[Some recommendations for lowering blood loss in multiple births].
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Female↗
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Results for “Multiple Birth Offspring”
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[Multiple births in the Netherlands, 1900-1988].
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Demography↗
Prenatal diagnosis and multiple pregnancy.
The incidence of twins, triplets, and high-order multiples has increased dramatically in the last two decades secondary to greater reliance on fertility treatments and to delayed childbearing. Offspring of a multiple gestation are at increased risk for both chromosomal and structural abnormalities. Prenatal diagnosis in these patients is challenging. Options for screening tests are limited. Invasive diagnostic procedures are complex. Likewise, physicians and patients may be faced with the dilemma of deciding how to manage discordant results. The following paper will review the unique concerns associated with prenatal diagnosis in a multiple pregnancy and the current methods of prenatal screening in these patients. Invasive prenatal diagnosis will also be explored.
Adult↗
Maternal physiology and complications of multiple pregnancy.
Approximately 1% to 3% of all pregnancies in the United States are multiple gestations. The vast majority (97-98%) are twin pregnancies. Multiple pregnancies constitute significant risk to both mother and fetuses. Antepartum complications-including preterm labor, preterm premature rupture of the membranes, intrauterine growth restriction, intrauterine fetal demise, gestational diabetes, and preeclampsia-develop in over 80% of multiple pregnancies as compared with approximately 25% of singleton gestations. This article reviews in detail the maternal physiologic adaptations required to support a multiple pregnancy and the maternal complications that develop when these systems fail or are overwhelmed.
Female↗
[Multiple births in the Netherlands, 1900-1993].
Data on multiple births in the Netherlands since 1900 are examined. It is noted that "since 1975 the number of multiple births is increasing rather strongly, partly under the influence of the application of modern medical technology (e.g. hormone treatment) to infertility problems...." Age distribution by sex among paternal and fraternal twins living in the Netherlands is also discussed. (SUMMARY IN ENG)
Age Distribution↗
[Triplets, quadruplets and more...].
Theoretically, a woman could bear unlimited number of fetuses. Practically, the human being on the top of his phylogenetic spread, has chosen the singleton birth as its dominant. The anatomical constitution of the woman let her feed no more than two children at the same time. This were probably the reasons for considering the multiple birth as a nature phenomenon. With the time passing, there was a growing body of legends and misunderstandings, based on exagerated histories on their births. Based on world literature, the super multiple births are analyzed.
Adult↗
[Fertility treatments: possibilities for fewer multiple births and lower costs--the 'Umbrella' study].
Since the 1980s, increasingly more fertility treatments have been performed in the Netherlands. The use of ovarian hyperstimulation during in vitro fertilisation (IVF) and intrauterine insemination (IUI) has contributed to an explosive increase in the number of multiple births. To control the costs of treatment and outcomes, the Minister of Health, Welfare and Sport commissioned research on possible improvements in the performance of fertility treatments in 1999. The results of this research ('Umbrella study'), reported in 2005, suggested that costs and the incidence of multiple births could be reduced if (a) IUI is only performed if the chance of spontaneous pregnancy is less than 30%; (b) the guideline 'Intrauterine insemination' is followed more closely regarding hormonal stimulation; (c) stimulation is used less frequently during IVF; and (d) no more than 1 embryo is placed in the uterus at a time. To achieve these results, all parties involved must revise their policies. In particular, current reimbursement regulations inhibit the implementation of the research results in practice.
Costs and Cost Analysis↗
Medical miracle or medical mischief? The saga of the McCaughey septuplets.
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Adult↗
Number of embryos for transfer after IVF and ICSI: a Cochrane review.
BACKGROUND: The most common complication of IVF is multiple pregnancy, which occurs in 25% of pregnancies following the transfer of two embryos. Single embryo transfer can minimize twin pregnancies but could also lower live birth rates. Our aim was to perform a systematic review of randomized trials to determine the effectiveness of single versus double embryo transfer. METHODS: Cochrane Collaboration review methods were followed. Randomized controlled trials comparing single and double embryo transfers were identified by searching Medline, EMBASE and the Cochrane register of controlled trials. Contents of specialist journals and proceedings from meetings of relevant societies were hand searched. Data were pooled with Rev Man software using the Peto-modified Mantel-Hanzel method. RESULTS: Pooled results from four trials indicate that although double embryo transfer leads to a higher live birth rate per woman [odds ratio (OR) 1.94, 95% confidence interval (CI) 1.47-2.55] in a fresh IVF cycle, comparable results are obtained by subsequent transfer of a frozen embryo (OR 1.19, 95% CI 0.87-1.62). The multiple pregnancy rate is significantly higher (OR 62.83, 95% CI 8.52-463.57) after double embryo transfer. CONCLUSIONS: Single embryo transfer significantly reduces the risk of multiple pregnancy, but also decreases the chance of live birth in a fresh IVF cycle. Subsequent replacement of a single frozen embryo achieves a live birth rate comparable with double embryo transfer.
Adult↗
Depression and anxiety disorders during multiple pregnancy and parenthood.
Depression or anxiety disorders may affect more than 25% of multiple birth parents during the perinatal period. Such parents often are uninformed, suffer in silence and fear, and are reticent to seek help. When depression, panic attacks, and obsessive-compulsive disorder are not recognized or are left untreated, parent health, parent-infants interaction, child development, and family stability may be seriously compromised. Nurses, as partners in care at the family and community levels, have a pivotal role to play in prevention-focused health, education, and social support programs; the identification of parents at risk; and the early recognition and support of women and families affected by these disorders.
