Multiple Gestations, An Issue of Clinics in Perinatology

Cover......Page 1
Preface......Page 2
Incidence......Page 3
Types of twins......Page 5
Causes of twinning......Page 11
References......Page 14
History of assisted reproductive technology......Page 17
Current statistics......Page 18
Multiple pregnancy complications......Page 19
Multiple embryo transfer......Page 20
Improve implantation rates......Page 22
Preimplantation genetic diagnosis......Page 24
Single embryo transfer......Page 25
Multiple gestation and ovulation induction......Page 26
Birth defects after intracytoplasmic sperm injection/in vitro fertilization......Page 27
References......Page 28
Determination of amnionicity and chorionicity......Page 31
The first 14 weeks (first trimester)......Page 32
Beyond the 15th week (second and third trimesters)......Page 37
Fetal anatomic survey......Page 38
Cord entanglement......Page 41
Twin reversed arterial perfusion......Page 43
Fetal surveillance......Page 47
Fetal growth assessment......Page 48
Cervical length......Page 49
Twin-twin transfusion syndrome......Page 50
Summary......Page 53
References......Page 54
Amniocentesis......Page 57
Technique......Page 58
Postprocedural loss rates......Page 59
Technique......Page 60
Chorionic villus sampling versus amniocentesis......Page 61
Multifetal pregnancy reduction......Page 62
Chorionic villus sampling before multifetal pregnancy reduction......Page 63
Natural history of multifetal pregnancies......Page 64
Pregnancy outcomes after multifetal pregnancy reduction......Page 65
Psychologic impact of multifetal pregnancy reduction......Page 66
Technique......Page 67
Pregnancy outcome after selective termination......Page 68
Percutaneous umbilical blood sampling......Page 69
References......Page 70
Down Syndrome Screening in Twins......Page 74
Second-trimester ultrasound screening......Page 75
Second-trimester biochemical screening......Page 76
Pseudorisk calculation......Page 77
First-trimester biochemical screening......Page 78
Impact of assisted reproduction technology and ethnicity on first- and second-trimester serum markers in twins......Page 79
First-trimester nuchal translucency sonographic screening......Page 80
Combined nuchal translucency and first-trimester serum screening......Page 81
For dichorionic twins......Page 82
First- versus second-trimester screening......Page 83
Summary......Page 84
References......Page 85
Evolution of the problem......Page 88
Solutions for the problem......Page 89
Factors affecting outcome in high-order multiple gestations......Page 91
Presenting the management plan to the patient......Page 92
Events in the first trimester......Page 93
The second trimester......Page 94
Background uterine activity......Page 95
The concept of threshold of contractions......Page 96
Prevention of preterm labor in high-order multiple gestation......Page 97
The third trimester......Page 98
Results of our management strategy......Page 99
Summary......Page 100
References......Page 101
Nutrition in Multiple Gestations......Page 104
Effect of plurality on maternal risk factors......Page 105
Effect of assisted conception on maternal risk factors......Page 106
Maintenance of stable blood glucose levels......Page 107
Supplementation with calcium, magnesium, and zinc......Page 108
Magnesium......Page 109
Zinc......Page 110
Singletons......Page 111
Weight gain in twin pregnancies......Page 112
Weight gain in triplet pregnancies......Page 114
Multiples......Page 115
Effect of parity......Page 116
Hemodynamics and iron status......Page 117
Patient education and model of care......Page 118
Specialized prenatal programs for multiples......Page 119
Prenatal antecedent of childhood and adult health......Page 121
References......Page 122
Maternal adaptation......Page 131
Antepartum management......Page 133
Preterm labor......Page 134
Delayed delivery of second twin (asynchronous delivery)......Page 136
Preeclampsia......Page 137
Fatty liver of pregnancy......Page 138
Triplets......Page 139
References......Page 140
Maternal and fetal risks......Page 143
Diagnosis......Page 144
First- and second-trimester screening......Page 145
Preterm labor/birth......Page 146
Antepartum surveillance......Page 148
Unique complications associated with multiple gestations......Page 149
Death of one twin......Page 150
References......Page 151
Intrapartum Management of Twins: Truths and Controversies......Page 155
Labor characteristics in twin gestations......Page 156
Induction and augmentation techniques......Page 157
Vertex-vertex twins: the optimal presentation......Page 158
Delivery time interval between twins......Page 159
A recommendation for cesarean delivery......Page 161
Safety of vaginal delivery for nonvertex second twins......Page 162
A call for randomized trials......Page 163
Intrapartum external cephalic version......Page 164
Does prematurity alter the route of delivery?......Page 165
The nonvertex first twin: is the management choice clear?......Page 168
Vaginal birth after cesarean delivery......Page 169
References......Page 170
Monochorionic Twin Pregnancies......Page 174
Perinatal mortality and morbidity......Page 175
Chorionicity determination......Page 176
Twin-twin transfusion......Page 178
Amnioreduction and septostomy......Page 180
Laser photocoagulation of chorioangiopagus......Page 182
Selective reduction......Page 184
Twin reversed arterial perfusion......Page 185
In utero death of co-twin......Page 186
Selective fetal growth lag......Page 187
Conjoined twins......Page 188
References......Page 189
Paucity and limitations of data......Page 194
Prematurity, birth weight, and mortality......Page 195
Neurologic outcomes......Page 196
Zygosity and chorionicity......Page 200
Intrauterine growth restriction and multiples......Page 203
Higher-order multiples......Page 204
Assisted reproductive technologies......Page 205
Maternal (and paternal) long-term impacts......Page 208
References......Page 209