Pregnancy Loss: Multiple Pregnancy versus Multiple Birth

2005 ◽  
pp. 282-284 ◽  
Keyword(s):  
Pregnancy Loss ◽  
Multiple Pregnancy ◽  
Multiple Birth

Spontaneous loss of a co-twin and the risk of birth defects after assisted conception

2016 ◽  
Vol 7 (6) ◽  
pp. 678-684 ◽  
Author(s):  
M. J. Davies ◽  
A. R. Rumbold ◽  
M. J. Whitrow ◽  
K. J. Willson ◽  
W. K. Scheil ◽  
...  
Keyword(s):  
Birth Defects ◽  
Pregnancy Loss ◽  
Multiple Pregnancy ◽  
Fetal Loss ◽  
South Australia ◽  
Increased Risk ◽  
Study Population ◽  
Infertility Patients ◽  
Twin Pregnancies ◽  
Singleton Pregnancies

The study of very early pregnancy loss is impractical in the general population, but possible amongst infertility patients receiving carefully monitored treatments. We examined the association between fetal loss and the risk of birth defects in the surviving co-twin in a retrospective cohort study of infertility patients within an infertility clinic in South Australia from January 1986 to December 2002, linked to population registries for births, terminations and birth defects. The study population consisted of a total of 5683 births. Births from singleton pregnancies without loss were compared with survivors from (1) pregnancies with an empty fetal sac at 6–8 weeks after embryo transfer, (2) fetal loss subsequent to 8-week ultrasound and (3) multiple pregnancy continuing to birth. Odds ratios (OR) for birth defects were calculated with adjustment for confounders. Amongst infertility patients, the prevalence of birth defects was 7.9% for all twin pregnancies without fetal loss compared with 14.6% in pregnancies in which there had been an empty sac at ultrasound, and 11.6% for pregnancies with fetal loss after 6–8 weeks. Compared with singleton pregnancies without loss, the presence of an empty sac was associated with an increased risk of any defect (OR=1.90, 95% confidence intervals (CI)=1.09–3.30) and with multiple defects (OR=2.87, 95% CI=1.31–6.28). Twin pregnancies continuing to birth without loss were not associated with an overall increased prevalence of defects. We conclude that the observed loss of a co-twin by 6–8 weeks of pregnancy is related to the risk of major birth defects in the survivor.

A Study of Maternity Provision in the UK in Response to the Needs of Families Who Have a Multiple Birth

1992 ◽  
Vol 41 (4) ◽  
pp. 353-364 ◽  
Author(s):  
J.R. Spillman
Keyword(s):  
Social Services ◽  
Current Practice ◽  
Multiple Pregnancy ◽  
Higher Order ◽  
Multiple Birth ◽  
Successful Result ◽  
Social And Emotional ◽  
Care And Support ◽  
High Risk Infants ◽  
The Uk

Multiple pregnancy is NEVER planned. A few years ago one could categorically make such a statement. Perhaps nowadays one cannot be so sure. Although parents are still unlikely to be able to plan such an event, it does seem that current infertility treatments may allow or even encourage practitioners to use methods which predispose to a multiple pregnancy. The practice of returning several fertilised embryos to the uterus in the hope of achieving a successful result has meant that many parents who longed for a baby have had to adjust to the realisation of a multiple pregnancy with all the effects such an occurrence has on family physical, social and emotional resources.The Study of Triplets and Higher Order Births by the Office of Population Censuses and Surveys [1] highlighted the striking increase in Multiple Births in recent years. This was particularly evident in the case of triplets and higher order births. (Fig. 1) Care of these high-risk infants is costly in resources and no increased funding has been given to the National Health Service or Social Services budgets to provide care and support for the families.This study endeavours to ascertain the needs of such families preconceptually, antenatally, intra-partum, postnatally and in the early months following the birth. It also tries to assess how appropriate current practice is in meeting these needs.

