus 2%; P = .01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Multifetal pregnancy in older women and perinatal outcomes

OBJECTIVE: To examine multifetal pregnancy in older women and perinatal outcomes.DESIGN: A cross-sectional study.SETTING: A nationwide vital registry.PATIENT(S): A national population-based database that links the live birth, fetal, and infant death certificates reported of multiple gestations in the United States from 1995 to 1997. It includes 155,777 twin and 5,630 triplet pregnancies.INTERVENTION(S): None.MAIN OUTCOME MEASURE(S): Very preterm birth (<33 weeks), very low birthweight (<1,500 g), and perinatal and infant deaths.RESULT(S): Compared with those with singleton pregnancies, women with multifetal gestation tended to be older, non-Hispanic white, better educated, married, and nulliparous and to have earlier and more frequent prenatal care. Pregnancies conceived by assisted reproductive technology accounted for an increasing number of multiple gestations in older women. In women with lower socioeconomic status, older age was associated with higher risks of poor perinatal outcomes in twin pregnancy (relative risks ranging from 1.0 to 1.9 with a dose-response pattern). However, in women with higher socioeconomic status, older women did not have a higher risk of poor perinatal outcomes than younger women.CONCLUSION(S): The effect of older maternal age on perinatal outcomes in multifetal pregnancies may have been altered by assisted reproductive technology, frequent prenatal surveillance, and advanced neonatal care.     

Outcome of twin pregnancies after assisted reproductive techniques--a comparative study

OBJECTIVE: To compare obstetrical and perinatal outcome of twin pregnancies after assisted reproductive techniques (ART) with that of twins conceived spontaneously. STUDY DESIGN: Hospital based retrospective study. RESULTS: There were 132 twin deliveries of which 36 were conceived after ART. Patients of the ART group were mostly nulliparous and slightly older. There was no statistically significant difference in the frequency of preterm delivery or mean gestational age at delivery. Elective Caesarean delivery was more frequent in twin pregnancies conceived after ART, and there were no other differences in maternal complications. There was also no difference in the mean birth weight or frequency of neonatal complication between the two groups. CONCLUSION: In this comparative study, the obstetric and neonatal outcomes between spontaneous twins and those conceived after ART are similar except for higher operative deliveries in the latter group of twins.     

Perinatal outcomes with intrahepatic cholestasis of pregnancy in twin pregnancies

Objective: To describe perinatal outcomes of twin pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP).

Methods: We conducted a retrospective cohort study of women delivered at a large tertiary obstetric center in Shanghai, China from January 2006 to May 2014. Delivery data were abstracted from medical records of all twin gestations delivered at the hospital.

Results: A total of 129/1922(6.7%) twin and 1190/92?273 singleton (1.3%) pregnancies were complicated by ICP. An increased risk of stillbirth among twin pregnancies was observed (3.9% and 0.8% in the ICP and non-ICP groups, respectively; aOR 5.75, 95% CI 2.00–16.6). Stillbirths with ICP and twins occurred between 33 and 35 weeks gestation compared to 36–38 weeks gestation among singletons. ICP in twins was also associated with an increased risk of preterm birth (<37 weeks) with an aOR of 4.17 (95% CI 2.47–7.04) and an aOR of 1.89 (95% CI 1.26–2.85) for delivery <35 weeks. Twin pregnancies complicated by ICP also had increased meconium staining of amniotic fluid and lower birth weight.

Conclusions: Twin pregnancies with ICP have significantly increased risks of adverse perinatal outcomes including stillbirth and preterm birth. Stillbirth occurs at an earlier gestational age in twin gestation compared to singletons, suggesting that earlier scheduled delivery should be considered in these women.     

Perinatal mortality in twin pregnancies: a 3-year analysis in Seine Saint-Denis (France).

OBJECTIVES: Our purpose was to evaluate perinatal mortality in twins and to investigate factors associated with this mortality. STUDY DESIGN: A prospective study on the perinatal mortality was performed in the department of Seine-Saint-Denis. Out of all the perinatal deaths, we have retrospectively isolated those arising from twin pregnancies. RESULTS: There were 54 twin pregnancies complicated with perinatal death. The perinatal mortality rate in twin pregnancy was 78.0 per 1000 twin babies delivered. Out of 86 twin deaths, 38 (44.2%) were born before 28 weeks gestation and out of 82 twin perinatal deaths, 37 (45.1%) weighed less than 1000 g. Chorionicity was recorded in 44 twin pairs: 21 (47.7%) were dichorionic and 23 (52.3%) monochorionic. Finally, out of 48 twin sets there were four (8.3%) monoamniotic pregnancies. CONCLUSIONS: The present data show that extreme prematurity represents nearly half of perinatal mortality in twins. This study indicates also a significant proportion of monochorionic placentation among twin pregnancies with poor outcome.     

