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PubMed1984

The Genain Quadruplets: electrophysiological, positron emission, and X-ray tomographic studies.

Four 51-year-old monozygotic quadruplets concordant for schizophrenia, originally studied at the National Institute of Mental Health 25 years ago, were restudied with topographic electroencephalography (EEG), evoked potentials (EPs), computed tomography (CT scans), polysomnographic sleep recordings, and positron emission tomography (PET) with 18F-2-deoxyglucose. EEG and EP findings were consistent with those from other groups of patients with schizophrenia and showed great similarity within the quadruplets. CT scans revealed uniformly small lateral ventricles. PET scans replicated earlier findings of relatively low glucose use in the frontal lobes but did not show strong familial concordance.

Brain↗
PubMed1980

The mothering of twins, triplets and quadruplets.

The present investigation was stimulated by the steadily rising incidence of twins, triplets and quadruplets over the last few decades. It set out to obtain mothers' reported reactions when faced with the tidings of the arrival of multiple infants, and to study mothers' means of coping with and their ways of relating to these twins and "supertwins"--Scheinfeld's term for triplets, quadruplets, and quintuplets.

Attitude↗
PubMed2003

Quadruplet pregnancy following transfer of two embryos: Case report.

Following a long period of secondary unexplained infertility, a couple had assisted conception treatment with IVF and transfer of two embryos 2 days later. The woman conceived and was found to have a quadruplet pregnancy. Following spontaneous labour onset at 34 weeks gestation, she was delivered by immediate Caesarean section. All four babies (three boys, one girl) were eventually discharged home with the mother. All the boys were found to be of differing zygosity. The quadruplet pregnancy was attributed to natural conception following intercourse and fertilization of oocytes not collected at the time of IVF. The wisdom of intercourse during a cycle of IVF is discussed.

Adult↗
PubMed1993

Quadruplet pregnancy in a 51-year-old menopausal woman following oocyte donation.

A quadruplet pregnancy occurred in a woman 51 years of age following oocyte donation and embryo transfer. Successful pregnancy occurred following two previously unsuccessful attempts. The patient underwent a selective reduction of her pregnancy to two fetuses at approximately 13 weeks gestational age. Her pregnancy continued uneventfully and she underwent the delivery of two viable infants at 38 weeks gestational age by Caesarean section. This case represents the first quadruplet pregnancy to be established in a woman of 50 years of age or older. It illustrates both the benefits and risks of oocyte donation to women of advanced reproductive age.

Embryo Transfer↗
PubMed1989

Is elective cerclage justified in the management of triplet and quadruplet pregnancy?

The main complication in multiple gestation with more than two fetuses is prematurity, with its concomitant increase in perinatal mortality and morbidity. Clearcut indications as to management of these pregnancies are lacking, and the efficiency of elective cerclage is controversial. Twelve triplets and three quadruplets out of 27 multiple pregnancies were electively sutured and compared to 10 triplets and two quadruplets without this procedure. Otherwise, both groups were managed uniformly regarding bed-rest, beta-mimetic drugs and dexamethasone for the enhancement of fetal lung maturity. Mean duration of pregnancy in patients with cerclage was 35 weeks, significantly longer than those who did not undergo this procedure (30.7 weeks) (p < 0.01). Furthermore, in the former group, the mean neonatal weight was significantly higher (p < 0.01), mean Apgar scores were better, significantly lower rates of respiratory distress syndrome occurred (p < 0.05), perinatal mortality rate was significantly reduced (p < 0.01) and the mean hospitalization period was shorter (p < 0.025). It seems that elective cervical suture is a definite contribution to the successful management of multiple pregnancies with more than two fetuses.

Apgar Score↗
PubMed1994

Variable outcome of a congenital cytomegalovirus infection in a quadruplet after primary infection of the mother during pregnancy.

A congenital cytomegalovirus (CMV) infection in a quadruplet has not been reported previously in the literature. We describe a congenital CMV infection in a quadruplet after primary CMV infection of the mother during pregnancy. One infant died antenatally, while another had cholestatic jaundice at birth and died of liver failure at three months of age. Of the two surviving infants, one showed no signs or symptoms of congenital CMV infection at 18 months of age, whereas the other had hearing loss and delayed development. CMV cultures of urine were positive at six weeks of age in all three infants born alive. The diagnosis of congenital CMV infection after primary CMV infection of the mother during pregnancy was made retrospectively by detection of CMV-immediate early antigen in three placentas as well as by examination of serum obtained from the mother during pregnancy.

Adult↗
PubMed1998

A case report of breastfeeding quadruplets: factors perceived as affecting breastfeeding.

The number of higher-order multiple births in the United States quadrupled between 1970 and 1994. The number of women choosing to breastfeed their higher-order multiples also has risen. In this report, a mother of quadruplets identifies factors and interventions she perceived as having a positive or negative impact on breastfeeding. Maternal motivation coupled with a mother's personal approach to breastfeeding quadruplets may be key factors in shaping breastfeeding outcomes, such as in this case where one quad weaned at 12 months and the remaining three breastfed for 2 1/2 years. With increased discussion of this select population, lactation consultants and other health professionals will be able to develop breastfeeding care plans which reflect this population's unique needs and concerns from the prenatal through postpartum periods.

