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PubMedDate not supplied

Management of a triplet gestation complicated by uterus didelphys.

BACKGROUND: Assisted reproductive technologies are making it possible for women to conceive when it was otherwise impossible. One of the side effects is multiple gestations. This may be especially disadvantageous when it occurs within an anomalous uterus. PATIENT AND METHODS: A 36-year-old women with the help of gamete intrafallopean transfer conceived triplets in a uterus didelphys. This pregnancy was further complicated by anencephaly of one of the triplets. The patient was managed by a combination of chorionic villi sampling and selective reduction that ended with the successful delivery of a term infant. CONCLUSION: Pregnancy reduction can be safely performed in a twin pregnancy on one side of a uterus didelphys. More reports will be required to determine whether this is the most optimal choice.

Adult↗
PubMed2005

Development of hemophagocytic lymphohistiocytosis in triplets infected with HHV-8.

Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder of immune dysregulation, characterized by end-organ damage from lymphocytic infiltration and macrophage activation. All known mutations associated with the HLH occur in genes critical in the perforin-granzyme pathway. Herein, we report HLH occurring in 2 female triplet infants who also had associated human herpesvirus type 8 (HHV-8) infections. The subjects had identical novel compound-heterozygous mutations in the Perforin alleles, resulting in undetectable perforin expression and NK-cell cytotoxicity. Both infants also had evidence of infection with HHV-8. These reports are, to our knowledge, the first cases of HLH in triplets and the first reported cases of HHV-8 infection associated with HLH in non-renal transplant and non-HIV-infected subjects.

Female↗
PubMed1982

Identical triplets: non-identical psychosis?

In contrast to all previous reports of psychoses in genetically identical siblings, identical triplets aged 28 were discordant by major Kraepelinian type of psychosis. Two of them had been diagnosed schizophrenic while the third was diagnosed manic depressive. Re-evaluation of their illnesses using standardized methods and diagnosis by blind raters suggested that the discordance was not due to simple misdiagnosis or different diagnostic bias between psychiatrists. These triplets illustrate some of the shortcomings of a strictly applied Kraepelinian dichotomy and show that a genetic perspective is important in attempting to resolve the classificatory problems of atypical psychoses.

Adult↗
PubMed2006

The association between small-for-gestational age triplet pregnancies and neonatal mortality: a novel approach to growth assessment in multiple gestations.

It is customary to estimate the uteroplacental function in singletons by defining appropriateness of birth weight by gestational age. Such a measure, however, is not available for the entire multiple pregnancy set. We evaluate a new index, total triplet birth weight, expressed as multiples of the median (MOM) birth weight of singleton gestations. We categorized triplet sets as small-, appropriate-, and large-for-gestational age pregnancies (SGA, AGA, and LGA, respectively), defined as <1 SD, +/-1 SD, and >1 SD from the mean MOM birth weight of singleton gestations. We used the 1995-1998 US matched multiple dataset to evaluate this index and to explore the association between the three categories in terms of risk of neonatal mortality. The mean +/- SD MOM value was 2.3 +/- 0.4. There was an inverse correlation between mean MOM and gestational age. LGA pregnancy status was associated with multiparity, race (being white), and high social status (education). Maternal age did not influence MOM scores. Compared with the LGA pregnancy category, the risk for neonatal mortality was more than doubled in the AGA pregnancy group and more than 9-fold in the SGA pregnancy category. We propose that this new measure could be a useful proxy for the uteroplacental efficiency in a similar way that the SGA designation works for singleton infants.

Adult↗
PubMed1987

A triplet pregnancy after gonadotropin-releasing hormone pulsatile infusion therapy in a postoperative case of growth hormone-producing pituitary macroadenoma.

Intravenous GnRH pulsatile infusion therapy (10 micrograms/pulse, 90-min interval) was conducted in an acromegalic patient from whom 2/3 of a GH-producing pituitary macroadenoma had been removed. Before infusion therapy, plasma levels of GH and PRL were 10-20 and 15-25 ng/ml, respectively, while those of LH and FSH were subnormal without intrinsic fluctuations. Ovulation was induced after 13 days of infusion which was terminated on the 23rd day of therapy. Luteal function was supported by hCG (5,000 IU per dose) which was given 4 times from the 23rd to the 31st day of the treatment cycle. Triplet pregnancy was diagnosed ultrasonographically within 7 weeks of gestation. Although GH and PRL levels increased gradually as the gestational period progressed and plasma levels of GH and PRL of 32-55 and 30-67 ng/ml, respectively, were detected after 30 weeks of gestation, neither adverse signs related to the enlargement of the residual pituitary tumor nor manifestation of acromegaly was observed. The immunoreactive somatomedin-C levels during this period were not greater than those in normal pregnant women. Caesarean section was performed at 34 weeks and 3 normal healthy infants were delivered. Detailed analyses of hormonal changes throughout the period of GnRH pulsatile infusion and subsequent luteal phase revealed that the triplet pregnancy had been induced by the GnRH therapy itself and that hCG stimulation did not play any critical role. The residual tumor mass secreted increasing amounts of GH during the latter period of pregnancy but the somatomedin-C levels were not associated with this elevation. Therefore, the clinical as well as the hormonal findings strongly suggested that the GH secreted in increasingly large amounts by the residual tumor mass during pregnancy was defective in certain biological properties.

