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PubMed2003

Role of transvaginal sonographic cervical length in predicting spontaneous preterm delivery in triplet pregnancies with therapeutic cerclage.

OBJECTIVE: To assess the role of transvaginal sonographic cervical length in predicting spontaneous preterm delivery at < 32 weeks in patients with both triplet pregnancy and therapeutic cerclage. STUDY DESIGN: The maternal records of all triplet pregnancies with therapeutic cerclage and sonographic cervical length before and after cerclage were reviewed (n = 17). Each of these triplet gestations was matched with 2 triplet pregnancies without cerclage based on cervical length after cerclage (+/- 0.5 cm) and gestational age (+/- 3 weeks). Statistical analysis included Fisher's exact test or chi 2 analysis, one-way analysis of variance, logistic regression analysis and receiver operating characteristic curve analysis. RESULTS: Cerclage was placed at a gestational age of 19.0 +/- 3.1 weeks (mean +/- SD) and increased cervical length from 2.0 +/- 0.7 cm to 3.1 +/- 1.4 cm (P < .05). The rate of spontaneous preterm delivery at < 32 weeks was higher among cases than controls (7/17 vs. 4/27, P = .08). Logistic regression analysis demonstrated that only postcerclage cervical length was predictive of spontaneous preterm delivery at < 32 weeks, with a cervical length of 3.3 cm the optimal predictor. CONCLUSION: In women with triplets and therapeutic cerclage, the only significant predictor of spontaneous preterm delivery at < 32 weeks is cervical length after cerclage placement.

Adult↗
PubMed1992

Outcome of twin, triplet, and quadruplet in vitro fertilization pregnancies: the Norfolk experience.

OBJECTIVE: To review the maternal morbidity and neonatal morbidity and mortality associated with in vitro fertilization (IVF) multiple pregnancies. DESIGN: Retrospective analysis of data collected from office and hospital records and from questionnaires sent to patients, their obstetricians, and pediatricians. SETTING: Patients (all with private insurance carriers) enrolled in an academic IVF program (The Jones Institute for Reproductive Medicine). PATIENTS, PARTICIPANTS: All IVF pregnancies resulting in one or more gestational sacs on the initial ultrasound at 6 to 7 weeks were reviewed. MAIN OUTCOME MEASURES: The frequency and severity of obstetrical and neonatal complications and the perinatal mortality of IVF twins, triplets, and quadruplets were compared. These were also compared with non-IVF multiple pregnancies. RESULTS: From 1982 to 1990, 629 IVF pregnancies progressed beyond 20 weeks; 115 twins (18.3%), 15 triplets (2.4%), and 4 quadruplets (0.6%). There was a high incidence of antenatal complications such as abortions (30.3%, 42%, and 20%), premature labor (41.5%, 92.3%, and 75%), pregnancy-induced hypertension (17.0%, 38.6%, and 50%), and gestational diabetes mellitus (3.1%, 38.5%, and 25%) for twins, triplets, and quadruplets, respectively. The mean gestational age at delivery was 35.5 +/- 3.7, 31.8 +/- 2.7, and 31.0 +/- 1.7 weeks, respectively. There was also a proportionate progressive increase in neonatal complications. The mean weights were 2,473 +/- 745, 1,666 +/- 441 and 1,414 +/- 368 g, respectively. Twins (22.7%), 64.1% of triplets, and 75% of quadruplets needed admission to the neonatal intensive care unit and remained for an average of 12.0 +/- 2.3, 17.4 +/- 14.0, and 57.8 +/- 17.9 days, respectively. There was no difference in the mean Apgar scores or the incidence of congenital malformations in the three groups. The corrected perinatal mortality rates were 38.5, 0.0, and 0.0 per thousand live births, respectively. CONCLUSION: Triplet and quadruplet IVF pregnancies have increased obstetrical and neonatal complications compared with IVF twins. The perinatal mortality and the incidence of congenital malformations are, however, comparable in all three groups.

Adult↗
PubMed2004

Breast-feeding and bottle-feeding of twins, triplets and higher order multiple births.

