Dichorionic Triamniotic Triplet Pregnancy Complicated by Twin Anemia Polycythemia Sequence: The Place of Fetal Therapy

2014 ◽  
Vol 17 (6) ◽  
pp. 589-593 ◽  
Author(s):  
Thérèse H. Griersmith ◽  
Alison M. Fung ◽  
Susan P. Walker
Keyword(s):  
Preterm Labour ◽  
Multiple Pregnancy ◽  
Unintended Consequence ◽  
In Vitro Fertilisation ◽  
Multiple Pregnancies ◽  
Triplet Pregnancy ◽  
Monochorionic Twins ◽  
Common Presentation

Monochorionic twins as part of a high order multiple pregnancy can be an unintended consequence of the increasingly common practice of blastocyst transfer for couples requiring in vitro fertilisation (IVF) for infertility. Dichorionic triamniotic (DCTA) triplets is the most common presentation, and these pregnancies are particularly high risk because of the additional risks associated with monochorionicity. Surveillance for twin-to-twin transfusion syndrome, including twin anemia polycythemia sequence, may be more difficult, and any intervention to treat the monochorionic pair needs to balance the proposed benefits against the risks posed to the unaffected singleton. Counseling of families with DCTA triplets is therefore complex. Here, we report a case of DCTA triplets, where the pregnancy was complicated by threatened preterm labour, and twin anemia polycythemia sequence (TAPS) was later diagnosed at 28 weeks. The TAPS was managed with a single intraperitoneal transfusion, enabling safe prolongation of the pregnancy for over 2 weeks until recurrence of TAPS and preterm labour supervened. Postnatal TAPS was confirmed, and all three infants were later discharged home at term corrected age, and were normal at follow-up. This case highlights that in utero therapy has an important role in multiple pregnancies of mixed chorionicity, and can achieve safe prolongation of pregnancy at critical gestations.

scholarly journals Resuscitative hysterotomy for maternal collapse in a triplet pregnancy

2020 ◽  
Vol 13 (7) ◽  
pp. e235328
Author(s):  
Zenab Yusuf Tambawala ◽  
Masuma Cherawala ◽  
Sadia Maqbool ◽  
Lama Khalid Hamza
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Output ◽  
Cardiopulmonary Resuscitation ◽  
Maternal Age ◽  
Gravid Uterus ◽  
In Vitro Fertilisation ◽  
Multiple Pregnancies ◽  
Triplet Pregnancy

We encountered a 47-year-old woman, at 35 weeks of gestation, carrying triplets, who attended the hospital with severe pre-eclampsia and at admission had eclamptic fit followed by cardiac arrest. Cardiopulmonary resuscitation was started when she did not respond to initial measures; resuscitative hysterotomy was started on the site of collapse immediately, within 4 min postarrest, to deliver the triplets within 5 min postmaternal cardiac arrest. Timely decision of resuscitative hysterotomy done primarily to restore maternal cardiac output due to a grossly gravid uterus saved the mother and the triplets. With increasing maternal age and use of in vitro fertilisation resulting in multiple pregnancies, maternal comorbidities are more likely. These could result in maternal collapse in which case timely resorting to resuscitative hysterotomy can make survival of mother and feti more likely.

Preterm labour in multiple pregnancies

1993 ◽  
Vol 5 (2) ◽  
pp. 105-119 ◽  
Author(s):  
James P Neilson ◽  
Caroline A Crowther
Keyword(s):  
Perinatal Mortality ◽  
Preterm Labour ◽  
Multiple Pregnancy ◽  
High Rate ◽  
Fetal Malformation ◽  
Multiple Pregnancies ◽  
Neonatal Deaths ◽  
Late Abortion ◽  
Early Neonatal Deaths ◽  
Singleton Pregnancies

Multiple pregnancy is associated with a high rate of perinatal loss – mainly due to preterm labour but with important contributions from fetal malformation, intrauterine growth retardation and twin-twin transfusion syndrome. The overall perinatal mortality rate is consistently around six times that of singleton pregnancies but the rate rises progressively with the number of fetuses. Rates of 63,164,200,214 and 416 per 1000 births have been recently reported for twins, triplets, quadruplets, quintuplets and sextuplets respectively. In addition to these alarming figures, it should be emphasized that the restricted concept of perinatal mortality obscures the real extent of loss. If we include late abortion (after 20 weeks), late neonatal deaths and deaths in infancy from perinatal causes, as well as the usual indices of perinatal mortality (stillbirths and early neonatal deaths) we find that the total loss rate from twin pregnancy alone doubles and may be close to 10%. Although the rate of loss from multiple pregnancies is now substantially higher than that associated with the pregnancies of diabetic women, the challenge of multiple pregnancy has not been met with the same commitment or organisation of specialized perinatal services as has diabetes.