The role of sonographic assessment of cervical length in the prediction of preterm birth in primigravidae with twin gestation conceived after infertility treatment

OBJECTIVE: To identify the risk factors for preterm birth in primigravidae with twin gestation and the role of transvaginal ultrasonographic assessment of the cervix. METHODS: Between January 1996 and December 1996, 54 twin pregnancies were prospectively enrolled. All women were at their first pregnancy. All women conceived following infertility treatments and all had a normal uterine cavity proven by hysterosalpingography (HSG) or hysteroscopy. Multiple logistic regression analysis was used to evaluate the association between the length of the cervix at 18-24 weeks of gestation and outcome variables, controlling for possible confounding factors. RESULTS: The mean +/- SD maternal age was 30.9 +/- 5.3 years (range 22-46), and five of them were aged 40 or more. Nine patients (20.5%) delivered prematurely, defined as spontaneous delivery at or before 34 weeks of gestation. There was no statistically significant difference between women who delivered before or after 34 weeks of gestation in regard to maternal age, body mass index (BMI), weight gain in pregnancy, smoking and work during pregnancy. The mean cervical length of patients who delivered before 34 weeks of gestation (30.1 +/- 6.1 mm) was significantly shorter than that of women who delivered after 34 weeks of gestation (42.2 +/- 6.2 mm; P < 0.001). Cervical length longer than 35 mm predicted delivery after 34 weeks of gestation with sensitivity and specificity of 88.5% and 88.9%, respectively. The positive and negative predictive values were 96.9% and 66.7%. CONCLUSION: A transvaginal ultrasonographic measurement of the cervix > 35 mm at 18-24 weeks in twin gestation can identify patients at low risk for delivery before 34 weeks. Maternal age, BMI, weights gain, smoking and work during the pregnancy did not influence the duration of the pregnancy.     

Optimal gestational age for twin delivery.

OBJECTIVE: We evaluated the timing of twin delivery associated with perinatal outcome in gestations of at least 36 completed weeks. STUDY DESIGN: This was a retrospective analysis of infant and maternal hospital records for a consecutive series of twin deliveries at New York Hospital-Cornell Medical Center. The inclusion criteria were delivery after 36 weeks' gestation during a 7-year period (1987 to 1993), without congenital anomalies or early fetal demise. Adverse perinatal outcomes were compared between deliveries before 38 weeks' gestational age and those at or after 38 weeks' gestation. RESULTS: Of 776 twin deliveries during the study period, 329 met the inclusion criteria. Adverse perinatal outcome was significantly higher among the twin pregnancies that delivered before 38 weeks' gestation compared with those that delivered at or after 38 weeks' gestation. Twin pregnancies that delivered between 36 and 37 weeks' gestation were 13 times more likely to require neonatal intensive care compared with those who delivered at or after 38 weeks' gestation (95% confidence interval 1.8 to 95.9; p < 0.001). CONCLUSION: In uncomplicated twin gestations, delivery at between 36 and 37 weeks' gestation was not associated with a reduction in neonatal complications compared with deliveries at or after 38 weeks' gestation.     

Genetic amniocentesis in twin pregnancies

Summary. Eighty-three patients with twin pregnancies were seen at the University Hospital of Rotterdam between 1 January 1980 and 31 August 1985 for prenatal genetic studies. No abnormal karyotypes were found. Amniotic fluid was successfully obtained from both amniotic sacs in 77 patients. In two pregnancies elevated levels of alpha-fetoprotein (AEP) were found in both sacs. One of these pregnancies was terminated and the other continued until term. One pregnancy miscarried 4 weeks after amniocentesis at 19 weeks gestation; three women were delivered between 23 and 28 weeks, 36 at between 28 and 37 weeks and 42 women after 37 weeks. The perinatal mortality rate was 55/1000 (9 of 164). These results show that genetic amniocentesis is a safe and reliable technique in twin pregnancy but the interpretation of elevated AFP levels is complicated by the fact that AFP diffuses across the amniotic membranes between the two sacs.     

Maternal and perinatal complications in triplet compared with twin pregnancy

Objective: To compare maternal and perinatal complications in triplet and twin pregnancies. Study design: Case-controlled study in the setting of a University Hospital. Each pregnancy of a consecutive series of 40 triplet pregnancies of 20 weeks or more was matched for parity and maternal age with two sets of twins delivered in the same year. Primary end points of the analysis were maternal complications and perinatal outcome. Results: Of the triplets 82% and of the twins 36% were a result of assisted reproduction. Pre-term labor occurred significantly more often in triplet than in twin gestation. Triplets had a significantly lower median birth-weight (1478 vs. 2030 g) and gestational age at delivery (32 vs. 35.5 weeks). The mean neonatal hospital stay was significantly longer in triplets, mainly related to the lower birth-weight, but there was no significant difference between triplets and twins in the incidence of major neonatal complications. Conclusion: This data of the anticipated perinatal outcome in triplet and twin pregnancies may be used to counsel women with a triplet pregnancy considering selective reduction to twins. All methods of assisted reproduction should aim at prevention of multifetal gestation.     

