However, the frequency of this type is too low for separate analyses even in large twin cohorts. Several subdivisions are devoted to iatrogenic twining, not just commenting on the overall increased incidence, but also the type of technology related to a particular zygosity types. Hypertension associated with haemoconcentration and proteinuria so-called pre-eclampsia has a much worse prognosis. Reducing the multiple gestation pregnancy rate should be a high priority for assisted reproductive treatment programmes, despite the pressure from some patients to transfer more embryos in order to improve success. The coverage is also limited to assisted reproductive treatment cycles. At present all registries report total live birth rate, which includes the desired outcome singletons combined with the adverse outcome multiple births. Vaginal delivery is the method of choice in many women class 1 woman and cesarean section is seldom a cardiac indication.
This report was prepared by P. This book proves to be a valuable resource to those involved in all aspects of caring for multiple gestations. For parents with multiple gestations, detailed information should be available throughout the pregnancy, birth and prenatal period and further into early childhood. Contraindications for pregnancy are: poor maternal functional class, poor ventricular function, severe cyanosis without pulmonary hypertension oxygen saturation 40 mm and aortic valve involvement moderate to severe aortic regurgitation , symptomatic hypertrophic obstructive cardiomyopathy. The family costs per multiple gestation delivery are approximately 4-, 11- and 18-fold greater for twins, triplets and higher order deliveries, respectively, compared to singleton deliveries. Summary Establishing the study of multiple pregnancy and the perinatal care of children from multiple births as a recognized specialty within maternal-fetal medicine, the first edition of Multiple Pregnancy was a landmark publication.
These patients can be reassured. Is it the same in twin pregnancies? Compared to singleton deliveries the costs are approximately 4-, 11- and 18-fold greater for twins, triplets and higher order deliveries, respectively. Throughout this segment it is apparent the immense impact assisted reproductive technologies has had on the growing incidence of multiples. Therefore, iron supplementation and stricter surveillance of haemoglobin concentration is required. Finally, thorough consideration is given to parental needs both in the antepartum and the postpartum periods. . Reporting the combined singleton and multiple birth rates in this way obscures the true success rate.
This transitions to the promising position that three-dimensional sonography may become a standard in the management of multiples, with text supported by superb images. Fully revised, this new Second Edition has been expanded to include more on epidemiology, biologic mechanisms, the impact of infertility treatments, prenatal diagnosis, and fetal therapy. Preconception counseling must be offered if unfavourable outcome is likely. It also may occur more frequently for male than female fetuses, hence the slightly skewed sex ratio in twins. Allowing for inflation of health care cost at 5% per year , the projected year 2000 costs of delivering multiple gestation pregnancies arising in assisted reproductive treatment cycles per family are as follows. Careful monitoring should possibly also be aimed at planning to deliver them if such birthweight is exceeded. During this period 2173 fresh and frozen-thawed embryo transfers were performed.
There are huge differences in perinatal morbidity and mortality, depending on whether the two fetuses share one gestational sac: in a study by Derom et al. This approach would be more valuable if we had non-invasive methods of assessing the developmental competence of individual embryos. This section begins with the early part of pregnancy examining the psychological impact of multifetal pregnancy reduction progressing to post-natal issues such as the higher rate of child abuse in multiple birth families. Furthermore, ultrasound enables detection of fetal anomalies, evaluation of individual fetal growth and of possible growth discrepancies between the twins. Therefore, based on the prior observations, it is without reservation that I invite one to make this text a part of their personal library, for you will find it to be a valuable resource when caring for multiple gestations. Perinatal morbidity and mortality also increased 4- to 10-fold in twins. The first was excessive overlap.
Differences according to fetal sex Two types of data show that the female twin fetus is more sensitive than its male counterpart to its intrauterine environment. Unfortunately, there is a parallel increase in the incidence of multiple pregnancies, many of which are unanticipated. Most common route of delivery was caesarean section 58. Women with intermediate and high risk pregnancy must be followed and managed in a high risk pregnancy unit and a team from obstetricians, cardiologists, anesthetists, pediatricians, neonatologists and cardiac surgeons who are skilled in high risk pregnancies. There is a 3—7-fold increase in cerebral palsy amongst twins and over 10-fold in triplets. Whereas in male pairs the mean reduction of birthweight when the placentas are fused amounts to 270 g, it amounts to almost twice as much, 495 g, in girls. Thus, a number of assumptions are made about costs and trends in order to bridge gaps in the available data.
Data from different countries suggests that success depends more on the number of embryos available for transfer than the number transferred. The estimates were based on 1125 twin and 85 higher order gestations. These patients can be reassured. Over the past two decades, an epidemic of multiple pregnancies has taken place in the developed world due to the widespread use of assisted reproductive technology. However, a clinician involved in the care of multiples will find the content on aneuploidy most clinically relevant particulary when counseling the patients about risk of an anomalous fetus and the optimal diagnostic testing for the individual patient. Infertility specialists in all countries should address the prevention of multiple births in the most appropriate way, by means of improved clinical procedures. The nature of prior surgical procedures and the residua and sequelae following therapy are essential to manage a pregnant woman with cardiovascular disease.
If the number of large follicles exceeds three, the cycle should be cancelled and the couple advised to abstain from intercourse. Twin studies are confounded by the vanishing twin syndrome: between 10 and 20% of viable twin fetuses disappear. Treatment with gonadotrophins should be confined to those who are resistent to clomiphene, i. Regarding both the literature and our own cases, we can make the following management suggestions: a the cord should be ligated as high as possible; b fetal growth, cervical length and dilatation should be observed by weekly ultrasound scans, and c it seems that both cervical cerclage and tocolysis prolong the delivery interval, while prophylactic antibiotics have no beneficial effect. Births n 7448 4822 1176 Total prematurity 9. There were a total of 161 multiple pregnancies with the overall incidence of 37.