OBJECTIVE: This study was performed to determine the rates of breast-feeding and/or bottle-feeding in mothers of twins, triplets and higher order multiple births compared to those in mothers of singletons, and identify factors associated with decision as to breast-feed or bottle-feed. METHODS: The subjects were 1,529 mothers of twins aged 6 months-6 years and 258 mothers of triplets and higher order multiple births (higher multiples) aged 6 months-6 years (234 mothers of triplets, 20 mothers of quadruplets, 4 mothers of quintuplets). Also, 1,300 subjects were recruited as a control group from mothers of singletons aged 6 months-6 years. Information regarding feeding methods, including exclusive breast-feeding, mixed-feeding and bottle-feeding with formula milk only, and duration of breast-feeding (in months) was collected. RESULTS: There were significantly higher rates of bottle-feeding in mothers of twins and higher multiples than in mothers of singletons. Duration of breast-feeding in mothers who chose exclusive breast-feeding or mixed-feeding for twins and higher multiples was significantly shorter than those for the singletons. The feeding methods for the twins or higher multiples were not associated with prematurity or low birth weight. However, after adjusting for each associated factor using logistic regression analysis, the decision to bottle-feed was significantly associated with non-cooperation of the husband in childrearing and degree of anxiety that mothers felt when informed of a multiple pregnancy. The odds ratio indicated that mothers who received no cooperation from the husband for childrearing were 1.83 times more likely to choose bottle-feeding as those who received cooperation. Further, the odds ratio indicated that mothers who felt greater anxiety when informed of a multiple pregnancy were 1.73 times more likely to choose bottle-feeding as those who did not feel much anxiety. CONCLUSION: This study found that establishment and continuation of breast-feeding for twins, triplets and higher order multiple births are much more difficult than for singletons. Further, cooperation of the husband in childrearing and the degree of maternal anxiety when informed of a multiple pregnancy are significant factors affecting the decision to breast-feed or bottle-feed for twins, triplets or higher order multiple births.

Adult↗
PubMed2005

Advanced maternal age and fetal growth inhibition in triplets.

OBJECTIVE: To determine whether advanced maternal age is associated withfetal growth inhibition in triplets. STUDY DESIGN: We conducted a retrospective cohort study on triplet live births in the United States from 1995 through 1998. The outcomes of fetal growth inhibition measured were low birth weight, very low birth weight, preterm birth, very preterm birth and smallnessfor gestational age. We generated adjusted ORs after taking into account intracluster correlations using the generalized estimating equation framework. RESULTS: As compared to women of younger maternal age (20-29), mature (30-39) and older women (> or =40 years) with triplet gestations tended to have a lower likelihood offetal growth inhibition. Mean birth weight and mean gestational age at delivery increased with increasing maternal age in a dose-dependent pattern (p for trend < 0.0001). As compared to triplets born to younger mothers, those of older women were less likely to have low birth weight (OR=0.51, 95% CI=0.37-0.69) or very low birth weight (OR = 0.58, 95% CI = 0.47-0.72) or to be preterm (OR = 0.39, 95% CI = 0.27-0.56) or very preterm (OR = 0.67, 95% CI = 0.55-0.80). The riskfor small-for-gestational-age infants was comparable. CONCLUSION: Older maternal age is associated with morefavorable triplet fetal growth parameters, although the exact mechanisms of this paradox remain poorly understood.

Adult↗
PubMed1991

Individual growth curve standards in triplets: prediction of third-trimester growth and birth characteristics.

We investigated the ability of Rossavik growth models, determined from measurements obtained before 24 weeks (head circumference [HC], abdominal circumference [AC], femur diaphysis length, and estimated fetal weight [EFW]) or 25 weeks (thigh circumference), to predict third-trimester growth and birth characteristics in normally growing triplets. Comparisons of coefficient c values for six anatomical measurements indicated no statistically significant differences in the second-trimester growth of triplets, twins, and singletons. Third-trimester triplet values for HC, AC, and femur diaphysis length were predicted with an accuracy of +/- 6-8%. For thigh circumference and EFW, the comparable values were +/- 17 and +/- 15%, respectively. The HC at birth was predicted without bias; the random error was approximately -27 to 9.0%. Weight, AC, and thigh circumference were systematically overestimated (16.5, 20.9, and 16.3%, respectively). After correction for systematic errors, these characteristics could be predicted with random errors of -13.0 to 9.5% (weight), -12.0 to 2.8% (AC), and -16.7 to 11.3% (thigh circumference). Growth Potential Realization Index values had means of approximately 100% and ranges from 90-121%. The mean triplet value of the Neonatal Growth Assessment Score was 13.6, ranging from 2.8-26.5. These results are similar to those for singletons and twins and indicate that individual assessment of growth in triplets can be performed with the same methods used for both singletons and twins.

