Perinatal outcome after multifetal reduction to twins compared with nonreduced multiple gestations

Article Abstract:

The risk of premature birth, fetal growth retardation, and death is greater for multiple gestations (twins, triplets, quadruplets, etc.) than for single gestations. Multiple gestations are becoming more common, however, especially with the increased use of fertility agents by couples experiencing fertility problems. To reduce the risk and improve the outcome of multiple gestations, a procedure called fetal reduction has been developed. This procedure has been used for reducing quadruplet or triplet pregnancies to twins. This is done by selectively killing one or more of the fetuses so that only two remain. To determine if this procedure improves the outcome of multiple gestations, 62 women with multiple gestations were studied. The women were previously infertile and had undergone ovulation induction (a method used to release eggs from the ovaries) in order to be able to become pregnant. A total of 156 infants were born. Of the women, 22 had twins, 20 had triplets, five had triplets that had been reduced to twins, six had quadruplets, and nine had quadruplets that were reduced to twins. The average age at delivery was 35 weeks for the twins, 35 weeks for the triplets reduced to twins, 33 weeks for the triplets, 31 weeks for the quadruplets reduced to twins, and 25 weeks for the quadruplets. Quadruplet pregnancies were associated with the highest mortality. Only nine infants from six quadruplet pregnancies survived. There were only three deaths in quadruplet pregnancies that were reduced to twin pregnancies and none among the triplet pregnancies that were reduced to twin pregnancies. Infants from quadruplet or triplet pregnancies that were reduced to twin pregnancies weighed an average on 3.5 pounds less than infants from natural (nonreduced) twin pregnancies. It is concluded that reducing quadruplet pregnancies to twin pregnancies improves the outcome. However, the outcome of triplet pregnancies was similar for natural triplets and those reduced to twins, suggesting there is no advantage to reducing pregnancies involving under four fetuses. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical examination, Triplets, Quadruplets, Abortion, Therapeutic, Therapeutic abortion

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Pseudomonoamniotic twins with cord entanglement following genetic funipuncture

Article Abstract:

Amniocentesis is a procedure that is used to test for genetic defects in the developing fetus. The procedure involves inserting a long thin needle into the mother's abdomen and into the amniotic sac surrounding the fetus to obtain a sample of amniotic fluid. In twin pregnancies, both amniotic sacs should be tested separately. Amniocentesis is successful in 90 percent of twin pregnancies. However, when it is not successful a procedure called funipuncture is used to obtain samples of fetal white blood cells. This procedure can be dangerous in twin pregnancies because it can make a hole between the two amniotic sacs (pseudomonoamniotic twins). Fetal death arising from tangled umbilical cords occurs in 30 percent of cases of monoamniotic twins, and both twins survive in only 40 percent of the cases. A case is reported of pseudomonoamniotic twins caused by funipuncture. After undergoing two unsuccessful amniocentesis procedures, the 37-year-old woman underwent funipuncture at week 24 of pregnancy. The funipuncture was successful and ultrasound showed the normal growth of two fetuses. Labor began at week 39 of pregnancy, and the first infant, weighing 5.6 pounds, was delivered. The umbilical cord was tangled with the cord from the second baby. The second baby was delivered buttocks first and weighed 5.7 pounds. The two placentas had fused together following puncture of the amniotic sac during funipuncture. In this fortunate case, both infants survived and were in good health. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Diagnosis, Fetal membranes, Chromosome abnormalities, Amniocentesis, Amniotic sac, Amnion

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Survival of twins after acute fetal hemorrhage from ruptured vasa previa

Article Abstract:

When a fetus in a woman pregnant with twins suddenly began bleeding during an attempt to attach an electrode to its head, the authors suspected vasa previa, the presentation of the arteries of the umbilical cord in front of the head during labor, complicated by the rupture of those blood vessels where they enter the placenta. The fetus's heart rate slowed (bradycardia). The twins were immediately delivered via cesarean section. One twin had lost extensive amounts of blood. The other twin appeared normal. The affected infant received blood transfusions and other appropriate treatments. After six months, both infants appeared normal. This is the first case reported in the medical literature of both twins surviving such a condition.

Causes of, Diseases, Hemorrhage, Diseases in twins

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