Placental weight and birth weight to placental weight ratio in monochorionic and dichorionic growth-restricted and non-growth-restricted twins

OBJECTIVE: The aim of the present study was to compare the placental weight and birth weight/placental weight ratio for intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. METHODS: This was a retrospective analysis of placentas from twin pregnancies. Placental weight and the birth weight/placental weight ratio were compared in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. The association between cord insertion type and placental lesions in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins was also investigated. RESULTS: A total of 105 monochorionic (intrauterine growth restriction=40; non-intrauterine growth restriction=65) and 219 dichorionic (intrauterine growth restriction=57; non-intrauterine growth restriction=162) placentas were analyzed. A significantly lower placental weight was observed in intrauterine growth-restricted monochorionic (p=0.022) and dichorionic (p<0.001) twins compared to non-intrauterine growth-restricted twins. There was no difference in the birth weight/placental weight ratio between the intrauterine growth restriction and non-intrauterine growth restriction groups for either monochorionic (p=0.36) or dichorionic (p=0.68) twins. Placental weight and the birth weight/placental weight ratio were not associated with cord insertion type or with placental lesions. CONCLUSION: Low placental weight, and consequently reduced functional mass, appears to be involved in fetal growth restriction in monochorionic and dichorionic twins. The mechanism by which low placental weight influences the birth weight/placental weight ratio in intrauterine growth-restricted monochorionic and dichorionic twins needs to be determined in larger prospective studies.

Fetal growth according to different reference ranges in twin pregnancies with placental insufficiency

The aim of this study was to compare different fetal growth curves in twin pregnancies with severe placental insufficiency. A retrospective cross-sectional analysis of 47 twin pregnancies with absent or reverse end diastolic flow in the umbilical artery of one fetus was performed. Pregnancies with major fetal abnormalities, twin-twin transfusion or three or more fetuses were not included. The estimated fetal weight zeta-scores were calculated for both fetuses (abnormal Doppler and co-twin) according to the following criteria: Hadlock, Liao and Araújo. The abdominal circumference zeta-scores were calculated according to Hadlock, Liao, Araújo, Ong and Stirrup. The mean estimates of the zeta-score values were calculated using generalized estimating equation regression analysis. The mean gestational age at inclusion was 27.4±4.7 weeks. The fetal sex and the interaction Doppler findings × criteria correlated significantly with the zeta-score values (p <0.001 for both variables). The estimated fetal weight mean zeta-scores (standard error) according to each criteria were as follows: Hadlock - abnormal Doppler: -2.98 (0.18), co-twin: -1.16 (0.15); Liao - abnormal Doppler: -2.89 (0.24), co-twin: -0.58 (0.19); and Araújo - abnormal Doppler: -3.05 (0.29), co-twin: -0.75 (0.18). Values for abdominal circumference were as follows: Hadlock - abnormal Doppler: -3.14 (0.26), co-twin: -1.13 (0.19); Liao - abnormal Doppler: -2.63 (0.27), co-twin: -0.42 (0.19); Araújo - abnormal Doppler: -2.44 (0.22), co-twin: -0.71 (0.14); Ong - abnormal Doppler: -3.36 (0.34), co-twin: -1.48 (0.23); and Stirrup AD -- -2.36 (0.14), co-twin: -1.18 (0.10). Sex- and plurality-specific charts should be used in the evaluation of fetal growth in twin pregnancies with placental insufficiency.

