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PubMedDate not supplied

Incidence and outcome of multiple pregnancy after in vitro fertilization.

The aim of this study was to analyse the experience of IVF multiple pregnancies, in relation to the maternal morbidity and the neonatal morbidity and mortality. We considered 48 multiple pregnancies: 36 twins (group A), 8 triplets (group B), 2 quadruplets (group C), and 2 quintuplets (group D). The mean maternal age was 29.72 years and the mean gestational age was 36.83 weeks. Of the 36 patients with two babies, 20 (55.60%) had cesarean section, whereas 12 were delivered vaginally. All the triplets, quadruplets and quintuplets were delivered abdominally. Twenty-three cervical cerclage were placed. In group A 7 patients had premature rupture of the membranes (PROM), 2 had pregnancy-induced hypertension (PIH) and 14 had premature labour. In group B 4 patients had premature labour, 3 hadPROM and 2 had PIH. In group C one patient had premature labour. In group D 2 patients had premature labour and one also PIH. Multiple pregnancies lead to a high incidence of antenatal complications and extensive neonatal morbidity which translate into prolonged and expensive hospitalization for the neonates.

Adult↗
PubMed1997

[Actual conditions of help and support of childcare in families with multiple birth children].

A mailed questionnaire survey was conducted on a population of 705 mothers of twins, 96 mothers of triplets, 7 mothers of quadruplets and 2 mothers of quintuplets to study the actual conditions of help and support of childcare in the families with multiple birth children. The following results were obtained. 1) In this study, 90.6% of the mothers of twins, 89.6% of the mothers of triplets, 100.0% of the mothers of quadruplets and 100.0% of the mothers of quintuplets had at least one relative and friend from whom they received practical help and regular support. However, 5.8% of the mothers of twins and 8.3% of the mothers of triplets did not have others from whom they received help and support. 2) Lack of time to take care of the other children was reported by approximately 90% of mothers with twins who did not have others from whom they received help and support for childcare. 3) Mothers who did not receive help and support from others for childcare reported severe fatigue, compared to mothers who received help and support from others: mothers of twins, especially reported severe mental fatigue and mothers of triplets or more, severe physical fatigue. 4) Mothers of twins who had no way to alleviate stress reported severe physical and mental fatigue, compared to mothers who had ways to alleviate stress. Mothers of triplets or more showed a similar tendency as mothers of twins. These mothers alleviated stress by talking with other mothers of multiple birth children, friends, their maternal mother or their husband.

Adult↗
PubMed1989

tRNA hopping: enhancement by an expanded anticodon.

At a low level wild-type tRNA(1Val) inserts a single amino acid (valine) for the five nucleotide sequence GUGUA which has overlapping valine codons. Mutants of tRNA(1Val) with an insertion of A or U between positions 34 and 35 of their anticodons have enhanced reading of the quintuplet sequences. We propose that this decoding occurs by a hopping mechanism rather than by quintuplet pairing. Such hopping involves disengagement of the paired codon and anticodon with the mRNA slipping two (or more) bases along the ribosomal--peptidyl tRNA complex and subsequently re-pairing at a second codon--the landing site. The mutant with the anticodon sequence 3'CAAU5' 'hops' over the stop codon in the mRNA sequence GUG UAA GUU with the insertion of a single amino acid (valine). In contrast, in reading the same sequence, the mutant with the anticodon 3'CAUU5' hops onto the stop with the insertion of two valine residues. It is likely that in some instances of hopping alternate anticodon bases are used for the initial pairing and at the landing site.

Alleles↗
PubMed1995

Evolving patterns of iatrogenic multifetal pregnancy generation: implications for aggressiveness of infertility treatments.

