Twin Anemia-Polycythemia Sequence: Perinatal Management and Outcome

2015 ◽  
Vol 40 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Eran Ashwal ◽  
Yoav Yinon ◽  
Michal Fishel-Bartal ◽  
Abraham Tsur ◽  
Benjamin Chayen ◽  
...  
Keyword(s):  
Gestational Age ◽  
Neonatal Morbidity ◽  
Control Group ◽  
Monochorionic Twins ◽  
Monochorionic Twin ◽  
Gestational Age At Delivery ◽  
Perinatal Management ◽  
Intrauterine Blood Transfusion ◽  
And Control ◽  
Twin Pregnancies

Objective: To determine the perinatal outcome of monochorionic twin pregnancies complicated by twin anemia-polycythemia sequence (TAPS). Methods: All monochorionic twins diagnosed with TAPS between 2011 and 2014 were included. Each twin pair with TAPS (study group) was compared with 2 uncomplicated monochorionic twin pairs who were matched for gestational age at delivery (control group). Neonatal morbidity and mortality were evaluated. Results: During the study period, 179 monochorionic twins were followed at our center, of whom 46 underwent laser ablation due to twin-to-twin transfusion syndrome. TAPS was diagnosed in 10 cases; 8 of them were spontaneous, and 2 occurred following laser surgery. Out of 7 patients diagnosed prenatally with TAPS, 5 cases were managed expectantly, and 2 cases were treated with intrauterine blood transfusion. The rates of severe and mild central nervous system lesions on postnatal ultrasound were similar in the TAPS group and control group (5.0 vs. 2.5%, p = 0.61, and 5.0 vs. 12.5%, p = 0.25, respectively). Additionally, severe neonatal morbidity was comparable between the groups. All neonates were alive at 1 month of age. Conclusion: The neonatal outcome of monocohorionic twins affected by TAPS is favorable and comparable to gestational age-matched uncomplicated monochorionic twins.

Long-term outcomes of laser coagulation of feto-fetal anastomoses in monochorionic twins

2020 ◽  
Vol 15 (5) ◽  
pp. 52-56
Author(s):  
A.E. Bugerenko ◽  
◽  
Zh.Yu. Kunyakh ◽  
O.B. Panina ◽  
Yu.S. Mirakyan ◽  
...  
Keyword(s):  
Gestational Age ◽  
Laser Coagulation ◽  
Control Group ◽  
Healthy Children ◽  
Long Term Outcomes ◽  
Monochorionic Twins ◽  
Gestational Age At Delivery ◽  
One Year ◽  
Experimental Group

Objective. To evaluate long-term outcomes of fetoscopic laser coagulation (FLC) of placental anastomoses in monochorionic twins with feto-fetal transfusion syndrome (FFTS). Patients and methods. The experimental group included live infants after FLC born to 76 women between 2012 and 2017. The control group comprised monochorionic, diamniotic (MCDA) twins with no complications born to 109 women. The following criteria were used in the analysis: gestational age at FLC, FFTS stage (Quintero staging system), gestational age at delivery, and delivery method. During follow-up, we analyzed children’s data at birth and at the age of one and three years. Results. The number of healthy children and children with minimal health problems in the experimental group was 106 (84.8%) by the age of one year and 112 (89.6%) by the age of 3 years. Nineteen children (15.2%) were disabled at the age of one year; by 3 years of age, their number decreased to 13 (10.4%). In the control group, 2 participants (1.8%) had neurological disabilities. Conclusion. The majority of children born after FLC were healthy and socially adapted. The most common disorders after FLC were neurological disorders (8.8%), cardiovascular disorders (14.8%), retinopathy of prematurity (15.7%), and bronchopulmonary dysplasia (10%). The main factor affecting the development of complications in these children was gestational age at delivery. The optimal gestational age was 33–35 weeks, when the risk of disability was similar to that in MCDA twins without complications. Key words: monochorionic twins, feto-fetal transfusion syndrome, fetoscopy

scholarly journals Association Between Gestational Trophoblastic Disease (GTD) History and Clinical Outcomes in in Vitro Fertilization/intracytoplasmic Sperm Injection (IVF/ICSI) Cycles