Anxiety Disorders↗
Controlling the high order multiple birth rate: the European perspective.
The dramatic increase in the incidence of high order multiple pregnancies that has occurred since the mid-1970s is due to three main factors: increasing female age at conception; increasing use of ovulation induction agents and the introduction of sophisticated assisted reproduction techniques. High order multiple pregnancies are at significantly higher risk of complications than singleton pregnancies, for the fetuses, babies and the mothers. The aim of all fertility treatments is to achieve a healthy live child for each couple seeking treatment. Treatment of infertility by IVF and related techniques provides an ideal opportunity to limit the number of high order multiple pregnancies by reducing the number of embryos transferred to the woman. The realization that high order multiple pregnancy can and should be avoided has increasingly led, in most European countries, to a restriction of the number of embryos for transfer to two or even one, without a significant decrease in a couples' chance of achieving a pregnancy. The experience of European countries in reducing the number of embryos transferred is reviewed and a recommendation made that a responsible attitude to embryo transfer is adopted by all practitioners of assisted reproduction.
Embryo Transfer↗
[Judgment of 30 September 1992].
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Behavior↗
Increase in maternity benefits.
In 1988, a new system of increased maternity benefits was introduced in Iceland. Allowances of Kr 17,370 are payable for four months as of 1988 and allowances of Kr 19,489 are payable for five months as of 1989. Allowances are payable for an additional month in the case of multiple births and for six months if the child is seriously ill. Moreover, a daily maternity benefit (Kr 817 in 1989) is payable, if the mother was employed for at least 1032 hours in the previous year; half that amount is payable if the mother was employed for between 516 and 1031 hours during the previous year. The daily allowance may be paid to the father from the second month onward, if he takes leave to look after the child.
Developed Countries↗
A multiple pregnancy register in the north of England.
A regional population-based Multiple Pregnancy Register was established in 1998, with the aim of collecting detailed information on multiple pregnancies to enable research into mortality and morbidity in multiples. Multiple pregnancies are notified to the Register as soon as they are detected, irrespective of whether they resulted in a spontaneous abortion, termination of pregnancy or registered birth. Nine hundred and twenty-six twin pregnancies were recorded during 1998-99, giving a twinning rate of 14.8 per 1000 maternities (rate at birth 13.0 per 1000 maternities). Sixty one per cent of twin pregnancies were detected before 13 weeks of gestation. Chorionicity was determined in 82.6% of 849 twin maternities with at least one stillbirth or livebirth. The fetal loss rate before 24 weeks of gestation was 10.5% (194/1852). The perinatal and infant mortality rates were 40.6 per 1000 births and 32.6 per 1000 livebirths respectively. A prospective Multiple Pregnancy Register not only allows monitoring of trends in multiple birth rates and mortality, but also etiological research and long-term follow-up studies.
Abortion, Induced↗
Extension of maternity leave.
In 1987, the period when prenatal maternity allowance is paid in Finland was extended from 25 to 30 days. The total period when maternity allowance is paid is now 263 days. In 1988, the period when maternity allowance is paid was extended another 60 days in the case of multiple births.
Demography↗
[[Perinatal mortality rates in single and multiple births, and the effects of maternal age, birthweight, and other factors on the perinatal mortality rates in Japan]].
"The perinatal mortality rate (PMR) was analyzed using... Vital Statistics for 1950-1991 in Japan. Secular changes in the PMRs were analyzed according to sex and single-multiple births. This paper also investigated the effects of maternal age, birth order, gestational age, and birthweight on the PMR." (SUMMARY IN ENG)
Age Factors↗
Why and how should multiple pregnancies be prevented in assisted reproduction treatment programmes?
Although most professional societies have issued guidelines to diminish the number of embryos to be transferred during assisted reproductive techniques, the incidence of multiple pregnancies remains unacceptably high. The burden of morbidity and mortality seems to increase substantially with each fetus in a multiple gestation. As a result, there has been growing debate on the need to prevent multiple pregnancies. The infertility specialists who can solve the infertility problem are usually shielded from the complications of multiple pregnancies. If they were involved in the delivery and, more particularly in the care of multiple pregnancies (both financially and socially), their attitude would probably change. IVF centres should gradually reduce the mean number of embryos per transfer in terms of the cost:benefit ratio. A further reduction to one single embryo per transfer in good cases would be similarly acceptable. Laboratory expertise is of vital importance, especially in terms of embryo culture, embryo selection, and freezing and thawing techniques in embryo transfer programmes for reducing the number of transferred embryos.
Cost-Benefit Analysis↗
The impact of multiple preterm births on the family.
Multiple births are important contributors to the preterm and low birthweight population and the numbers of twin births have been steadily rising since the early 1980s in all developed countries. This is largely due to the increased use of ovulation induction and multi-embryo transfer in the treatment of subfertility. Parents of preterm twins have been shown to be less responsive to their infants than those with singletons. Parental stress with twins has also been demonstrated by the higher incidence of maternal depression and of child abuse in multiple birth families. Furthermore, siblings of twins are more likely to have behaviour problems. Mortality and long-term morbidity rates are greatly increased amongst multiple birth children. The problems of the single surviving twin and the unaffected co-twin of a disabled child are often underestimated as is the complexity of the bereavement of parents who still have surviving multiples. Addressing the cause of the epidemic of iatrogenic multiple births is likely to be the single most effective way to reduce the number of preterm infants and the long-term problems to which they are prone.
Bereavement↗