Errors in Birth Registrations and Coding of Twins and Higher Order Multiples

Twin Research ◽  
2002 ◽  
Vol 5 (4) ◽  
pp. 270-272 ◽  
Author(s):  
Peter O.D. Pharoah
Keyword(s):  
Infant Death ◽  
Death Certificate ◽  
Multiple Pregnancy ◽  
Higher Order ◽  
Multiple Births ◽  
Multiple Birth ◽  
Multiple Pregnancies ◽  
England And Wales ◽  
Parental Counselling

AbstractDizygotic compared with monozygotic conceptions are at decreased risk of fetal and infant death and serious morbidity in surviving infants. Different sex twin maternities must be dizygotic but miscoding and incorrect registration of sex and number of fetuses may lead to an incorrect assignment of zygosity. The aim of the study was to validate the coding and registration of number and sex of births in multiple pregnancies. Fetal and infant death registrations from all multiple maternities in England and Wales 1993–1998 were examined. There were 51,792 twin, 1627 triplet and 51 higher order multiple maternities that were registered. Among these there were 1926 fetal deaths, 58 of which were registered as being of indeterminate sex but were coded as male in 56 and female in 2 cases. A fetus papyraceous was registered as male in 19 and as female in 19 cases. Other fetal deaths weighing ≤100g, with no mention of papyraceous on the death certificate, nevertheless, likely to be of indeterminate sex, were registered as male in 26 and as female in 23 cases. In 13 maternities, the number of infants registered at birth was less than the number mentioned on the registration certificate. It cannot be assumed that multiple births of different registered sex are dizygotic. As surviving infants from a monozygotic multiple birth are at much greater risk of infant death and serious morbidity than dizygotic multiple births, incorrect assignment of sex has important implications for parental counselling and may have medicolegal relevance when attributing negligence as the cause of morbidity in a survivor from a multiple pregnancy.

scholarly journals Does the transfer of a poor quality embryo with a good quality embryo benefit poor prognosis patients?

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Wenjie Wang ◽  
Jiali Cai ◽  
Lanlan Liu ◽  
Yingpei Xu ◽  
Zhenfang Liu ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Poor Prognosis ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Poor Quality ◽  
Single Embryo Transfer ◽  
Multiple Birth ◽  
Good Quality Embryo

Abstract Background While single embryo transfer (SET) is widely advocated, double embryo transfer (DET) remains preferable in clinical practice to improve IVF success rate, especially in poor prognosis patients with only poor quality embryos (PQEs) available in addition to one or no good quality embryos (GQEs). Furthermore, previous studies suggest PQE might adversely affect the implantation of a GQE when transferred together. This study aims to evaluate the effect of transferring an additional PQE with a GQE on the outcomes in poor prognosis patients. Methods A total of 5037 frozen-thawed blastocyst transfer (FBT) cycles between January 2012 and May 2019 were included. Propensity score matching was applied to control for potential confounders, and we used generalized estimating equations (GEE) models to identify the association between the effect of an additional PQE and the outcomes. Results Overall, transferring a PQE with GQE (Group GP) achieved significantly higher pregnancy rate (PR), live birth rate (LBR) and multiple pregnancy rate (MPR) than GQE only (group G). The addition of a PQE increased LBR in patients aged 35 and over and in patients who received over 3 cycles of embryo transfer (ET) (48.1% vs 27.2%, OR:2.56, 95% CI: 1.3–5.03 and 46.6% vs 35.4%, OR:1.6, 95% CI: 1.09–2.35), but not in women under 35 and in women who received less than 3 cycles of ET (48.7% vs 43.9%, OR:1.22, 95% CI: 0.93–1.59 and 48.3% vs 41.4%, OR:1.33, 95% CI: 0.96–1.85). Group GP resulted in significantly higher MPR than group G irrespective of age and the number of previous IVF cycles. Conclusions An additional PQE does not negatively affect the implantation potential of the co-transferred GQE. Nevertheless, the addition of a PQE contributes to both live birth and multiple birth in poor prognosis patients. Physicians should still balance the benefits and risks of DET.

