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Multiple pregnancy and infertility
Published in Janetta Bensouilah, Pregnancy Loss, 2021
Perinatal mortality statistics do not accurately reflect the problems of multiple pregnancies, because the highest rate of fetal loss occurs prior to viability. Monochorionic twins have a six times higher fetal loss rate (12%) between 10 and 24 weeks’ gestation compared with dichorionic twins and singletons.4 Furthermore, it is estimated that around 20% of twin pregnancies end in the early resorption of one fetus previously seen on ultrasound, which is known as the ‘vanishing twin’ phenomenon. However, this may not provide a truly accurate picture of the degree of pregnancy loss that multiples present, as the death of one fetus, a single intrauterine death (sIUFD), may occur before the diagnosis of multiple pregnancy has been made and may therefore go unrecognised.
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].
Obstetrics: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
‘Vanishing twin syndrome’ – no long-term effect on other twin.Late 2nd or 3rd trimester – cerebral palsy and increased neurological damage, death, preterm delivery.Coagulation disorder in the mother.
Further evidence that a supraphysiologic estradiol level during ovarian stimulation affects birthweight: findings of fresh and frozen embryo transfer with comparable estradiol levels on human chorionic gonadotropin trigger
Published in Gynecological Endocrinology, 2021
Lu Luo, Huiying Jie, Minghui Chen, Limei Zhang, Yanwen Xu
Two very recent studies on FET cycles showed contradictory results, providing evidence of the negative impact of peak E2 levels during COS on subsequent singleton birthweight from FET cycles. Cai et al. [15] reported a nearly 2.5-fold increase in the incidence of term SGA and LBW in a retrospective study with 2066 patient. Zhang et al. [16] demonstrated a dose-dependent manner on peak E2 concentration to the decrease of neonatal birthweight. The different results between these two studies and ours could largely be attributed to the underlying bias of cases included. In fact, selection bias was inevitable due to the nature of retrospective study. In the two aforementioned studies, gestational complications were not reported, and the cases with vanishing twin or multifetal reduction could also be analyzed as singleton live birth. Further, only direct numbers of birth weight were reported in the study of Zhang et al. [16] but not SGA percentage, which could be less informative to evaluate the birth weight of infant.
Perinatal outcome in children born after assisted reproductive technologies
Published in Upsala Journal of Medical Sciences, 2020
Ulla-Britt Wennerholm, Christina Bergh
A Nordic study from the CoNARTaS group analysed trends in perinatal health in ART singletons (n = 62,379) versus a control group of spontaneously conceived singletons (n = 362,215) (70). The rates of perinatal outcomes were stratified into four time periods: 1988–1992, 1993–1997, 1998–2002, and 2003–2007. There was a substantial decline in the risk of being born preterm and very preterm for singletons conceived after ART but not for singletons born after spontaneous conception. Rates of low birth weight, stillbirth, and infant deaths also declined among ART singletons. A possible explanation for the positive development may be a change in the ART population, with healthier women with shorter time of infertility undergoing ART treatment. Other factors are increased use of ICSI for male-factor infertility, cryopreservation, and single embryo transfer. Single embryo transfer reduces the risk of the vanishing twin phenomenon, a risk factor for preterm birth (71).
A rare pseudo tumour in the extraembryonic coelom in first trimester of pregnancy: ultrasound and pathology
Published in Journal of Obstetrics and Gynaecology, 2019
Seiji Sumigama, Atsushi Enomoto, Satoshi Matsukawa, Takafumi Ushida, Kenji Imai, Tomoko Nakano, Tomomi Kotani, Fumitaka Kikkawa
The principal differential diagnosis was an enlarged yolk sac; a vanishing twin or an acardiac twin. An enlarged yolk sac (>6 mm) is related to a spontaneous abortion (Lindsay et al. 1992), but we ruled out it because a normal-sized yolk sac was detected. A monoamniotic twin can be usually diagnosed after the amnions become evident after 7 weeks of gestation (Howe 1996; Perni et al. 2008). We also ruled out a vanishing twin and an acardiac twin because the mass was detected so early (5 weeks). Thus, we diagnosed it as a parenchymal mass of an unknown origin and could not predict the prognosis of this pregnancy. After counselling the couple, it was decided to terminate the pregnancy. Labour was induced using prostaglandin E1 and ended in stillbirth at 12 weeks. Macroscopically, there was a foetus, normal villi and a yolk sac co-existent with not a parenchymal mass but a cystic mass 2 cm in diameter. The content of the mass appeared to be of a yellow mucous. The umbilical cord was short (Figure 1(B)). The foetus showed omphalocele and was suspected to have a right lower limb contracture deformity. No amniotic bands were detected. A hematoxylin-eosin-stained section revealed that the cystic mass was not a simple cyst, but had an internal structure of multifold membranes that might have contributed to the high-echoic finding by ultrasonography (Figure 1(C)). One side of the membrane had a single-layered cubical or flat epithelium, the other side had no epithelium (Figure 1(D)). The yolk sac appeared normal with a number of calcifications inside it. The villi had scattered haemorrhages. The karyotype of the villi was 46XY.