Adult↗
PubMed1990

Zygosity in two cases of triplet.

A total of 11 techniques including 57 items for zygosity diagnosis was employed in two sets of triplet. Namely, placenta-fetal membrane, LDH isoenzymes, etc. The authors made an investigation in detail on the pedigree history of polyembryony and systematic analysis of two sets of male triplets. The conclusion was that the first triplet came from a single ovum, whereas the second triplet developed from double ova. Different methods for the zygosity diagnosis were discussed. It was considered that there was hereditary influence in the occurrence of triplets developing either from a single ovum or from multiple ova.

Adult↗
PubMed1978

[The use of partusisten in the delivery of triplets with an incarcerated fetus (author's transl)].

A triplet delivery is reported. The multiple pregnancy was undiagnosed prior to labor. Twins were diagnosed on admission for delivery. The ultrasonic and abdominal EKG findings at term are discussed. The hitherto undiagnosed third triplet became incarcerated following the administration of two units of syntocinon after the delivery of the second triplet. The intrapartum tocolysis with partusisten became life saving for the third triplet on three counts. 1. The progressive acidosis was stopped. 2. Time was gained to prepared for delivery of the last triplet. 3. Internal podalic version and extraction was much easier.

Diagnostic Errors↗
PubMed1994

[Two-year follow-up cohort studies on triplets: development of children and mother-child relationship].

BACKGROUND: The number of triplets births has increased during the last 15 years. The psychomotor development of triplets, problems concerning long-term relationships between the mother and her children and between the children themselves are still incompletely studied. PATIENTS AND METHODS: Eleven families with triplets, consecutively born at the Clinique Baudelocque, were assessed at home for 2 years by the same psychologist. IQ was measured in each child at the age of 2 years using the Brunet-Lezine test. At this age, all mothers completed the Symptom-Check List allowing to assess eventual relationship difficulties between the mother and their children. RESULTS: The psychomotor development of the children (IQ = 100) was similar to the mean score in the general population. The mother reported great physical fatigue during the first year after birth and psychological difficulties during the second year. They mentioned behavioral problems and difficult relationships among the triplets. They complained of not being able to fulfill the children's demands. In four families, more severe difficulties, potentially damaging the psychological well-being of the children, required an intervention during the survey. CONCLUSIONS: Improved and prolonged help to families with triplets is necessary, requiring the participation of pediatricians, nurses, psychologists, social workers and specialized people.

Child Development↗
PubMed1996

Triplet pregnancy and fetal reduction counselling.

The aim of this study was to compare the fetal loss between triplet pregnancies that underwent fetal reduction to twins and triplets which continued in spite of reduction being suggested to all of them. During a five year period a total of 3,518 cycles underwent ovarian stimulation with GnRH analogues, HMG, pure-FSH and HCG for the purpose of IVF; 2,918 women underwent ovarian aspiration leading to 2,380 embryotransfers. A total of 560 clinical pregnancies were detected with 24 clinical triplet pregnancies. Fourteen women continued their triplet pregnancy while 10 women underwent fetal reduction to twins. From 42 fetuses (14 triplets) starting the third trimester only 29 survived (total fetal loss 30.9%). From 14 fetuses (7 twins) starting the third trimester all survived. Three twins were lost during the second trimester due to cervix incompetence. Fetal reduction to twins must be proposed to each multifetal pregnancy, considering the very serious high mortality rate.

Female↗
PubMed1996

[Obstetrical management of triplets. A series of forty five cases].