In-vitro fertilisation and risk of multiple pregnancy

The Lancet ◽  
2002 ◽  
Vol 360 (9330) ◽  
pp. 414
Author(s):  
Ozkan Ozturk ◽  
Allan Templeton
Keyword(s):  
Multiple Pregnancy ◽  
In Vitro Fertilisation

scholarly journals Antenatal fetal death in multiple pregnancy: is early prediction possible?

2021 ◽  
Vol 14 (6) ◽  
pp. 602-611
Author(s):  
V. I. Tsibizova ◽  
D. V. Blinov ◽  
V. O. Bitsadze ◽  
T. M. Pervunina ◽  
E. V. Komlichenko ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Reference Values ◽  
Fetal Death ◽  
Multiple Pregnancy ◽  
First Trimester ◽  
Multiple Pregnancies ◽  
Vitro Fertilization ◽  
Diagnostic Potential ◽  
Increased Risk

Introduction. Perinatal mortality in multiple pregnancies increases by 8–10 times compared to singletons. Stillbirth is a significant part of all complications of multiple pregnancies. Although the incidence of perinatal mortality in multiple pregnancies has decreased consistently compared to extremely high rates in the past, it remains relatively high, despite significant positive changes in the management of such pregnancies. Aim: to assess the diagnostic potential of the first trimester's biochemical screening in multiple pregnancies for predicting antenatal fetal death. Materials and Methods. As part of a retrospective study, a cohort of twin pregnancies after in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or spontaneous conception underwent screening of the first trimester at 11+0–13+6 weeks of gestation as recommended by the Fetal Medicine Foundation. Determination of pregnancy-associated plasma protein-A (PAPP-A) in blood serum with subsequent calculation of the relative PAPP-A MoM (multiples of median) – a multiple of the median (an indicator of how much the individual test result deviates from the reference values) was performed. Results. Prenatal screening and outcomes of 302 multiple pregnancies showed that with PAPP-A MoM < 0.5, antenatal fetal death occurred with a frequency of 42.86 % (6/14), with PAPP-A MoM within the reference values – In 12.67 % (28/221), with PAPP-A MoM > 2.0 – in 6.7 % (2/30). Differences between patients with PAPP-A MoM < 0.5 and PAPP-A MoM within the reference values, as well as PAPP-A MoM < 0.5 and PAPP-A MoM > 2.0 were statistically significant (p = 0.002 and p = 0.004, respectively). No differences were detected between spontaneous and assisted reproductive technology (ART) pregnancies. Conclusion. In women with multiple pregnancies resulting from ART or spontaneous, PAPP-A MoM values below the reference interval (< 0.5) in the first trimester are associated with an increased risk of antenatal fetal death.

scholarly journals Single Fetal Death in Triplet Pregnancy

2014 ◽  
Vol 26 (1) ◽  
pp. 69-70
Author(s):  
Syeda Nazia Akhter ◽  
Rumana Sheikh ◽  
Ahmad Sharif Russo ◽  
Sumaya Tasneem
Keyword(s):  
Fetal Death ◽  
Neonatal Outcome ◽  
Multiple Pregnancy ◽  
Psychological Support ◽  
Triplet Pregnancy ◽  
Mortality And Morbidity ◽  
Risk Of Mortality ◽  
Proper Diagnosis ◽  
Medicine Today

