This paper reviews the patterns of occurrence, measurement and the effect of birth weight discordance on fetal and neonatal mortality in multiple pregnancies (twins and triplets). Birth weight discordance is fairly common among multiple pregnancies, and about one-quarter of the twin deliveries are affected by a birth weight discordance of ...

Fetoscopic laser coagulation of placental vascular anastomoses is considered to be the treatment of choice in severe twin-to-twin transfusion syndrome. The aim of fetoscopic laser surgery is to separate completely the inter-twin placental circulation. Incomplete laser coagulation may result in residual vascular anastomoses. The incidence and clinical implications of residual ...

OBJECTIVE: The purpose of this study was to define the association between unequal placental sharing and birth weight discordance in monochorionic/diamniotic twin pregnancies. STUDY DESIGN: The study comprised a prospective cohort of monochorionic/diamniotic twin pregnancies who were delivered in Kaiser Permanente-Northern California, 1997-2003. Dye injection studies of fresh postpartum placentas ...

OBJECTIVE: The aim of this study was to examine fetal gene expression in maternal plasma after fetoscopic intervention for twin-twin transfusion syndrome or congenital diaphragmatic hernia. STUDY DESIGN: Twelve women with pregnancies that were complicated by twin-twin transfusion syndrome and 10 women carrying fetuses with congenital diaphragmatic hernia were sampled ...

Pregnancy outcome and characteristics of women who conceive following subfertility treatment remains a subject of great interest. We analyzed these variables among 199 women who delivered a registerable twin birth compared with 1773 women who delivered a naturally conceived twin birth in a population-based obstetric cohort drawn from around Oxford, ...

OBJECTIVE: To evaluate whether serial transvaginal sonographic examination of the cervix with the woman in a standing position improves the prediction of spontaneous preterm birth (SPB) compared with the conventional posture. METHODS: For both a recumbent and upright maternal position, the inter- and intraobserver agreement of cervical length (CL) measurement ...

Patients with sickle cell disease routinely take folic acid daily as a supplement to maintain effective erythropoiesis. One of the controversial effects of folic acid is its effect on twin gestation rates. In this report, we present our experience in patients with sickle cell disease and twin pregnancy. Our data ...

We analyzed depressive and psychosomatic symptoms in relation to parental preference in 419 twins at the age of 22 to 30 years. Depressiveness was elicited with Children's Depression Inventory and reported as a total score and three subscales (low self-confidence, anhedonia and sadness) based on factor analysis as reported in ...

PURPOSE OF REVIEW: Despite the recent demonstration of the benefit of the primary laser over amnioreduction, overall survival is far from optimal (70-80%), and therefore diagnosis and management of early and late complications following placental surgery became of great importance. RECENT FINDINGS: Laser therapy has proven to be better than ...

OBJECTIVE: To clarify the association between childhood pregnancy and risk of stillbirth. STUDY DESIGN: We analyzed singleton and twin pregnancies that occurred in children (10-14 years old) in the United States from 1989 to 2000. We estimated the absolute and relative risks of stillbirth by using 15- to19-year-old and 20- ...

This study aimed to evaluate the prevalence of birthweight discordance among twins, to determine the risk cut-off point for birthweight discordance, and to clarify whether perinatal deaths are aggravated by birthweight discordance or by low birthweight itself. A population-based analysis of all twins born between 1995 and 1999 in Japan ...

Bipagous conjoined twins are rare with an incidence of 1 in 50,000 to 1 in 100,000 births, but rarer still are heteropagous dicephalic dipus with an incidence of 0.1-0.2 per 10,000 births. No more than 4 sets of such surviving twins-sharing an undivided torso and two legs have been recorded ...

Thrombin-antithrombin complex (TAT) is a sensitive marker for thrombin formation, and alpha2-plasmin inhibitor-plasmin complex (PIC) is a marker for fibrinolysis. Previous studies have shown that blood coagulation and fibrinolysis are activated in normal pregnancies. Thus, the present study examined changes in TAT and PIC levels during the course of singleton ...