OBJECTIVE: To evaluate management of triplet pregnancies. METHODS: A retrospective study of 45 triplet pregnancies which occurred spontaneously or after assisted reproductive technologies. All were managed by the same obstetrical and pediatric team. Obstetrical data were collected. RESULTS: Major etiologies were fertility drugs and in vitro methods (66%). Mean maternal age as 30 years, higher with assisted reproductive technologies (p < 0.05). Risks of chorioamniotitis, preeclampsia and anemia were respectively 4.4%, 13.3% and 70%. Triplets had a 100% prematurity rate and mean gestational age was 33.6 weeks; 22.2%, 51.1% and 64.4% delivered before respectively 32, 34 and 35 weeks of gestation. Triplet had a 91% cesarean section rate. CONCLUSION: Triplet pregnancies present a high risk of prematurity and infertility specialists have to be vigilant in the use of fertility drugs. Their management requires early reduced maternal physical activity.

Adult↗
PubMed1998

[Mid- and long-term outcome of 77 triplets and their families].

OBJECTIVE: To compare the family status and neurodevelopment of triplets conceived by spontaneous pregnancy (SP), ovarian stimulation (OS), in vitro fertilization (IVF), and gametal intra-fallopian transfer (GIFT). DESIGN: A follow-up study consisted of neurodevelopmental examination and/or of interviews of parents/pediatricians/teachers and social workers. Outcome of the children was categorized as defective (mild, moderate, severe) or normal. SETTING: The Port-Royal neonatal unit and follow-up clinic. SUBJECTS: From 1/01/1987 to 31/12/94, one to all three neonatal triplets were admitted to the Port-Royal neonatal unit. Pregnancy was SP in 12, OS in 24, IVF in 36, GIFT in 5. All survivors (36 SP, 68 OS, 98 IVF, 14 GIFT) were included and their outcome (at 3 to 10 years of age) was known in 75 families. RESULTS: Prematurity < 32 weeks was highest in the SP pregnancies, with no birth > 37 weeks, and more small-for-dates babies. As of this writing, the neurodevelopmental status was normal or included only a mild deficit (mainly visual corrections) in 82% of SP survivors, 94% of OS survivors, 98% of IVF survivors, all 14 GIFT survivors. Moderate and major deficits were found in one or two siblings of 7 sets of triplets, 5 of which were born < 32 weeks (1 SP, 3 OS, 1 IVF). In all groups, family status was characterized by the need to move, financial problems, maternal exhaustion and parental breakdowns. Five OS mothers, 5 IVF mothers, and one GIFT mother each had one to three subsequent SP pregnancies. In 1997, all families included one to eight children. Because of the cumulative effect of losses, deficits, and other post-natal difficulties, only one of four families had no problems. CONCLUSION: The overall outcome of surviving triplets is good but they are both a prenatal and post-natal hardship for the parents, chiefly the mother. We advocate a more cautious use of OS, no triple implantation at the first IVF, and more social help and guidance for the families during the pregnancy and the first 3 years of life of the triplets.

Adolescent↗
PubMed1998

Birth in triplet pregnancies. Vaginal delivery--how often is it possible?

OBJECTIVE: To compare cesarean section with vaginal delivery in triplet pregnancies. DESIGN: Medical records of 16 triplet pregnancies were retrospectively reviewed. SETTING: One hospital where planned, vaginal delivery of triplet gestations is the preferred policy. SUBJECTS: Sixteen women giving birth to triplets in the University Hospital, Uppsala, Sweden. RESULTS: Nine women were delivered vaginally, seven with cesarean section. The corrected mortality was 3.3% in the group delivered vaginally and zero in the cesarean section group. Twenty-three percent of the babies in the vaginally delivered group were without any morbidity and 6% in the corresponding cesarean section group. CONCLUSIONS: In terms of fetal outcome cesarean section in triplets is not superior to a policy of vaginal delivery. Vaginal delivery may be suggested when there are no obvious obstetrical contraindications.

Adult↗
PubMed2003

Photoinduced intramolecular electron transfer and triplet energy transfer in a steroid-linked norbornadiene-carbazole dyad.

