Twin pregnancy outcome of our clinic: A three- year follow up

Monoamniotic twin pregnancy is a rare type of twin pregnancy which poses risk of cord entanglement and sudden death of either one or both fetuses. The role of antenatal surveillance by Ultrasound Doppler for umbilical cord and ultrasonic evidence of cord entanglement or knotting may predict the pregnancy outcome but yet unavoidable. The discussion will include antenatal surveillance in this rare type of pregnancy.

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Effect of the trends of estradiol level on the outcome of in vitro fertilization-embryo transfer with antagonist regimens: a single center retrospective cohort study

10.21203/rs.3.rs-1066884/v1 ◽

2021 ◽

Author(s):

Chun-Xiao Wei ◽

liang zhang ◽

Cong-Hui Pang ◽

Ying-Hua qi ◽

Jian-Wei Zhang

Keyword(s):

In Vitro Fertilization ◽

Pregnancy Rate ◽

Pregnancy Outcome ◽

Embryo Transfer ◽

Ovarian Response ◽

Vitro Fertilization ◽

The Relationship ◽

Estradiol Levels

Abstract BackgroundThe outcome of in vitro fertilization-embryo transfer is often determined according to follicles and estradiol levels following gonadotropin stimulation. However, there is no accurate indicator to predict pregnancy outcome, and it has not been determined how to choose subsequent drugs and dosage based on the ovarian response. This study aimed to make timely adjustments to follow-up medication to improve clinical outcomes based on the potential value of estradiol growth rate. MethodsSerum estradiol levels were measured on the day of gonadotrophin treatment (Gn0), four days later (Gn4), seven days later (Gn7), and on the trigger day (HCG). The ratio was used to determine the increase in estradiol levels. According to the ratio of estradiol increase, the patients were divided into four groups: group A1 (Gn4/Gn0≤6.44), group A2 (6.44˂Gn4/Gn0≤10.62), group A3 (10.62˂Gn4/Gn0 ≤21.33), and group A4 (Gn4/Gn0>21.33); group B1 (Gn7/Gn4≤2.39), group B2 (2.39˂Gn7/Gn4≤3.03), group B3 (3.03˂Gn7/Gn4≤3.84), and group B4 (Gn7/Gn4>3.84). We analyzed and compared the relationship between data in each group and pregnancy outcome. ResultsIn the statistical analysis, the estradiol levels of Gn4 (P = 0.029, P = 0.042), Gn7 (P< 0.001, P = 0.001), and HCG (P< 0.001, P = 0.002), as well as the ratios of Gn4/Gn0 (P = 0.004, P = 0.006), Gn7/Gn4 (P = 0.001, P = 0.002), and HCG/Gn0 (P< 0.001, P< 0.001) both had clinical guiding significance, and the lower one significantly reduced the pregnancy rate. The outcomes were positively linked to groups A (P = 0.040, P = 0.041) and B (P = 0.015, P = 0.017). The logistical regression analysis revealed that group A1 (OR = 0.440 [0.223–0.865]; P = 0.017, OR = 0.368 [0.169–0.804]; P = 0.012) and B1 (OR = 0.261 [0.126–0.541]; P< 0.001, OR = 0.299 [0.142–0.629]; P = 0.001) had opposite influence on outcomes. ConclusionMaintaining a serum estradiol increase ratio at least above 2.39 on Gn7/Gn4 may result in a higher pregnancy rate. When estradiol growth is not ideal, gonadotrophin dosage should be adjusted appropriately to ensure the desired outcome.

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Siamese twin pregnancy in peritoneal dialysis : first case in the world

Bulletin de la Dialyse à Domicile ◽

10.25796/bdd.v1i1.35 ◽

2018 ◽

Vol 1 (1) ◽

pp. 39-42

Author(s):

D El Hamssili ◽

T. Bouattar ◽

R. Bayahia ◽

L. Benamar

Keyword(s):