2021 ◽  
Author(s):  
Xinyu Cai ◽  
Mei Zhang ◽  
Chenyang Huang ◽  
Yue Jiang ◽  
Jidong Zhou ◽  
...  
Keyword(s):  
Live Birth ◽  
Gestational Age ◽  
Live Birth Rate ◽  
Gestational Trophoblastic Disease ◽  
Control Group ◽  
Vitro Fertilization ◽  
Gestational Age At Delivery ◽  
History Of ◽  
And Control

Abstract Background: Gestational trophoblastic disease (GTD) usually affects young women of childbearing age. After treatment for GTD, 86% of women wish to achieve pregnancy. On account of the impacts of GTD and treatments as well as patient anxiety, large numbers of couples turn to assisted reproductive technology (ART), especially in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). But few studies have investigated whether a history of GTD affects the outcomes of IVF/ICSI in secondary infertile patients and how it occurs. We investigate whether a history of GTD affects the IVF/ICSI outcomes and the live birth rates in women with secondary infertility.Methods: This retrospective cohort study enrolled 176 women with secondary infertility who underwent IVF/ICSI treatment at the reproductive medical center of Nanjing Drum Tower Hospital from January 1, 2016, to December 31, 2020. Participants were divided into the GTD group (44 women with GTD history) and control group (132 women without GTD history matched from 8318 secondary infertile women ). The control group and the study group were matched at a ratio of 3:1 according to patient age, infertility duration, number of cycles and body mass index (BMI). We assessed retrieved oocytes and high-grade embryos, biochemical pregnancy, miscarriage, ectopic pregnancy, gestational age at delivery, delivery mode and live birth rates.Result(s): We found a significantly reduced live-birth rate (34.1% vs 66.7%) associated with IVF/ICSI cycles in patients with a GTD history compared to those without a GTD history. The biochemical pregnancy and miscarriage rates of the GTD group were slightly higher than those of the control group. In addition, there was a difference in gestational age at delivery between the GTD and control groups (p<0.001) but no differences in the mode of delivery (p=0.267). Furthermore, the number of abandoned embryos in the GTD group was greater than that in the control group (p=0.018), and the number of good-quality embryos was less than that in the control group (p=0.019). The endometrial thickness was thinner (p<0.001) in the GTD group. Immunohistochemistry (IHC) showed abnormal endometrial receptivity in the GTD group.Conclusion(s): The GTD history of patients undergoing IVF/ICSI cycles had an impact on the live-birth rate and gestational age at delivery, which might result from the thinner endometrium and abnormal endometrial receptivity before embryo transfer.

Perbandingan Efek Suplementasi Tablet Tambah Darah Dengan Dan Tanpa Vitamin C Terhadap Kadar Hemoglobin Pada Ibu Hamil Dengan Usiakehamilan 16-32 Minggu Di Desa Keniten Kecamatan Mojo Kabupaten Kediri

2017 ◽  
Vol 3 (1) ◽  
pp. 76
Author(s):  
Siti Asiyah ◽  
Dwi Estuning Rahayu ◽  
Wiranti Dwi Novita Isnaeni
Keyword(s):  
Treatment Group ◽  
Vitamin C ◽  
Gestational Age ◽  
Group Treatment ◽  
Sampling Technique ◽  
Hemoglobin Level ◽  
The Body ◽  
Control Group ◽  
Fetal Organ ◽  
And Control

The needed of Iron Tablet in pregnancy was increase than mother who not pregnant.  That  cause of  high metabolism at the pregnancy for formed of  fetal organ and energy. One of effort for prevent anemia in mother pregnant with giving the Iron tablet and vitamin c. The reason of  this research in 4 June – 11 July 2014 is for compare the effect of  iron tablet suplementation with and without vitamin C toward Hemoglobin level in mother pregnant With Gestational Age Of 16-32 Weeks In Desa Keniten Kecamatan Mojo Kabupaten Kediri. This research method using comparative analytical.  Research design type of Quasy Eksperiment that have treatment group and control group. Treatment group will giving by Iron tablet and 100 mg vitamin C, and control group just giving by iron tablet during 21 days. Population in this research are all of mother pregnant with Gestational Age Of 16-32 Weeks with Sampling technique is  cluster random sampling is 29 mother pregnant. Comparison analysis of  iron tablet suplementation effect with and without vitamin C toward Hemoglobin level in mother pregnant With Gestational Age Of 16-32 Weeks, data analysis using Mann Whitney U-test and the calculated U value (44,5) less than U-table (51). So there was difference of iron tablet suplementation effect with and without vitamin C toward Hemoglobin level in mother pregnant With Gestational Age Of 16-32 Weeks Therefore, the addition of vitamin C on iron intake is needed to increase the uptake of iron tablets. When the amount of iron uptake increases, the reserves of iron in the body will also increase, so as to prevent anemia in pregnant women; Keywords : Iron Tablet (Fe), Vitamin C, Hemoglobin level, Mother Pregnant