OBJECTIVE: Our purpose was to assess the changes in multifetal pregnancy generation as a function of utilization of ovulation stimulation and assisted reproductive techniques and to document the relative control of hyperstimulation between the methods. STUDY DESIGN: The methods of infertility treatment, number of fetuses, and outcomes of 220 patients referred for multifetal pregnancy reduction were compared over three time periods (1986 to 1989, 1991 to 1992, and 1992 to 1993). Clomiphene, human menopausal gonadotropin, and ovulation stimulation with urofollitropin were compared against gamete intrafallopian transfer, zygote intrafallopian transfer, and in vitro fertilization (assisted reproductive techniques). RESULTS: The proportion of multifetal pregnancies generated by assisted reproductive techniques has steadily risen from 26% in the first two time periods to nearly half in the last 2 years. However, the number and proportion of quintuplet and greater pregnancies from assisted reproductive techniques have steadily fallen while for ovulation stimulation the proportion has remained about one third. CONCLUSION: Despite considerably increased use and proportionate generation of triplet and quadruplet pregnancies, the incidence of quintuplets has fallen for assisted reproductive techniques while there has been no improvement for ovulation stimulation. Continued, greater vigilance, particularly in the use of human menopausal gonadotropin and urofollitropin, must be emphasized.

Clomiphene↗
PubMed1994

Improved results in multifetal pregnancy reduction: a report of 72 cases.

OBJECTIVE: To evaluate pregnancy outcome after either transabdominal or transvaginal multifetal pregnancy reduction. DESIGN: A study of 72 consecutive multifetal pregnancy reductions. SETTING: Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center Tel Hashomer, Israel. PATIENTS: Seventy-two patients with multifetal pregnancies: 2 twins, 27 triplets, 26 quadruplets, 10 quintuplets, 3 sextuplets, 1 septuplet, 2 nontuplets, and one pregnancy with 12 fetuses. INTERVENTION: Multifetal pregnancy reduction was performed at 9 to 13 weeks' gestation by either transabdominal or transvaginal potassium chloride injection. MAIN OUTCOME MEASURES: Early and late complications related to the procedure, outcome of pregnancy, and comparison of two periods. RESULTS: Procedures performed between 1984 and 1989 (36 patients) were associated with a 33.3% pregnancy loss, whereas those performed between 1990 and 1992 (36 patients) were associated with no pregnancy loss. Of the 17 patients with quintuplets or more, 10 (59%) delivered live and healthy newborns. No difference was found when comparing the transabdominal and the transvaginal approaches. CONCLUSIONS: Both transvaginal and transabdominal approaches are comparable. There is a remarkable decrease in pregnancy loss with experience.

Abortion, Therapeutic↗
PubMed1975

Ovarian hyperstimulation syndrome.

Eighteen patients hospitalized for excessive ovarian hyperstimulation syndrome are reported. In 14 cases the ovarian hyperstimulation was induced by human menopausal -onadotropins and in 4 cases by combined treatment with clomiphene and HCG. In 5 patients the hyperstimulation was associated with conception, which resulted in 1 quintuplet delivery, 1 early quintuplet abortion, 1 twin abortion, 1 normal delivery, and 1 missed abortion. The regimen of treatment was a conservative one. The patients were hospitalized and treated with infusion of plasma expanders. Anticoagulant therapy was administered only in cases that showed clinical evidence of thromboembolic pheomena or laboratory evidence of severe hemoconcentration. The pathogenesis of the ovarian hyperstimulation syndrome, prevention, and management are discussed. This syndrome should be diagnosed early and treated intensively.

Abdomen, Acute↗
PubMed1992

Higher multiple births and the modern management of infertility in Britain. The British Association of Perinatal Medicine.

