Pregnancy Prognosis Associated With an Isolated Single Umbilical Artery in Twin Pregnancy

2014 ◽  
Vol 17 (6) ◽  
pp. 584-588 ◽  
Author(s):  
Thomas J. Cade ◽  
Fabricio Da Silva Costa ◽  
Karen Reidy ◽  
Lex W. Doyle ◽  
Sarah E. Mitchell ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Twin Pregnancy ◽  
Umbilical Artery ◽  
Perinatal Death ◽  
Mode Of Delivery ◽  
Growth Restriction ◽  
Ultrasound Images ◽  
Single Umbilical Artery ◽  
Risk Pregnancy

To determine the prognosis of an isolated single umbilical artery (SUA) in a twin pregnancy, we selected twin pregnancies with a second trimester ultrasound diagnosing a SUA in at least one fetus at our tertiary hospital. This was confirmed by placental histopathology or by expert review of ultrasound images. Cases were identified by searching the hospital ultrasound database over a period of 7.5 years. Higher order multiples or coexistent aneuploidy or major anomalies were excluded. Each case of an isolated SUA was assigned three consecutive twin pregnancy controls paired for chorionicity and maternal age. Primary outcomes were preterm birth <34 weeks, small for gestational age (SGA) or perinatal death. Other outcomes included antenatal growth restriction, mode of delivery, and admission to neonatal intensive care or special care nursery. Nine pregnancies (18 fetuses) were identified for analysis as cases. Isolated SUA was associated with preterm birth <34 weeks (odds ratio = 12.2; 95% CI = 2.0–75.2; p = .005) but not for SGA. There was also no difference in SGA between the affected twin and its normal co-twin. Perinatal death was increased but after controlling for gestational age and clustering this finding was no longer significant. We conclude that isolated SUA in twins adds a degree of risk to an already high-risk pregnancy but does not increase the need for surveillance for growth restriction.

scholarly journals Twin pregnancies: incidence and outcomes in a tertiary health centre of Uttarakhand, India

2018 ◽  
Vol 7 (9) ◽  
pp. 3520 ◽  
Author(s):  
Purnima Upreti
Keyword(s):  
Gestational Age ◽  
Twin Pregnancy ◽  
Health Centre ◽  
Mode Of Delivery ◽  
Presentation Mode ◽  
Fetal Outcomes ◽  
Health Care Centre ◽  
Risk Pregnancy ◽  
Term Labour ◽  
Twin Pregnancies

Background: The frequency of twin pregnancies varies among different regions, countries and populations mostly due to the variation in dizygotic twinning. Twin pregnancy is associated with adverse maternal and fetal outcomes. This study was aimed to find out the frequency and outcome of twin pregnancies in a tertiary health centre of Uttarakhand.Methods: This is a retrospective hospital record-based study of the twin deliveries (with gestational age of 28 weeks and above) which took place in a tertiary health care centre of Uttarakhand from January 2016 to December 2017. Data regarding age, parity and registration status of women who delivered twins, factors associated with twin pregnancy, gestational age, fetal presentation, mode of delivery, pregnancy complications and neonatal outcome was collected and analyzed.Results: The frequency of twin pregnancy was found to be 1 in 52 pregnancies or 1.9%. Majority (56.4%) of the participants were in the age group of 21-25 years. 52.8% were multipara. 74.3% were unbooked. 3.7 % conceived after ovulation induction and 8.2% had family history of twins. Pre-term labour (58.3%) was the most common complication followed by malpresentation (around 37%). Cephalic-cephalic was the commonest fetal presentation (43.8%).58.3% neonates were premature at birth and 83.4% had low birth weight. Male-male was the commonest sex combination of twin pair (30.4%) followed by female-female (28.6%).Conclusions: Twin pregnancy is a high-risk pregnancy associated with adverse maternal and fetal outcomes.

scholarly journals Perinatal Outcome in Twin Pregnancy at Khaipur Medical College, Khairpur Mirs, Pakistan

