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Chapter 13 - Multiple Gestation

from Part II - INTRAPARTUM AND POSTPARTUM

Published online by Cambridge University Press:  07 May 2010

John Patrick O'Grady ,
Martin L. Gimovsky ,
Lucy A. Bayer-Zwirello  and
Kevin Giordano
By
V. Ravishankar  and
J. Gerald Quirk
John Patrick O'Grady
Affiliation:
Tufts University, Massachusetts
V. Ravishankar
Affiliation:
Clinical Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences State University of New York at Stony Brook Stony Brook University School of Medicine Stony Brook, New York
J. Gerald Quirk
Affiliation:
Professor and Chair, Department of Obstetrics, Gynecology, and Reproductive Medicine State University of New York at Stony Brook
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Summary

This chapter explores the maternal and fetal complications, advances in prenatal diagnosis, and management of complications unique to multiple gestations. Tidal volume and oxygen consumption in multiple gestations are increased, as is the normal alkalosis seen in singleton pregnancy. Hypertensive disorders increase by at least twofold in twin gestations. Hemorrhagic complications occur more frequently with twins. Growth of singletons and twins is comparable until 27 weeks gestation. The uterus accommodates the larger volume imposed by twins by overdistension, and beyond a certain limit, premature labor can result. Preterm deliveries (less than 37 weeks' gestation) occurred in 10.6% of singleton pregnancies against a phenomenal rate of 61.2% of live births in multiple gestations. Diagnosis of multiple gestations, establishing chorionicity, identifying anomalies, foreseeing possible maternal and fetal complications, prevention and treatment of preterm labor, and management of growth restriction are some of the areas of medicolegal concerns in multiple gestations.

Keywords

congenital anomaliesfetal complicationshypertensive disorderspreterm deliverysingleton pregnancypreterm labormultiple gestationspreterm deliveriestwin gestationsweeks' gestation
Type
Chapter
Information
Operative Obstetrics , pp. 322 - 347
Publisher: Cambridge University Press
Print publication year: 2008