OBJECTIVE: To assess prospectively the number of triplet and higher multiple births born in 1989 and their methods of conception. To assess obstetric factors and the effect of these pregnancies on neonatal medical services. DESIGN: All consultant paediatricians received a monthly card asking whether they had been involved in the management of triplet and higher multiple pregnancies delivered after 22 weeks gestation. Detailed questionnaire sent to those giving a positive response. SETTING: British Paediatric Surveillance Unit organized mailings to all members of the British Paediatric Association working in the British Isles. SUBJECTS: 156 pregnancies resulting in 482 babies (143 triplets, 12 quadruplets and 1 quintuplet set). These data were compared to nationally collected OPCS data. MAIN OUTCOME MEASURES: Method of conception, obstetric performance, neonatal outcome. RESULTS: Of the 156 pregnancies, 47 (31%) were conceived naturally, 52 (34%) had ovarian stimulation (usually with clomiphene or gonadotrophins) 37 (24%) had IVF and 17 (11%) GIFT. All quadruplet and quintuplet pregnancies were established after assisted reproduction. Mothers who had had IVF were significantly older than those who had ovulation induction alone. The median gestation at birth was 33 weeks. Overall 181 (40%) of the babies required intensive care for a median duration of 5 days. The perinatal mortality of the triplets alone and quads and quins together was 70 and 104 per 1000 respectively. CONCLUSIONS: Assisted reproduction is the major cause of triplets and higher multiple births and ovarian stimulation is the single most important technique currently in use. These babies are very likely to be born pre term and make considerable demands on neonatal intensive care facilities.

Adult↗
PubMed2001

Epidemiological trends in multiple births in the United States, 1971-1998.

The astounding rise in multiple births in the United States continues. We analyzed live birth files from the U.S. National Center for Health Statistics. Twin, triplet, quadruplet, and quintuplet+ rates were calculated for the period 1971-1977 and for each year between 1990 and 1998. Triplet rates were also computed within categories of mother's education and age. The twin rate increased from 1.8% in 1971-77 to 2.8% in 1998. The rate of triplets increased 5.9-fold, quadruplets 11.9-fold, and quintuplets+ 5.3-fold between 1971-77 and 1998. Increases in triplet rates were much more marked among births to university-educated women and women 30 years and older. Among women 45 years and older, the triplet rate was approximately fifty times higher in 1998 than in 1971-77. This group of older women (> or = 45 years) had the highest multiple birth rate in 1998.

Adult↗
PubMed1992

Fetal development in cattle with multiple ovulations.

Treatment of lactating and nonlactating parous cows (n = 379) with 12 mg of FSH-P to evaluate development of multiple bovine fetuses resulted in ovulation rates ranging from 1 to 27 corpora lutea (CL). Fertilization rate (i.e., ova fertilized at 6 to 8 d postmating, 80.0%) was not affected by ovulation rate. The percentage of fetuses developing normally at 51 to 53 d postmating decreased (P less than .01) as ovulation rate increased; 1 CL, 100.0%; 2 CL, 100.0%; 3 CL, 66.7%; 4 CL, 45.8%; 5 CL, 33.3%; 6 to 10 CL, 13.6%; and greater than 10 CL, 8.9%. Of the 86 cows permitted to calve, 47 produced singles, 22 twins, 9 triplets, 7 quadruplets, and 1 quintuplets. Calf birth weight and gestational length decreased (P less than .01) as the number of calves born increased from one to two to three. Smaller decreases (P less than .05) in birth weight occurred among triplets, quadruplets, and quintuplets, whereas gestational length did not differ (P greater than .1) among these groups. Systemic progesterone concentrations in the dam were proportional (P less than .01) to the number of fetuses in utero between d 126 and 266 for dams gestating one, two, or three or more fetuses; estrone sulfate was lower (P less than .01) in dams with one than in those with two or more fetuses. Placental weight (i.e., cotyledons plus intercotyledonary membranes) per fetus at 52 +/- 1 d of gestation and at term decreased as the number of fetuses increased. The chorioallantoic membranes were often fused among multiple fetuses and contained either all viable or all dead fetuses, but not both, within the same anastomosed placental unit. These results suggest that ovulation rate is the first limiting factor to increasing cow productivity for beef cattle because some bovine females had the capacity to gestate up to three fetuses per uterine horn, or a total of five fetuses, above which pregnancy was terminated.

Abortion, Veterinary↗
PubMed2001

Frequency of a monochorionic pair in multiple gestations: relationship to mode of conception.

