BACKGROUND: The purpose of this study was to compare the fetal/infant mortality risk associated with each additional week of expectant management to that associated with immediate delivery in women with multiple gestations. METHODS: This was a retrospective national cohort study of 94,170 multiple deliveries, 92,619 (98.4%) twin and 1,352 (1.44%) triplet pregnancies, between 32 0/7 and 42 6/7 weeks of gestation recorded in the Korean vital statistics database. We investigated the risks of stillbirth and infant death after birth in Korea according to the week of gestation in twin and triplet pregnancies. RESULTS: The risk of stillbirth significantly increased between 34 and 35 weeks of gestation and between 37 and 38 weeks of gestation in twin pregnancies and between 34 and 37 weeks of gestation in triplet pregnancies. The risk of infant death following delivery gradually decreased as pregnancies approached full term. Week-by-week differences were statistically significant between 33 and 34 weeks, with decreasing risks of infant death at advancing gestational ages in twin pregnancies. At 37 weeks of gestation, the relative risk of mortality was significantly higher with expectant management compared with immediate delivery (relative risk, 3.00; 95% confidence interval, 1.41–6.38). CONCLUSION: In twin pregnancies, delivery at 37 weeks of gestation can minimize the risks of stillbirth and infant death in uncomplicated cases, although individual maternal and fetal characteristics must be considered when determining the optimal timing of delivery. In multiple pregnancies, close fetal surveillance is needed after 34 weeks of gestation.
Cohort Studies* ; Delivery, Obstetric ; Female ; Gestational Age ; Humans ; Infant Death* ; Infant* ; Korea ; Mortality ; Parturition ; Pregnancy ; Pregnancy, Multiple* ; Pregnancy, Triplet ; Pregnancy, Twin ; Retrospective Studies ; Stillbirth* ; Twins ; Vital Statistics

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

OBJECTIVE: To investigate the effect of the type of placenta and the portion of umbilical cord insertion on birthweight and growth discordancy in twin pregnancies. METHODS: We selected 120 twins of 146 multiple pregnancies between March, 2000 and March, 2002, and one fetus of all cases at least weighed 500 g or more and over 24 weeks of gestation. The fetuses were included that 44 twins (88 fetuses) had monochorionic placentas and the 76 twins (152 fetuses) had dichorionic placentas. The dichorionic twins were divided into two groups; one (38 twins, 76 fetuses) showed the fused type of placenta and the other (38 twins, 76 fetuses) showed the separate type of placenta. The types of umbilical cord insertion were also divided into the central portion and the peripheral portion, the peripheral portion was defined within 2 cm of margin of placenta, and included marginal and velamentous insertion of umbilical cord. Stastical analysis were performed with Student t-test and runs test. p<0.05 was defined significantly. RESULTS: 1. The central type of umbilical cord insertion in dichorionic placenta was more frequent than that of monochorionic placenta (p<0.01). 2. The dichorionic infants, regardless the number of placenta, who weighed more than monochorionic infants at birth (p<0.01). 3. Twin pairs with over 25% of growth discordancy were 16 cases (13.3%), which included 9 cases (9/76, 11.8%) of dichorionic placenta and 7 cases (7/44, 15.9%) of monochorionic placenta. The severe growth discordancy was more commonly developed in monochorionic twins than dichorionic twins (p<0.01). 4. Perinatal deaths in twin pairs with over 25% of GD were 12 cases, which included 3 cases (3/18, 16.7%) of dichorions, and 9 cases (9/14, 64.3%) of monochorions. Therefore, perinatal death was showed more commonly in monochorinic twin infants (p<0.01). CONCLUSION: The type of umbilical cord insertion affected the birthweight of dichorionic separated infants. Monochorionic placenta attributed to more severe growth discordancy and increased perinatal death rate than the dichorionic placenta. Antenatal detection of chorionicity and the portion of umbilical cord insertion may improve the perinatal outcome.
Chorion ; Female ; Fetus ; Humans ; Infant ; Mortality ; Parturition ; Placenta* ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin* ; Umbilical Cord*

With delayed childbearing and increased use of ovulation-stimulating drugs and assisted reproductive technologies (ART), the incidence of multiple pregnancies has increased dramatically in the past 20 years. One of the most common and serious complications of multiple pregnancies is preterm delivery. The delivery of the initial fetus in a multiple gestation usually is followed by the delivery of the subsequent fetus or fetuses shortly there after. However, a few successful delayed-interval deliveries have been reported since the first case in 1880 by Carson. Since that time, an interest in delayed-interval delivery has been developed and spurred by the increased prevalence of multiple gestations and preterm deliveries associated with these pregnancies. We report a case of a delayed-interval delivery in a twin pregnancy with an interval of 71 days. This case is the longest interval case and the fisrt delayed-interval delivery in monochorionic twin in Korea.
Female ; Fetus ; Humans ; Incidence ; Korea ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin* ; Prevalence ; Reproductive Behavior ; Reproductive Techniques, Assisted