Peritoneal Dialysis ◽

Twin Pregnancy ◽

Antihypertensive Drugs ◽

Successful Pregnancy ◽

Dialysis Dose ◽

Cerebral Malformation ◽

Emergency Cesarean ◽

First Case ◽

Obstetrical Ultrasound

Introduction: The probability of conception is low in peritoneal dialysis (PD), and the probability of successful pregnancy is even lower. Nearly 60 years after the first reported case of successful pregnancy in a dialysis patient, many questions about pregnancy during dialysis remain unresolved, namely the required dialysis dose, the follow-up rhythm, the choice of the the most appropriate dialysis technique. Case report: We report the first case worldwide of twin Siamese pregnancy in a patient on continuous ambulatory peritoneal dialysis (CAPD). The pregnancy was diagnosed at 7 weeks of amenorrhea (WA). The patient was initially under 2 exchanges per day, with 2-liter bags of Dianealof 1.36% glucose. As soon as the pregnancy was discovered, the prescription was modified, putting the patient under 3 exchanges a day with the same concentrates. The infusion volume was maintained at 2 liters up to 18 WA , and then reduced to 1.5 liters due to patient discomfort and abdominal hyperpressure. Daily ultrafiltration ranged from 180 to 800 ml with 1 liter diuresis. The blood pressure was well controlled, with an average of 125/80 mmHg, without need of antihypertensive drugs. On a biological level, the Kt / V was 2.2, nPCR was 0.8, and the weekly clearance was 80 L / 1.73 m². The average hemoglobin was 11.5 g / dl under erythropoietin 9000 units per week. At 20 WA, obstetrical ultrasound revealed a mono-chorionic, mono-amniotic twin pregnancy. Due to high maternal and fetal risks, closer obstetrical control was indicated. At 24 WA, morphological obstetrical ultrasound coupled with Doppler examination of the uterine and umbilical arteries favored the diagnosis of mono-amniotic mono-chorionic twin pregnancy with strong suspicion of Siamese contiguous to the pelvis, with a cerebral malformation in one of the fetuses. The patient experienced intense contractions and pelvic pain leading to an emergency cesarean section with two surviving Siamese twins, contiguous to the pelvis, weighing 900g, but who died one day after delivery. Conclusion: Pregnancy during dialysis is at high maternal and fetal risks. It is necessary to prepare and follow this pregnancy to optimize the chances of success. This implies an adaptation of the medical treatment and dialysis prescription, including the volume and modality of exchanges. The same holds true for gynecological and obstetrical follow-up, which must be regular and strict, in order to prevent any maternal-fetal complications.

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MATERNAL COMPLICATIONS OF MULTIPLE GESTATIONS IN SECOND AND THIRD TRIMESTER OF PREGNANCY.

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2015.5.1.591-596 ◽

1969 ◽

Vol 5 (1) ◽

pp. 591-596

Author(s):

SAIMA KHATTAK ◽

MUHMMAD BILAL AWAN ◽

MUHMMAD DANYAL AWAN

Keyword(s):

Twin Pregnancy ◽

Reproductive Technologies ◽

High Order ◽

Multiple Gestation ◽

Third Trimester ◽

Triplet Pregnancy ◽

Maternal Complications ◽

Multiple Gestations ◽

Risk Pregnancy

BACKGROUND: In recent times, the incidence of multiple pregnancies has significantly increased dueto medication for induced ovulation and other reproductive technologies. The present study is designedto see the maternal complication of multiple gestations in pregnancy.OBJECTIVE: To determine the maternal complications associated with multiple gestation in secondand third trimester of pregnancy.METHODOLOGY: This descriptive study was carried out in the department of obstetrics andGynaecology unit at Lady Reading Hospital Peshawar. Duration of the study was 06 months from 1stJanuary 2012 to 1st July 2012. All patients with twin gestations, triplets and high order multiples visitingobstetrics and Gynaecology unit at Lady Reading Hospital Peshawar and who were admitted in wardwere included in the study and after taking informed consent their characteristics were recorded byfilling proforma.RESULTS: Sixty patients with multiple gestations were included in the study. Fifty four (90%) of themhad twin pregnancy and 06 (10%) had triplet pregnancy. The antenatal complications detected in thesepatients were preterm labour 23(32.3%), anaemia 18(30%), pregnancy induced hypertension, preeclamptic toxaemia, eclampsia 13(21.7%), Malpresentation 13(21.7%), Antepartum Haemorrhage 5(8.3%), 5 patients (8.3%) had PROM, 4 (6.7%) had polyhydramnios, 3(5%) had miscarriages, 5 (8.3%)had postpartum haemorrhage, 44(73.3%) patients had spontaneous vaginal delivery and 15(25%)underwent caesarean section. In 28(46.7%) patients cephalic/cephalic was the most commonpresentation.CONCLUSION: Multiple gestation is a high risk pregnancy and is associated with both maternal andfetal complications. Patient needs to be educated about the importance and advantages of early antenatalbooking and regular antenatal follow-up to reduce the risks to the mother and the babies.KEY WORDS: Twin pregnancy, Triplets, High-order multiplets; Complications-Second Trimester,Third trimester.

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Takotsubo cardiomyopathy complicating a twin pregnancy at partum

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195020 ◽

2019 ◽

Vol 7 (11) ◽

pp. 4375

Author(s):

B.V. Nagabhushana Rao ◽

A. Rekha ◽

A. Sankar Narayan ◽

A. Manjusha

Keyword(s):

Takotsubo Cardiomyopathy ◽

Twin Pregnancy ◽

Apical Ballooning ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Women Authors ◽

Ventricular Ejection Fraction ◽

Menopausal Women ◽

Post Menopausal

Takotsubo cardiomyopathy is a rare syndrome characterized by acute left ventricular dysfunction with regional left ventricular ballooning, mimicking myocardial infarction. This condition is often described in post-menopausal women. Authors present a case in an elderly primi with twin gestation immediately after Cesarean surgery. We discussed her presentation, investigations, diagnosis, management and outcome. 35 year female, a primi with twin pregnancy developed chest pain and shortness of breath immediately after Cesarean surgery. Her Electrocardiograph was abnormal, and Echocardiogram demonstrated abnormal apical ballooning of the left ventricle and severe dysfunction. Cardiac enzymes were elevated and chest skiagram showed pulmonary edema. She was managed in the intensive care unit with oxygen supplementation, diuretics and inotropes. She made an excellent recovery with normalization of left ventricular ejection fraction within 8 days. During the six months follow up, she was asymptomatic and left ventricular function remained normal.

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