OBJECTIVE: To elucidate the synchronization of phases of diurnal rhythms in fetal heart rate (FHR) baseline between twin fetuses and the occurrence of sustained fetal tachycardia. METHODS: FHR was simultaneously recorded in twins for 24 h in 7 monochorionic diamniotic (MD) and 8 dichorionic diamniotic (DD) twin pregnancies at 35 ...

Placental vascular anastomoses in monochorionic twins may lead to acute or chronic inter-twin transfusion. We report an uncommon form of chronic inter-twin transfusion, referred to as twin anemia-polycythemia sequence (TAPS), with severe anemia in one twin and polycythemia in the other, without the characteristically associated twin oligo-polyhydramnios sequence (TOPS) seen ...

PURPOSE: Benign rolandic epilepsy (BRE) is considered a genetically determined idiopathic partial epilepsy. We analyzed a large sample of twins from four international twin registers to probe the genetics of BRE. We also aim to synthesize the apparently conflicting family and twin data into a model of BRE etiology. METHODS: ...

We report a case of a 26-year-old multigravida pregnant woman with a history of 3 stillbirths with hydrops fetalis who presented with 17 weeks menstrual age. Sonographic examination revealed twin gestation. Twin 1 showed subcutaneous edema, pleural effusion, and mesomelic limb shortening, suggestive of lethal skeletal dysplasia (Roberts syndrome). Twin ...

OBJECTIVES: To establish the distribution of serological and ultrasound first-trimester Down syndrome markers in twins and identify correlations of significance for risk calculation. METHODS: Nuchal translucency (NT), PAPP-A and betahCG data were extracted from 181 twin pregnancies (31 mono- and 150 dichorionic) with a normal outcome. All pregnancies were consecutively ...

The heritability of sensation seeking is investigated in an extended twin design, including mono- and dizygotic twins and their siblings. Besides a comparison of the phenotypic resemblance between monozygotic twins and dizygotic twins, the design allows for an explicit test of the assumption that results from twins may be generalized ...

OBJECTIVE: To identify maternal factors that increase the risk of preeclampsia in twin gestations and to investigate whether twins conceived by in vitro fertilization (IVF) lead to an increased risk of preeclampsia development. MATERIALS AND METHODS: A retrospective population-based cohort study of twin deliveries was performed. Maternal characteristics and perinatal ...

BACKGROUND: Monochorionic monoamniotic twins (MoMo) occur in one of 10,000 pregnancies. Cord entanglement, malformations, twin-to-twin transfusion syndrome (TTS) and prematurity are responsible for their high perinatal morbidity and mortality. OBJECTIVE: To report our experience with 36 sets of MoMo twins (1990 to 2005) and to provide updated information for counseling. ...

Macrophage colony-stimulating factor (M-CSF) is present in the placenta and has been implicated in placental growth and development. M-CSF levels in peripheral blood increase significantly with progression of pregnancy in uncomplicated singleton pregnancy. This study investigated whether serum M-CSF levels in singleton pregnancy differed from those in twin pregnancy. A ...

We performed uterine artery Doppler velocimetry in 16 nulliparous and 16 parous women with non-preeclamptic singleton gestations and 16 nulliparous and 16 parous women with dichorionic twin gestations at 17-18 and 26-27 weeks of gestation. In both singleton and twin pregnancies, the average pulsatility index (PI) in nulliparous women was ...

BACKGROUND: To investigate whether second trimester serum inhibin levels differ in pregnancies conceived by assisted reproduction technology (ART). METHODS: In Israel, serum samples from twin pregnancies were obtained for inhibin testing from women either referred for routine ultrasound monitoring, follow up after multi-fetal reduction or amniocentesis, largely for advanced maternal ...

BACKGROUND: This study determined whether twins conceived through assisted reproduction technology (ART) have an increased risk of perinatal complications compared with natural twin pregnancies and investigated potential associated major risk factors. METHODS: This retrospective study consisted of 199 twins born between 1994 and 2003. There were four groups according to ...