Pulmonary function in advanced uncomplicated singleton and twin pregnancy / Função pulmonar em mulheres com gestação única ou gemelar avançada e sem complicações

Objective: Pregnancy brings about significant changes in respiratory function, as evidenced by alterations in lung volumes and capacities, which are attributable to the mechanical impediment caused by the growing foetus. This study was undertaken in order to identify changes in respiratory function during normal pregnancy and to determine whether such changes are more pronounced in twin pregnancy than in singleton pregnancy. Methods: Respiratory function was assessed in 50 women with twin pregnancies and in 50 women with singleton pregnancies (during the third trimester in both groups), as well as in 50 non-pregnant women. We measured the following pulmonary function test parameters: FVC; FEV1; PEF rate; FEV1/FVC ratio; FEF25-75%; and maximal voluntary ventilation. Results: All respiratory parameters except the FEV1/FVC ratio were found to be lower in the pregnant women than in the non-pregnant women. We found no significant differences between women with twin pregnancies and those with singleton pregnancies, in terms of respiratory function. Conclusions: Despite its higher physiological demands, twin pregnancy does not appear to impair respiratory function to any greater degree than does singleton pregnancy. .

Objetivo: A gravidez traz mudanças significativas na função respiratória, evidenciada por alterações nos volumes e capacidades pulmonares, que são atribuíveis ao impedimento mecânico causado pelo feto em crescimento. Este estudo foi realizado a fim de identificar alterações na função respiratória durante a gravidez normal e determinar se tais alterações são mais pronunciadas em gestação gemelar que em gestação única. Métodos: Foi avaliada a função respiratória de 50 mulheres com gestações gemelares e de 50 mulheres com gestações únicas (durante o terceiro trimestre em ambos os grupos), bem como de 50 mulheres não grávidas. Medimos os seguintes parâmetros de função pulmonar: CVF, FEV1, taxa do PFE, relação VEF1/CVF, FEF25-75% e ventilação voluntária máxima. Resultados: Todos os parâmetros, exceto a relação VEF1/CVF, foram menores nas mulheres grávidas do que nas mulheres não grávidas.Não foram encontradas diferenças significativas entre as mulheres com gestações gemelares e aquelas com gestações únicas em relação à função respiratória. Conclusões: Apesar das demandas fisiológicas maiores da gestação gemelar, essa não parece causar um comprometimento maior da função respiratória do que a gestação única. .

Gestação gemelar com mola hidatiforme completa e feto vivo após ovodoação e fertilização in vitro: relato de caso / Twin pregnancy with a complete hydatiform mole and a live fetus following egg donation and in-vitro fertilization: case report

Introdução: a gestação gemelar com mola hidatiforme completa e feto vivo é um evento raro e tem, na maior parte dos casos, evolução para aborto ou interrupção médica por causa dos riscos para a mãe e para o feto. Quando associada à reprodução assistida, a decisão de finalização é mais difícil por causa do desejo do casal em manter a gestação. Método: este artigo apresenta um caso de gestação gemelar dizigótica com mola hidatiforme completa em coexistência com feto diploide e placenta normal em uma paciente de 45 anos após fertilização in vitro por ovodoação. Resultados: paciente optou por manter a gestação e o parto ocorreu com 29 semanas, sem complicações maternas. Recém-nascido evoluiu com bom desenvolvimento neuropsicomotor, sem sequelas. Conclusão: este relato de caso ilustra a possibilidade de conduta expectante, porém não podemos ignorar o fato de que existe um alto risco de permanência da doença trofoblástica gestacional. Infelizmente, a raridade do caso torna o manejo clínico ainda controverso.

Introduction: twin pregnancy with complete hydatiform mole and live fetus is a rare event with the most cases resulting in abortion or medical interruption due to maternal and fetal risks. When associated with assisted reproduction, the decision of pregnancy interruption is more difficult due to the desire of the couple to maintain the pregnancy. Method: this study will present a case of twin dizygotic pregnancy with complete hydatiform mole coexisting with fetus diploid and normal placenta in a patient 45 years old, after in-vitro fertilization by egg donation. Results: patient chose to keep the pregnancy and the delivery occurred at 29 weeks without major maternal complications. Newborn evolved with good psychomotor developmentwithout sequelae. Conclusion: this case report illustrates the possibility of expectant management, but wecannot ignore the fact that there is a high risk of persistent gestational trophoblastic disease. Unfortunately, the rarity of the case makes the clinical management still controversial.

