PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Pregnancy, Multiple”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources
PubMed1998

Reducing multiple pregnancies by restricting the number of embryos transferred to two at the first embryo transfer attempt.

Though the multiple pregnancy rate in in-vitro fertilization-embryo transfer must be reduced, strict and uniform regulation of the number of embryos transferred may make it impossible for women with little natural fecundity to carry children. We therefore restricted the number of embryos per transfer. In the first half of the observation period (n = 100), we limited the number of embryos transferred to three regardless of the number of previous transfers. In the second half (n = 137), we strictly regulated the number of embryos transferred to two at the first attempt and three in the second and later attempts. The multiple pregnancy rate per pregnancy was significantly lower (P < 0.005) in the second period (20.4%) than in the first period (52.9%), while the clinical pregnancy rate and the implantation rate per transfer were similar in both observation periods. 60.7% (17/28) of the multiple pregnancies arose from the first embryo transfer attempt, and 17.9% (5/28) of them arose from a second attempt. The 18 multiple pregnancies in the first period involved six sets of triplets, while the 10 multiple pregnancies that arose in the second period all involved twins. The implantation rate per transfer at the first attempt was significantly higher than that at the second or later attempts. The criterion for determining the number of embryos transferred should be simple to minimize errors of judgement. We believe that our method of restricting the numbers of embryos transferred may be one method of reducing multiple pregnancies without eliminating the possibility of having children for women with low fecundity.

Adult↗
PubMed2004

Termination of multiple pregnancy at 18-24 weeks' gestation by Laminaria dilatation and evacuation.

OBJECTIVE: To compare outcome in women undergoing termination of multiple pregnancy as compared with singleton pregnancy at 18-24 weeks' gestation by Laminaria dilatation and evacuation. STUDY DESIGN: The medical records of 372 consecutive women undergoing does not increase pregnancy termination by Laminaria dilatation and evacuation at 18-24 weeks' gestation between January 1997 and December 2001 were reviewed and divided into a group with multiple pregnancies (38 cases) and a group with singleton pregnancies (334 cases). The 2 groups were then compared for differences in patient characteristics, indications for pregnancy termination and operative outcome. Statistical methods included Student's t and chi2 test. RESULTS: Patients with multiple pregnancies were significantly older (P < .01), and a greater percentage of them were married (P < .001). The percentage of pregnancies following infertility treatment was also significantly higher in the group with multiple pregnancies (P < .0001). Furthermore, significantly more patients with multiple than singleton pregnancy underwent pregnancy termination due to preterm premature rupture of membranes (42.1% vs. 0.3%) (P < .00001), while significantly more singleton pregnancies were terminated due to structural and chromosomal fetal malformations (34.5% vs 10.6%) (P = .03). Operative outcome between the study groups differed mainly regarding blood transfusion; it was significantly greater in the group of patients undergoing multiple, as compared with singleton, termination (7.9% vs. 0.3%) (P < .00001). The group with multiple pregnancy had a longer hospital stay (1.7 +/- 0.9 vs. 1.2 +/- 0.5 days) (P < .001). CONCLUSION: Termination of multiple pregnancies at 18-24 weeks' by dilatation and evacuation appears safe when performed by skilled surgeons. There is an increased need for blood transfusion.

Abortion, Induced↗
PubMed1997

Comparison of the role of cervical and intrauterine insemination techniques on the incidence of multiple pregnancy after artificial insemination with donor sperm.