BACKGROUND: Sirenomelia is a rare congenital malformation characterized by fusion of the lower extremities and is associated with renal agenesis and absent bladder. Oligohydramnios usually occurs early in pregnancy. CASE: A 21-year-old primigravida with a twin gestation was diagnosed with sirenomelia in 1 of the twins at 18 weeks; they ...

BACKGROUND: Chromosomal abnormality in one fetus of a monozygotic twin pregnancy is rare, and discussion of prenatal detection of such a case offers some insight into this clinical problem. CASE: A 28-year-old gravida 1 had ultrasound screening at 11 weeks of gestation that revealed a monochorionic, diamniotic twin pregnancy with ...

BACKGROUND: Placental abscess formation is rarely recognized prenatally. We present a case detected ultrasonographically that developed from a central line infection and caused recurrent maternal bacteremia. CASE: A young woman with a 21-week twin gestation presented with recurrent fevers. She had received treatment for bacteremia due to Serratia marcescens. The ...

The successful outcome of twin gestation after the endoscopic metroplasty of uterus septus class Va was described. Authors described and discussed the technical details of diagnosis and treatment of this rare malformation. Five months after treatment the patient spontaneously became pregnant. The pregnancy was determined as dizygotic twins. The cesarean ...

Obtaining the maximal number of calves from each cow according to its natural genetic reproduction ability is the main condition of intensification of reproduction and increase of milk production. Twins rate in the black-and-white cattle population in Lithuania is 2.4%. Cows whose mothers have calved twins at least 1 time ...

OBJECTIVE: Coagulation abnormalities after single fetal demise are well described, but similar cases had not been previously reported following therapeutic selective termination. CASE: A 23-year-old G(3) P(2001) with a monochorionic-diamnionic twin pregnancy underwent selective termination at 20 4/7 weeks for severe twin-twin transfusion syndrome. Her fibrinogen thereafter decreased and she ...

OBJECTIVE: To determine the relationship between amnionicity and number of yolk sacs before 11 weeks of gestation. METHODS: Twenty-two cases of monochorionic multiple pregnancy were scanned before 11 weeks of gestation. There were 21 sets of twins and one of triplets. Amnionicity was determined by visualization of a dividing amniotic ...

OBJECTIVES: To investigate a potential role of leptin and insulin-like growth factor (IGF)-I on fetal growth and metabolic function we determined plasma leptin and IGF-I concentrations in twins in relation to discordant fetal growth. STUDY DESIGN: In studying monochorionic twins with inter-twin birth weight difference, we investigated the relative contribution ...

OBJECTIVES: To assess the natural history and perinatal outcome in monochorionic diamniotic twin pregnancies with discordant amniotic fluid volume without signs of severe twin-twin transfusion syndrome (TTTS). METHODS: This was an observational study of 84 consecutive monochorionic twin pregnancies which did not meet the criteria for severe TTTS and endoscopic ...

The pathogenetic mechanisms leading to the development of congenital heart disease and congenital intracranial arteriovenous malformation are still unclear. We report on a monochorionic twin pregnancy with twin-to-twin transfusion syndrome (TTTS), in which vein of Galen malformation (VGM) was diagnosed in the donor twin and transposition of the great arteries ...

AIMS: To examine whether coagulation-fibrinolysis in late pregnancy in women with twin pregnancies is more pronounced than in women with singleton pregnancies. PATIENTS AND METHODS: The plasma levels of D-dimer, fibrinogen/fibrin degradation products (FDP), and fibrinogen, the platelet count, and the antithrombin activity were assessed from 3 weeks before delivery ...

Few long-term studies have yet described neuropsychological outcome in preterm twins. Our aim was to assess, by long-term evaluation, neuropsychological outcome in preterm twins in order to define a correct follow-up program. Our study was a cohort one, with an index and a comparison group. Neonatal medical records of all ...

