RURAL ; Twin Multiple Birth ; Poverty ; Health

We report on two cases of diamniotic dichorionic pregnancy with delayed delivery of the second twin. Case 1 was a 29-year-old woman with a twin pregnancy at 19 weeks and 0 day presenting with a preterm rupture of the membranes (PROM) of the first twin. The patient was treated with ritodrine and systemic broad-spectrum antibiotics. Six hours after admission, the first twin was delivered stillborn without complication. At 23 weeks and 5 days, preterm labor resulted in and the second twin being delivered stillborn at a weight of 564 g. The interval between the first and second delivery was 33 days. Case 2 was a 30-year-old woman with a twin pregnancy at 15 weeks and 4 days presenting with amniotic fluid leakage. PROM was found, and she was treated with ritodrine and systemic broad-spectrum antibiotics. The next day, the first twin was delivered stillborn. At 26 weeks, due to adverse effects, ritodrine was changed to isoxsuprine and magnesium sulfate to control uterine contractions. At 33 weeks and 5 days, onset of labor was observed, and 11 hours after the cessation of treatment with isoxsuprine and magnesium sulfate, a viable female fetus was delivered by spontaneous vaginal delivery, weighing 1,806 g. The mother developed atonic bleeding of the uterus immediately after delivery.;The interval between the first and second twin deliveries was 33 days in case 1 and 127 days in case 2. The longer interval resulted in better fetal outcome, but it also may have increased the risk to the mother.
Twin Multiple Birth ; Delivery ; week ; Ritodrine ; Pregnancy

Premature Ovarian Failure (POF) is associated with subfertility. Despite efforts to induce ovulation, success rates are low. We report a case of POF spontaneously conceiving twins while on hormone replacement therapy.
Ovarian Failure, Premature ; Spontaneous ; Twin Multiple Birth ; Pregnancy ; success

OBJECTIVE: The purpose of this study was to evaluate the clinical course of discordant fetal growth and perinatal outcome in relation to dichorionic and monochorionic twin for different degrees of birth weight difference. METHODS: Between Jan. 1992 and Dec, 1997, 154 twin pairs were born at Yonsei medical center and there were 36 pairs of twins which had 20% or more birth weight difference. The placental examination were performed routinely on all multiple births and 13 pairs of dichorionic twins and 23 pairs of monochorionic twins were consisted of the study population. These twin pairs were divided into three groups based on birth weight difference: 20-29%(as group A), 30-39%(as group B), and 40% or more(as group C). Gestational age, birth weight, gender and perinatal outcomes were observed for each twin pairs. RESULTS: The perinatal death in the monochorionic twin pairs showed 9(34.6%) as group A, 4(50%) as group B, and 5(41,7%) as group C and in the dichorionic twin paus 1(10.0%) as youp A, 0 as group B and 5(62.5%) as group C. Up to 40% of birth weight difference, dichorionic twin pairs showed good perinatal outcomes compared with monochorionic twin pairs but over 40% or more of birth weight diffaence, however there were no significant difference of perinatal outcomes by chorionicity. In the monochorionic twin pairs, the cause of perinatal death showed 3 cases of prematurity, 2 cases of congenital anomalies and 2 cases of IIOC and 2 cases of cord lesions in group A whenas in the group B and C 3 cases of prematurity and 6 cases of congenital anomalies. In the dichorionic twin pairs, different-sex twin pairs showed no perinatal death in all three groups but in same-sex twin pairs there were 6 perinatal deaths. CONCLUSION: More recent improved fetal ultrasonographic surveillance such as determination of chorionicity, identification of fetal sex and evaluation of fetal anomalies help to make a clinical decision in growth discordant twin up to 40% of weight difference each other.
Birth Weight ; Chorion ; Fetal Development* ; Gestational Age ; Humans ; Multiple Birth Offspring ; Pregnancy, Twin

The freemartinism syndrome affects almost all female calves born as co-twins to male calves, whereas little is known about this phenomenon in female sheep. Within this context, 1,185 ewe-lambs from the Ripollesa sheep breed were genotyped for the presence of oY1 polymorphism (a non-autosomal region of the Y chromosome). Neither ewe-lambs from single births (856) nor ewe-lambs from all-female multiple births (170) were revealed as freemartins, whereas five of 159 ewe-lambs from multiple births with male co-twins were freemartins (3.15 ± 1.38%). All freemartin ewe-lambs were confirmed by physical examination of external genitalia. The results confirm a low incidence of freemartinism from heterosexual twin pregnancies in Ripollesa sheep.
Animals ; Cattle ; Female ; Freemartinism ; Genitalia ; Heterosexuality ; Humans ; Incidence ; Male ; Multiple Birth Offspring ; Parturition ; Physical Examination ; Pregnancy, Twin ; Sheep

There has been a significant increase in the number of multiple pregnancies that are associated with a high risk of preterm delivery among Korean women. However, to date, delayed-interval delivery in women with multiple pregnancy is rare. We report a case of delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a dichorionic diamniotic twin pregnancy. The patient presented with vaginal leakage of amniotic fluid at 16 weeks of gestation and was diagnosed with a preterm premature rupture of membranes. Three days later, the first twin was delivered, but the neonate died soon after. The second twin remained in utero, and we decided to retain the fetus in utero to reduce the morbidity and mortality associated with a preterm birth. The patient was managed with antibiotics and tocolytics. Cervical cerclage was not performed. The second twin was delivered vaginally at 34 weeks and 5 days of gestation, 128 days after the delivery of the first-born fetus. This neonate was healthy and showed normal development during the 1-year follow-up period. Based on our experience with this case, we propose that delayed-interval delivery may improve perinatal survival and decrease morbidity in the second neonate in highly selected cases.
Amniotic Fluid ; Anti-Bacterial Agents ; Cerclage, Cervical ; Female ; Fetus ; Follow-Up Studies ; Humans ; Infant, Newborn ; Membranes ; Mortality ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin ; Premature Birth ; Rupture ; Tocolytic Agents ; Twins