PURPOSE: Our purpose was to investigate the role of the insemination technique used in an artificial insemination program with donor sperm (AID) in multiple pregnancy rates. METHODS: We carried out a retrospective nonrandom analysis of 300 pregnancies corresponding to 300 cycles in women from our Artificial Insemination Donor Sperm Program. All cycles were stimulated with gonadotropins. Single and multiple pregnancy cycles and intracervical and intrauterine pregnant cycles were compared. RESULTS: Intracervical insemination was performed in 173 cycles (58%), and intrauterine insemination in 127 (42%). Two hundred twenty-three pregnancies were single (74%), and 77 multiple (26%). In multiple pregnancy cycles, initial dose and mean total daily dose of gonadotropins, plasma estradiol levels, and number of follicles > or = 14 mm were significantly higher compared to those in single pregnancy cycles. Multiple pregnancy rte was significantly higher among pregnancies after intrauterine insemination (32%) than after intracervical insemination (21%). CONCLUSIONS: The intrauterine technique of insemination in AID-stimulated cycles with gonadotropins is related to multiple pregnancy risk.

Adult↗
PubMed2006

Pregnancy and infant outcome of 80 consecutive cord coagulations in complicated monochorionic multiple pregnancies.

OBJECTIVE: This study was undertaken to document pregnancy and infant outcome after cord coagulation with laser and/or bipolar as a technique for selective feticide in complicated monochorionic multiple pregnancies. STUDY DESIGN: Prospective follow-up study in 2 tertiary fetal medicine centers. RESULTS: Eighty cases were included in the study (73 twins, 7 triplets). The survival rate was 83% (72/87). There were 9 intrauterine fetal deaths (10%), 5 within 24 hours and 4 between 4 and 10 weeks after the procedure. There was 1 termination of pregnancy because of chorioamnionitis. Median gestational age at delivery was 35.4 weeks, with 79% of patients delivering after 32 weeks. Preterm prelabor rupture of the membranes before 25 weeks accounted for all perinatal deaths (n = 5). Of the children older than 1 year of age (n = 67), 62 (92%) have a normal development. CONCLUSION: Cord coagulation is an effective method for selective feticide in monochorionic multiple pregnancies.

Child↗
PubMed1994

Obstetrical implications in multiple pregnancies.

In the present study 90 multiple pregnancies were examined. These were subdivided on the basis of the number of embryos involved (74 twins, 10 triplets, 6 quintuplets) and on whether they were followed at our clinic for the entire pregnancy or not. In each group we analysed certain variables, calculating the respective mean values and standard deviations. We used the ANOVA test to discriminate the eventual differences in the means of the variables analysed, operating a p < 0.05 significance value. In addition, significant differences were analysed by the test of Contrasts (Scheffe F-test). The concept that emerged from the data investigated is that careful management of these pregnancies, carried out in high-level structures, can reduce the incidence of complications on both the maternal and fetal side and thus prevent "minimal brain damage" in the newborn.

Abortion, Spontaneous↗
PubMed1999

Incidence and perinatal outcome of multiple pregnancies after intracytoplasmic sperm injection compared to standard in vitro fertilization.

PURPOSE: Our purpose was to assess the incidence of multiple pregnancies and their obstetric outcome after intracytoplasmic sperm injection. METHODS: The study group comprised women who delivered twins or triplets after intracytoplasmic sperm injection and standard in vitro fertilization. The incidence and main perinatal outcome of 140 multiple pregnancies resulting from intracytoplasmic sperm injection or standard in vitro fertilization treatment were analyzed. RESULTS: A total of 60 multiple pregnancies was obtained after intracytoplasmic sperm injection (3.4 +/- 1.1 embryos/cycle) and 80 after standard in vitro fertilization (3.3 +/- 2.0 embryos/cycle). The incidence of multiple pregnancy, i.e., 22.6 compared to 20.7%, respectively, was calculated. The obstetric outcome of 47 multiple pregnancies after intracytoplasmic sperm injection was 39 twin deliveries at between 27 and 37 weeks of gestation (mean, 36 +/- 3.3) and 8 successful triplet deliveries between 26 and 36 weeks of gestation (mean 32.6 +/- 2.4). The outcome after regular in vitro fertilization was similar. No major malformations were observed. CONCLUSIONS: The results of this study showed that the incidence of multiple pregnancies after intracytoplasmic sperm injection was similar to that after standard, conventional in vitro fertilization. The perinatal outcome did not differ between both groups.

