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 19 recordsLinked to original sources
PubMed1992

Prenatal diagnosis in multiple pregnancies.

Multiple pregnancy, with its high rate of fetal loss and increasing incidence, merits greater clinical attention and research. Prenatal diagnosis in multiple pregnancy poses particular difficulties in terms of safety and technique of invasive procedures, interpretation of laboratory results, and the human dilemmas produced by the demonstration of discordant abnormality. Recent applications of ultrasound, including Doppler ultrasound, are also discussed in the context of the monochorionic placenta, prediction of preterm labor, and detection of intrauterine growth retardation.

Amniocentesis↗
PubMed1976

Duration and complications of multiple pregnancies.

Multiple pregnancies reach full term only in a remarkably lower percentage with respect to single pregnancies. Even in the case of multiparae, delivery occurs some three weeks before term. Complications may concern either pregnancy and puerperium or delivery. The former include (1) abortions, especially frequent in the case of monoplacental and monochorial pregnancies; (2) rarer events, such as hydramnios, placenta praevia, association of an ectopic pregnancy with an intrauterine pregnancy, molar degeneration of one egg with normal development of the other; (3) gestoses of the first and second trimester, more frequent than in single pregnancy; and (4) higher incidence, during puerperium, of hemorrhage, phlebitis, and uterine subinvolution. With respect to delivery, normal delivery only occurs in approximately 70% of twin pregnancies, the period of dilatation being generally longer than normal. Better assistance and techniques during labor and especially in the interval between delivery of first and second twin have remarkably reduced the higher mortality rate, especially for the second twin.

Abortion, Spontaneous↗
PubMed1992

[Hormonal and ultrasound monitoring of early pregnancy--differential diagnosis of extrauterine pregnancy and multiple pregnancy].

In this study sonographical and hormonal findings in 63 patients with intrauterine singleton pregnancy were compared with 18 patients with multiple pregnancies and 28 patients with ectopic pregnancy. The earliest detection of the intrauterine gestational sac was obtained with a HCG level of 659 mlU/ml. The sonographical development correlated well with HCG values. There was no statistically significant correlation between gestational age and HCG. In multiple pregnancies with sonographical findings comparable to the development in singletons HCG values were remarkably elevated. A discrimination between multiple and ectopic pregnancies by sonographical and hormonal criteria cannot be performed sufficiently in a HCG zone of 1500 mlU/ml. Close sonographical and hormonal follow-up until diagnosis of the intrauterine pregnancy is necessary.

Chorionic Gonadotropin↗
PubMed1990

Multiple pregnancy.

Most multiple pregnancies are diagnosed, but early diagnosis still presents some problems. Congenital malformation is commoner in multiple pregnancies, usually without concordance, which complicates decisions about pregnancy termination. Because of the higher perinatal mortality rates, women with multiple pregnancies should be offered extra antenatal care, with the specific objectives of early diagnosis and timely treatment of pre-eclampsia, preterm labour and growth retardation. If growth retardation affects only one fetus, intervention must be carefully judged. Measures such as bedrest, fetal monitoring and elective operative delivery are reviewed, and no evidence of benefit is found from their routine use. However, such interventions are valuable in selected cases.

Delivery, Obstetric↗
PubMed1990

[Pregnancy outcome following cerclage. 2. Multiple pregnancy].

In a retrospective study pregnancy and labour after cerclage had been studied in comparison to 160 patients with singleton pregnancies and a matched pair control group of multiple pregnancies without operative cervix closure. Cervical incompetence in multiple pregnancy observed more frequently than in singleton ones is not correlated to obstetric history, but has a bad prognosis because of necessity of tocolysis during pregnancy, marked shortening of duration of pregnancy, lowering of length and weight of newborns. An increase in frequency of amniotic infections had to be calculated following cerclage in multiple pregnancies, too. Our results especially in multiple pregnancies are not so optimistic. This statement is valid also for the indication to its prophylactic use.

Adult↗
PubMed1992

Relationship of follicle number and other factors to fecundability and multiple pregnancy in clomiphene citrate-induced intrauterine insemination cycles.

OBJECTIVE: To determine characteristics associated with pregnancy and multiple gestation after clomiphene citrate (CC)-intrauterine insemination (IUI). DESIGN: Prospective study of all patients undergoing CC-IUI between January 1, 1983 and December 31, 1989. SETTING: Private fertility clinic. PATIENTS: Eight hundred forty-nine patients undergoing 1,974 cycles of CC-IUI. MAIN OUTCOME MEASURES: Relationship between number and size of preovulatory follicles, age, additional infertility diagnosis, medication, and initial semen quality to fecundity, birth, and multiple gestation. RESULTS: Uncorrected, per cycle fecundity was 7.2%. The number of follicles greater than or equal to 12 mm (r = 0.055, P less than 0.05) was and the number greater than or equal to 15, 18, and 21 mm was not correlated with fecundity. Endometriosis with (P = 0.013) or without (P less than 0.0005) tubal adhesions and tubal adhesions alone (P = 0.005), decreased fecundability by 50%. Initial semen quality did not affect fecundity, unless semen concentration was less than 5 x 10(6)/mL or motility was less than 20%. Multiple pregnancy was not associated with the dose of CC, use of human chorionic gonadotropin, or number of follicles. CONCLUSIONS: Multiple pregnancy was unrelated to follicle numbers or to CC dose. The highest birth rates after CC-IUI occurred when initial sperm concentration was greater than or equal to 5 x 10(6)/mL, motility was greater than or equal to 20%, and no endometriosis or adhesions were present.