OBJECTIVES: To evaluate the safety and efficacy of selective fetal reduction (SFR) and compare the outcome of twin pregnancy after SFR in multiple pregnancy induced by assisted reproductive technology (ART) with that of natural twin pregnancy. METHODS: From September 1995 to March 2002 in Ajou University Hospital, SFR was performed in 79 patients whose gestational sacs were more than 3. Of these 79 patients, 47 patents resulted in twin pregnancy after SFR. SFR was performed using transvaginal intracardiac KCl injection at gestational age of 6~9 weeks. Control group was composed of 264 patients with natural twin pregnancy, who delivered after intrauterine pregnancy at 24 weeks, from June 1994 through December 2002. We compared Obstetric and perinatal outcomes between SFR group and natural twin group. RESULTS: Among 47 patients with twin pregnancy after SFR, 2 spontaneous abortion were occurred at intrauterine pregnancy at 8 and 19 weeks. Obstetrical and perinatal outcomes were available in 43 patients. Single intrauterine fetal death was occurred in 1 of 43 (2.3%) patients in SFR group. incidence of preterm labor, premature rupture of membrane, preeclampsia and placenta previa were similar, but gestational diabetes mellitus (GDM) was occurred more frequently in SFR group (3 (7.0%) vs 4 (1.5%), p=0.02). Mean gestational age, mean birth weight, incidence of discordancy, use of intubation and ventilation, incidence of fetal anomaly, low (<7) Apgar score and intrauterine growth restriction were similar in both groups. CONCLUSION: Twin pregnancy after SFR has the increased incidence for GDM but other obstetric and perinatal outcome was similar compared with natural twin pregnancy. So SFR is a safe and effective procedure, so we suggest SFR is needed in multifetal pregnancy more than triplet.
Abortion, Spontaneous ; Apgar Score ; Birth Weight ; Diabetes, Gestational ; Female ; Fetal Death ; Gestational Age ; Gestational Sac ; Humans ; Incidence ; Intubation ; Membranes ; Obstetric Labor, Premature ; Placenta Previa ; Pre-Eclampsia ; Pregnancy ; Pregnancy Reduction, Multifetal* ; Pregnancy, Multiple ; Pregnancy, Twin* ; Reproductive Techniques, Assisted ; Rupture ; Triplets ; Ventilation

Congenital anomalies occur in 2-3% of neonates but this incidence increases in multiple pregnancies, especially when fetuses are monozygotic. when pregnancies are affected with one anomalous fetus combined to a normal one, the proper management and counseling is difficult.We experienced a twin pregnancy in which one anencephalic fetus was combined to a normal one. Karyotype analysis was normal in both fetus. After close counseling we decided to continue the pregnancy. Intermittent amnioreduction was done for persistent polyhydramnios. At 29 weeks of gestation membrane was ruptured prematurely and we delivered by cesarean section due to breech-cephalic presentation. The birth weight of the normal and anencephalic fetuses were 1070 gm and 1050 gm, respectively. The anencephalic fetus died immediately after birth but the healthy one showed good crying and movement and its Apgar score was 6 in 1 minute and 8 in 5 minute. Although the infant needed intensive care for 90 days in the nursery room finally discharged in good condition. We report a case of twin pregnancy in which anencephaly was associated with a normal fetus, so after close counseling we opted to continue the pregnancy resulting in the delivery of a viable fetus.
Anencephaly ; Apgar Score ; Birth Weight ; Cesarean Section ; Counseling ; Crying ; Female ; Fetus* ; Humans ; Incidence ; Infant ; Infant, Newborn ; Critical Care ; Karyotype ; Membranes ; Nurseries ; Parturition ; Polyhydramnios ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin* ; Twins*

Maternal serum alpha-fetoprotein(MSAFP) has been a world wide screening test for open neural the tube defect. But elevation of MSAFP is related to not only neural tube defect, but also incorrect gestational age, congenital anomalies such as congenital nephrosis, esophageal and intestinal obstruction, low birth weight, oligohydroamnios, fetal death and chromosomal anomalies. If MSAFP is elevated, gestational age, congenital anomalies such as neural tube defect, multiple pregnancy and fetal death must be evaluated by ultrasound. When the ultrasound is nondiagnostic, amniotic fluid AFP(AFAFP) levels are measured and if AFAFP is elevated, presence or absence of aetylchoineststarase(AChE) is determined to rule out the false positive of amniotic AFP. Amniotic AChE test yielded detection rate of open spina bifida of 99%, 98% for anecephaly and a false-positive rate of 0.34%. We report a case with elevated AFAFP and positive amniotic AChE result in one fetus of the twin pregnancy conceived by ICSI and ZIFT, but in which targeted ultrasound findings were normal, maintained the pregnancy to term and normal twin was delivered by elective cesarean section.
Acetylcholinesterase ; alpha-Fetoproteins ; Amniotic Fluid* ; Cesarean Section ; Female ; Fetal Death ; Fetus* ; Gestational Age ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Intestinal Obstruction ; Mass Screening ; Nephrosis ; Neural Tube Defects ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin* ; Sperm Injections, Intracytoplasmic* ; Spina Bifida Cystica ; Ultrasonography ; Zygote Intrafallopian Transfer ; Zygote*