The fetus papyraceus is a remarkably mumified fetus and the complication is rare in multiple pregnancy. If one fetus of multiple pregnancy died in uterus remote from term and other fetus did not, the fetus with placenta is compressed by the membrane of living fetus in uterus and then the dead fetus becomes a fetus papyraceus. Recently we had experienced two cases of fetus papyraceus in twin pregnancy at our department of Obstetrics and Gynecology, Keimyung University School of Medicine. We present these cases with brief literatures.
Female ; Fetus* ; Gynecology ; Humans ; Membranes ; Obstetrics ; Placenta ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin* ; Uterus

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

Twin pregnancies are at substantially higher risks for premature delivery than singleton pregnancies. This further increases their risk of perinatal and infant mortality. Recently there has been a marked increase in multiple pregnancies as a direct result of assisted reproductive technology. Cervical incompetency is a condition in which a pregnant woman's cervix begins to dilate and efface before her pregnancy has reached term. And multiple pregnancies and pregnancies by in vitro fertilization (IVF) have been increasing the risk of cervical incompetency. In twin pregnancy during preterm delivery, successful delayed-interval deliveries may improve the neonatal outcomes of the second fetus. We report a case of a delayed interval delivery in twin pregnancy of incompetent of cervix with an interval of 28 days after 3rd emergency cerclage.
Cervix Uteri ; Emergencies* ; Female ; Fertilization in Vitro* ; Fetus ; Humans ; Infant ; Infant Mortality ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin* ; Reproductive Techniques, Assisted ; Twins*

Twin pregnancies are at substantially higher risks for premature delivery than singleton pregnancies. This further increases their risk of perinatal and infant mortality. Recently there has been a marked increase in multiple pregnancies as a direct result of assisted reproductive technology. Cervical incompetency is a condition in which a pregnant woman's cervix begins to dilate and efface before her pregnancy has reached term. And multiple pregnancies and pregnancies by in vitro fertilization (IVF) have been increasing the risk of cervical incompetency. In twin pregnancy during preterm delivery, successful delayed-interval deliveries may improve the neonatal outcomes of the second fetus. We report a case of a delayed interval delivery in twin pregnancy of incompetent of cervix with an interval of 28 days after 3rd emergency cerclage.
Cervix Uteri ; Emergencies* ; Female ; Fertilization in Vitro* ; Fetus ; Humans ; Infant ; Infant Mortality ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin* ; Reproductive Techniques, Assisted ; Twins*

OBJECTIVE: The prevalence of multifetal pregnancies has increased up to 30% as a result of the introduction of ovulation inducing agents for assisted reproductive teclmology(ART). An exttemely poor pognosis could be expected for viable pregnancies in multifetal gestation. So, to decrease the consequence of multiple pregnancies and prevent complications, especially premature baby irreversibly damaged, selective fetal reduction to the smaller number of fetuses should be considered in an early gestational period. METHODS: From May 1994 to Apr 1998, transvaginal selective fetal reduction in 13 pati including 9 triplet, 3 quadruplet and 1 quintuplet. Of the 13 patients, 4 were obtained by controlled ovarian hyperstimulation with intrauterine insemination (COH with IUI), 6 were by IVF-ET, 2 wae by controlled ovarian hyperstimulation with natural contact and 1 was by natural conception. Selective fetal reduction using intracardiac KC1 injection and aspiration of amniotic fluid carried out in 8-11 weeks of gestation. RESULTS: After procedures, 8 patients were remained as twin pregnancies, 5 patients as singleton pregnancies and 1 of the remaining twin embryos vanished after procedure. There have been 7 sets of twin delivery including 1 stillbirth and 3 singleton delivery. 1 cases are ongoing state. All of the singleton delivery were completed after 37 weeks of gestation. Of the twin delivery, 2 cases were delivered after 37 weeks of gestation, 2 cases in 35-37 weeks, and 3 cases before 35 weeks of gestation. Unfortunately, 1 stillbirth occurred in 20 weeks of gestation and 2 cases of singleton were aborted. As 3 losses(2 singleton, 1 twin) occurred, the delayed fetal loss rate in this selective fetal reduction was 25.0%(3/12). There was no fetal anomaly related to the procedure. CONCLUSION: Selective fetal reduction in multifetal pregnancies is a rather safe procedure and it may improve the outcome of multiple pregnancies.
Amniotic Fluid ; Embryonic Structures ; Female ; Fertilization ; Fetus ; Humans ; Insemination ; Ovulation ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Multiple ; Pregnancy, Twin ; Prevalence ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted* ; Stillbirth ; Triplets

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