Prediction of intrauterine death and severe preterm delivery in twin pregnancies discordant for major fetal abnormality

Twin pregnancies are high-risk pregnancies accompanied with multiple complications, such as: spontaneous abortion, preterm rupture of the membranes, preterm delivery, intrauterine death of one or both twins etc. There is no consensus about the management of twin pregnancies complicated with preterm rupture of the membranes of one twin and risk of preterm delivery. These cases are rarely found in the literature. We present a case of a 35 years old patient, hospitalized in a tertiary level institution, because of a diamniotic dichorionic twin pregnancy complicated with preterm rupture of the membranes of the first twin at 19 weeks of gestation. She had one delivery with Caesarean section 16 years ago. In consultation with the patient induction of labor was done with delivery of the first twin, a death male fetus. After that, antibiotics and tocolytic therapy were administrated and the patient remained in the hospital about one week. The patient was discharged at home with regular control of her condition and condition of the fetus. The patient was again hospitalized at 33 weeks of gestation with uterine contractions on cardiotocography. After administration of corticosteroid therapy for fetal lung maturation she delivered spontaneously the second twin in a good condition and she was discharged from hospital after 16 days. In twin pregnancies clinicians must think about delayed interval delivery of the second twin, after delivery of the first twin, with an aim to increase chances for survival, especially for pregnancies less than 30 weeks of gestation.

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Faculty Opinions recommendation of Cytokines and the risk of preterm delivery in twin pregnancies.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717954765.793462015 ◽

2012 ◽

Author(s):

Fatma F Verit

Keyword(s):

Preterm Delivery ◽

Twin Pregnancies

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Prediction of Spontaneous Preterm Delivery in Twin Pregnancies By Cervical Length at Mid-Gestation

Twin Research and Human Genetics ◽

10.1375/twin.11.5.552 ◽

2008 ◽

Vol 11 (5) ◽

pp. 552-557 ◽

Cited By ~ 20

Author(s):

Katharina Klein ◽

Hubertus Gregor ◽

Kora Hirtenlehner-Ferber ◽

Maria Stammler-Safar ◽

Armin Witt ◽

...

Keyword(s):

Preterm Delivery ◽

Smoking Habit ◽

Cervical Length ◽

Spontaneous Preterm Delivery ◽

Spontaneous Labour ◽

High Incidence ◽

High Cervical ◽

Twin Pregnancies ◽

Preterm Rupture Of Membranes ◽

Spontaneous Delivery

AbstractThe objective of our study was to evaluate the correlation of the cervical length at 20–25 weeks of gestation with the incidence of spontaneous preterm delivery in twins in a country with a high incidence of preterm delivery compared to other European countries. Cervical length was measured in 262 consecutive patients. Previous preterm delivery before 34 weeks of gestation, chorionicity, maternal age, body-mass-index, smoking habit and parity were recorded as risk factors for preterm delivery. Women who were symptomatic at 20–25 weeks and who delivered because of other reasons than spontaneous labour and preterm rupture of membranes or at term were excluded. The primary outcome was incidence of preterm birth before 34 weeks. Two hundred and twenty-three patients were analyzed. Thirty-two (14%) delivered before 34 weeks. There was a significant correlation between cervical length of less than 25 mm and spontaneous delivery before 34 weeks (50% vs. 13%,p= .007). In addition, logistic regression analysis found cervical length to be the only significant predictor of spontaneous delivery before 34 weeks (OR 1.084; 95% CI 1.015; 1.159;p= .017). We conclude that the risk of severe preterm delivery in twins is high. Cervical length at mid-gestation was the only predictor of delivery before 34 weeks.

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Intrauterine death of a single fetus in twin pregnancies

Journal of Perinatal Medicine ◽

10.1515/jpme.1988.16.5-6.467 ◽

1988 ◽

Vol 16 (5-6) ◽

pp. 467-476 ◽

Cited By ~ 12

Author(s):

Jens Wessel ◽

Karin Schmidt-Gollwitzer

Keyword(s):

Intrauterine Death ◽

Twin Pregnancies

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Pregnancy Outcome of Twin Pregnancy at Gandaki Medical College Teaching Hospital, Pokhara, Nepal

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v11i02.22898 ◽

2018 ◽

Vol 11 (02) ◽

pp. 1-4

Author(s):

M Tripathi ◽

R Shrestha

Keyword(s):

Preterm Delivery ◽

Teaching Hospital ◽

Gestational Age ◽

Twin Pregnancy ◽

College Teaching ◽

Neonatal Morbidity ◽

Maternal Complications ◽

Cross Sectional ◽

Neonatal Complications ◽

Twin Pregnancies

Objectives: To evaluate maternal and neonatal complications and pregnancy outcomes of twin pregnancies. Methods: The cross sectional study was conducted using retrospective data on the twin pregnancies with more than 28 weeks of gestational age. The study used data over a period of five years, from March 10, 2010 to March 9, 2015 in the Department of Obstetrics and Gynecology, GMC Teaching Hospital Pokhara. Results: Of the 50 twin pregnancies, the most common maternal complication was preterm delivery (40%). Other maternal complications were anemia (36%), pregnancy induced hypertension (14%), premature rupture of membranes (14%), postpartum hemorrhage (12%) and antepartum hemorrhage (6%). Median gestational age at delivery was 37 weeks. Most common route of delivery was cesarean section (66%). Most common neonatal complication was low birth weight (48%) births first twin and second twin 56%. Conclusion: Twin pregnancy has high maternal and neonatal complications, especially preterm delivery that increases the risk of significant neonatal morbidity and mortality.

