Biomedical subjects
Publications and source records attributed to W Malinowski.
This study is a prospective review of 136 multiple gestations identified sonographically in the first trimester. Of these, 35 (25.7%) demonstrated the "vanishing twin" phenomenon, often with associated bleeding. The prognosis for the remaining fetus/fetuses was a good in dichorionic and bad in monochorionic twin pregnancy.
The onset of labor in the pregnant women with multiple gestation brings the obstetrician and perinatologist to another decision point. What mode of delivery is most appropriate: cesarean section or vaginal delivery? The aim of the study was to analyze the twin pregnancy delivery, the mode of delivery and neonatal well being.
The paper summarized the program of prenatal management of multiple pregnancy. The need for outpatient multiple pregnancy clinic is stressed.
The purpose of this study was to evaluate the relationship between the yolk sacs separated or not separated by septum and chorionicity twin pregnancies scanned early in the first trimester. Moreover, to determine the relation between size and morphologic features of the yolk sac and outcome twin pregnancy. Twenty four of 38 spontaneous twin pregnancies were dichorionic, eight--monochorionic diamniotic, five monochorionic twin gestations with discordant sizes and views of yolk sacs, and one a twin ectopic pregnancy (underwent salpingectomy). In all 38 sets of twin two yolk sacs were identified. During the first trimester of dichorionic twin pregnancy, the yolk sacs were always separated by a septum and not separated ("Eight" sign) in monochorionic twin pregnancy. In five cases, one of yolk sacs was abnormally large (> 8 mm) and had thinner wall. Three (all MC) of the five mothers spontaneously aborted during the next 2-3 weeks. In one case of monochorionic twin ectopic pregnancy two yolk sacs were seen normally. The sonographic identification of yolk sacs allows a reliable and simple determination chorionicity twin pregnancy. Moreover, visualization of large size (> 8 mm) of yolk sac can be used as a predictor of abnormal outcome pregnancy.
Intrauterine fetal death of one twin in second trimester is a rare obstetric complication. The choice of management of the mother and viable twin is very complex and difficult. This study is a prospective review of 11 twin gestations involving the intrauterine death of one fetus in second trimester. The obstetrical history, placental pathology, autopsy findings, and neonatal history of the surviving infant are reviewed.
OBJECTIVE: The purpose of this study was to evaluate the relationship between the yolk sacs separated or not separated by septum and chorionicity twin pregnancies scanned early in the first trimester, and the relation between size and morphologic features of the yolk sac and the outcome of twin pregnancies. RESULTS: In all 38 sets of twins two yolk sacs were identified. During the first trimester of a dichorionic twin pregnancy, the yolk sacs were always separated by a septum and not separated ("Eight" sign) in monochorionic twin pregnancy. In five cases, one of yolk sac was abnormally large (> 8 mm) and had thin wall. Four of the five mothers spontaneously aborted during the next 2-3 weeks. In one case of monochorionic twin ectopic pregnancy two yolk sacs were seen normally. CONCLUSION: The sonographic identification of yolk sacs in multiple pregnancies allows an early and efficient recognition of presence and chorionicity of twin pregnancy, both in intra- and extrauterine. Identification of abnormal yolk sac or yolk sacs suggests death of one or all embryos.
Twin reversed arterial perfusion (TRAP) syndrome is a rare but severe complication of monozygotic monochorionic twin pregnancies. The outcome is invariably fatal for the abnormal twins and for 50-75% of the normal co-twins. The prenatal diagnosis of the TRAP always has to be presumed in a multiple pregnancy within which a twin pair grows whenever cardiac activity can not be proved echographically. We present discuss--based upon literature research--pathogenic mechanisms, pathologic-anatomic, echographic diagnosis and management of these high-risk pregnancies.
OBJECTIVE: The aim was to determine the chorionic and amniotic types in multifetal pregnancies with transvaginal ultrasonography at very early stage of gestation. STUDY DESIGN: Twenty-one spontaneous multifetal pregnancies were scanned transvaginally before 8 weeks' gestation (four of them from 4th week). The chorionic and amniotic type was determined ultrasonographically. All twin gestations had postpartum pathologic evaluation of the placenta and histologic determination of the chorionic and amniotic type. RESULTS: Ultrasonographic evaluation of the 21 pregnancies demonstrated 20 twin and 1 triplet gestation. Four of the twin pregnancies were monochorionic-diamniotic. Triplet was monochorionic-triamniotic (spontaneously aborted in 8th week of gestation). In all 20 twin pregnancies, transvaginal ultrasonography correctly predicted the chorionic and amniotic type before 8 weeks of gestation. CONCLUSION: Transvaginal ultrasonography allows a reliable, simple and rapid determination; the dichorionic twin pregnancy in 4 weeks, monochorionic in 5 weeks, and differentiation of mono- or diamniotic in 7 weeks of gestation.