2021 ◽  
pp. 46-52
Author(s):  
Nusrat Fozia Pathan ◽  
Shazia Jamali ◽  
Maqsood Ahmed Siddiqui ◽  
Khushi Muhammad Sohu ◽  
Ameer Ali Jamali ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Gestational Age ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Twin Pregnancy ◽  
Mode Of Delivery ◽  
Case Series ◽  
Risk Pregnancy ◽  
The Mean ◽  
Twin Pregnancies

Objective: To determine the perinatal outcome of twin pregnancy and to find out the frequency of twin deliveries in hospital based population. Study Design: Descriptive case series. Place and Duration of Study: The study was conducted over a period of 02 Year 1st January 2018 to 31st December 2019 in the Obstetrics and Gynaecology Department at KMC Khairpur Mirs, Sindh Pakistan. Methodology: All the patients of age 20-35 years with twin pregnancies of gestational age above 30 weeks presenting in labour ward of KMC Khairpur Mirs were studied. A detailed history was taken, general physical (G.P) examination and obstetrical examination performed, targeted investigations carried out to detect various fetal complications. Patients were assessed for a mode of delivery, records for data like age, gestational age, weight of baby, APGAR score expressed in term of mean±SD and data like perinatal mortality, prematurity, intra uterine growth restriction (IUGR), the weight of baby and APGAR score expressed in terms of frequencies and percentages on SPSS version 20. Results: In this study total numbers of deliveries were 7200, among them 83 were twin pregnancies the frequency of twin was 1.15%. Booked cases were 24.1%, unbooked was 75.9%. The highest incidence of 42.2% of twin gestation was seen in women between ages 31-35 years, the mean age of patients was seen 30.1±4.1 and regarding the parity incidence was high 54.2% in multiparous l-5. The total number of preterm deliveries was 45(55.2%), gestational age was (35-36+6dnys) weeks in 22.89% of cases, and the mean gestational age of patients was 35.7±2.5. Perinatal mortality was 38(22.9%), stillborn and early neonatal deaths (ENND) were 18.4% and 36.8% and common in twin-2. Conclusion: Twin pregnancy is-a-high-risk-pregnancy still is a major obstetrical and perinatal challenge. The frequency of twin pregnancy seen in this study is 1.15% unbooked and unsupervised pregnancies are more common i.e 75.9%.  Prematurity is common perinatal morbidity 51.20%.  perinatal mortality is 22.9% and highest in twin-2.

Association of Isolated Single Umbilical Artery With Small for Gestational Age and Preterm Birth

2015 ◽  
Vol 126 (4) ◽  
pp. 760-764 ◽  
Author(s):  
Ashley N. Battarbee ◽  
Anna Palatnik ◽  
Linda M. Ernst ◽  
William A. Grobman
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Umbilical Artery ◽  
Single Umbilical Artery

Impact of Intended Mode of Delivery on Outcomes in Preterm Growth-Restricted Fetuses

2017 ◽  
Vol 35 (07) ◽  
pp. 605-610
Author(s):  
Spencer Kuper ◽  
Michelle Wang ◽  
Robin Steele ◽  
Joseph Biggio ◽  
Lorie Harper ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Umbilical Artery ◽  
Perinatal Death ◽  
Mode Of Delivery ◽  
Neonatal Resuscitation ◽  
Preterm Births ◽  
Growth Restriction ◽  
Neonatal Outcomes ◽  
The Impact

Background Scheduled cesarean is frequently performed for fetal growth restriction due to concerns for fetal intolerance of labor. Objective We compared neonatal outcomes in preterm growth-restricted fetuses by intended mode of delivery. Study Design We performed a retrospective cohort study of indicated preterm births with prenatally diagnosed growth restriction from 2011 to 2014 at a single institution. Patients were classified by intended mode of delivery. The primary outcome was a composite of adverse neonatal outcomes, including perinatal death, cord blood acidemia, chest compressions during neonatal resuscitation, seizures, culture-proven sepsis, necrotizing enterocolitis, and grade III–IV intraventricular hemorrhage. Secondary analysis was performed examining the impact of umbilical artery Dopplers. Results Of 101 fetuses with growth restriction, 75 underwent planned cesarean deliveries. Of those induced, 46.2% delivered vaginally. Delivery by scheduled cesarean was not associated with a decreased risk of the composite outcome (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 0.45–5.78), even when only those with abnormal umbilical artery Dopplers were considered (aOR, 2.8; 95% CI, 0.40–20.2). Conclusion In this cohort, planned cesarean was not associated with a reduction in neonatal morbidity, even when considering only those with abnormal umbilical artery Dopplers. In otherwise appropriate candidates for vaginal delivery, fetal growth restriction should not be considered a contraindication to trial of labor.