Perinatal outcome of twin pregnancies with one structurally affected fetus: a case-control study.

OBJECTIVE: To determine whether one structurally affected fetus of a twin pregnancy further increases the risk of preterm delivery and to compare perinatal morbidity and mortality in these pregnancies with twin gestations with structurally normal fetuses. STUDY DESIGN: The cases (n = 25) included all twin gestations diagnosed from 1991 to 1994 with a sonographically detected fetal anomaly and a structurally normal co-twin delivered after 24 completed weeks' gestation. The control group consisted of 547 twin gestations delivered during the study period with no sonographically detected structural anomalies in either twin. RESULTS: Compared with controls, pregnancies with a single anomalous fetus (cases) delivered at a significantly lower gestational age (mean +/- SD: 34.0 +/- 3.2 weeks versus 35.6 +/- 3.2 weeks; p = 0.019) and had a significantly increased preterm delivery rate (76.0% vs 55.4%; p = 0.042). There was no significant difference in the incidence of intraventricular hemorrhage or respiratory distress syndrome, yet the perinatal mortality (80.0/1000 vs 6.4/1000; p = 0.000) and the average nursery stay (45.5 +/- 43.3 days versus 17.0 +/- 24.0 days; p = 0.003) were significantly increased for cases compared with controls. In addition, a significantly greater birth weight discordancy (> or = 30%) was seen in cases compared with controls (32.0% versus 9.1%; p = 0.002). The normal co-twin did not show any significant difference in the perinatal outcome variables studied when compared with controls. CONCLUSION: Compared with structurally normal twin pairs, twin gestations with a single anomalous fetus are at a significantly increased risk for preterm delivery. In addition, the anomalous fetus, but not the structurally normal co-twin, has a significantly increased mortality rate and a longer nursery stay. Finally, despite the increased risk for preterm delivery in twin pregnancies with one anomalous fetus, it is the nature of the anomaly itself that dictates the perinatal outcome.     

The outcome of triplet versus twin pregnancies

OBJECTIVE: The purpose of this study was to examine and to determine whether triplet pregnancies are associated with a significantly greater risk of adverse outcome than are twin pregnancies. METHODS: Maternal and perinatal outcomes were evaluated retrospectively in 41 sets of triplets and twin pregnancies that were matched for maternal age, parity, mode of delivery, preterm delivery, mode of conception, and antepartum complications. MAIN OUTCOME MEASURES: Perinatal outcome in triplet versus twin gestation. RESULTS: Triplets had a significantly lower mean average birth weight than in twin gestation (1,596 vs. 2,317 g, p<0.018) and gestational age at delivery (32.9 vs. 35.9 weeks; p< 0.03). Preterm labour occurred significantly more often in triplet than in twin gestation (80.5 vs. 41.5%) as did preterm delivery (87.8 vs. 46.2%). Triplets required a longer hospital stay than did twins (25 vs. 9 days; p<0.04). There were no significant differences between the groups in number of administrations to the Special Care Baby Unit (32.5 vs. 30.5%). Apgar score <7 at 5 min was significantly more in triplet as compared with twin gestation (17 vs. 6%; p<0.0015). Neonatal deaths occurred significantly more in triplets than in twins (26 vs. 8.5%; p< 0.0001). There were no significant differences between the groups in maternal antepartum or neonatal complications such as anaemia, pregnancy-induced hypertension, placental abruption, respiratory distress syndrome or intraventricular haemorrhage. Preterm labour was the only complication that occurred significantly more often in the triplet than in the twin gestation. CONCLUSIONS: We concluded that this information could be useful in counseling patients with respect to the anticipated perinatal outcome of triplet pregnancies.     

Perinatal outcome of ICSI pregnancies compared with a matched group of natural conception pregnancies in Flanders (Belgium): a cohort study

A retrospective cohort study was conducted with an intracytoplasmic sperm injection (ICSI) group and a naturally conceived comparison group. A total of 1655 singleton and 1102 twin ICSI births were studied with regard to perinatal outcome. Control subjects (naturally conceived pregnancies) were selected from a regional registry and were matched for maternal age, parity, place of delivery, year of birth and fetal sex. The main outcome measures were duration of pregnancy, birth weight, Apgar score <5 after 5 min, neonatal complications, perinatal death and congenital malformations. Twin births, when compared with singletons, carry a much higher risk of poor perinatal outcome. For both ICSI singletons and ICSI twins, no significant difference was found between ICSI and naturally conceived pregnancies for all investigated parameters. After excluding like-sex twin pairs, ICSI twin pregnancies were at increased risk for perinatal mortality (OR = 2.74, CI = 1.26-5.98), prematurity (OR = 1.38, CI = 1.10-1.75) and low birth weight (OR = 1.34, CI = 1.06-1.69) compared with spontaneously conceived different-sex twin pairs. In conclusion, the perinatal outcome of ICSI singleton and twin pregnancies was very similar to that of spontaneously conceived pregnancies in this large cohort study. After excluding like-sex twin pairs, ICSI twins were at increased risk for prematurity, low birth weight and higher perinatal mortality compared with the natural conception comparison group.     