Adult↗
PubMed2002

Iatrogenic multiple pregnancy.

Iatrogenic - physician-made - multiple pregnancies (IMPs) significantly contribute to the epidemic of twins and high-order multiples in most developed and in many developing countries. The primary etiology for IMPs is treatment of reduced fecundity, some but not all of which is associated with specific lifestyle changes of women in the second half of the 20th century. IMPs contribute to increased perinatal morbidity and mortality related to prematurity and low birth weights. In addition, the use of assisted conception techniques increases the frequency of monozygotic twinning and related pathology. Because assisted conceptions are costly interventions, current numbers of IMPs represent a balance between the need to maximize success rates and the desire to minimize the untoward outcome rates. We believe that eliminating procedures associated with unavoidable IMPs and controlling the number of transferred embryos can achieve a significant reduction in the adverse perinatal outcomes and costs associated with IMPs.

Adult↗
PubMed2003

[Multiple pregnancies: epidemiology and management].

Since the 1980s, the percentage of multiple pregnancies in the Netherlands has increased. Nowadays, the percentage of triplets is decreasing but there is still an increase in the percentage of twin pregnancies. A major cause is that Dutch women tend to delay starting a family until an advanced age. This increases their chances of a spontaneous multiple pregnancy. Moreover, they are prone to subfertility and consequently have a greater chance of undergoing treatments involving assisted-reproduction techniques such as intra-uterine insemination (IUI) and in-vitro fertilisation. In the Netherlands, the majority of higher order multiple pregnancies result from mild ovarian hyperstimulation in combination with IUI. In case of in-vitro fertilisation, since the practice of transferring a maximum of two embryos still results in 20-25% twin pregnancies, single-embryo transfer should be advocated more often.

Adult↗
PubMedDate not supplied

[Multiple pregnancies. FIVNAT].

FIVNAT register has collected 10,510 deliveries after IVF attempts from 1986 to 1993. The multiple pregnancy rate is 27.2%, 23.5% for twin pregnancies, 3.6% for triplets pregnancies and 0.15% for multiples pregnancies over 3. Triplet pregnancy proportion, before embryo reduction, reached 8% in 1989 then decreased to 6.1% in 1993. In 1994 the proportion of 3 and 4 embryos transfers has decreased and that of 2 embryos transfers has increased, but global pregnancy rate per transfer is 1.6% lower than pregnancy rate in 1993. This point shows how difficult it is to decrease multiple pregnancy rate without decreasing global pregnancy rate.

Adult↗
PubMed2001

[Maternal morbidity in multiple pregnancies].

BACKGROUND: This study aimed to outline the clinical physiognomy of maternal morbidity in multiple pregnancies in order to improve maternal and feto-neonatal. METHODS: We reviewed the admissions to Department B of the Gynecology and Obstetrics Clinic at Turin University during the decade 1989-1998. Out of 17,445 pregnancies, we noted a 205 multiple pregnancies (1.17%), including 199 sets of twins, 5 triplets and 1 quadruplets. The percentages for the incidence of the various forms of maternal morbidity were compared to a control group of 1000 single births. RESULTS: Of 205 multiple pregnancies, 169 (82.43%) presented complications of varying severity and associated with statistically significant increase (always over 50%). These took the form of: premature birth (75.12%), PROM (28.29%), threat of premature birth (14.63%), phlebectasia (9.75%), anemia (8.78%), hyperemesis in the first quarter (8.29%), abortion (4.89%), polyhydramnios (4.39%), urinary tract infection (1.95%), detachment of the placenta (1.95%), liver pathology (1.46%), placenta previa (0.97%). CONCLUSIONS: The pathological picture revealed by this survey may seriously jeopardise the normal evolution of pregnancy, with severe repercussions for mother and fetus-neonate. These high-risk pregnancies should be included in a preventive programme of medical-social-outpatient and home assistance to guarantee early hospitalisation.

