The ''stuck twin'' phenomenon: ultrasonographic findings, pregnancy outcome, and management with serial amniocenteses

Article Abstract:

''Stuck'' twins are said to occur in cases of twin pregnancy with two amniotic sacs (in which the fetuses float) where one fetus is situated next to the uterine wall in an abnormally small amount of amniotic fluid (oligohydramnios), while the other is in an abnormally large amount of amniotic fluid (polyhydramnios). The survival rate for both fetuses is very poor (less than 20 percent, at the institution where the authors are based), and premature labor usually occurs. Results from the management of 13 ''stuck twin'' pregnancies are reported; the outcomes from the 8 pregnancies that were managed with serial amniocenteses were considerably more favorable (69 percent survival; 11 of 16 fetuses). With this approach, the pregnant women underwent serial amniocenteses (removal of small amounts of amniotic fluid for evaluation) of the polyhydramniotic sac, with removal of fluid until the sac appeared normal with ultrasound examination. Only two fetuses of the 10 that were managed without amniocenteses survived; none of these had been the ''stuck'' twin. Prenatal data for the pregnancies are presented. The possible causes of this phenomenon are diverse. Serial amniocenteses can improve the survival rate of fetuses that are so affected; however, it is possible that survivors experience an abnormally high rate of complications (2 of the 11 survivors developed brain or kidney complications). This possibility should be taken into account by clinicians and parents who contemplate serial amniocenteses. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Pregnancy, Complications of, Pregnancy complications, Amniocentesis, Pregnancy, Multiple, Multiple pregnancy

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Femur length shortening in the detection of Down syndrome: is prenatal screening feasible?

Article Abstract:

Ultrasonographic imaging, the use of high frequency sound to visualize internal structures, can be used to study the growing fetus. Recently, fetal bone measurements have been used to help detect fetuses with Down's syndrome, a chromosomal abnormality marked by mental retardation and short stature. A relatively large ratio (greater than 1.8) of the biparietal diameter, a measurement of the parietal bones of the skull, to the length of the femur, the long leg bone, is suggestive of Down's syndrome. Before this ratio can be utilized as a prenatal diagnostic tool, the association between femur length and biparietal diameter must be confirmed. The femur length, the predicted femur length and the biparietal/femur length ratio were calculated and compared among 49 Down's syndrome fetuses and 572 normal fetuses. In the 49 Down's syndrome fetuses, seven (14.3 percent) had short femurs compared with 35 out of 572 (6.1 percent) of the normal fetuses. The probability that short femur length can predict Down's syndrome was 0.93 percent in a high-risk population and 0.33 percent in a low-risk population. Although fetuses with Down's syndrome are more likely to have short femur lengths, such results are less useful predictors than originally described. It is argued that the positive predictive value of any new screening test should be at least as good as that obtained with genetic amniocentesis performed on a 35-year-old woman (0.4 percent). (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Down syndrome, Prenatal diagnosis, Femur

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The association between decreased amniotic fluid volume and treatments with nonsteroidal anti-inflammatory agents for preterm labor

Article Abstract:

Nonsteroidal anti-inflammatory drugs (NSAID) are frequently used to inhibit early labor. These drugs have been associated with a decrease in the level of amniotic fluid, which surrounds the fetus. Low levels of amniotic fluid may jeopardize the health of the fetus. The relationship between the decrease of amniotic fluid and the use of NSAID for the inhibition of labor was studied. The amniotic fluid of patients using NSAID and other agents used in the treatment of early labor was measured by means of ultrasound (the use of high frequency sound to visualize internal structures). About 83 percent of patients receiving NSAID had decreases of amniotic fluid. When treatment with NSAID was discontinued, practically all patients returned to pre-treatment fluid levels. Patients receiving other agents used in the control of early labor showed no decrease in fluid. Patients using NSAID tended to deliver earlier than those using other agents. The use of NSAID is recommended only when other treatment modalities fail.

Analysis, Drug therapy, Nonsteroidal anti-inflammatory drugs, Nonsteroidal anti-inflammatory agents, Labor, Complicated, Labor complications

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