scholarly journals Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

2021 ◽  
Vol 10 (4) ◽  
pp. 643
Author(s):  
Veronica Giorgione ◽  
Corey Briffa ◽  
Carolina Di Fabrizio ◽  
Rohan Bhate ◽  
Asma Khalil
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Chi Square ◽  
Increased Risk ◽  
Twin Pregnancies

Twin pregnancies are commonly assessed using singleton growth and birth weight reference charts. This practice has led to a significant number of twins labelled as small for gestational age (SGA), causing unnecessary interventions and increased risk of iatrogenic preterm birth. However, the use of twin-specific charts remains controversial. This study aims to assess whether twin-specific estimated fetal weight (EFW) and birth weight (BW) charts are more predictive of adverse outcomes compared to singleton charts. Centiles of EFW and BW were calculated using previously published singleton and twin charts. Categorical data were compared using Chi-square or McNemar tests. The study included 1740 twin pregnancies, with the following perinatal adverse outcomes recorded: perinatal death, preterm birth <34 weeks, hypertensive disorders of pregnancy (HDP) and admissions to the neonatal unit (NNU). Twin-specific charts identified prenatally and postnatally a smaller proportion of infants as SGA compared to singleton charts. However, twin charts showed a higher percentage of adverse neonatal outcomes in SGA infants than singleton charts. For example, perinatal death (SGA 7.2% vs. appropriate for gestational age (AGA) 2%, p < 0.0001), preterm birth <34 weeks (SGA 42.1% vs. AGA 16.4%, p < 0.0001), HDP (SGA 21.2% vs. AGA 13.5%, p = 0.015) and NNU admissions (SGA 69% vs. AGA 24%, p < 0.0001), when compared to singleton charts (perinatal death: SGA 2% vs. AGA 1%, p = 0.029), preterm birth <34 weeks: (SGA 20.6% vs. AGA 17.4%, p = 0.020), NNU admission: (SGA 34.5% vs. AGA 23.9%, p < 0.000). There was no significant association between HDP and SGA using the singleton charts (p = 0.696). In SGA infants, according to the twin charts, the incidence of abnormal umbilical artery Doppler was significantly more common than in SGA using the singleton chart (27.0% vs. 8.1%, p < 0.001). In conclusion, singleton charts misclassify a large number of twins as at risk of fetal growth restriction. The evidence suggests that the following twin-specific charts could reduce unnecessary medical interventions prenatally and postnatally.

scholarly journals Outcome of Twin Pregnancy in a Periurban Hospital

2016 ◽  
Vol 27 (2) ◽  
pp. 57-62
Author(s):  
Saria Tasnim ◽  
FM Anamul Haque ◽  
Sameena Chowdhury
Keyword(s):  
Birth Weight ◽  
Twin Pregnancy ◽  
Perinatal Death ◽  
Post Partum ◽  
Mode Of Delivery ◽  
Labor Pain ◽  
Maternal Complications ◽  
Management Options ◽  
History Of ◽  
Second Twin