Adult↗
PubMed1991

[Anesthetic management of caesarean section for the delivery of quadruplets].

Multiple gestation pregnancies are accompanied with risks for both mother and fetuses. Morbidity and mortality of both of them are increased compared with singleton pregnancies. We have presented a case of a 30-year-old parturient with quadruplets. The pregnancy had been complicated by premature labour, anemia, toxemia, coagulopathy, pulmonary congestion and malpresentation. On the 29th week of pregnancy, an elective Caesarean section was scheduled. There is no ideal anesthetic technique for quadruplets. In this case general anesthesia was chosen, because she had coagulopathy. The anesthesia and postoperative course were uneventful. The patient and the four babies had no complication nor sequela on their discharge. The anesthetic considerations for multiple gestation pregnancies were also discussed.

Adult↗
PubMed1996

Successful urgent cerclage in a quadruplet gestation.

Pregnancies complicated by quadruplets are rare but at high risk for premature cervical dilation, premature deliveries, and increased perinatal mortality. This report presents a case of a patient carrying quadruplets whose cervix became 4 cm dilated at 21 weeks even though there were no reported uterine contractions. Despite bed rest and combination tocolytic therapy, the cervix dilated to 6 cm and the membranes protruded. Described here are refinements of an Olatunbosun technique to successfully perform the cerclage. Labor occurred at 32 weeks, and a cesarean delivery was performed before the transvaginal removal of the cerclage. The four appropriately-grown fetuses adjusted well in the intensive care nursery.

Adult↗
PubMed1996

[Successful twin delivery following reduction of quadruplet pregnancy].

The authors report first time in the Hungarian literature on multifetal pregnancy reduction: a quadruplet pregnancy was reduced to twins on transabdominal way in the 16th week of gestation on request of the parents. The quadruplets resulted from a forcefully induced ovulation. First weeks of gestation were complicated by a severe but effectively treated ovarian hyperstimulation syndrome. Following the successful and uncomplicated intervention the course of pregnancy was undisturbed, two living healthy babies were delivered in the 35th gestation week. Placentae of the liveborn as well as of the stillborn fetuses were pathologically examined. On occasion of the case report theoretical and practical questions of multifetal pregnancy reduction are discussed in details from indications through technical implementation to a review of legal, ethical and also psychological relations of that intervention. A standpoint for the national practice is also framed by the authors.

Adult↗
PubMed1999

Clinical management of a quadruplet pregnancy combining a triplet pregnancy with a classical hydatidiform mole: case report and review of literature.

A 28-year-old Taiwanese woman who had received ovulation induction by clomiphene citrate (CC), follicular-stimulating hormone (FSH), and human chorionic gonadotrophin (hCG) treatment was diagnosed with a quadruplet pregnancy containing a hydatidiform mole and three fetuses at nine weeks' gestation. Expectant management failed to achieve any viable neonate due to massive antepartum haemorrhage and preterm delivery at 25 weeks' gestation. Five other cases previously reported involving quadruplets or triplets with a complete hydatidiform mole and two or three fetuses are reviewed. All cases ended as premature non-viable fetuses. Analysis of the clinical features, management, and outcome both in our patient and these reports suggest that more efficacious treatment planning, such as selective feticide, should be considered in order to improve the likelihood of attaining an advanced gestational age for a single fetus.

Abortion, Spontaneous↗
PubMed1993

Deficiency of 1-methylguanosine in tRNA from Salmonella typhimurium induces frameshifting by quadruplet translocation.

The trmD gene encodes the tRNA(m1G37)methyltransferase, which methylates guanosine (G) to 1-methylguanosine (m1G) at position 37 of tRNAs that read CUN (leucine), CCN (proline), and CGG (arginine) codons. A mutant, trmD3, has previously been isolated, which at high temperature lacks m1G in tRNA, and this deficiency was correlated with a +1 frameshifting activity. In this study, the mechanism of this trmD3-induced frameshift involving mutant tRNA(Pro) and tRNA(Leu) species has been investigated. Potential frameshifting sites for proline tRNAs, CCC-N, were efficiently suppressed in the mutant strain. Hybrid beta-galactosidases encoded by plasmid constructs containing the sites CCC-U and CCC-A were subjected to amino-terminal sequencing. The protein sequences demonstrated that a quadruplet translocation had occurred and that a proline was inserted at these sites, suggesting that a tRNA(Pro) deficient in m1G is the frameshifting agent. Therefore, a mechanism involving a quadruplet codon-anticodon interaction is favoured for trmD3-dependent +1 frameshifting. Of the four potential sites for tRNA(Leu) (CCU-N), two, CCU-U and CCU-C, were significantly suppressed in the trmD3 mutant. Thus, species of tRNA(Leu) may also act as +1 frameshift suppressors. No -1 frameshifting activity was found with the trmD3 mutant.