The single fetal death in multiple pregnancy is not rare. Death of one fetus in multiple pregnancy increases the risk of mortality and morbidity of the surviving fetus. Proper diagnosis and intervention in appropriate time can improve the maternal and neonatal outcome. Adequate counselling psychological support and close follow up are mandatory. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21320 Medicine Today 2014 Vol.26(1): 69-70

scholarly journals Risks and challenges in multiple pregnancy

2021 ◽  
Vol 10 (12) ◽  
pp. 4578
Author(s):  
Aditi Agarwal ◽  
Arti Sharma ◽  
Neeta Bansal ◽  
Neha Panwar ◽  
Shweta Singh ◽  
...  
Keyword(s):  
Placenta Previa ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
Obstetric Care ◽  
Elevated Risk ◽  
Multiple Pregnancies ◽  
Triplet Pregnancy ◽  
Mother And Child ◽  
Fetal Complications ◽  
Fetal Malformations

Because of breakthroughs in reproductive medicine, multiple pregnancies have become more common in the industrialized world. As a result, obstetric care for women with multiple pregnancies and neonatal care for the same has become more demanding. Multifetal pregnancies are linked to an elevated risk for both the mother and child. There is increased incidence of obstetric complications such as spontaneous abortion, hypertensive disorders, placenta previa, and fetal malformations. Perinatal outcome is also affected which is attributable to increased incidence of fetal complications like prematurity, congenital malformations, growth discordance and cord accidents. We are presenting 2 cases, one of MCMA twin pregnancy with fetal congenital anomaly and another of a triplet pregnancy and their perinatal outcomes.

scholarly journals Twin pregnancy, fetal reduction and the 'all or nothing problem’

2020 ◽  
pp. medethics-2020-106938
Author(s):  
Joona Räsänen
Keyword(s):  
Moral Theory ◽  
Twin Pregnancy ◽  
Assisted Reproductive Technologies ◽  
Multiple Pregnancy ◽  
Reproductive Technologies ◽  
In Vitro Fertilisation ◽  
Singleton Pregnancy ◽  
Fetal Reduction ◽  
Health Related

Fetal reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. Use of assisted reproductive technologies increases the likelihood of multiple pregnancies, and many fetal reductions are done after in vitro fertilisation and embryo transfer, either because of social or health-related reasons. In this paper, I apply Joe Horton’s all or nothing problem to the ethics of fetal reduction in the case of a twin pregnancy. I argue that in the case of a twin pregnancy, there are two intuitively plausible claims: (1) abortion is morally permissible, and (2) it is morally wrong to abort just one of the fetuses. But since we should choose morally permissible acts rather than impermissible ones, the two claims lead to another highly implausible claim: the woman ought to abort both fetuses rather than only one. Yet, this does not seem right. A plausible moral theory cannot advocate such a pro-death view. Or can it? I suggest ways to solve this problem and draw implications for each solution.

scholarly journals Hearing function in twins from spontaneous and induced pregnancy

2019 ◽  
Vol 64 (5) ◽  
pp. 49-54
Author(s):  
I. V. Rakhmanova ◽  
L. G. Sichinava ◽  
S. Yu. Lebedeva
Keyword(s):  
Otoacoustic Emissions ◽  
Assisted Reproductive Technologies ◽  
Multiple Pregnancy ◽  
Reproductive Technologies ◽  
High Risk Group ◽  
Multiple Pregnancies ◽  
Auditory Function ◽  
Vitro Fertilization ◽  
Distortion Product

In recent years, an increase in the frequency of multiple pregnancies has been observed worldwide, which is primarily associated with the widespread use of assisted reproductive technology for the treatment of infertility. Pregnancy resulting from in vitro fertilization is a high-risk group. In the world scientific literature there are practically no works on the study of auditory function in children from multiple pregnancy. As for the studies of the auditory function of children from multiple pregnancies, such works are practically absent in the literature. The article presents the results of an audiological examination of 204 children from twins, 94 of which were born as a result of using assisted reproductive technologies, and 110 from a spontaneous multiple pregnancy. According to an audiological survey using the method of otoacoustic emission at the frequency of product distortion in the expected period of labor, we have proven that the conception method (spontaneous or induced) does not affect the maturation of the auditory function in children from twins: registration of the distortion product otoacoustic emissions (DPOAE) test is 56,1 and 54,4% of cases, respectively. The auditory function of each child from one twin must be considered individually.

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