What Information Should the Multiple Birth Family Receive Before, During and After the Birth?

1990 ◽  
Vol 39 (2) ◽  
pp. 259-269 ◽  
Author(s):  
D.A. Hay ◽  
C. Gleeson ◽  
C. Davies ◽  
B. Lorden ◽  
D. Mitchell ◽  
...  
Keyword(s):  
Multiple Pregnancy ◽  
Multiple Birth ◽  
Service Access ◽  
Vitro Fertilization ◽  
Fertility Drugs ◽  
Conflicting Demands ◽  
Pregnancy And Delivery ◽  
Major Review ◽  
Birth Family

AbstractAdvances in the management of the multiple pregnancy and delivery must be accompanied by corresponding improvements in service access outside key centres and especially in the information families receive about what may happen during or after the pregnancy. A major review of birthing services in Victoria has focussed attention on four areas where the quality of information is often inadequate. 1) Prepregnancy and the standard of counselling about the incidence of multiples as a result of fertility drugs and in vitro fertilization procedures and about problems which may accompany a multiple birth. 2) Antenatal: At what stage of the pregnancy should parents be told of the multiple pregnancy and how should monitoring of the mother and procedures such as bedrest take into account what are often conflicting demands within the family? 3) Perinatal: Families are frequently illprepared for a cesarean delivery and for the procedures for premature multiples. The problem is often compounded by separation of the mother from one or both twins. While bereavement services are improving, much still needs to be learned about handling congenital abnormalities in one or more multiples. 4) Postnatal: Irrespective of the level of prenatal advice, families greatly underestimate the workload with multiples. The resulting stress contributes to the incidence of postnatal depression, child abuse and divorce now being reported from multiple birth families. Some suggestions are made from social psychology and genetic counselling about how families can best handle risk information to achieve the goal of neither under- nor overestimating the risks at these different stages of the multiple pregnancy.

scholarly journals Twins in Dairy Herds. Is It Better to Maintain or Reduce a Pregnancy?

Animals ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 2006 ◽  
Author(s):  
Fernando López-Gatius
Keyword(s):  
Pregnancy Loss ◽  
Animal Health ◽  
Multiple Pregnancy ◽  
Prostaglandin F2α ◽  
Hormone Treatment ◽  
Dairy Herds ◽  
Multiple Pregnancies ◽  
Pregnancy Diagnosis ◽  
Best Management ◽  
Twin Pregnancies

Multiple ovulations and so multiple pregnancies have increased recently in dairy cattle. The incidence of the double ovulation impact in high producers at insemination may be over 20%. Twin pregnancies are undesirable as they seriously compromise the welfare and productive lifespan of the cow and herd economy. Clinical problems extend from the time of pregnancy diagnosis to pregnancy loss, abortion or parturition. Early pregnancy loss or abortion of multiple pregnancies lead in most cases to culling. In cows reaching their term, mean productive lifespan is up to about 300 days shorter for cows delivering twins than for cows delivering singletons. While there is an urgent need to address multiple pregnancy prevention procedures in the foreseeable future, the incidence of twin pregnancies continues to rise in parallel with increased milk production. Herein, we review two contrasting measures proposed for the time of twin pregnancy diagnosis: (1) gonadotropin-releasing hormone treatment for pregnancy maintenance, or (2) embryo reduction. These options are discussed in terms of their implications for individual animal health and herd economy. Our main conclusions find that manual twin reduction has proven to be the best management option, whereas the use of prostaglandin F2α for inducing abortion may be a better option than doing nothing.

scholarly journals Safety and Efficacy of Higher Order Multifetal Pregnancy Reduction: A Single-Center Retrospective Study

2020 ◽  
Vol 10 (03) ◽  
pp. e228-e233
Author(s):  
Yan Liu ◽  
Xie Tong Wang ◽  
Hong Yan Li ◽  
Hai Yan Hou ◽  
Hong Wang ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Birth Weight ◽  
Pregnancy Loss ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
Higher Order ◽  
Sample Population ◽  
Safety And Efficacy ◽  
Multifetal Pregnancy ◽  
Multifetal Pregnancy Reduction

