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Heterotopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Spontaneous heterotopic triplets—a tubal ectopic pregnancy and a twin pregnancy—are rare occurrences [28]. Six cases of spontaneous heterotopic triplets were identified in review. Early surgical intervention is the key to successful treatment of heterotopic triplet pregnancy and allows good neonatal outcome.
Assisted Reproductive Technology and Multiple Pregnancy
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Rezan A. Kadir, Zdravka Veleva
Vanishing twin syndrome (VTS) (Figure 15.2) is a spontaneous reduction of a fetus in utero. It occurs in approximately half and one-third of pregnancies starting as triplets and twins, respectively. It has been reported that VTS is associated with adverse perinatal outcome with an increased risk for congenital anomalies, malformations of cortical development in monochorionic twins, low birth weight, preterm labor, and increased perinatal mortality [31].
Psychological Impact of Infertility and Assisted Reproduction 1
Published in Rosa Maria Quatraro, Pietro Grussu, Handbook of Perinatal Clinical Psychology, 2020
One of the most important risks involved in ART treatment is the likelihood of multiple births. In Europe in 2013, 17.5% of all births following “fresh” IVF/ICSI cycles were twin births and 0.5% triplet births (Calhaz-Jorge et al., 2017). In comparison with births after spontaneous conception, the rate of twins is 15 times higher and the rate of triplets 36 times higher. If we leave out the six countries in which in over half of the treatment cycles only one embryo was transferred back (so-called “elective single-embryo transfer”), the share of twin births rises to 20% and that of triplets to 0.9%. Despite greatly improved obstetric intervention resources, the health risks for multi-birth progeny should not be underestimated. Compared with singletons, the risk of cerebral palsy is four times higher in twins and 18 times higher in triplets, while the risk of death by age 1 year is seven times higher for twins and 20 times higher for triplets. Half of the twins and almost 90% of the triplets born after ART treatment in Europe are premature. In the meantime, however, other risks associated with ART like the ovarian hyperstimulation syndrome, bleeding, or infection have become very rare (Calhaz-Jorge et al., 2017).
A randomized phase 2 trial of first-line docetaxel, carboplatin, capecitabine (CTX) and epirubicin, oxaliplatin, capecitabine (EOX) in advanced esophagogastric adenocarcinoma
Published in Acta Oncologica, 2021
Peter C. Petersen, Lone N. Petersen, Ivan Vogelius, Jon K. Bjerregaard, Lene Baeksgaard
A number of trials show that the risks of triplets versus doublets outweigh the potential benefits. In the FLOT65+ randomized trial elderly patients with metastatic esophagogastric adenocarcinoma did not gain benefit from docetaxel, oxaliplatin, and 5-FU (FLOT) compared to 5-FU and oxaliplatin (FLO) but had more toxicity [16]. Recently, a large randomized phase 3 trial in patients with metastatic gastric cancer showed that 2-weekly docetaxel, cisplatin and S-1 compared to cisplatin and S-1 increased toxicity, in particular grade 3 or 4 neutropenia, without adding benefit [17]. Similarly, it has been observed that the addition of epirubicin to FU and platinum increases toxicity without increasing response rates or overall survival compared to FOLFOX [18]. Real-world evidence of the utilization of chemotherapy in clinical practice confirms these findings [19,20].
Transabdominal fetal reduction: a report of 124 cases
Published in Journal of Obstetrics and Gynaecology, 2021
Mi Sun Kim, Sukho Kang, Youngri Kim, Ji Yeon Kang, Myoung Jin Moon, Min Jung Baek
The initial numbers of embryos were 48 twins, 63 triplets, 11 quadruplets, and 2 quintuplets. Table 2 presents data on the pregnancy loss and fetal loss rate by the initial number of fetuses. A total of 48 cases began as twin pregnancies and were reduced to singleton pregnancies. Among them, 14 cases were due to suspected anatomical abnormalities, 10 due to chromosomal abnormalities, and 20 had poor obstetrical history. A total of 63 cases began as triplet pregnancies, among which 50 were reduced to twin pregnancies and 13 cases with triplets with monochorionic pairings were reduced to singleton pregnancies. Reduction from triplet to twin pregnancies resulted in shortened gestational age, less birth weight, and a higher preterm delivery rate compared to reduction from triplet to singleton pregnancies (p < .05) (Table 3).
Strangulated internal hernia following severe ovarian hyperstimulation syndrome: a case report
Published in Gynecological Endocrinology, 2021
Likun Wei, Yanfang Zhang, Xueru Song
The present case had severe OHSS related to multiple pregnancy after ovulation induction. We described the detrimental effect of an internal hernia, strangulated intestinal obstruction, and subsequent intestinal necrosis on the patient’s health. This case highlighted the need for vigilance of surgical acute abdomen in women with OHSS when insufferable abdominal pain cannot be alleviated after conservative treatment, or persistent severe gastrointestinal symptoms are not easily explained by the initial diagnosis. Clinicians should pay more attention to a previous history of abdominal surgery, physical examination results, and imaging results, and seek the consultation of surgeons, in order to make an early diagnosis in acute abdomen. It is necessary to relax the indications of exploratory laparotomy to avoid subsequent severe complications. Triplet pregnancy is a common iatrogenic complication in infertility treatment by ovarian induction. In the present case, pregnancy termination was requested to relieve the progress of OHSS, which was a life-threatening condition. As OHSS can lead to fatal harm in reproductive women, physicians must attach great importance to the risk factors of OHSS and make exact evaluation and intervention during the infertility treatment to decrease the incidence and severity of OHSS.