E. F. Santana, Vivian M. Correa, I. Bottura, José Pedro Parise Filho
{"title":"Time and Mode of Delivery in Twin Pregnancies","authors":"E. F. Santana, Vivian M. Correa, I. Bottura, José Pedro Parise Filho","doi":"10.5772/INTECHOPEN.80092","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80092","url":null,"abstract":"There are many suitable recommendations for twin gestation term in the literature. In many protocols, resolution is recommended for dichorionic pregnancies around 38 weeks, at 36 weeks for monochorionic (devoid of complications) and at 32–34 weeks in cases of single amniotic chamber. The main risk associated with vaginal delivery is connected to the possibility of anoxia of the second twin. However, a cesarean delivery performed by non-cephalic presentation of the second twin is associated with increased maternal morbidity without improved neonatal outcome. The most important factors in the decision of the delivery mode include the presentation of the fetus, gestational age, and weight or the weight difference between the fetuses.","PeriodicalId":307028,"journal":{"name":"Multiple Pregnancy - New Challenges","volume":"03 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129754287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Complications in Monochorionic Pregnancies","authors":"B. Toneto","doi":"10.5772/INTECHOPEN.83390","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.83390","url":null,"abstract":"Monochorionic (MC) pregnancies have higher rates of fetal morbidity and mortality when compared to dichorionic (DC) ones. Therefore, the early diagnostic of chorionicity is of great importance. Monochorionic pregnancies have specific complications such as twin to twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR), twin anemia polycythemia sequence (TAPS), and twin reversed arterial perfusion sequence (TRAPS). MC pregnancies have several unique and serious complications that contribute to a perinatal mortality rate of 11%. The pathophysiology of most of these complications is related to the placental angio-architecture, and it results from an unbalanced perfu sion between the fetuses. The screening of TTTS starts in 16 weeks with a sonographic follow-up every 2 weeks. In the last decade, there was an improvement in the treatment of TTTS. With the advent of the fetoscopic laser photocoagulation (FLPC), there was a drastic increase in the survival rate of the fetuses with TTTS when compared with serial amnioreduction. Besides that, in TRAPS, fetoscopic procedures such as cord occlusion improve the outcome of the normal fetus. We will also discuss sFGR and its classification and management. The aim of this chapter is to review the most important complications in MC pregnancies.","PeriodicalId":307028,"journal":{"name":"Multiple Pregnancy - New Challenges","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123165824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preterm Birth in Twins","authors":"M. S. França, T. K. Hamamoto, A. Moron","doi":"10.5772/INTECHOPEN.82447","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.82447","url":null,"abstract":"Multiple pregnancy differs from singleton pregnancy in several aspects, including increased risk of preeclampsia, fetal malformation, maternal morbidity, and mortality. However, certainly, prematurity is a fundamental concern when twin gestation is approached, due to the frequency of this disease and also to the severity of preterm birth, which unfortunately can also occur near to the fetal viability limit. Labor in twin pregnancy generally occurs before singleton pregnancy. Nevertheless, another factor can contribute to raise even more preterm birth rates in this already high-risk gestation: the short cervix. Although only 1–2% of twin pregnancy present short cervix at transvaginal ultrasound, this association increases the chance of unfavorable outcome for the newborn, frequently causing death of one or both twins. So, many strategies were proposed to minimize this catastrophic situation: follow-up of cervical length to prevent preterm birth, pessary use, progesterone, tocolysis to postpone birth in 48 hours to 7 days in order to use corticosteroids in fetal pulmonary maturation, and magnesium sulfate use to neuroprotection.","PeriodicalId":307028,"journal":{"name":"Multiple Pregnancy - New Challenges","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115375876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Antsaklis, Maria Papamichail, M. Theodora, M. Syndos, G. Daskalakis
