The Northwestern University multihospital twin study: IV. Duration of gestation according to fetal sex

Recently MacGillivray has observed that the average duration of male twin gestations is shorter than that of either female twin or male/female twin gestations. The data from 562 twin gestations from the Northwestern University multihospital twin study were used to test this observation. Male twin gestations were slightly but significantly shorter than other twin gestations as measured by pediatric examination (p < 0.005). Approaching significance at the 0.05 level were findings that male twin gestations were shorter than other twin gestations when measured by dates, and that the male twins were slightly shorter and lighter than other twins. No significant differences were found between male/female twin gestations and female twin gestations. No relationship could be found between twin sex combinations and a variety of maternal and obstetric factors. Taken together, the results suggest that male twin gestations differ in some distinctive biologic sense from other twin gestations.     

Adolescent triplet pregnancy.

The occurrence of spontaneous triplet pregnancy among teenagers is a rare event. The present communication describes two cases encountered at the Mt. Hope Maternity Hospital since its inception in 1981.     

The Northwestern twin chorionicity study: testing the 'placental crowding' hypothesis

OBJECTIVE: To evaluate the relation between placental proximity and frequency of birth weight discordance and small-for-gestational age (SGA) infants. STUDY DESIGN: Retrospective three-tier chorionicity analysis of 1155 twin placentas comparing birth weight characteristics of the twins in different placental types. RESULTS: Dichorionic-separate, but not dichorionic-fused twins, are heavier than monochorionic-diamniotic and monoamniotic twins (2376+/-721 vs. 2274+/-770, P < 0.006, and 2376+/-721 vs. 2166+/-782, P < 0.04). SGA twins are less frequent among dichorionic twins (OR 0.4; 95% CI 0.3, 0.6). Fewer sets with two SGA infants are present among dichorionic-separate compared to monochorionic-diamniotic pairs (OR 0.3; 95% CI 0.1, 0.8). The same trends are found when comparing all dichorionic to all monochorionic twins. Twins of all placental types have similar gestational ages and discordance values. CONCLUSIONS: Dichorionic-separate placentas are least likely to experience 'placental crowding' and thus are associated with heavier twins and fewer sets with one or two SGA infants.     

Chorionic villus sampling for first-trimester prenatal diagnosis: Northwestern University program

We present our initial experience in developing a chorionic villus sampling program at Northwestern University. In phase 1, we performed chorionic villus sampling in 58 patients prior to elective first-trimester abortion, assessing the reliability and reproducibility of obtaining adequate villus samples and performing cytogenetic analysis by means of both the direct and culture methods. Specimens were categorized according to quality: class I, multiple identifiable villi (n = 20); class II, few villi or villi mixed with decidua (n = 15); class III, no villi (n = 23). There was a positive trend between operator experience, amount of villi obtained, and quality of cytogenetic preparations. In March, 1984, we received Institutional Review Board approval to perform chorionic villus sampling in continuing pregnancies (phase 2). Among the first 20 cases we found two abnormalities (47,XY, + 13; 45,X). The remaining 18 pregnancies were continuing. Recommendations are made for developing a chorionic villus sampling program.     

The improving outcome of triplet pregnancies

During the period 1975 to 1988, 78 triplet pregnancies that reached a gestational age greater than or equal to 20 weeks were treated in our department--a prevalence of 1/849 deliveries. A total of 69 (88%) of the pregnancies occurred after treatment with ovulation-induction agents. The most common complication of pregnancy was premature contractions. Elective cervical cerclage neither prolonged gestation nor decreased fetal loss. The mean gestational age at delivery was 33.2 weeks + 3.8 weeks and 86% of the patients were delivered of premature infants. The perinatal and neonatal mortality rates were 93/1000 and 51/1000, respectively. Our results show a higher proportion of low Apgar scores and respiratory disorders in the third vaginally delivered infants. Follow-up of very low birth weight infants revealed four infants (10.5%) with severe neurologic handicaps. Results of this study suggest that cesarean section is the preferred mode of delivery in triplet pregnancies. Maternal, fetal, and neonatal risks of triplet gestations are relatively low and compare favorably with recent reports on twin pregnancies.     

Possibilities and evaluation of the use of tumor markers in gynecologic oncology. 1. Biochemical parameters

There can be not doubt that a knowledge of cancer diagnosis is becoming of increasing importance throughout all medicine disciplines. Neoplastic disorders are usually related with the incidence of heterologic molecules, so called tumor-markers. The authors present in this paper a selection of these substances which are able to announce malignant growth in gynaecologic oncology. They give recommendations in favour of practice.     