The authors describe the case of gastroschisis and Dandy-Walker syndrome of the surviving fetus after the intra-uterine co-twin demise in a monochorionic twin pregnancy.
The authors present gastroschisis which occurred in a surviving fetus after the co-twin demise in a monochorionic pregnancy. They analyze the problems of prenatal ultrasound diagnosis of gastroschisis stressing the adequate planning of delivery with necessary additional diagnostic and therapeutic efforts.
This paper summarizes our experience with Doppler velocimetry in survivors of intrauterine co-twin demise. In the first trimester, ten dichorionic deaths occurred; none of the survivors developed flow disorders. During the second trimester, there were three intrauterine demises, two of them were monochorionic and the survivors developed flow disorders: one presented transitory venous flow aberration, the other one an impaired development of diastolic flow. In the third trimester, two intrauterine deaths occurred. One case of twin to twin transfusion syndrome (TTTS) was complicated by the donor's death and the recipient showed a loss of diastolic flow. The second one happened during a dichorionic twin pregnancy. The survivor presented high systolic/diastolic daily ratio (S/D = 7.8).
Our study reports five cases of prenatal ultrasound diagnosis of nuchal cystic hygroma and early diagnosis for both fetus and mother. We observed that nuchal cystic hygroma is frequently associated to cytogenetic abnormalities, congenital structural anomalies and non-immune hydrops fetus universalis.
The term gestational trophoblastic disease is used to indicate a group of both benign and malignant trophoblast, including molar degeneration of villi, hydatid mole, invasive mole and choriocarcinoma. This study shows a new classification of trophoblastic disease existing with a living fetus or fetuses. Benign hydatid mole is the initial stage of the disease continuum, whereas highly malignant choriocarcinoma is the final stage of this spectrum.
The acute form of twin-to-twin transfusion syndrome is caused by rapid transfer of blood from one of the twins to another via placental anastomoses. Usually, this only occurs during the second stage of labour as a result of a sudden relative rise of blood pressure in one of the fetal circulations. This can result in the sudden intrauterine death of a fetus (or both, as in our case). Currently, there is no reliable means of identifying such an at-risk pregnancy by means of ultrasound antenatally. We would classify this as TTTS Type III.
Authors characterized the Doppler indices asymmetry phenomenon on two exemplary cases. This phenomenon is due to placenta asymmetry. The impact on methodology of the Doppler examination is pinpointed.
The authors did analyzed Doppler indices in 26 twin pregnancies recognized by ultrasound in the first trimester, 20% of them resulted in singleton birth. There were disturbances of arterial and venous flow in cases of fetal demise occurring in the second and third trimester.
The diagnosis of abruptio placentae praecox of the second twin is usually difficult. The clinical symptoms may not be evident. The appearance of the new (third) hypoechogenic space, on ultrasound scan, was in our case the only diagnostic clue. It proved to be blood from the abrupted edge of twin B's placenta penetrating the dividing septum. Its characteristic ultrasound image brought forward the idea and namegiving 'boomerang phenomenon' and indeed, it could return like a boomerang as the intrauterine fetal demise, if ignored. This picture could mislead to the conclusion of being the leakage of amniotic fluid or the amniotic sack of the 'vanishing fetus' in primarily triplet pregnancy. The potentially ominous prognosis of abruptio placentae praecox warrants strict supervision of pregnancies with this phenomenon.
The course of preeclamptic/eclamptic patients may be complicated by HELLP syndrome, a syndrome of intravascular hemolysis (H), elevated liver enzymes (EL) and low platelets count (LP). These patients typically present at early third trimester with epigastric or right upper quadrant pain, nausea and vomiting. They may present without the clinical signs of preeclampsia. The most frequent maternal complication are intravascular coagulopathy and acute renal failure. The grave prognosis for mother and fetus warrants physician awareness in order to accomplish early diagnosis and proper management.