OBJECTIVE: To determine whether the mode of conception affects the frequency of monochorionicity in multiple gestations. METHODS: Our study population consisted of all women with multiple gestations who had a first-trimester sonogram at our institution between May 1998 and April 2000. The frequency of monochorionicity in pregnancies conceived naturally was compared with the frequency in pregnancies achieved via any form of assisted reproductive technology and among the different types of assisted reproductive technology. RESULTS: Our study consisted of 464 multiple gestations comprising 332 twin, 113 triplet, 16 quadruplet, and 3 quintuplet pregnancies. The higher the fetal number, the more likely the pregnancy resulted from assisted reproductive technology (72.6% of twins, 84.1% of triplets, 92.8% of quadruplets, and 100% of quintuplets; P < .05, Fisher exact test). Monochorionic pairs were found more commonly in naturally conceived pregnancies than in those resulting from assisted reproductive technology (28.2% versus 5.4%; P < .000001, chi2 test). The frequency of monochorionic pairs after in vitro fertilization with blastocyst transfer on day 5 (10.5%) was double the frequency from in vitro fertilization with cleavage stage transfer on day 3 (4.9%), but the difference was not statistically significant (P = .24, Fisher exact test). CONCLUSIONS: Monochorionic pairs are relatively common in naturally conceived twins and in higher-order multiple gestations with more than 3 fetuses arising from assisted reproductive technology, but they are uncommon in twins and triplets arising from assisted reproductive technology There is a trend toward a higher frequency of monochorionic pairs after day 5 blastocyst transfer than day 3 transfer, but a larger study population is needed to confirm this finding.

Chorion↗
PubMed2001

Mechanisms of twinning. I. Effect of environmental diversity on genetic expression in monozygotic multifetal pregnancies.

OBJECTIVE: To examine, using fingerprint homology, the interaction of genetic and environmental factors in arriving at the final phenotypic expression in uniovular triplets, quadruplets and quintuplets. STUDY DESIGN: The fingerprints of several multifetal sets were collected and matched. A total of 250 fingers were printed. A comparison based on the classic dactylographic patterns was made. Zygosity of each set was known from placental chorionicity studies, as well as blood typing and physical similarities. RESULTS: As the monozygotic set size increased, the ipsilateral print concordance diminished. At one extreme, with twins there is 88% homology; at the other end, with quintuplets the correspondence is 71%. CONCLUSION: The overall trend of these results paralleled increasing intrauterine environmental diversity and tended to support the volar pad pressure hypothesis of prenatal fingerprint development.

Dermatoglyphics↗
PubMed1994

Obstetrical implications in multiple pregnancies.

In the present study 90 multiple pregnancies were examined. These were subdivided on the basis of the number of embryos involved (74 twins, 10 triplets, 6 quintuplets) and on whether they were followed at our clinic for the entire pregnancy or not. In each group we analysed certain variables, calculating the respective mean values and standard deviations. We used the ANOVA test to discriminate the eventual differences in the means of the variables analysed, operating a p < 0.05 significance value. In addition, significant differences were analysed by the test of Contrasts (Scheffe F-test). The concept that emerged from the data investigated is that careful management of these pregnancies, carried out in high-level structures, can reduce the incidence of complications on both the maternal and fetal side and thus prevent "minimal brain damage" in the newborn.

Abortion, Spontaneous↗
PubMed1989

[Duration of pregnancy in higher degree multiple birth].

The relationship of birth-weight and gestational age was analyzed in 39 multiple pregnancies (27 x triplets, 9 x quadruplets, 3 x quintuplets). Prophylactic cerclage has no benefit for the duration of the pregnancy. Premature rupture of the membranes was the major indication to delivery (33.3%) followed by maternal (28.2%) and foetal (28.2%) causes.

Cervix Uteri↗
PubMed2005

Is peripartum hysterectomy more common in multiple gestations?