{"title":"Early Pregnancy Ultrasound Assessment of Multiple Pregnancy","authors":"P. Antsaklis, Maria Papamichail, M. Theodora, M. Syndos, G. Daskalakis","doi":"10.5772/INTECHOPEN.81498","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.81498","url":null,"abstract":"As the frequency of multiple pregnancies is increasing, every obstetrician has to know that the correct, accurate, and timely determination of gestational age, chorionicity, and amnionicity has significant importance in the management of a multiple pregnancy. Surveillance, complications, outcome, morbidity, and mortality are totally different in a monochorionic and a dichorionic pregnancy. In this chapter, we will present the sonographic figures that are visualized in the first trimester in a multiple pregnancy and help us define the gestational age, chorionicity, and amnionicity. We will classify them into two periods: the early first trimester, including the 10 first weeks of gestation and the late first trimester including the period between the 10th and 14th week of gestation. Finally, we will review some interesting, although infrequent, cases from the literature, showing that pitfalls in the determination of both chorionicity and amnionicity exist and highlighting the importance of being aware of their subsistence.","PeriodicalId":307028,"journal":{"name":"Multiple Pregnancy - New Challenges","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117095203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Historical Studies of Hellin’s Law","authors":"J. Fellman","doi":"10.5772/INTECHOPEN.79583","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79583","url":null,"abstract":"Theorems, proofs, laws and rules are commonly named according to the presumed dis- coverer, but often earlier investigators have contributed substantially to the findings. One example of this is Hellin ’ s law, which was named after Hellin, although he was not the first to derive it. In research on twinning and higher multiple maternities, the law has played a central role because it is approximately correct, despite showing discrepancies that are difficult to explain or eliminate. However, most studies are based on empirical rates of multiple maternities. Such studies can only serve to identify errors too large to be characterized as random. It has been mathematically proven that Hellin ’ s law does not hold as a general rule. Consequently, improvements to this law have been proposed.","PeriodicalId":307028,"journal":{"name":"Multiple Pregnancy - New Challenges","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134399728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Judicious Fertility Treatment to Minimise the Risk of Multiple Pregnancy","authors":"F. Langdon, R. Hart","doi":"10.5772/INTECHOPEN.79288","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79288","url":null,"abstract":"Pregnancies resulting from fertility treatment are associated with higher rates of multiple pregnancy and have higher rates of pregnancy complications than spontaneously conceived pregnancies. Methods exist to make fertility treatment safer and less likely to result in multiple pregnancy and practitioners should be practicing fertility treatment with the aim to produce a healthy, term, singleton pregnancy. Approaches to minimising the risk of multiple pregnancy include carefully monitoring ovulation induction (OI) cycles to produce mono-follicular ovulation. Identifying patients at risk of excessive response to ovulation induction and treating them with low dose therapies and close monitoring is a critical step in practicing safe OI treatment. Performing single embryo transfer in all but exceptional cases of in-vitro fertilisation (IVF), and never transferring more than two embryos, is the single, most successful way to reduce the multiple pregnancy rate with IVF. An appreciation of the increased risk of mono-chorionic twinning with IVF is also important. This chapter will explore ways to minimise the risk of multiple pregnancy with a variety of fertility treatments.","PeriodicalId":307028,"journal":{"name":"Multiple Pregnancy - New Challenges","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132869099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Multiple Pregnancy in Women of Advanced Reproductive Age","authors":"Laura Pérez Martín, D. Marina","doi":"10.5772/INTECHOPEN.81096","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.81096","url":null,"abstract":"Assisted reproduction techniques (ARTs) allow women of advanced reproductive age to become pregnant. One of the most frequent complications of ART is twin pregnancy. Cases where both factors are present represent a specially vulnerable population for obstetric complications and medical perinatal and post-partum consequences for both the mother and babies. Pre-existing medical conditions are more frequent at advanced age, and the pregnancy physiological changes and the high metabolic demand associated with a twin pregnancy may reveal or worsen any previous disease. A careful counselling process is very important in this population and certain obstetric interventions might be particularly addressed to it. Single embryo transfer should be strongly enforced in advanced age women to minimise risk for the mother and children.","PeriodicalId":307028,"journal":{"name":"Multiple Pregnancy - New Challenges","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122660512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stelios Fiorentzis, Styliani Salta, Michail Pargianas, ArtemisPontikaki, D. Koutsoulis, C. Akrivis, DimitriosAkrivis, I. Kosmas