Abstract Objective This research was aimed to study the safety and efficacy of higher order multifetal pregnancy reduction (MFPR). Study Design This was a retrospective study of patients from an academic maternity center between 2005 and 2015. We evaluated outcomes of 131 consecutive patients who underwent higher order MFPR (quadruplets and greater). MFPR was performed at 11 to 18 weeks of gestation in all cases. In total, 122 of 131 cases of higher order multiple pregnancy were reduced to twins. We discuss the perinatal outcomes of patients who underwent higher order MFPR, followed by a comparative analysis between the 122 cases of MFPR that were reduced to twins and 101 cases of nonreduced twin pregnancies. Results The study included 104 sets of quadruplets, 20 sets of quintuplets, 5 sets of sextuplets, 1 set of septuplets, and 1 set of octuplets. The perinatal outcomes of the 131 cases were as follows: pregnancy loss, preterm deliveries at 28 to 33 (+6/7) weeks, and preterm deliveries at 34 to 36 (+6/7) weeks occurred in 23.66, 9, and 37% of cases, respectively. The mean time of delivery was 36.56 ± 1.77 weeks, and mean birth weight was 2,409.90 ± 458.16 g, respectively. A total of 122 cases that were reduced to twins were compared with nonreduced twins. The pregnancy loss rate for reduced twins was significantly higher than that for nonreduced twins. The preterm labor rate, mean delivery week, mean birth weight, birth-weight discordance, incidence of gestational diabetes mellitus, and pregnancy-induced hypertension were not significantly different between the groups (p > 0.05). Conclusion Perinatal outcomes were significantly improved by reducing the number of fetuses in higher order multifetal pregnancies. This study involved a large, diverse sample population, and the results can be used as a reference while conducting prenatal counseling.

The North of England Multiple Pregnancy Register: Five-Year Results of Data Collection

2006 ◽  
Vol 9 (6) ◽  
pp. 913-918 ◽  
Author(s):  
Martin P. Ward Platt ◽  
Svetlana V. Glinianaia ◽  
Judith Rankin ◽  
Chris Wright ◽  
Marjorie Renwick ◽  
...  
Keyword(s):  
Data Collection ◽  
Gestational Age ◽  
Multiple Pregnancy ◽  
Population Based ◽  
Multiple Birth ◽  
Multiple Pregnancies ◽  
The North ◽  
Explicit Consent ◽  
Health And Social Care ◽  
Risk Rate

AbstractFrom 1998 the population-based North of England Multiple Pregnancy Register (MPR) has collected data on all multiple pregnancies in the region from the earliest point of ascertainment in the pregnancy. This article describes the development of the MPR and the findings of the first 5 years of data collection. Mothers now give explicit consent for their inclusion with named data, in accordance with section 60 of the Health and Social Care Act 2001. During 1998 to 2002, 2310 twin pregnancies were registered, with an increasing twinning rate of 13.6 to 16.6 per 1000 maternities. Chorionicity ascertainment in twin maternities with at least one stillbirth or live birth has improved from 81% in 1998 to 91% in 2002. Before 24 weeks of gestation, 8.4% (359/4620) of fetuses were lost either spontaneously or as a result of termination of pregnancy. The perinatal mortality rate was much higher in monochorionic than dichorionic twins, mainly due to differences in stillbirth rates (49.0 vs. 11.5 per 1000 maternities respectively, risk rate = 4.2; 95% confidence intervals 2.7–6.6). The gestational-age-specific neonatal mortality rates were similar in twins and singletons, except in the group of term births (≥37 weeks' gestation) when compared by conventional gestational age categories. For stillbirths, the rates were even lower than in singletons in gestational age categories of less than 32 weeks. The register is an important resource of data on multiple pregnancies, which allows monitoring of trends in multiple birth rates and pregnancy losses and provides a unique opportunity for etiological and long-term follow-up studies.

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