Unilateral triplet ectopic pregnancy. A case report.

Multifetal ectopic pregnancy has remained a rare finding, with 94 cases reported since the first, in 1891 by De Ott. This case report is the fifth of unilateral triplet ectopic pregnancy.     

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.     

Biochemical studies on dipeptidyl peptidases I to IV of the human placenta

Homogenates of human term placentae were utilized to demonstrate the presence of four dipeptidyl peptidases (DPP I to IV) after sequential fractionations with gel filtration and anion-exchange chromatography. DPP I was assayed with SerTyrNA as substrate and showed the characteristics of a thiol-dependent serine enzyme with optimum at pH 4.5 and a molecular weight of 210,000. DPP II, analysed with LysAlaNA as substrate, had an optimum at pH 5.5 and a molecular weight of 130,000 with no dependence on thiol groups or divalent ions. DPP III was studied with ArgArgNA as substrate. It was optimally hydrolysed at pH 8.8 and had a molecular weight of 84,000. The enzyme was highly suppressed by chelating agents but could be reactivated by Co2+ and some other divalent ions. DPP IV, with GlyProNA as substrate, displayed an optimum at pH 8.2. The fractionations displayed multiple forms of the enzyme, possibly indicating the presence of proto- and polymeric DPP IV activities. The protomer had a molecular weight of 260,000 and showed no dependence on thiol groups but was sensitive to Zn2+.     

Biochemical alterations of uterine leiomyoma extracellular matrix in type IV Ehlers-Danlos syndrome

Collagens and glycosaminoglycans were assessed in 6 leiomyomas from otherwise healthy ("control") patients and 1 leiomyoma from a patient with type IV Ehlers-Danlos syndrome. The type IV Ehlers-Danlos leiomyoma contained less type III collagen and dermatan sulfate than control leiomyomas. This might contribute to the formation of a defective collagen network in type IV Ehlers-Danlos syndrome.     

Cervical length dynamics in triplet pregnancies: a retrospective cohort study

Purpose

To review our experience with a screening program that included sequential cervical length measurements in our large population of triplet pregnancies.

Methods

Seventy-eight triplet pregnancies were retrospectively included. Cervical length measurements were performed by transvaginal ultrasound in 2-week intervals from week 16 + 0 onwards in a tertiary-care center in Vienna. The main outcome measurement was preterm delivery prior to 32 + 0 weeks of gestation. Statistical analyses were performed using paired and unpaired t tests and a stepwise linear regression model.

Results

There were 26 cases of preterm delivery (33.3%). Women with preterm delivery revealed significant cervical length shortening from week 22 + 0 (median 33 mm, interquartile range, IQR 17–39) to 24 + 0 (median 21 mm, IQR 7–30; p = 0.005). This was not observed in women without preterm delivery. From week 22 + 0 onwards, both groups showed further significant 2-week differences in cervical length (p < 0.05). Univariate analysis of cervical length in weeks 20 + 0, 22 + 0, and 24 + 0 as well as cervical length dynamics from 22 + 0 to 24 + 0 predicted preterm delivery.

Conclusions

In triplet pregnancies, a decrease in cervical length seems physiological from week 22 + 0 onwards. A sharp decrease in cervical length from the 22 + 0 to the 24 + 0 week as well as the smaller cervical length in weeks 20 + 0, 22 + 0, and 24 + 0 increase the risk of preterm delivery.

     

Obstetric complications and perinatal outcome in triplet pregnancies.

The incidence of multiple pregnancies with more than two fetuses has significantly increased since the introduction of ovulation agents and assisted reproductive technologies. Over a 15-year period there were 35 triplet pregnancies beyond 24 weeks that delivered at the King Fahad Hospital, an incidence of 1 in 1,099 deliveries. Early diagnosis is important for improving the rate of fetal salvage in triplet pregnancy. These pregnancies were managed on an outpatient basis. Prophylactic interventions were not utilised. A total of 91% of the pregnancies had at least one antenatal complication, pre-term labour being the most common (80%) followed by anaemia (43%). The average gestational age at delivery was 31.7 weeks (SD 4.2 weeks). A total of 94.3% of the patients were delivered by lower segment caesarean section. The mean birth weight of the neonates was 1,552 g (SD 510 g) and mean 5-min Apgar score was 7.6 (SD 0.8). The corrected perinatal mortality rate in the study was 152/1,000. Pregnancy outcome did not vary with birth order or mode of conception. Higher rate of pre-term births among triplet pregnancies make considerable demands on the neonatal intensive care unit. All methods of assisted reproduction should aim at prevention of multifetal pregnancies.