Obstetric complications of twin pregnancies

Advances in assisted reproductive technology and increases in the proportion of maternities in older women have both contributed to the steep increase in the incidence of twin pregnancies since the 1980s. Maternal and perinatal complications are higher in twins than in singleton pregnancies. A significant proportion of perinatal mortality and morbidity among twins is due to the high incidence of preterm delivery and the added complication of twin-to-twin transfusion syndrome (TTTS) in monochorionic twins. Monochorionic twins also have a much higher rate of perinatal mortality than dichorionic twins, the greatest risk being before fetal viability (<24 weeks gestation). Early diagnosis of twins and their chorionicity, close fetal surveillance, particularly of monochorionic twins, and prompt therapeutic intervention in TTS are necessary to reduce perinatal mortality. Intrapartum management in the hospital setting with anaesthetic and neonatal facilities, as well as critical assessment of mode of delivery, have led to better outcomes. Ultrasonography is a valuable tool in the management of twin pregnancy. This chapter briefly summarises these topics, with a particular focus on recent literature.     

Obstetric outcome of twin pregnancies conceived by in vitro fertilization and ovulation induction compared with those conceived spontaneously

OBJECTIVE: To compare the obstetric characteristics of twin pregnancies conceived by in vitro fertilization (IVF) and ovulation induction with those conceived spontaneously. DESIGN: Case control study. SETTING: Tertiary Medical Center. PATIENTS: All twin deliveries that were achieved by IVF (n=558) and ovulation induction (n=478) from January 1988 through December 2002 were evaluated. Each group was compared with a control group that conceived spontaneously (n=3694) and was delivered during the same period. INTERVENTIONS: Ovulation induction, IVF-ET. MAIN OUTCOME MEASURES: Obstetrical complications. RESULTS: Multivariate analysis showed that patients who conceived with the assistance of IVF and ovulation induction had a significantly higher risk for gestational diabetes mellitus (odds ratio [OR]=2.41, 95% confidence interval [CI]=1.77-3.29 and OR=1.71, CI=1.2-2.42, respectively), cesarean section (OR=2.17, 95% CI=1.74-2.70 and OR=1.76, CI=1.43-2.16, respectively), and a lower gestational age at birth in the IVF group (OR=0.91, 95% CI=0.88-0.94), compared with their controls. CONCLUSIONS: After controlling for maternal age, and nulliparity we demonstrated that twin pregnancies conceived with the assistance of IVF and ovulation induction are at increased risk for gestational diabetes mellitus, and delivery by cesarean section. In addition, IVF conceived pregnancies have a lower gestational age at birth.     

Intensive management and early delivery reduce antenatal mortality in monoamniotic twin pregnancies

BACKGROUND: Intensive management and elective delivery between 32 and 35 weeks of monoamniotic twin pregnancies were suggested as improving perinatal outcome. We sought to evaluate this management as viewed by the outcome of monoamniotic twin pregnancies in our population. METHODS: A retrospective systematic chart review of all monoamniotic twin pregnancies, diagnosed from January 1986 to June 2002, was performed in three medical centers. Demographics, pregnancy course, and perinatal outcome were evaluated. The management and outcome were compared between the group of survivors and the groups of intrauterine fetal demise (IUFD) and miscarriage. RESULTS: Thirty-three pairs of monoamniotic twins were identified. Excluded were three women, who chose to terminate the pregnancy. Total survival rate was 60% (of 60 fetuses, 36 were born alive, but one neonate died due to sepsis). None of the IUFD occurred in hospitalized patients, and two pairs of twins died after 32 weeks. In the 10 twin pairs who died in utero, cord entanglement was documented in eight (80%). There were two cases of twin discordance and two cases of twin-to-twin transfusion syndrome. One twin of the live-born group had congenital transposition of the great arteries. Furthermore, one of the hospitalized patients was delivered by means of an emergency cesarean section because of a non-reassuring non-stress test at 30 weeks. CONCLUSIONS: Women with monoamniotic twin pregnancies should be advised about the very high mortality and morbidity rate. Early diagnosis, close in-hospital antenatal surveillance starting at fetal viability, and elective delivery at 32 weeks would reduce the antenatal mortality.