Clomiphene↗
PubMed1991

[A program to lower perinatal morbidity and mortality in women with multiple pregnancies].

A total of 511 females with multiple pregnancy (486 with twins and 25 with triplets) were examined for the nature of fetal development, and management of pregnancy, labor and postpartum period. An early diagnosis was found to play a decisive role in the implementation of therapeutical and preventive measures. A classification of the prenatal development of monozygotic twins was presented. It was shown that the optimal management of pregnancy in multiple-pregnant females was effective in relation to the time of employing the basic components of the program. It was demonstrated that the active management of labour was important in multiple pregnancy; the results of clinical trials of this procedure were also provided. In terms of the risk for perinatal morbidity and mortality, three groups were identified, these may include females with multiple pregnancy. Implementing the proposed treatment-and-prevention measures showed that perinatal morbidity and mortality rates in multiple pregnancy might be substantially reduced.

Female↗
PubMed1977

[Management and monitoring of multiple pregnancies (author's transl)].

The fetal prognosis in multiple pregnancies can be improved by a multifaceted antenatal program which includes early diagnosis prior to 28 weeks gestation, follow-up of multiple pregnancies in the high risk antenatal clinic, early discontinuation of work, treatment of pre-eclampsia, bed rest in hospital between 28 and 33 weeks and sometimes cerclage, prophylactic and therapeutic administration of labour inhibiting drugs, speedy delivery of the second twin and immediate pediatric care. Bed rest and administration of labour inhibiting drugs are the most important points of this program. With this combination, the utero-placental perfusion can be improved. The gestation can be prolonged and the incidence of small weight neonates and the incidence of the perinatal mortality can be reduced. Since even a large antenatal clinic only cares for a small number of multiple pregnancies, a multicentre study to determine the optimal management of multiple pregnancies is urgently required. Multiple pregnancies had too little attention in modern perinatal medicine and deserve all our attention for an improvement of their outcome.

Adrenergic beta-Agonists↗
PubMed1991

Multiple pregnancies: risk factors and prognostic variables during induction of ovulation with human menopausal gonadotrophins.

Multiple pregnancies still constitute a major and relatively frequent complication of induction of ovulation by human menopausal gonadotrophins (HMG) despite the increasing sophistication of monitoring techniques. In order to define specific variables which may be associated with multiple pregnancies, we have compared 51 multiple pregnancy cycles to 51 consecutive control singleton pregnancy cycles, following HMG induction of ovulation. The aetiology and classification of anovulation, duration of infertility, total amount of HMG utilized per cycle and the duration of stimulation were not associated with an increase in the rate of multiple pregnancy. Basal serum oestradiol levels and its periovulatory pattern were remarkably similar in the singleton and multiple pregnancy groups. The mean age of the multiple pregnancy group (29.4 +/- 4.4 years) was significantly lower than the mean age of the singleton pregnancy group (31.6 +/- 5.3 years) (P less than 0.05). In the multiple pregnancy group, there were significantly more cycles with intermediate sized (15-17 mm). (P less than 0.002), small sized (12-14 mm). (P less than 0.02) and immature follicles (less than 12 mm) (P less than 0.03), at the time of human chorionic gonadotrophin (HCG) administration, as compared with the singleton pregnancy group. Furthermore, a direct linear correlation was observed between the number of intermediate sized follicles and number of implanted embryos. The presence of intermediate sized follicles at the time of HCG administration after HMG induction of follicular maturation is predictive of, and independently associated with, a higher incidence of multiple pregnancy.

Estradiol↗
PubMed1976

A reduction in multiple pregnancies following the use of a clomiphene citrate: human gonadotrophin sequence.

The results of stimulation with gonadotrophins at the Sterility Clinic (Crown Street) are presented. Two different techniques have been employed involving 86 patients. All patients have similar indications for treatment. All have received the same preliminary investigations and all have been treated previously with a minimum of three cycles of Clomiphene Citrate without satisfactory response (i.e. "clomid failures). Technique (1) involved 51 patients and consisted of daily injections of Human Pituitary Gonadotrophin (H.P.G.) followed by an ovulating injection of Human Chorionic Gonadotrophin (H.C.G.) and a follow up injection of H.C.G. on post-ovulatory Day 7 or 8. This technique had a pregnancy rate of 64 per cent and a multiple pregnancy rate of 34 per cent. Technique (2) involved 35 patients and consisted of 5 days priming with Ethinyl Oestradiol and Clomiphene Citrate together, followed immediately by daily injections of H.P.G., then an ovulating injection of H.C.G. and a follow up injection of H.C.G. on post-ovulatory Day 7 or 8. The results of this variation in technique were a pregnancy rate of 69 percent, a multiple pregnancy rate of 8 percent. It is suggested that the use of Clomiphene Citrate in the latter technique acts as a "buffer" against the more extreme ovarian responses to H.P.G. acting alone and has the apparent advantage of a higher pregnancy rate, a lower multiple pregnancy rate and a reduction in the number of foetuses in each of the multiple pregnancies.