Short- and long-term outcomes of preterm spontaneous twin anemia-polycythemia sequence

2020 ◽  
Vol 48 (4) ◽  
pp. 329-334
Author(s):  
Soo Jin Han ◽  
Seung Mi Lee ◽  
Sohee Oh ◽  
Subeen Hong ◽  
Jeong Won Oh ◽  
...  
Keyword(s):  
Cord Blood ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Control Group ◽  
Long Term Outcomes ◽  
Neurodevelopmental Outcomes ◽  
Monochorionic Twin ◽  
Increased Risk ◽  
Study Population

AbstractBackgroundIn monochorionic twin pregnancy, placental anastomosis and inter-twin blood transfusion can result in specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). It is well established that adverse outcomes are increased in TTTS, but reports on the neonatal and long-term outcomes of TAPS are lacking. The objective of this study was to evaluate the neonatal and neurodevelopmental outcomes in spontaneous TAPS.MethodsThe study population consisted of monochorionic twin pregnancies with preterm birth (24–37 weeks of gestation) between November 2003 and December 2016 and in which cord blood was taken at the time of delivery. According to the result of hemoglobin in cord blood, the study population was divided into two groups: a spontaneous TAPS group and a control group. Neonatal and neurodevelopmental outcomes were compared between the two groups.ResultsDuring the study period, 11 cases were diagnosed as spontaneous TAPS (6.4%). The TAPS group had lower gestational age at delivery and had a higher risk for cesarean delivery. However, neonates with TAPS were not at an increased risk for neonatal mortality and significant neonatal morbidity. In addition, the frequency of severe cerebral lesion during the neonatal period and the risk of cerebral palsy at 2 years of age were not different between the two groups.ConclusionThe spontaneous TAPS diagnosed by postnatal diagnostic criteria was not associated with the increased risk of adverse neonatal and neurodevelopmental outcomes. Further studies are needed to evaluate the morbidity of antenatally diagnosed TAPS.

Twin Pregnancies Complicated by a Single Malformed Fetus: Chorionicity, Outcome and Management

2010 ◽  
Vol 13 (5) ◽  
pp. 501-507 ◽  
Author(s):  
Ali Gedikbasi ◽  
Alpaslan Akyol ◽  
Gokhan Yildirim ◽  
Ali Ekiz ◽  
Ahmet Gul ◽  
...  
Keyword(s):  
Gestational Age ◽  
Statistical Significance ◽  
Expectant Management ◽  
Control Group ◽  
Study Group ◽  
Preliminary Evaluation ◽  
Gestational Age At Birth ◽  
The Impact ◽  
Twin Pregnancies ◽  
Age At Birth

The objective of this study was to evaluate the impact of one abnormal fetus in a twin pregnancy, to compare impact of chorionicity and clinical outcome of intervention and expectant management. Thirty-seven dichorionic (DC) twins and 18 monochorionic (MC) twins complicated with one malformed fetus were evaluated for gestational age, birthweight and perinatal outcome. Six hundred and forty-two twin pregnancies were evaluated in the database. The control groups consisted of 429 DC and 86 MC twins without anomalous fetus. Mean birthweight and gestational age at birth for DC control group were (n= 429; 2137g and 34.71 weeks), DC study group,n= 37; 2117g (p= .338) and 33.97 weeks (p= .311), and DC study group with major malformations,n= 30; 2019g (p= .289) and 33.3 weeks (p= .01), and showed only significance for gestational age. There was no statistical significance between MC control group,n= 86; 2097g and 34.93 weeks, and MC study group,n= 18; 2237g (p= .338), and 34.42 weeks (p= .502). Because of limited data, the preliminary evaluation for expectant management and intervention, and survival of at least one normal fetus showed no impact. We conclude that, although, all DC twin pregnancies have a risk for preterm delivery, DC twins complicated with major malformation of one twin, have a lower mean gestational age at birth. Preliminary results for intervention does not improve fetal outcome for DC and MC twins and needs further evaluation with greater studies of impact or review.