Bichromophoric compound 3 beta-((2-(methoxycarbonyl)bicyclo[2.2.1]hepta-2,5-diene-3-yl)carboxy)androst-5-en-17 beta-yl-[2-(N-carbazolyl)acetate] (NBD-S-CZ) was synthesized and its photochemistry was examined by fluorescence quenching, flash photolysis, and chemically induced dynamic nuclear polarization (CIDNP) methods. Fluorescence quenching measurements show that intramolecular electron transfer from the singlet excited state of the carbazole to the norbornadiene group in NBD-S-CZ occurs with an efficiency (Phi SET) of about 14 % and rate constant (kSET) of about 1.6 x 10(7) s-1. Phosphorescence and flash photolysis studies reveal that intramolecular triplet energy transfer and electron transfer from the triplet carbazole to the norbornadiene group proceed with an efficiency (TET + TT) of about 52 % and rate constant (kTET + kTT) of about 3.3 x 10(5) s-1. Upon selective excitation of the carbazole chromophore, nuclear polarization is detected for protons of the norbornadiene group (emission) and its quadricyclane isomer (enhanced absorption); this suggests that the isomerization of the norbornadiene group to the quadricyclane proceeds by a radical-ion pair recombination mechanism in addition to intramolecular triplet sensitization. The long-distance intramolecular triplet energy transfer and electron transfers starting both from the singlet and triplet excited states are proposed to proceed by a through-bond mechanism.

Androstenes↗
PubMed2004

Excitonic coupling strength and coherence length in the singlet and triplet excited states of meso-meso directly linked Zn(II)porphyrin arrays.

Excitation-energy transport (EET) phenomena in meso-meso directly linked Zn(II)porphyrin arrays in the singlet and triplet excited states were investigated with a view to electronic coupling strength and coherence length by steady-state and time-resolved spectroscopic measurements. To investigate energy transfer in the triplet states, we modified the Zn(II)porphyrin arrays with bromo substituents at both ends. The coupling strength of the Soret bands of the arrays was estimated to be about 2200 cm-1, and that of the Q bands is about 570 cm-1. The coherence length in the S1 state of the Zn(II)porphyrin arrays was determined to be 4-5 porphyrin units, which is comparable to that of the well-ordered two-dimensional circular structure B850 in the peripheral light-harvesting antenna (LH2) in photosynthetic purple bacteria. This indicates that the Zn(II)porphyrin arrays are well suited for mimicking natural light-harvesting antenna complexes. On the other hand, the rate of energy transfer in the triplet state is estimated to be on the order of 100 microseconds-1, and the very weak coupling between the triplet states (ca. 0.003 cm-1), indicates that the triplet excitation energy is essentially localized on a single porphyrin moiety.

Journal Article↗
PubMed1993

Novel triplet repeat containing genes in human brain: cloning, expression, and length polymorphisms.

Human genes containing triplet repeats may markedly expand in length and cause neuropsychiatric disease, explaining the phenomenon of anticipation (increasing severity or earlier age of onset in successive generations in a pedigree). To identify novel genes with triplet repeats, we screened a human brain cDNA library with oligonucleotide probes containing CTG or CCG triplet repeats. Fourteen of 40 clones encoded novel human genes, and 8 of these inserts have been sequenced on both strands. All contain repeats, and 5 of the 8 have 9 or more consecutive perfect repeats. All are expressed in brain. Chromosomal assignments reveal a distribution of these genes on multiple autosomes and the X-chromosome. Further, the repeat length in two of the genes is highly polymorphic, making them valuable index linkage markers. We predict that many triplet repeat-containing genes exist; screening with the CTG probe suggests approximately 50-100 genes containing this type of repeat are expressed in the human brain. Since additional disorders, such as Huntington's disease, bipolar affective disorder, and possibly others, show features of anticipation, we suggest that these novel human genes with triplet repeats are candidates for causing neuropsychiatric diseases.

Base Sequence↗
PubMed1978

Bacteriochlorophyll fluorescence of purple bacteria at low redox potentials. The relationship between reaction center triplet yield and the emission yield.