Chorionic Gonadotropin↗
PubMed1990

Obstetrical results after embryonic reductions performed on 34 multiple pregnancies.

Thirty-four women with multiple pregnancies (three or more fetuses) underwent embryonic reduction in order to reduce abortions, premature births or fetal growth-retardation by obtention of twins. Four early abortions occurred. Thirty pregnancies reached term and out of 60 fetuses, 58 infants were born alive. Fetal death in utero of one twin occurred in two pregnancies. The mean term until delivery was 36 +/- 2.8 weeks gestation and the prematurity rate was 51.7%. Of 55 neonates, 25 were underweight within the 10th percentile and 10 out of 55 neonates were underweight below the 3rd percentile. There were three deaths in the early neonatal period. The rate of perinatal mortality was 8.3%. Fifty-four children are currently healthy and one child has a mild axial hypotonia. A reduction in prematurity was observed with a gain of 2 weeks on reported data concerning triplet pregnancies. The rate of low-birth-weight infants was high, 63.5% being underweight at birth.

Abortion, Incomplete↗
PubMed1989

Low multiple pregnancy rate in combined clomiphene citrate--human menopausal gonadotrophin treatment for ovulation induction or enhancement.

Sixty-five infertile women, 37 with anovulation, eight with ovulatory disturbances and 20 with unexplained infertility were treated by a combination of clomiphene citrate (CC) from cycle day 5 (or 3) and human menopausal gonadotrophin (HMG) begun 3 days later for induction or enhancement of ovulation. Monitoring was carried out by measuring preovulatory 17-beta-oestradiol (E2) and progesterone (P) concentrations in blood samples and by follicle measurements using ultrasound. Forty-seven pregnancies resulted with a multiple pregnancy rate of 7.7% for those completed. This incidence is very low and within the range found for CC induction and might result from the later commencement of stimulation compared with many other protocols. These results were achieved with a low incidence of ovarian hyperstimulation syndrome (2.6% per cycle). The HMG doses given were low in comparison with those found in other forms of induction. The deleterious effects of this combined mode of induction on cervical mucus and the occurrence of premature spontaneous ovulation were much less than in the sequential mode of treatment. These results suggest that combined induction treatment by CC and HMG as described offers a means of achieving low rates of multiple pregnancies a known complication in the induction of ovulation.

Adult↗
PubMed1989

[Perinatal and maternal risks in multiple pregnancies].

The perinatal risk in multiple pregnancies is part of the traditional gabonese culture. The authors study the perinatal mortality of twins which is four times higher than in single pregnancies. Prematurity represents the main etiology: 30 p. cent of twin deliveries occur before 32 weeks. The fetal prognosis improves from 2,000 g but deteriorates beyond 2,500 g, emphasizing the role of intra-uterine hypoxia aggravated by the obstetrical trauma. The increased mortality of the second twin, which was demonstrated by all, and the birth delay, become harmful beyond 30 minutes. The maternal pathology consists in frequent hypertensive complications and severe gravidic anemias. The maternal mortality is three times higher than in single deliveries and is related to delivery haemorrhages. The authors propose to improve the prognosis with early ultrasonographic diagnosis and pregnancy monitoring, along with social measures covering a number of prenatal tests, with hospital delivery supervised by obstetrical and neonatal teams. On the contrary, they do not believe that caesarean section is a determining factor in the improvement of fetal prognosis.

Female↗
PubMed1991

[Prevention of iatrogenic multiple pregnancies].

A significant increase of twin and multiple pregnancies induced by infertility treatment has been observed. These high-risk pregnancies should be efficiently prevented. Gonadotrophin treatment for anovulation being the main culprit, it should be undertaken: 1) if other induction methods have failed. 2) under strict echographic and hormonal monitoring. After in vitro fertilization, number of embryos replaced should be selectively limited (to 2 or 3) on the basis of their vitality scores. Partial reduction of a multiple pregnancy should remain an exceptional solution.

Anovulation↗
PubMed1988

Multiple pregnancy in the Maltese population.

This study analyses the multiple birth statistics for the Maltese Islands since 1959. Hospital twin births delivering during the period of 1983-1985 are analysed for a number of variables. The incidence of multiple pregnancy for the Maltese Islands appears to have decreased slightly since 1959 with an overall rate of 10.21 per 1000 maternities. The ratio of dizygotic to monozygotic twinning was computed to be 1.64. Patients with multiple pregnancies are shown to be generally elderly and multiparous. The pregnancy outcome is more likely to be complicated by an operative delivery, while the infant is more likely to be premature and of low birth weight. The perinatal mortality rate for multiple pregnancies is markedly in excess of that for singleton births.

Cause of Death↗
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↗