OBJECTIVE: To compare the occurrence of peripartum hysterectomy between singleton and multiple gestations. METHODS: This was a historical cohort study comparing the occurrence of peripartum hysterectomy between singleton and multiple gestations at Banner Good Samaritan Regional Medical Center, Phoenix, Arizona, from January 1, 1996, to December 31, 2001. RESULTS: During the study years, 42,595 singleton, 1,131 twin, 164 triplet, 35 quadruplet, and 2 quintuplet deliveries occurred. A total of 100 peripartum hysterectomies were performed. Of these hysterectomies, 88 occurred in singletons, 5 in twins, 6 in triplets, and 1 in quadruplets. The overall occurrence of peripartum hysterectomy was 2.28 per 1,000, and the occurrence of emergent peripartum hysterectomy was 1.73 per 1,000. Multiple gestations had a significantly greater risk of emergent peripartum hysterectomy than singletons (odds ratio [OR] 6.04, 95% confidence interval [CI] 3.28-11.11; P < .001). This difference was more pronounced among higher-order multiple gestations: twins (OR 2.95, 95% CI 1.22-7.13, P = .03), triplets (OR 25.22, 95% CI 11.02-57.77, P < .001), and quadruplets (OR 19.53, 95% CI 3.34-114.69, P = .04). When compared with singletons, higher-order multiple gestations had nearly a 24-fold increased risk of emergent peripartum hysterectomy (OR 23.97, 95% CI 11.05-51.99, P < .001). CONCLUSION: Multiple gestations have a significantly higher occurrence of emergent peripartum hysterectomy than singletons. This information should be used in counseling and managing patients with these pregnancies.

Adult↗
PubMed2002

Routine cervical cerclage in higher order multiple gestation -- does it prolong the pregnancy?

Preterm birth following cervical dilatation is the greatest threat to infants of a multiple pregnancy. Lacking reliable data concerning the effect of prophylactic cerclage, we compared a study group to controls for maternal and perinatal outcome. Sixteen of 94 triplet-, 9 of 18 quadruplet/quintuplet-pregnancies, treated with prophylactic cerclage, were retrospectively compared to those without cervical cerclage respectively. Kruskal-Wallis test and Mann-Whitney-U test were performed as non-parametric one way analysis of variance. For the analysis of frequencies Chi Square test or Fisher's exact test were performed. Odds ratio with 95% confidence interval was used to compare the need for intravenous tocolysis as well as perinatal morbidity and mortality. Gestational age at delivery was not different from the controls in all studied groups. Birth weight revealed a 200 g dominance for the "no cerclage-triplets", while this significant difference was inverted for quadruplets/quintuplets (1245 g vs. 1069 g). With respect to gestational age at birth, need for hospitalisation or medical intervention no benefit was achieved. Moreover, perinatal outcome analysed by arterial pH, APGAR-Score and perinatal mortality was not altered by a prophylactic cerclage. Perinatal morbidity for quadruplets and quintuplets was even higher in cerclage pregnancies. Therefore, these retrospective results disclaim a positive impact of cervical cerclage on pregnancy management or perinatal outcome in multifetal pregnancies.

Apgar Score↗
PubMed1998

HLA haplotype sharing in rheumatoid arthritis sibships: risk estimates subdivided by proband genotype.