scholarly journals Pregnancy Outcome of Twin Pregnancy at Gandaki Medical College Teaching Hospital, Pokhara, Nepal

2018 ◽  
Vol 11 (02) ◽  
pp. 1-4
Author(s):  
M Tripathi ◽  
R Shrestha
Keyword(s):  
Preterm Delivery ◽  
Teaching Hospital ◽  
Gestational Age ◽  
Twin Pregnancy ◽  
College Teaching ◽  
Neonatal Morbidity ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Neonatal Complications ◽  
Twin Pregnancies

Objectives: To evaluate maternal and neonatal complications and pregnancy outcomes of twin pregnancies. Methods: The cross sectional study was conducted using retrospective data on the twin pregnancies with more than 28 weeks of gestational age. The study used data over a period of five years, from March 10, 2010 to March 9, 2015 in the Department of Obstetrics and Gynecology, GMC Teaching Hospital Pokhara. Results: Of the 50 twin pregnancies, the most common maternal complication was preterm delivery (40%). Other maternal complications were anemia (36%), pregnancy induced hypertension (14%), premature rupture of membranes (14%), postpartum hemorrhage (12%) and antepartum hemorrhage (6%). Median gestational age at delivery was 37 weeks. Most common route of delivery was cesarean section (66%). Most common neonatal complication was low birth weight (48%) births first twin and second twin 56%. Conclusion: Twin pregnancy has high maternal and neonatal complications, especially preterm delivery that increases the risk of significant neonatal morbidity and mortality.

scholarly journals Risk of severe acute maternal morbidity according to gestational age at delivery in twin pregnancies

2022 ◽  
Vol 226 (1) ◽  
pp. S595-S596
Author(s):  
Lola Loussert ◽  
Catherine Deneux-Tharaux ◽  
Aurélien Seco ◽  
François Goffinet ◽  
Diane Korb ◽  
...  
Keyword(s):  
Gestational Age ◽  
Maternal Morbidity ◽  
Severe Acute Maternal Morbidity ◽  
Gestational Age At Delivery ◽  
Twin Pregnancies

scholarly journals Study of maternal and perinatal outcome among twin pregnancies with one twin demise

2019 ◽  
Vol 8 (7) ◽  
pp. 2622
Author(s):  
Sunanda N. ◽  
Akhila M. V.
Keyword(s):  
Gestational Age ◽  
Perinatal Outcome ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Time Interval ◽  
Delivery Mode ◽  
Care Hospital ◽  
Monochorionic Twins ◽  
Medical College ◽  
Twin Pregnancies

Background: To study the incidence, management and to determine maternal and perinatal outcome in cases of twin pregnancy with one twin demise in the second half of the pregnancy.Methods: This retrospective study was carried out at Cheluvamba Hospital, a tertiary care hospital attached to Mysore medical college and research institute between September 2009 and 2014. 19 twin pregnancies complicated by single intrauterine fetal demise (IUFD) after 20 weeks of gestation were identified from the hospital records. Data collected included maternal age, parity, antenatal complications, cause of IUFD, gestational age at diagnosis, time interval between diagnosis of IUFD and delivery, mode of delivery, birth details, type of placentation and neonatal complications.Results: The incidence of twin with one twin demise was 2.056%. Mean gestational age at presentation was 33.86 weeks. Most common cause of death was growth discordance in 7 cases followed by placental insufficiency in 4 cases. 57.89% of cases had monochorionic placentation. Neonatal course was most commonly complicated by prematurity. Maternal course was uneventful in majority (63.15%) of cases with two maternal deaths due to intravascular coagulopathy sequelae.Conclusions: Single fetal death occurs more often in monochorionic twins. The main problem for the surviving twin is prematurity. It is very important to identify the chorionicity by ultrasound examination in early pregnancy and implement specific surveillance of monochorial pregnancies.