Objective: To determine the socio demographic characteristics, clinical presentation and obstetric outcome at delivery and immediate postpartum period of twin gestation in a periurban hospitalMaterial & Methods: An observational study was conducted between January 2000 to December 2004 at Institute of Child and Mother Health. All twin pregnancy irrespective of gestational age admitted in the in-patient department of Institute of Child and Mother Health for delivery and also those undiagnosed cases found to have twin birth were enrolled in the study consecutively from January 2001 to December 2004. Data on socio-demographic factors, predisposing factors for twin gestation and obstetric characteristics was collected using a structured questionnaire. Hospital records were consulted for recording the investigation reports and management options. The outcome variables were maternal complications during antenatal, intranatal and immediate postnatal period, mode of delivery, birth weight and sex of newborn and fetal outcome. All twin pregnancies from the admitted obstetric patients were enrolled consecutivelyResults: During the study period there were 11,185 deliveries and among them 107 were twin gestation. About 22% were primigravida, 78.5% multigravida, 27.1% were illiterate. Most common age group were 24-29 years (39.4%). Antenatal care was availed by 71% of patients and 27.1% twins were not diagnosed till delivery. Family history of twin on maternal side was present in 58.1% and 31.8% had history of taking oral contraceptive immediately before the pregnancy. Ovulation inducing agents were given to 8.3% of twin. Presentations of fetus were both vertex 54.2%, 1st vertex and second breech 16%, and both breech 5.7%. About 55.1% were admitted with labor pain, 6.5% were undelivered second twin. Preterm birth was 27.2% and low birth weight of 1st baby 79.6% and second baby 80.9% respectively. Mode of delivery was vaginal delivery of both fetus 41.6%, caesarean section of both fetus 62.4%, and caesarean for second twin 3.1%. Same sex of both twins was found in 78% and male-male pair was 50%. There was one stillbirth, one conjoined twin and perinatal death was 11.2% Complications encountered during perinatal period were severe abdominal pain 9.3%, retained placenta in 7.3%; and post partum hemorrhage in 4.6% cases.Conclusion: Twin pregnancy is quite common and warrants specialized care during ante partum, intrapartum and postpartum period.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 57-62

Risk of Perinatal Death in Early-Onset Intrauterine Growth Restriction according to Gestational Age and Cardiovascular Doppler Indices: A Multicenter Study

2012 ◽  
Vol 32 (1-2) ◽  
pp. 116-122 ◽  
Author(s):  
Mónica Cruz-Lemini ◽  
Fàtima Crispi ◽  
Tim Van Mieghem ◽  
Daniel Pedraza ◽  
Rogelio Cruz-Martínez ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Gestational Age ◽  
Early Onset ◽  
Intrauterine Growth Restriction ◽  
Perinatal Death ◽  
Growth Restriction ◽  
Intrauterine Growth ◽  
Doppler Indices

scholarly journals A clinical study on maternal and fetal outcome in twin pregnancy at KIMS hospital, Hubli, Karnataka, India

2018 ◽  
Vol 7 (4) ◽  
pp. 1469
Author(s):  
Seeta Sunil Garag ◽  
Vinay Raju D.
Keyword(s):  
High Risk ◽  
Twin Pregnancy ◽  
Analytical Study ◽  
Perinatal Death ◽  
Fetal Outcome ◽  
The Past ◽  
Risk Pregnancy ◽  
Risk Condition ◽  
One Year ◽  
Singleton Pregnancies

Background: Development of two fetus inside the uterus is called twin gestation. Twin gestation is considered as high-risk pregnancy due to associated high maternal morbidity and perinatal mortality in comparison with singleton pregnancies. The past two decades have witnessed a sharp rise in the incidence of twin and higher order gestations.Methods: Prospective analytical study of all women admitted in Obstetrics and Gynaecology department with twin pregnancy at KIMS Hubli, over a period of one year between November 2016 and October 2017.Results: There were 11,127 deliveries occurred in study period of one year, out of which there were 174 twin deliveries accounting for 1.56% of prevalence rate. Anemia was the commonest complication occurring in 160 cases contributing around 90%. Preterm delivery was the second complication occurring in 124 cases accounting for 71%. Among 348 babies, there were 40 perinatal death accounting 11%. There was no maternal death.Conclusions: Twin pregnancy is a high-risk condition, should have mandatory hospital delivery. Early detection, proper treatment improves both maternal and neonatal outcome.

Preterm Birth or Small for Gestational Age in a Singleton Pregnancy and Risk of Recurrence in a Subsequent Twin Pregnancy

2015 ◽  
Vol 125 (4) ◽  
pp. 870-875 ◽  
Author(s):  
Nathan S. Fox ◽  
Erica Stern ◽  
Simi Gupta ◽  
Daniel H. Saltzman ◽  
Chad K. Klauser ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Twin Pregnancy ◽  
Singleton Pregnancy ◽  
Risk Of Recurrence
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