Adult↗
PubMed1983

The contribution of multiple pregnancy to perinatal mortality in Benin City.

The contribution of multiple pregnancy to overall perinatal mortality in the 3 major hospitals in Benin City has been reviewed. Although the incidence is 2.6% of all deliveries, it accounts for 14.3% of the overall perinatal mortality. The factors of importance in relation to perinatal loss included preterm delivery, low birthweight, birth order, malpresentation, mode of delivery, and failure to diagnose multiple pregnancy before labor. Bedrest is advocated. Health education is important in encouraging parturients to avail themselves of available antenatal facilities. A high index of suspicion for multiple pregnancy and referral of such patients to major units equipped to manage such high risk pregnancies will reduce fetal wastage.

Africa↗
PubMed2003

Reduction of the number of fetuses for women with triplet and higher order multiple pregnancies.

BACKGROUND: When couples are faced with the dilemma of a higher order multiple pregnancy there are three options. Termination of the entire pregnancy has generally not been acceptable to women, especially for those with a past history of infertility. Attempting to continue with all the fetuses is associated with inherent problems of preterm birth, survival and long term morbidity. The other alternative relates to reduction in the number of fetuses by selective termination. The acceptability of these options for the couple will depend on their social background and underlying beliefs. This review focused on reduction in the number of fetuses. OBJECTIVES: To assess a policy of multifetal reduction with a policy of expectant management of women with a triplet or higher order multiple pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (30 September 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002), and PubMed (to 30 September 2002). SELECTION CRITERIA: Randomized controlled trials with reported data that compared outcomes in mothers and babies who were managed expectantly with outcomes in women who underwent selective fetal reduction of a triplet or higher order multiple pregnancy. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: There were no randomised controlled trials identified. REVIEWER'S CONCLUSIONS: There are insufficient data available to support a policy of pregnancy reduction procedures for women with a triplet or higher order multiple pregnancy. While randomised controlled trials will provide the most reliable evidence about the risks and benefits of fetal reduction procedures, reduction in the number of fetuses by selective termination may not been acceptable to women, especially for those with a past history of infertility. The acceptability of this option, and willingness to undergo randomisation will depend on the couple's social background and beliefs, and consequently, recruitment to such a trial may prove exceptionally difficult.

Female↗
PubMed1979

Ultrasound diagnosis of fetal abnormalities in multiple pregnancy.

Over a period of four years, 41 cases of abnormal multiple pregnancies were diagnosed successfully by ultrasound. These include several rare combinations of abnormalities. The most frequent was a normal pregnancy and a synchronous blighted ovum. Others were twin blighted ova, blighted ovum and missed abortion, missed abortion in both gestational sacs, two embryonic echoes with the development of only one baby, normal fetus and an anencephalic twin, normal fetus and fetus papyraceous, and triplets with two fetuses papyraceous. The results suggest that one or more gestational sacs may be resorbed during pregnancy without any adverse effect on the coexisting normal fetus. From a practical point of view, it is important to be aware of these possibilities before giving the final diagnosis of multiple pregnancy to the patient. The more diagnostic ultrasound is used in obstetrics, the more rare abnormalities associated with multiple pregnancies will be revealed.

Abortion, Missed↗
PubMed1989

When do perinatal deaths in multiple pregnancies occur?

Perinatal mortality for multiple pregnancy remains at least 5 times the rate for singleton births. The major causes are neonatal deaths due to gross immaturity before 30 weeks' gestation, and stillbirths due to intrauterine growth retardation at all gestations, but especially after 32 weeks. Sixty four per cent of perinatal losses before 30 weeks' gestation occur before 26 weeks, highlighting the need to commence prophylactic measures earlier than usually recommended. The perinatal mortality in infants in multiple births weighing more than 2,500g is the same as that of singletons, but is 10 times this rate in multiple births weighing between 500g and 2,500g. Because the stillbirth rate in twins proceeding beyond 38 weeks' gestation is 3 times that of singleton births, elective termination of pregnancy is recommended if spontaneous labour has not occurred by this time.