The twin-twin transfusion syndrome (TTTS) complicates approximately 15% of monochorionic twin pregnancies. Severe TTTS is associated with poor neonatal outcome and a relatively high rate of neurological abnormalities. Some studies have suggested this outcome to be more severe in cases treated by amnioreduction. In this paper we present a hypothesis ...

OBJECTIVE: To report on a pair of monozygotic female twins discordant for Goldenhar syndrome. DESCRIPTION: The affected twin was a girl, who was delivered by caesarean section at 35 weeks' gestation. Her birth weight was 2,170 g, length 42.5 cm, head circumference 30 cm and her Apgar scores were 3/7. ...

The case reports a neonate (twin 2 of a twin girl pregnancy) presenting with seizures due to hypocalcaemia. The presumptive cause of the hypocalcaemia was maternal hyperparathyroidism with concurrent vitamin D deficiency. The first twin remained free of hypocalcaemia and was vitamin D replete, despite similar exposure in the pregnancy ...

We diagnosed active brucellosis infection at the tenth week of gestation in a woman with a twin pregnancy. Antimicrobial therapy with rifampicin was started at 900 mg/day and continued for six weeks. Healthy twins were delivered at the 38th week of gestation. Early and adequate treatment of maternal brucella infection ...

OBJECTIVE: To find connection between the type of congenital heart malformations and twin pregnancies. METHOD: Retrospective analysis of data of fetal cardiology database between 1 January 1996 and 30 November 2003. RESULTS: In single pregnancies 455 and in twin pregnancies 31 severe congenital heart malformations were diagnosed prenatally. In monozygotic ...

OBJECTIVE: We report on a case of a triploidy in one fetus of a twin pregnancy who presented with the findings of growth discordance. METHODS: Three weeks' difference between fetuses in ultrasonographic measurements in the first trimester was observed in a twin pregnancy following intracytoplasmic sperm injection (ICSI) treatment for ...

The association between monozygotic twins and posterior urethral valves (PUV) in postnatal life has been thoroughly described. In the fetus, the prenatal recognition of PUV is feasible. However, it has been repeatedly reported in singletons but never in monochorionic twins. We describe two cases of early prenatal diagnosis of concordant ...

BACKGROUND: The question about outcome in twins delivered early versus late remains unanswered. The objective of this study was to evaluate the association of the timing of delivering twins and the perinatal outcome. METHODS: A prospective cohort study was carried-out in Alexandria University Maternity Hospital. We planned to examine the ...

OBJECTIVE: Fetal vessel thrombosis has been related to pregnancy complications and adverse neonatal outcomes in singleton pregnancies, but the clinical and pathologic characteristics of fetal thrombosis in twin pregnancy are still ill defined. METHODS: To clarify the characteristics of fetal thrombosis in twins, we reviewed the histology slides and medical ...

Perinatal outcome of pregnancies caused by assisted reproduction technique (ART) is substantially worse when compared with pregnancies following natural conception. We investigated the possible risks of non-IVF ART on perinatal health. We conducted a retrospective cohort study with two exposure groups: a study group of pregnancies after controlled ovarian stimulation ...

OBJECTIVE: To test the hypothesis that low birth weight twins have a higher risk of osteoportotic fracture in later life, we investigated the association between fetal IGF axis and type-1 collagen markers of bone turnover in monochorionic (MC) twins with or without discordant birth weight of >or=20%. METHODS: Maternal and ...

OBJECTIVES: To report a successful selective feticide in a complicated monochorionic monoamniotic (MCMA) pregnancy. METHODS: A case of MCMA pregnancy with severe twin-twin transfusion syndrome and discordant for hypoplastic left heart syndrome was diagnosed at 16 weeks' gestation. A complete ultrasound and fetoscopic surveillance was performed, ruling out cord entanglement ...

Monoamniotic twins represent an uncommon manifestation of the monozygotic twinning process (1% of monozygotic twins). They are the result of ovum division beyond 8 days postconception and are characterised by a single amnion and a single yolk sac. There may be two or one (conjoined twins) embryos present. This form ...