Adenoma↗
PubMed2004

The ponderal index in triplets: II. Gestational age-related patterns of neonatal weights and lengths.

In order to evaluate the determinants of high and low ponderal indices in triplets, we analyzed prospectively collected data from a cohort of 2181 triplet births. Low and high neonatal ponderal indices (birth weight/[length]3) were defined as below or above 1 SD from the mean. The mean ponderal index was of 2.4 +/- 0.4. At 30-31 weeks, there were significantly more infants with a low ponderal index; after 33 weeks, more infants were born with a high index. Birth weights of infants with a high index were significantly higher throughout the entire range of gestational ages, whereas their lengths were significantly smaller. Both birth weights and infant length had significant correlations with gestational ages for infants with a low (R2=0.97 and R2=0.94, respectively) as well as with high ponderal indices (R2=0.95 and R2=0.94, respectively). The regression analyses suggest, however, different patterns for infants with low or high ponderal indices.

Anthropometry↗
PubMed2005

Combined sonographic and endoscopic umbilical cord occlusion in twin and triplet gestations.

OBJECTIVE: To review our experience with a minimally invasive technique for umbilical cord occlusion as a method of selective feticide in monochorionic sets. STUDY DESIGN: Umbilical cord occlusion was completed using 3 mm bipolar cautery under ultrasound guidance (3D/4D, n = 6; 2D, n = 6) with pre and post ligation endoscopic evaluation. RESULTS: 12 cases of monochorionic sets where selective feticide was performed were identified during the period 2000 to present. There were four triplet and eight twin gestations in the study cohort. Median interval from intervention to delivery was 16 weeks (range, 5-19). All co-twins survived the procedure and 15 of 16 were delivered after 33 weeks. CONCLUSIONS: Umbilical cord occlusion in monochorionic sets can be accomplished in a minimally invasive manner with combined endoscopic and ultrasound guidance in both twin and triplet pregnancies.

Constriction↗
PubMed1993

Fetal outcome of triplets in a Turner mosaic.

Pregnancies are now being reported resulting from fertilization of donor oocytes in women with ovarian failure. A case of triplets in a Turner mosaic is reported herein following transfers of embryos resulting from donor oocytes. She had previously demonstrated a normal sized uterine cavity by hysterosalpingography. The opinion from our group was that she should consider selective reduction but a perinatology consult thought she should have a favorable outcome. Her pregnancy was complicated by polyhydramnios, pre-term labor, and eventual fetal demise at 25 and 27 weeks of all three fetuses. Natural pregnancies in patients with gonadal dysgenesis have been reported in at least 138 patients. Many aborted or had stillbirths and this high rate of fetal mortality has been ascribed to chromosomal abnormalities. The continued use of donor oocytes will provide data to evaluate whether there will continue to be a higher spontaneous abortion rate and complications in second and third trimesters in Turner's pregnancies even in single pregnancies. The outcome of this case can at least be provided to future gonadal dysgenesis patients with triplets to help them in their decision as to whether or not to have selective reduction.

Adult↗
PubMed1998

Should multifetal pregnancy reduction be used for prevention of preterm deliveries in triplet or higher order multiple pregnancies?

This article reviews the arguments for the use of multifetal pregnancy reduction (MFPR) for the prevention of preterm deliveries in triplet and higher order multiple pregnancies and evaluates its effectiveness based on data from published studies. The arguments in favour of pregnancy reduction are based on the substantial mortality and morbidity associated with these pregnancies. Triplets and higher order multiples have increased rates of preterm delivery and intrauterine growth retardation, both of which are independent risk factors for death and handicap. Even controlling for gestational age, rates of mortality and handicap are higher for multiples than for singletons. Moreover, the family's risk of losing a child or having a handicapped child is greater because there are more infants at risk. MFPR effectively lowers these risk by reducing the frequency of preterm delivery. However, its effectiveness may be limited. In some studies, the proportion of preterm deliveries in reduced pregnancies remains above levels found in spontaneous twin or singleton pregnancies and MFPR does not appear to reduce the prevalence of low birth weight. Furthermore, the procedure itself has unwanted side effects: it increases the risk of miscarriage, premature rupture of the membranes and causes adverse psychological effects such as grief or depression for many patients. The authors note that a majority of the higher order multiple pregnancies result from a medical intervention in the first place, either through IVF techniques or the use of ovulation stimulation drugs. Although MFPR is an effective measure for reducing the substantial morbidity and mortality associated with higher order multiple pregnancies, preventive methods, such as limiting to 2 the number of embryos transferred for IVF and better control of the use of ovulation induction drugs, remain more effective and less intrusive.

