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At least 19 recordsLinked to original sources
PubMed1976

Duration and complications of multiple pregnancies.

Multiple pregnancies reach full term only in a remarkably lower percentage with respect to single pregnancies. Even in the case of multiparae, delivery occurs some three weeks before term. Complications may concern either pregnancy and puerperium or delivery. The former include (1) abortions, especially frequent in the case of monoplacental and monochorial pregnancies; (2) rarer events, such as hydramnios, placenta praevia, association of an ectopic pregnancy with an intrauterine pregnancy, molar degeneration of one egg with normal development of the other; (3) gestoses of the first and second trimester, more frequent than in single pregnancy; and (4) higher incidence, during puerperium, of hemorrhage, phlebitis, and uterine subinvolution. With respect to delivery, normal delivery only occurs in approximately 70% of twin pregnancies, the period of dilatation being generally longer than normal. Better assistance and techniques during labor and especially in the interval between delivery of first and second twin have remarkably reduced the higher mortality rate, especially for the second twin.

Abortion, Spontaneous↗
PubMed1977

[Management and monitoring of multiple pregnancies (author's transl)].

The fetal prognosis in multiple pregnancies can be improved by a multifaceted antenatal program which includes early diagnosis prior to 28 weeks gestation, follow-up of multiple pregnancies in the high risk antenatal clinic, early discontinuation of work, treatment of pre-eclampsia, bed rest in hospital between 28 and 33 weeks and sometimes cerclage, prophylactic and therapeutic administration of labour inhibiting drugs, speedy delivery of the second twin and immediate pediatric care. Bed rest and administration of labour inhibiting drugs are the most important points of this program. With this combination, the utero-placental perfusion can be improved. The gestation can be prolonged and the incidence of small weight neonates and the incidence of the perinatal mortality can be reduced. Since even a large antenatal clinic only cares for a small number of multiple pregnancies, a multicentre study to determine the optimal management of multiple pregnancies is urgently required. Multiple pregnancies had too little attention in modern perinatal medicine and deserve all our attention for an improvement of their outcome.

Adrenergic beta-Agonists↗
PubMed1976

A reduction in multiple pregnancies following the use of a clomiphene citrate: human gonadotrophin sequence.

The results of stimulation with gonadotrophins at the Sterility Clinic (Crown Street) are presented. Two different techniques have been employed involving 86 patients. All patients have similar indications for treatment. All have received the same preliminary investigations and all have been treated previously with a minimum of three cycles of Clomiphene Citrate without satisfactory response (i.e. "clomid failures). Technique (1) involved 51 patients and consisted of daily injections of Human Pituitary Gonadotrophin (H.P.G.) followed by an ovulating injection of Human Chorionic Gonadotrophin (H.C.G.) and a follow up injection of H.C.G. on post-ovulatory Day 7 or 8. This technique had a pregnancy rate of 64 per cent and a multiple pregnancy rate of 34 per cent. Technique (2) involved 35 patients and consisted of 5 days priming with Ethinyl Oestradiol and Clomiphene Citrate together, followed immediately by daily injections of H.P.G., then an ovulating injection of H.C.G. and a follow up injection of H.C.G. on post-ovulatory Day 7 or 8. The results of this variation in technique were a pregnancy rate of 69 percent, a multiple pregnancy rate of 8 percent. It is suggested that the use of Clomiphene Citrate in the latter technique acts as a "buffer" against the more extreme ovarian responses to H.P.G. acting alone and has the apparent advantage of a higher pregnancy rate, a lower multiple pregnancy rate and a reduction in the number of foetuses in each of the multiple pregnancies.

Chorionic Gonadotropin↗
PubMed1979

Ultrasound diagnosis of fetal abnormalities in multiple pregnancy.

Over a period of four years, 41 cases of abnormal multiple pregnancies were diagnosed successfully by ultrasound. These include several rare combinations of abnormalities. The most frequent was a normal pregnancy and a synchronous blighted ovum. Others were twin blighted ova, blighted ovum and missed abortion, missed abortion in both gestational sacs, two embryonic echoes with the development of only one baby, normal fetus and an anencephalic twin, normal fetus and fetus papyraceous, and triplets with two fetuses papyraceous. The results suggest that one or more gestational sacs may be resorbed during pregnancy without any adverse effect on the coexisting normal fetus. From a practical point of view, it is important to be aware of these possibilities before giving the final diagnosis of multiple pregnancy to the patient. The more diagnostic ultrasound is used in obstetrics, the more rare abnormalities associated with multiple pregnancies will be revealed.