There is a well-known association between rheumatoid arthritis (RA) and HLA-DR4. Recent research has indicated that both DR4 haplotypes are important in disease predisposition (favoring a recessive mode of inheritance). Others have suggested that certain combinations of genotypes, in particular Dw4/Dw14 heterozygotes, may be more important than others. We examined the mode of inheritance of RA using data from the Arthritis and Rheumatism Council's national repository of family material [Worthington et al. (1994) Br J Rheumatol 33:970-976]. There were 85 affected sibships consisting of 77 sib pairs, 6 trios, 1 quintuplet, and 1 sextuplet. The affected sibs shared two, one, and zero parental HLA haplotypes in a ratio of 0.42:0.43:0.15, which was significantly different from random expectations (P = 0.00009). Risk estimates for RA to sibs were calculated based on an overall sibling recurrence risk of 3.9%. Risks for those sharing two, one, and zero parental HLA haplotypes were 6.5% [95% confidence interval (CI) = 5.1-7.9%], 3.3% (95% CI = 2.6-4.0%), and 2.5% (95% CI = 1.5-3.5%), respectively. We also examined the risk of RA based on the DRbeta1 genotype status of sib and proband. After excluding genotypic combinations with small numbers, the highest genotype-specific risks were seen for sibs sharing two haplotypes with either a DRbeta1*0401/DRbeta1*0404 (12.5%, 95% CI = 6.9-15.2%) or a DRbeta1*0401/DRbeta1*0408 (11.1%, 95% CI = 4.5-15.1%) proband. An independent assessment based on the AGFAP methodology confirmed the increase in risk for these genotypes, in particular for DRbeta1*0401/DRbeta1*0408. The excess being due to *0401/*0408 rather than to *0401/*0404 may explain why the Dw4/Dw14 effect is not always observed.

Alleles↗
PubMed1995

New variant of type II von Willebrand's disease with structural abnormality of plasma von Willebrand factor in a patient with very mild bleeding history.

A new variant of von Willebrand's disease has been discovered in 2 members of a Macedonian family of 6. The proband, an 8-year-old boy, showed a prolonged bleeding episode on 1 occasion. Ristocetin-induced platelet aggregation and bleeding time were normal. In plasma, ristocetin cofactor activity (RCo) and von Willebrand factor (vWf) antigen were reduced to the same clearly low level. The determination of vWf antigen of platelets resulted in borderline values, while RCo was clearly reduced. Low- and intermediate-resolution agarose gel electrophoresis showed absence of the largest multimers in plasma vWf, and slight reduction in platelet vWf. High-resolution gels revealed abnormal multimeric structure only in plasma vWf. The smaller multimers could be resolved in a broad central band flanked by 4 fainter satellite bands; however, satellite bands close to the central band were more intense, and more distant ones were fainter, compared to normal plasma. The central band of the fastest-moving multimer was markedly intensified, and the mobility of the whole quintuplet was slightly reduced. Heredity seems to be autosomal-dominant. No mutation was found in exon 28 of the vWf gene. Because there was only 1 mild bleeding episode in the family, this structural variation seems to have only little clinical consequence. We conclude that this vWf abnormality is different from those observed in other type II variants previously described. Based on the revised classification by the International Society on Thrombosis and Haemostasis, we proposed designation type 2A-Bern for this new subtype.

Base Sequence↗
PubMedDate not supplied

Age differences in growth and physical abilities in trained and untrained girls 10-17 years of age.

The purpose of the present study was to assess the age differences in growth characteristics and physical abilities of physically active adolescent girls and to compare them to corresponding data for girls nonactive in sport. The cross-sectional study was carried out on 643 Estonian girls, 10-17 years of age, who were regularly training track and field, and 902 nonactive girls. The organized physical activity of the studied girls consisted of lessons in the school curriculum (2 x 45 minutes per week) for both groups and special track and field training for the first group. Height, weight, and the body mass index (BMI) were used to characterize growth status. Physical ability was assessed with the 30-m dash, standing long jump, medicine ball throw (2 kg), standing quintuplet jump, isometric strength of back extensor muscles, and 1-minute ergocycling at the highest possible rate. Girls active in track and field were taller in all the age groups (P < 0.05-0.001) and lighter except at 17 years, when they were heavier (P > 0.05), but the differences at 12 and 13 years were not significant. BMI was also significantly lower in active girls (P < 0.05-0.001) in all age groups, except at 17 (P > 0.05). The actively training girls had higher physical abilities at all ages from 10-17. The annual differences in performance scores were significant (P < 0.05-0.001) up to 15 years except for the standing long jump. Differences in mean scores of most motor abilities were minimal or reduced significantly at 13-14 years in nonactive girls, but were significant in active girls.

Adolescent↗