L'accouchement gémellaire à la maternité Issaka Gazobi : à propos d'une étude rétrospective de 710 cas colligés sur 4 ans (janvier 2009 au 31 décembre 2012

L'avènement d'une grossesse gémellaire et son déroulement, constitue une situation à haut risque maternel et périnatal. Le pronostic de la grossesse gémellaire dépend de son diagnostic précoce, de la qualité du suivi prénatal et de l'accouchement en milieu spécialisé. Ainsi une étude rétrospective sur 4 ans, allant du 1er janvier 2009 au 31 décembre 2012 à la MIG nous a permis de noter que : * La fréquence de l'accouchement gémellaire est de 3,42% * L'âge maternel moyen est de 27,75 ans avec une prédominance de la tranche de 25 à 29 ans avec 207 cas (29,2%). * L'ethnie Zarma-Sonrai est l'ethnie majoritaire 54,37% suivi de l'ethnie Haoussa 22,68%. * Plus de ¾ des patientes sont sans professions (78,59%) ; * 51,1% des patientes sont non scolarisé. *Les paucipares et les nullipares sont les plus nombreuses avec respectivement 24,93% et 24,79%. * 43 patientes n'ont effectuées aucune consultation prénatale 6,1%. * La plupart des grossesses gémellaires ont été suivies par les sages-femmes 350 cas (49,30%) puis les infirmières 229 cas (32,30%). * 396 échographies obstétricales (53,66%) sont réalisées au 3ème Trimestre. * 59,01% des patientes sont référées des autres centres. * La prématurité représente 319 cas (44,93%). * 63,61 % des accouchements sont survenus après opérations de césariennes. * Nous déplorons 8 décès maternel soit un taux de mortalité de 1,13%.La principale cause est la crise d'éclampsie /PES avec 5 cas (62,5%). * Le taux de létalité périnatal est de 13,39% pour les 1ers jumeaux et 15,93% pour les 2èmes jumeaux

Longitudinal reference ranges for fetal ultrasound biometry in twin pregnancies

OBJECTIVE: The purpose of this study was to establish longitudinal reference ranges for fetal ultrasound biometry measurements and growth parameters in twin pregnancies. METHOD: A total of 200 uncomplicated twin pregnancies before 21 weeks of gestation were recruited for this prospective, longitudinal study. Women who abandoned follow-up, pregnancies with unknown outcomes or pregnancies with complications were excluded. Ultrasound scans were performed every three weeks, and biparietal and occipitofrontal diameters, head and abdominal circumferences, and femur diaphysis length measurements were obtained for each fetus at each visit. Estimated fetal weight, biparietal/occipitofrontal diameter, head circumference/abdominal circumference, and femur diaphysis length/abdominal circumference ratios were also calculated. Multilevel regression analysis was performed on normalized data. RESULTS: A total of 807 ultrasound examinations were performed in 125 twin pregnancies between 14 and 38 weeks of gestation (6.5±1.4 scans/pregnancy). Regression analysis demonstrated significant correlations for all variables with gestational age, namely log of the biparietal diameter (r = 0.98), log of the occipitofrontal diameter (r = 0.98), log of the head circumference (r = 0.99), log of the abdominal circumference (r = 0.98), square root of the femur length (r = 0.99), log of the estimated fetal weight (r = 0.99), biparietal/occipitofrontal ratio (r = -0.11), head/abdomen circumference ratio (r = -0.56), and log of the femur length/abdominal circumference ratio (r = 0.61). Values corresponding to the 10th, 50th, and 90th percentiles for estimated fetal weight at 28, 32, and 36 weeks, respectively, were as follows: 937, 1,096, 1,284 g; 1,462, 1,720, 2,025 g; and 2,020, 2,399, 2,849 g. CONCLUSION: In twin pregnancies, fetal ultrasound biometry measurements and growth parameters show a significant correlation with gestational age.