Female↗
PubMed1975

An appraisal of lumbar epidural blockade in labour in patients with multiple pregnancy.

A series of 102 patients with a multiple pregnancy (including three sets of triplets) delivered vaginally is presented. An epidural block was provided for 55 of these patients, and comparisons were made between these patients and those who did not have an epidural block. There was a higher incidence of low Apgar-minus-colour (A-C) scores at one minute among the second twins of at least 36 weeks gestation in the epidural series, but no other remarkable contrasts in the (A-C) scores of the respective group of infants. In the non-epidural series two second twins of at least 36 weeks gestational age apparently suffered severe cerebral trauma. Of the 91 liveborn infants in the non-epidural series, five died (two with intracranial haemorrhage, three with hyaline membrane disease); of the 112 liveborn infants in the epidural series, two died (both with hyaline membrane disease). The incidence of instrumental delivery of infants presenting by the vertex, and of breech extraction, was markedly higher in the epidural series. The mean interval between full dilatation of the cervix and delivery of the first twin was greater in the epidural series, but the mean interval between delivery of the first and second infant was smaller in the epidural series. It is concluded that the provision of an epidural block for labour and delivery to patients with a multiple pregnancy is beneficial to the infants.

Anesthesia, Epidural↗
PubMedDate not supplied

[Decrease in cerclage incidence in multiple pregnancies by vaginal ultrasound monitoring].

Cervical insufficiency is a frequent complication particularly in case of multiple pregnancy and is often considered to be an indication for cerclage operation. We performed a vaginosonographic monitoring prospectively in 35 cases with multiple pregnancy in order to diagnose cervical insufficiency early and to perform cerclage operation when indicated. The results were compared with a group of 41 patients with multiple pregnancy who received prophylactic cerclage in other hospitals. No significant difference occurred concerning the duration of the pregnancy. In patients without prophylactic cerclage the frequency of preterm contractions was significantly lower, the frequency of premature rupture of membranes, however, was higher. Our results confirm the hypothesis that the application of a prophylactic cerclage does not improve fetal outcome in case of multiple pregnancy. Vaginosonographic as a single monitoring procedure seems to sufficient for the early diagnosis of cervical insufficiency.

Adult↗
PubMed1995

Genetic analysis prior to selective fetal reduction in multiple pregnancy: technical aspects and clinical outcome.

Multiple pregnancies resulting from ovarian stimulation are at a higher risk of carrying at least one fetus affected by Mendelian or chromosomal anomalies, the incidence of which is directly related to the order of multiples. Genetic analysis before fetal reduction was offered to both high- and low-risk pregnant women carrying two or more fetuses after ovulation induction. Chorionic villus sampling (CVS) and fetal reduction were achieved by transabdominal needling. The use of short-term culture, the polymerase chain reaction and fresh tissue enzymatic analyses have made it possible for genetic diagnosis to be available in a few days. A total of 100 patients had multifetal pregnancy reduction performed by a single operator; all of them completed pregnancy and none was lost at follow-up. The total fetal loss before 24 weeks was 7% and no statistically significant relationship was found with the final number of fetuses and CVS. Perinatal losses (3.9%) were only present in the series with a final number of two fetuses. Pregnancy duration and birthweight were significantly higher in singletons than in twins, but were not related to CVS. The rate of chromosomal disorders was higher (7.2%) in the study series than in singleton pregnancies not undergoing fetal reduction. Diagnostic error due to incorrect sampling was reported in 1.5% of cases. These data support fetal reduction as a valuable strategy to improve the outcome of multiple pregnancy. The outcome of pregnancies reduced to singletons was significantly better than of those reduced to twins, and was not related to CVS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