{"title":"Quadruplets and Quintuplets","authors":"Stelios Fiorentzis, Styliani Salta, Michail Pargianas, ArtemisPontikaki, D. Koutsoulis, C. Akrivis, DimitriosAkrivis, I. Kosmas","doi":"10.5772/INTECHOPEN.80338","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80338","url":null,"abstract":"A high-order pregnancy is always a challenge not only for the couple but also for the obstetrician, the pediatricians, the midwives, and the whole stuff of an obstetric clinic. The breakthroughs of infertility treatments have made more couples to postpone the birth of their children until they feel professionally and financially safe, many times after the age of 40. The advanced age of the mother puts extra pressure to the clinician for immediate success, leading to a rise of high-order pregnancies until the introduction of regulations and laws in many countries. The cost of a quadruplet and quintuplet pregnancy can be unbearable, not only financially but also psychologically. The management of such a pregnancy is also challenging since its beginning and to the end. Modern techniques and methods can also be difficult to be implemented on a quadruplet of quintuplet pregnancy because of the fear of losing four or five embryos at once. At the same time, the limited number of cases makes it almost impossible for studies to be made and guidelines to be established for most of the cases.","PeriodicalId":307028,"journal":{"name":"Multiple Pregnancy - New Challenges","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115016537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. A. Varella, E. D. S. Fernandes, Jonas Arantes, Tiziana G. Acquaviva, Tania K Lucci, R. Hsu, Vinicius F David, V. Bussab, JaroslavaValentova, N. Segal, E. Otta
{"title":"Twinning as an Evolved Age-Dependent Physiological Mechanism: Evidence from Large Brazilian Samples","authors":"M. A. Varella, E. D. S. Fernandes, Jonas Arantes, Tiziana G. Acquaviva, Tania K Lucci, R. Hsu, Vinicius F David, V. Bussab, JaroslavaValentova, N. Segal, E. Otta","doi":"10.5772/INTECHOPEN.79907","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79907","url":null,"abstract":"Multiple pregnancies occur in humans and other primates, which indicate that the twinning propensity is phylogenetically old. Factors such as decreased sexual dimorphism and size, rich and diverse nutrition and paternal care are related to multiple pregnancies in other animals. In human populations, despite its costs, twinning has a genetic basis and in Europe, Africa, and America, it was found that it increases mothers’ fitness. Here, we explore the hypothesis that twinning represents an evolved physiological mechanism, particularly in mothers of higher age, as an ‘all-or-nothing’ last chance strategy for reproduction just before menopause. We present decade-long, large-scale population data about maternities from the city of São Paulo and the entire country of Brazil that indicate a considerable main effect of advanced age in promoting twinning, particularly dizygotic (DZ) twinning, but also monozygotic (MZ) twinning and higher order maternities. We also show that socioeconomic status is an important contextual factor increasing twinning. Besides the theoretical implications, these datasets establish a Brazilian countrywide twinning rate of 9.39‰ and highlight an increasing historical trend. This chapter promotes the importance of integrating proximate patterns from human and nonhuman animals and evolutionary factors in order to reach a comprehensive view about twinning.","PeriodicalId":307028,"journal":{"name":"Multiple Pregnancy - New Challenges","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121293320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Ionio, E. Mascheroni, Caterina Colombo, G. Lista
{"title":"Prenatal Attachment in Twin Pregnancy","authors":"C. Ionio, E. Mascheroni, Caterina Colombo, G. Lista","doi":"10.5772/INTECHOPEN.79365","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79365","url":null,"abstract":"Twin births are associated with several medical, healthcare, socio-emotional, psychologi- cal and developmental consequences for families. Parents generally describe twin pregnancies as physically and emotionally difficult. Moreover, compared to singleton pregnancies, twin pregnancies are reported to carry higher maternal as well as perinatal morbidity and mortality. The aim of this chapter is to review literature on twin pregnancy and to give a comprehensive framework about parents ’ experience of expecting twins. An important issue related to the psychological adjustment during twin pregnancies is pre- natal attachment. During pregnancy, mothers use to think about their child-to-be, and they start to create representation of themselves as mothers. Prenatal attachment in twin pregnancies may differ from that in singleton ones. During a twin pregnancy, the mother-to-be has to deal with an identification process with two children at the same time and have to create a mental space that allow her to make representation of both children. The monitoring of these pregnancies is important for the creation and the consolidation of these maternal representations: ultrasound examinations revealed the fetal gender that facilitates naming the unborn twins and thinking to them as individuals and this is particularly important in the case of complicated twin pregnancies.","PeriodicalId":307028,"journal":{"name":"Multiple Pregnancy - New Challenges","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127612132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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