Abortion, Missed↗
PubMed1975

An appraisal of lumbar epidural blockade in labour in patients with multiple pregnancy.

A series of 102 patients with a multiple pregnancy (including three sets of triplets) delivered vaginally is presented. An epidural block was provided for 55 of these patients, and comparisons were made between these patients and those who did not have an epidural block. There was a higher incidence of low Apgar-minus-colour (A-C) scores at one minute among the second twins of at least 36 weeks gestation in the epidural series, but no other remarkable contrasts in the (A-C) scores of the respective group of infants. In the non-epidural series two second twins of at least 36 weeks gestational age apparently suffered severe cerebral trauma. Of the 91 liveborn infants in the non-epidural series, five died (two with intracranial haemorrhage, three with hyaline membrane disease); of the 112 liveborn infants in the epidural series, two died (both with hyaline membrane disease). The incidence of instrumental delivery of infants presenting by the vertex, and of breech extraction, was markedly higher in the epidural series. The mean interval between full dilatation of the cervix and delivery of the first twin was greater in the epidural series, but the mean interval between delivery of the first and second infant was smaller in the epidural series. It is concluded that the provision of an epidural block for labour and delivery to patients with a multiple pregnancy is beneficial to the infants.

Anesthesia, Epidural↗
PubMed1978

Premature labor treatment with ritodrine in multiple pregnancy with three or more fetuses.

Modern treatment for anovulatory infertility increases the incidence of multiple pregnancies with three or more fetuses and predisposes to prematurity with high perinatal mortality and mortidity. Premature labor was successfully treated in four multifetal pregnancies with ritodrine hydrochloride, a beta-mimetic drug relaxing the uterus. Another patient misdiagnosed as false labor was not treated and lost three out of four premature babies. Beta-mimetic treatment is indicated in multiple pregnancies even in false labor, or when painless progress in cervical dilatation is observed, to avoid asymptomatic progression into true labor. In contrast to singleton pregnancies, advanced labor with more than four centimeters cervical dilatation should not preclude good chances for successful treatment. Persistence in treatment and repreated use of the most effective intravenous route combined with oral ritodrine administration is needed because of marked tendency to recurrences of premature labor. Progressive increase in the dose of oral ritodrine may be indicated by decrease in therapeutic response. Maternal tachycardia should be considered as an index of patient responsiveness to the beta-mimetic treatment. The therapy is most successful when the patient is hospitalized from the first episode of treatment until at least the 37th week of pregnancy. This is probably less expensive than prolonged hospitalization of several prematures in an intensive care nursery.

Adult↗
PubMed1979

Genetic amniocentesis in multiple pregnancy.

Eleven cases of twin pregnancy presenting for genetic diagnosis in the second trimester are reported. In all 11 cases, a correct chromosomal diagnosis was made on each of the twins. The technique used required only ultrasound and Evan's blue dye for direction of the amniocentesis. Amniography was not performed. The technique used is described in detail, and its advantages over more standard techniques are described.

Amniocentesis↗
PubMed1976

Serum immunoglobulins in multiple pregnancy.

The concentrations of immunoglobulins (Ig) G.A.M. and E were determined in paired umbilical cord and maternal sera in 50 twin pregnancies. Mean IgG levels were higher in cord than maternal sera and in most cases the cord IgG level related more closely to that of the other twin than to either maternal level or birthweight, and was in the range for singletons of the same gestational age. The three cases of fetofetal transfusion syndrome were exceptional in the large difference between IgG concentrations in recipient and donor twins. The discrepancy was much greater than that found between the levels of proteins produced by the fetus, suggesting a disturbance in maternofetal placental transfer. IgM was detected in all cord sera, with one exception, and the level was not related to order of birth. IgA was detected in 16% of cord sera, 13% in sera from first borns. IgE was detected in only 8% of cord sera and there was no evidence of placental transfer.

Female↗