Neonatal Morbidity of Monoamniotic Twin Pregnancies: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Danilo Buca ◽  
Daniele Di Mascio ◽  
Asma Khalil ◽  
Ganesh Acharya ◽  
Tim Van Mieghem ◽  
...  
Keyword(s):  
Gestational Age ◽  
Primary Outcome ◽  
Random Effect ◽  
Neonatal Morbidity ◽  
Small Sample ◽  
Respiratory Morbidity ◽  
Infectious Morbidity ◽  
Neurological Morbidity ◽  
Twin Pregnancies ◽  
Type Of Management

Objective This study was aimed to report the incidence of neonatal morbidity in monochorionic monoamniotic (MCMA) twin pregnancies according to gestational age at birth and type of management adopted (inpatient or outpatient). Study Design Medline and Embase databases were searched. Inclusion criteria were nonanomalous MCMA twins. The primary outcome was a composite score of neonatal morbidity, defined as the occurrence of at least one of the following outcomes: respiratory morbidity, overall neurological morbidity, severe neurological morbidity, and infectious morbidity, necrotizing enterocolitis at different gestational age windows (24–30, 31–32, 33–34, and 35–36 weeks). Secondary outcomes were the individual components of the primary outcome and admission to neonatal intensive care unit (NICU). Subanalysis according to the type of surveillance strategy (inpatient compared with outpatient) was also performed. Random effect meta-analyses were used to analyze the data. Results A total of 14 studies including 685 MCMA twin pregnancies without fetal anomalies were included. At 24 to 30, 31 to 32, 33 to 34, and 35 to 36 weeks of gestation, the rate of composite morbidity was 75.4, 65.5, 37.6, and 18.5%, respectively, the rate of respiratory morbidity was 74.2, 59.1, 35.5, and 12.2%, respectively, while overall neurological morbidity occurred in 15.3, 10.2, 4.3, and 0% of the cases, respectively. Infectious morbidity complicated 13, 4.2, 3.1, and 0% of newborns while 92.1, 81.6, 58.7, and 0% of cases required admission to NICU. Morbidity in pregnancies delivered between 35 and 36 weeks of gestation was affected by the very small sample size of cases included. When comparing the occurrence of overall morbidity according to the type of management (inpatient or outpatient), there was no difference between the two surveillance strategies (p = 0.114). Conclusion MCMA pregnancies are at high risk of composite neonatal morbidity, mainly respiratory morbidity that gradually decreases with increasing gestational age at delivery with a significant reduction for pregnancies delivered between 33 and 34 weeks. We found no difference in the occurrence of neonatal morbidity between pregnancies managed as inpatient or outpatient. Key Points

Correlation between Clinical, Placental Histology and Microbiological Findings in Spontaneous Preterm Births

2015 ◽  
Vol 40 (2) ◽  
pp. 141-149 ◽  
Author(s):  
Gali Garmi ◽  
Marina Okopnik ◽  
Yoram Keness ◽  
Noah Zafran ◽  
Elad Berkowitz ◽  
...  
Keyword(s):  
Gestational Age ◽  
Neonatal Outcome ◽  
Preterm Births ◽  
Neonatal Morbidity ◽  
Spontaneous Preterm Birth ◽  
Retrospective Case ◽  
Delivery Methods ◽  
Main Determinant ◽  
Gestational Age At Delivery ◽  
The Impact

Aims: To examine the occurrence of chorioamnionitis and abruption among women who had a spontaneous preterm birth (SPTB), the correlation between clinical and placental findings, and the impact of these complications on neonatal outcome after delivery. Methods: This was a retrospective case-control study conducted between 2008 and 2012 at a single teaching hospital. The study group included all women who had an SPTB (23-36 weeks). Placentas were cultured and underwent histological examination. Results: A total of 478 women were included. The mean gestational age at delivery was 32.6 ± 3.1 weeks. Overall, 260 (54.4%) women had either clinical and/or histological abruption or chorioamnionitis. Clinical chorioamnionitis was diagnosed before birth in 14 (2.9%) women, while histological chorioamnionitis (HCA) in 84 (17.4%). Overall, 38 neonates had infection. Placental cultures were negative in 65.8% (25/38) of these neonates, and in 77.1% (27/38), HCA was ruled out. Logistic regression analysis revealed that neonatal morbidity and mortality were correlated with gestational age at delivery (p = 0.02), not with placental pathology (p = 0.08). Conclusions: Half of the women with PTB had clinical or histological abruption, chorioamnionitis or both. A partial correlation was found between clinical and placental findings. The main determinant of neonatal outcome was gestational age at delivery and not placental findings.

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