Female↗
PubMedDate not supplied

Triplets with growth failure, microcephaly, mental retardation, nail hypoplasia and corpus callosum agenesis: is it a variant of Coffin-Siris or a new syndrome?

We report eight-year-old triplet girls whose clinical features included microcephaly, severe mental retardation, hypoplasia of distal phalanges of both fifth and second fingers and nail hypoplasia on second fingers, dysmorphic facial features, and partial corpus callosum agenesis. During infancy, a Pavlik harness was used for congenital hip dislocation, and they had difficulty in feeding. One had been operated for patent ductus arteriosus. To our knowledge, this rare combination has not been previously reported in triplets whose clinical features closely resemble those of Coffin-Siris syndrome. The other diagnostic possibilities are also reviewed.

Abnormalities, Multiple↗
PubMed2000

[Triplet pregnancies in materials from the Obstetrics and Perinatology AM in Lublin in 1989-1999].

A retrospective analysis of 14 triplet pregnancies at the Department of Obstetrics and Perinatology, University School of Medicine in Lublin, from January 1, 1989 to June 30, 1999 was undertaken. All pregnancies were ended by cesarean section. No difference in Apgar score and in average birth weight between I, II and III foetus was observed. The mean hospitalisation time for mothers was 32.5 +/- 29.01 days and the mean gestational age at delivery was 32.14 +/- 3.44 weeks. The indication for cesarean section in all cases was triplet pregnancy and additional complications: threatened intrauterine infection, threatened intrauterine asphyxia, abruptio placentae, preterm labour. Perinatal mortality rate was 12.82%.

Adult↗
PubMedDate not supplied

Delayed delivery in a triplet pregnancy.

Multiple gestations have a significantly increased incidence of preterm labor and preterm rupture of membranes. In this case, a 32-year-old woman had a car accident with preterm labor at 19 weeks' gestation. A vaginal delivery of the presenting triplet followed. After conservative management, the second and third triplets were delivered by cesarean section after a 70-day delay. A review of the literature was done.

Accidents, Traffic↗
PubMed2005

[Malformed pygopagus conjoined twins in a spontaneous triplet pregnancy].

This is a case study of malformed conjoined twins in a spontaneous triplet pregnancy. A 20-year-old primigravida spontaneously delivered at 22 weeks gestation a normal 425-gram male newborn followed by a delivery of a 525 grams pygopagus conjoined male twins. One twin had omphalocele, missing ears, cleft palate and dysmorphic figures while the other had imperforated anus and dysmorphic figures. The Apgar scores were 2/0. The placenta was monochorionic/diamniotic with single umbilical artery supplying both conjoined twins. Conjoined twin in a triplet pregnancy may be diagnosed by ultrasound as early as the first trimester. Failure in diagnosis of the condition resulted in early delivery of three premature infants. All three infants died after delivery.

Abnormalities, Multiple↗
PubMed1990

The outcome of triplet gestations complicated by fetal death.

Intrauterine death in twin pregnancies has been reported to be associated with a very high incidence of morbidity and mortality in the surviving co-twin, mostly attributed to vascular disruption when vascular anastomosis exists between the twins' circulations. The present study describes the obstetric, neonatal, and follow-up data of five triplet gestations complicated by intrauterine death of one or two fetuses, compared with a control group of triplets matched for gestational age. Delivery occurred an average of 30 +/- 26 days after the diagnosis of intrauterine fetal death. Four of the five placentas were monochorionic. All nine infants survived, but four were small for gestational age (SGA). A comparison of study cases and controls revealed that monochorionic placentation was found only in the study group, that SGA infants were more likely (but not significantly so) to be in the study group, and that study infants required significantly less ventilatory support. Although the only case of long-term morbidity was in the study group, the cause of this complication was consistent with prematurity.

Embryonic and Fetal Development↗
PubMed1989

Early and late surfactant treatment in preterm triplets.

Preterm triplets were treated with calf lung surfactant extract (CLSE). Two were treated at birth without development of respiratory distress syndrome (RDS); one was treated after development of RDS, with rapid improvement. These cases demonstrated the efficacy of exogenous surfactant and the potential benefit of prophylaxis (early treatment) over late treatment. Although various exogenous surfactants have been used successfully to treat or prevent RDS in preterm infants, the optimal time of surfactant treatment has not been established. Surfactant therapy at birth results in a reduction in the incidence and severity of RDS, but it could lead to unnecessary treatment in a significant portion of patients. On the other hand, delaying treatment is likely to lessen the benefits of exogenous surfactant by various factors, including barotrauma and oxygen toxicity. The triplets in this report were treated with Infasurf CLSE. Two were treated at birth without development of RDS, but one was treated after development of RDS, with rapid improvement of respiratory status.

Female↗
PubMed1988

Triplet pregnancy with delivery on three separate days.

Obstetric complications of triplet pregnancies may make the delivery of extremely premature infants in these multiple gestations inevitable. To our knowledge, this case represents the first report of triplets delivered on three separate days, 16 days apart, using the technique of delayed interval delivery. One of the infants survived.

Adult↗