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Abstract:
To examine the relationship between sonographic cervical length and maternal blood white blood cell count (WBC) count, as a marker of inflammation, in the third trimester and the risk of spontaneous preterm delivery in asymptomatic women with twin pregnancies. From a cohort of 362 consecutive asymptomatic women with twin pregnancies between 30 and 34 weeks of gestation who had been measured cervical length by transvaginal ultrasound and WBC count at the same time, 43 women with spontaneous preterm delivery at < 36 weeks were identified. A control group of 129 women with term deliveries closely matched for gestational age at measurements, chorionicity, and parity, was selected. Exclusion criteria were cervical cerclage, suspected twin-to-twin transfusion syndrome, and preeclampsia. Data were analysed using multivariate conditional logistic regression and Pearson's correlation analysis. Mean cervical length and mean body mass index at measurements were significantly lower in the preterm delivery group than in the term delivery group. No correlation was found between sonographic cervical length and WBC count. No association was found between WBC count and spontaneous preterm delivery at <36 weeks. Multivariate analysis, controlling for possible confounders, showed the association between the cervical length and spontaneous preterm delivery. In asymptomatic women with twin gestations, sonographically measured cervical length in the third trimester is associated with an increased risk for preterm delivery. However, a systemic inflammation implicating WBC in the third trimester may not play a role in developing a shortened cervical length and preterm delivery.Keywords:
Cervical insufficiency
Twin Pregnancy
Twin Pregnancy
Amniotic sac
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The effects of routine hospital care in twin gestation were evaluated by comparing the gestational outcome in two neighbouring university departments in southern Sweden. In Malmö, 79% (175/223) of all women with a twin pregnancy were given routine hospital care between the 26‐28th and 35th gestational week, whereas in Lund only 4% (16/409) received such treatment. Hospitalization averaged 9 weeks in Malmö, versus 2 weeks in Lund. We found no significant differences between the two areas regarding gestational length, birth weight, or perinatal mortality. This study indicates that routine hospital care does not improve the prognosis in twin gestation.
Twin Pregnancy
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To compare the outcome of twin gestations complicated by a single anomalous fetus with twin gestations with no fetal anomalies.The study included all patients with twin gestations diagnosed with a fetal anomaly in one fetus during 1990-1994, and excluded twin gestations with anomalies in both fetuses. The control twin group was composed of all other normal twin pregnancies followed and delivered at our center in the preceding 2 years.We reviewed 24 twin gestations with at least one anomalous fetus. Five cases were excluded because of anomalies in both fetuses, and a further five pregnancies had selective termination or termination of the entire pregnancy. There were 14 ongoing twin pregnancies with one anomalous fetus, and their median gestational age at diagnosis was 18 weeks (range 16-20). All twin anomalies were correctly diagnosed antenatally. Gestational age at delivery and birth weight were significantly lower for twins complicated by an anomaly compared with control twins (P = .008 and P = .001, respectively). The cesarean delivery and perinatal mortality rates of twin pregnancies with anomalies were significantly higher than those of normal twins (P = .01 and P < .001, respectively).The presence of a single anomalous fetus in a twin gestation significantly increases the risk of preterm delivery compared with nonanomalous twin gestations.
Twin Pregnancy
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Abstract Objective . The aim was to determine the chorionic and amniotic types in multifetal pregnancies with transvaginal ultrasonography at very early stage of gestation. Study design . Twenty-one spontaneous multifetal pregnancies were scanned transvaginally before 8 weeks' gestation (four of them from 4th week). The chorionic and amniotic type was determined ultrasonographically. All twin gestations had postpartum pathologic evaluation of the placenta and histologic determination of the chorionic and amniotic type. Results . Ultrasonographic evaluation of the 21 pregnancies demonstrated 20 twin and 1 triplet gestation. Four of the twin pregnancies were monochorionic-diamniotic. Triplet was monochorionic-triamniotic (spontaneously aborted in 8th week of gestation). In all 20 twin pregnancies, transvaginal ultrasonography correctly predicted the chorionic and amniotic type before 8 weeks of gestation. Conclusion . Transvaginal ultrasonography allows a reliable, simple and rapid determination; the dichorionic twin pregnancy in 4 weeks, monochorionic in 5 weeks, and differentiation of mono-or diamniotic in 7 weeks of gestation.
Transvaginal ultrasonography
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The purpose of this study was to determine the efficacy of sonographically indicated cerclage in multiple gestations with sonographic evidence of short cervical length (CL).Between 1996 and 2002, all multiple gestations undergoing serial CL determinations in the second trimester were identified in 2 separate institutions. Cervical lengths were measured sonographically with transvaginal probes (4-8 MHz). Short CL was defined as a closed CL of 2.5 cm or less. When a short CL was identified before 24 weeks, the study group underwent sonographically indicated cerclage via the modified Shirodkar technique; control patients were placed on bed rest without surgical intervention. The primary outcome was incidence of spontaneous preterm birth before 32 weeks. The groups were compared with the Mann-Whitney U test and the Fisher exact test, with a 2-sided P<.05 used to define statistical significance. Odds ratios were calculated, and 95% confidence intervals were reported.A total of 414 sets of twin gestations and 92 sets of triplet gestations were identified. The median gestational age at delivery for twin gestations was 34.0 weeks for patients who received cervical cerclage and 34.4 weeks for patients with short cervix and no cerclage (P=.77). The median gestational age at delivery for triplet gestations was 34.1 weeks for patients who received cervical cerclage and 33.0 weeks for patients with short cervix and no cerclage (P=.21). There was no difference in the rate of spontaneous preterm delivery at fewer than 28, 30, 32, and 34 weeks or in the rate of preterm premature ruptured membranes.In our study of multiple gestations with short CL, sonographically indicated cerclage was not associated with a lower incidence of spontaneous preterm delivery compared with conservative management.
Cervical cerclage
Cervical insufficiency
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Twin Pregnancy
Cervical cerclage
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Cervical insufficiency
Cervical cerclage
Twin Pregnancy
Bronchopulmonary Dysplasia
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Cervical cerclage in women with twin pregnancy is not routinely indicated but appears to be beneficial in subjects with a history of preterm birth or very short cervix or dilated cervix. There is a paucity of literature data regarding transabdominal or laparoscopic cervical cerclage (LCC) in twin pregnancy. It is uncertain whether LCC is more effective than transvaginal cerclage. Our own experience of 24 cases of LCC in twin pregnancy showed encouraging results. Further, well-planned studies are required to answer whether, when, and how cervical cerclage should be performed in women with twin pregnancy.
Cervical cerclage
Twin Pregnancy
Cervical insufficiency
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A case of molar gestation associated with an only fetus, both product of an twin gestation is presenting. We analyzed the clinical picture, the diagnostic method, the after birth resolution and evolution of this gestation. The result of a live newborn of 1,300 g and verify coexisting of complete hydatidiform mole.
Twin Pregnancy
Molar Pregnancy
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Twin Pregnancy
Abnormality
Amniotic sac
Quadruplets
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