This work describes fluorescence yield measurements in suspensions of strains of Rhodospirillum rubrum and Rhodopseudomonas sphaeroides in which the iron . quinone complex (X) was chemically reduced (state [PIX-]; P is the reaction center bacteriochlorophyll dimer, I is the long wavelength bacteriopheophytin), and compares these with the fluorescence observed when all the traps are open (state [PIX]) and with the fluorescence observed when all the traps are closed (state [P+IX]). At 77 K the amplitude and the shape of the fluorescence emission spectrum in [PIX-] are identical to those observed in [PIX]. This is a strong indication that all the extra fluorescence observed at room temperature in [PIX-] is, in fact, caused by an efficient back reaction [P+I-X-] leads to [P*IX-]. Using an equation similar to the original Vredenberg-Duysens relationship (Vredenburg, W.J. and Duysens, L.N.M. (1963) Nature 197, 355-357) but now assuming that a single reaction center has a probability pt of trapping an excitation and (1--pt) of re-emitting it to the surroundings, we are able to calculate pt as a function of the temperature by measuring the fluorescence in [PIX], [PIX-] and [P+IX] as a function of the temperature. The calculated pt values agree reasonably well with triplet yields measured in isolated reaction centers. Finally, we have measured the reaction center triplet yield (PTR) in intact systems and we have shown that the sum of the triplet yield and the remaining loss processes (PL) in the antenna bacteriochlorophyll including the bacteriochlorophyll dimer (such as fluorescence, internal conversion or direct triplet formation) is approximately constant; if we assume that at 77 K the only process which occurs in the reaction center is the formation of a reaction center triplet, than PTR + PL=1. The energy barrier between [P*IX-] and [P+I-X-] was estimated to be 0.11--0.15 eV for a set of preparations.

Bacteriochlorophylls↗
PubMed1979

Magnetophotoselection of the triplet state of reaction centers from Rhodopseudomonas sphaeroides R-26.

Reaction centers of the photosynthetic bacterium Rhodopseudomonas sphaeroides R-26, give rise to large triplet state EPR signals upon illumination at low temperature (11 K). Utilizing monochromatic polarized light to generate the EPR spectra (magnetophotoselection) we have shown that the intensities of the observed triplet signals are strongly dependent upon the wavelength and polarization direction of the excitation. These data can be used to calculate the orientations of the excited transition moments with respect to each other and with respect to the triplet state principal magnetic axes system. Our quantitative approach is to follow the procedure outlined in a previous publication (Frank, H.A., Friesner, R., Nairn, J.A., Dismukes, G.C. and Sauer, K. (1979) Biochim. Biophys. Acta 547, 484-501) where computer simulations of the observed triplet state spectra were employed. The results presented in the present work indicate that the transition moment at 870 nm which is associated with the bacteriochlorophyll 'special pair' lies almost entirely along one of the principal magnetic axes of the triplet state. Aso, the 870 nm transition moment makes an angle of approx. 60 degrees with the 546 nm transition moment which is associated with a bacteriopheophytin. This latter result is in agreement with previous photoselection studies on the same bacterial species (Vermeglio, A., Breton, J., Paillotin, G. and Cogdell, R. (1978) Biochim. Biophys. Acta 501, 514-530).

Bacterial Chromatophores↗
PubMed1981

The relationship of the carcinogenic/mutagenic potential of arylamines to their singlet-triplet nitrenium ion energies.

Utilizing intermediate neglect of differential overlap (INDO) and ab initio methodology, trends in the energy differences between the singlet and triplet states for mono- and polycyclic aryl nitrenium ions have been estimated. Calculations reveal an empirical correlation between the energy separation of the singlet and triplet states of the nitrenium ion and the ability of the parent amine to behave as a carcinogen or mutagen. Non-carcinogenic/non-mutagenic arylamines were characterized by nitrenium ions whose singlet states were much less stable than the triplet. Carcinogenic/mutagenic amines were characterized by nitrenium ions whose singlet states were of similar or greater stability than the triplet. By examination of the charge density at key ring atoms of the singlet and triplet species, a rational approach to the stabilization of one species relative to the other has merged and forms the basis for prediction of genotoxicity in closely related structures. The application of this empirical correlation to the prediction of the carcinogenic/ mutagenic potential of arylamines is discussed.

2-Acetylaminofluorene↗