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552: Twin pregnancies with short cervix: Vaginal progesterone is agent of choice for preterm delivery prevention

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2018.11.574 ◽

2019 ◽

Vol 220 (1) ◽

pp. S368-S369 ◽

Cited By ~ 1

Author(s):

Jared T. Roeckner ◽

Melanie Mitta ◽

Luis Sanchez-Ramos ◽

Andrew M. Kaunitz

Keyword(s):

Preterm Delivery ◽

Short Cervix ◽

Vaginal Progesterone ◽

Twin Pregnancies

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Cervical Length as a Predictor of Preterm Delivery in an Unselected Cohort of Women with Twin Pregnancies

American Journal of Perinatology ◽

10.1055/s-0038-1676484 ◽

2018 ◽

Vol 36 (12) ◽

pp. 1288-1294 ◽

Cited By ~ 1

Author(s):

Clifton O. Brock ◽

Leslie A. Moroz ◽

Cynthia Gyamfi-Bannerman

Keyword(s):

Preterm Delivery ◽

Meta Analysis ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Cervical Length ◽

Prospective Data ◽

Spontaneous Preterm Delivery ◽

False Discovery ◽

Twin Pregnancies ◽

Unselected Cohort

Objective To determine the risk of spontaneous preterm delivery (SPTD) associated with transvaginal cervical length (TVCL) in an unselected cohort. Study Design This is a retrospective study of serial TVCLs in unselected twin gestations. Receiver operator curves for SPTD were constructed from TVCLs at 18, 20, 22, and 24 weeks. Prediction thresholds were determined using a false discovery rate of 10%. The risk of SPTD was compared with previously published, prospective data from a meta-analysis. Results A total of 1,228 women were included. SPTD occurred prior to 35 weeks in 232 (18.9%), 126 (10.3%), and 24 (2.0%) women prior to 35, 32, and 28 weeks. TVCL was most predictive at 22 weeks (area under the curve = 0.67). TVCL thresholds for predicting SPTD prior to 35, 32, and 28 weeks were 3.1, 3.0, and 2.9 cm. Compared with a previous meta-analysis, the risk of SPTD < 34, 32, and 28 weeks was lower (positive likelihood ratio 9.0 vs. 5.4, 10.1 vs. 5.9, and 9.6 vs. 4.3). Conclusion TVCL is modestly predictive of SPTD in twin gestations. Compared with previous prospective studies, this cohort has lower risk of SPTD at similar TVCLs.

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Clinical and ultrasound features associated with congenital cytomegalovirus infection as potential predictors for targeted newborn screening in high-risk pregnancies

Scientific Reports ◽

10.1038/s41598-020-76772-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Hitomi Imafuku ◽

Hideto Yamada ◽

Akiko Uchida ◽

Masashi Deguchi ◽

Tokuro Shirakawa ◽

...

Keyword(s):

Preterm Delivery ◽

Medical Center ◽

Clinical Manifestations ◽

High Sensitivity ◽

Clinical Findings ◽

Youden Index ◽

Cmv Infection ◽

Fetal Abnormality ◽

Congenital Cytomegalovirus ◽

Fetal Abnormalities

AbstractThis prospective cohort study aimed to determine clinical factors associated with congenital cytomegalovirus (CMV) infection in pregnancy. Newborns born at a perinatal medical center received PCR analyses for CMV-DNA in their urine with informed consent. Clinical data, including age, maternal fever or flu-like symptoms, complications, ultrasound fetal abnormality, gestational weeks at delivery, and birth weight, were collected. Logistic regression analyses determined clinical findings associated with congenital CMV infection (cCMV). cCMV was diagnosed in 32 of 4380 pregnancies. Univariate and multivariable analyses revealed that age < 25 years old (OR 2.7, 95% CI 1.1–6.6; p < 0.05), the presence of maternal fever or flu-like symptoms (5.4, 2.6–11.2; p < 0.01), ultrasound fetal abnormalities (12.7, 5.8–27.7; p < 0.01), and preterm delivery at less than 34 gestational weeks (2.6, 1.1–6.0; p < 0.05) were independent clinical findings associated with cCMV. A combination of maternal fever/flu-like symptoms, ultrasound fetal abnormalities, or preterm delivery at less than 34 gestational weeks as optimal predictive factors showed 90.6% sensitivity, 66.4% specificity, and a maximum Youden index of 0.57. CMV-DNA tests in the urine of newborns born to mothers with these clinical manifestations may be an effective method in detecting cCMV as a targeted screening with a high sensitivity.

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