Amino Acid Sequence↗
PubMed2002

Insertions in the anticodon loop of tRNA1Gln(sufG) and tRNA(Lys) promote quadruplet decoding of CAAA.

Base insertion mutations in the anticodons of two different Escherichia coli tRNAs have been isolated that allow suppression of a series of +1 frameshift mutations. Insertion of a U between positions 34 and 35 of tRNAGln1 or addition of a G between positions 36 and 37 of tRNA(Lys) expand the anticodons of both tRNAs similarly to 3'-GUUU(-5') and allow decoding of complementary 5'-CAAA(-3') quadruplets. Analysis of the suppressed mRNA sequences suggests that suppression occurs by pairing of the expanded anticodons to all four bases of the complementary, quadruplet codon. The tRNA Gln mutants are identical to the sufG class of frameshift suppressors isolated both in Salmonella enterica serovar Typhimurium and E. coli by Kohno and Roth and previously thought to affect tRNA(Lys).

Anticodon↗
PubMed2003

Phase transition classes in triplet and quadruplet reaction-diffusion models.

Phase transitions of reaction-diffusion systems with site occupation restriction and with particle creation that requires n=3,4 parents, whereas explicit diffusion of single particles (A) is present are investigated in low dimensions by the mean-field approximation and simulations. The mean-field approximation of general nA-->(n+k)A, mA-->(m-l)A type of lattice models is solved and a different kind of critical behavior is pointed out. In d=2 dimensions, the 3A-->4A, 3A-->2A model exhibits a continuous mean-field type of phase transition, that implies d(c)<2 upper critical dimension. For this model in d=1 extensive simulations support a mean-field type of phase transition with logarithmic corrections unlike the recent study of Park et al. [Phys. Rev E 66, 025101 (2002)]. On the other hand, the 4A-->5A, 4A-->3A quadruplet model exhibits a mean-field type of phase transition with logarithmic corrections in d=2, while quadruplet models in one-dimensional show robust, nontrivial transitions suggesting d(c)=2. Furthermore, I show that a parity conserving model 3A-->5A, 2A--> zero in d=1 has a continuous phase transition with different kinds of exponents. These results are in contradiction with the recently suggested implications of a phenomenological, multiplicative noise Langevin equation approach and with the simulations on suppressed bosonic systems by Kockelkoren and Chaté [Phys. Rev. Lett. 90, 125701 (2003)].

Journal Article↗
PubMed1978

Maternal serum alpha-fetoprotein levels in triplet and quadruplet pregnancy.

Maternal serum alpha-fetoprotein (AFP) levels were higher in six triplet pregnancies and three quadruplet pregnancies than in control singleton pregnancies matched for maternal age, parity and time of gestation at which the serum sample was taken. Between 12 and 23 weeks of pregnancy, the average AFP levels among the triplet pregnancies was three times that found in the singleton pregnancies, and the level in the quadruplet pregnancies was even higher. Maternal serum AFP levels appear to be associated with the number of fetuses in utero.

Female↗
PubMed1972

Externally suppressible proline quadruplet ccc U.

Three (+1) frameshift mutations located at different genetic sites respond with high specificity to the same external suppressor. In each case, the suppressor restores small amounts of protein that is normal in electrophoretic mobility and heat stability. One of these proteins has been shown to have the wildtype amino acid sequence. The messenger RNA quadruplet CCCUappears to be common to all three frameshift sites and to be translated by the suppressor as proline. A likely suppressor agent is a proline transfer RNA with a quadruplet anticodon or its functional equivalent.

Alcohol Oxidoreductases↗
PubMed2000

Physiological variability in neonatal armadillo quadruplets: within- and between-litter differences.

The role of genetics on neonatal physiological variability was examined in the nine-banded armadillo (Dasypus novemcinctus). Since armadillos give birth to only monozygous quadruplets, the genetic variation within litters is essentially zero. Quadruplets born in captivity were isolated and weighed within 8 h of birth. Oxygen consumption (V.(O2)) was measured in resting neonates by flow-through respirometry, heart rate obtained from an electrocardiogram and ventilation was measured by impedance techniques. Following the measurements, neonates were returned to the mother. Measurements were repeated at 4 and 8 days after birth. Mean heart rate significantly increased from 132 beats min(-1) on the day of birth to 169 beats min(-1) on day 8. Mean ventilation rate significantly decreased from 81 breaths min(-1) on the day of birth to 54 breaths min(-1) on day 8. During this same developmental period, mean mass significantly increased from 100 g to 129 g, and mean mass-specific oxygen consumption significantly decreased from 32.2 ml O(2)kg(-1)min(-1) to 28.6 ml O(2)kg(-1) min(-1). For all variables measured, within-litter variability was always significantly less than between-litter variability, confirming a 'sibling effect' that we attribute to the genetic components determining physiological characters.

Aging↗