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References

Martin, JA, Hamilton, BE, Sutton, PD, et al: Births: Final Data for 2003. National Vital Statistics Reports 2005;54(2).Google ScholarPubMed
Reynolds, MA, Schieve, , Martin, JA, et al: Trends in multiple births conceived using assisted reproductive technology, United States, 1997–2000. Pediatrics 2003;111:1159–1162.Google ScholarPubMed
Centers for Disease Control and Prevention: Infant mortality and low birth weight among black and white infants: United States, 1980–2000. MMWR Morb Mortal Wkly Rep 2002;51:589–592.
Alexander, GR, Wingate, MS, Salihu, H, Kirby, RS: Fetal and neonatal mortality risks of multiple births. Obstet Gynecol Clin North Am 2005;32:1–16.CrossRefGoogle ScholarPubMed
Rydhstroem, H, Heraib, F: Gestational duration, and fetal and infant mortality for twins vs. singletons. Twin Res 2001;4:227–231.CrossRefGoogle ScholarPubMed
Pharoah, POD, Cooke, T: Cerebral palsy and multiple births. Arch Dis Child 1996;75:F174–177.CrossRefGoogle ScholarPubMed
Scher, AI, Petterson, B, Blair, E, et al: The risk of mortality or cerebral palsy in twins: A collaborative population-based study. Pediatr Res 2002;52:671–681.CrossRefGoogle ScholarPubMed
Blickstein, I: Do multiple gestations raise the risk of cerebral palsy?Clin Perinatol 2004;31:395–408.CrossRefGoogle ScholarPubMed
Kohl, SG, Casey, G: Twin gestation. Mt Sinai J Med 1975;42:523–539.Google ScholarPubMed
Imaizumi, Y: Twinning rates in Japan, 1951–1990. Act Genet Med Gemellol (Roma) 1992;41:165–175.CrossRefGoogle Scholar
Fakeye, O: Perinatal factors in twin mortality in Nigeria. Int J Gynecol Obstet 1986;24:309–314.CrossRefGoogle ScholarPubMed
Nylander, PPS: Biosocial aspects of multiple births. J Biosoc Sci 1971;3:29–38.CrossRefGoogle Scholar
Heuser, RL: Multiple Births: United States 1964. Washington, DC: National Center for Health Statistics, 1967;DHEW (series 21; No.14).
MacGillivray, I: Epidemiology of twin pregnancy. Semin Perinatol 1986;10:4–8.Google ScholarPubMed
Schenker, JG, Yarkone, S, Granat, M: Multiple pregnancies following induction of ovulation. Fertil Steril 1981;35:105–123.Google ScholarPubMed
Schachter, M, Raziel, A, Friedler, S, Strassburger, D, Burn, O, Ron-El, R: Monozygotic twinning after assisted reproductive techniques: A phenomenon independent of micromanipulation. Hum Reprod 2001;16:1264–1269.CrossRefGoogle ScholarPubMed
Behr, B, Fisch, JD, Milki, AA, et al: Blastocyst transfer is associated with an increased incidence of monozygotic twinning. The 15th Annual Meeting of the Europeon Society of Human Reproduction and Embryology, Tours, France. Hum Reprod 14 1991 (Abstract Bk. 1), P-081, p. 181.Google Scholar
Blickstein, I, Verhoeven, HC, Keith, LG: Zygotic splitting after assisted reproduction. N Engl J Med 1999;340:738–739.CrossRefGoogle ScholarPubMed
Kaufman, MH, O'Shea, KS: Induction of monozygotic twinning in the mouse. Nature 1978;276:707–708.CrossRefGoogle ScholarPubMed
Bamforth, F, Brown, L, Senz, J, Huntsman, D: Mechanisms of monozygotic (MZ) twinning: A possible role for the cell adhesion molecule, E-cadherin. Am J Med Genet 2003;120A:59–62.CrossRefGoogle ScholarPubMed
Benirschke K: Multiple gestation, incidence, etiology and inheritance. In Creasey, RK, Resnik, R (eds): Maternal-Fetal Medicine: Principles and Practice, 2nd ed. Philadelphia: W. B. Saunders, 1989; pp. 565–579.Google Scholar
Monteagudo, A, Timor-Tritsch, IE, Sharma, S: Early and simple determination of chorionic and amniotic type in multiple gestation in the first 14 weeks by high frequency transvaginal ultrasonography. Am J Obstet Gynecol 1994;170:824–829.CrossRefGoogle ScholarPubMed
Carroll, SGM, Soothill, PW, Sherif, AA, Porter, H, Montague, I, Kyle, PM: Prediction of chorionicity in twin pregnancies at 10–14 weeks of gestation. Br J Obstet Gynecol 2002;109:182–186.Google ScholarPubMed
Shetty, A, Smith, APM: The sonographic diagnosis of chorionicity. Prenat Diagn 2005;25:735–739.CrossRefGoogle ScholarPubMed
Sebire, NJ, Snijders, RJ, Hughes, K , et al: The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynaecol 1997;104:1203.CrossRefGoogle ScholarPubMed
Benirshke, K, Kaufmann, P: Pathology of the Human Placenta, 2nd ed. New York: Springer-Verlag, 1990; pp. 662–677.CrossRefGoogle Scholar
Monga M: Maternal cardiovascular and renal adaptation to pregnancy. In Creasy, RK, Resnik, R (eds): Maternal-Fetal Medicine: Principles and Practice, 5th ed. Philadelphia: W. B. Saunders, 2004; pp. 111–120.Google Scholar
Pritchard, JA: Changes in blood volume during pregnancy and delivery. Anesthesiology 1965;23:393–399.CrossRefGoogle Scholar
Veille, JC, Morton, MJ, Burry, KJ: Maternal cardiovascular adaptations to twin pregnancy. Am J Obstet Gynecol 1985;153:261–263.CrossRefGoogle ScholarPubMed
Leroy, B, Lefort, F, Jenny, R: Uterine heights and umbilical perimeter curves in twin pregnancies. Acta Genet Med Gemellol (Roma) 1982;31:195–198.CrossRefGoogle Scholar
Franchini, M: Hemostasis and pregnancy. Thromb Haemostat 2006;95:401–413.Google Scholar
MacGillivray, I: Twin pregnancies. Obstet Gynecol Annu 1978;7:135–151.Google ScholarPubMed
Davidson, KM, Simpson, LL, Knox, TA, D'Alton, ME: Acute fatty liver of pregnancy in triplet gestation. Obstet Gynecol 1998;91:806–808.Google ScholarPubMed
Casele, HL, Dooley, SL, Metzger, BE: Metabolic response to meal eating and extended overnight fast in twin gestation. Am J Obstet Gynecol 1996; 175:917–921.CrossRefGoogle ScholarPubMed
Schwartz, DB, Daoud, MA, Zazula, P, et al: Gestational diabetes mellitus: Metabolic and blood glucose parameters in singleton versus twin pregnancies. Am J Obstet Gynecol 1999;181:912–914.CrossRefGoogle ScholarPubMed
Redford, DHA, Whitfield, CR: Maternal serum alpha-fetoprotein in twin pregnancies uncomplicated by neural tube defects. Am J Obstet Gynecol 1985;152:550–553.CrossRefGoogle Scholar
Spinillo, A, Capuzzo, E, Piazzi, G, et al: Risk of spontaneous preterm delivery by combined body mass index and gestational weight gain patterns. Acta Obstet Gynecol Scand 1998;77:32–36.CrossRefGoogle ScholarPubMed
Luke, B, Minogue, J, Witter, FR, et al: The ideal twin pregnancy: Patterns of weight gain, discordancy, and length of gestation. Am J Obstet Gynecol 1993; 169:588–597.CrossRefGoogle ScholarPubMed
Institute of Medicine: Nutrition during Pregnancy. Washington, DC: National Academy Press, 1990.
Luke, B: Nutrition in Multiple Gestations. Clin Perinatol 2005;32:403–429.CrossRefGoogle ScholarPubMed
Luke, B: Nutrition and multiple gestation. Semin Perinatol 2005;29:349–354.CrossRefGoogle ScholarPubMed
Martin, J, Hamilton, B, Ventura, S, et al: Births: Final Data for 2001. National Center for Health Statistics Reports, 2002; p. 51.Google ScholarPubMed
Sibai, BM, Hauth, J, Caritis, S, et al: Hypertensive disorders in twin versus singleton gestations. Am J Obstet Gynecol 2000;182:938–942.CrossRefGoogle ScholarPubMed
Heyborne, KD, Porreco, RP: Selective fetocide reverses preeclampsia in discordant twins. Am J Obstet Gynecol 2004;191:477–480.CrossRefGoogle ScholarPubMed
Ananth, C, Demissie, K, Smulien, J, Vintzeleos, AM: Placenta previa in singleton and twin births in the United States, 1989 through 1998: A comparison of risk factor profiles and associated conditions. Am J Obstet Gynecol 2003;188:275–281.CrossRefGoogle ScholarPubMed
Ananth, C, Smulien, J, Vintzeleos, AM, Knuppel, R: Placental abruption among singleton and twin births in the United States: Risk factor profiles. Am J Epidemiol 2001;153:771–778.CrossRefGoogle ScholarPubMed
Guttmacher, AF: An analysis of 573 cases of twin pregnancy. II. The hazards of pregnancy itself. Am J Obstet Gynecol 1939;38:277–288.CrossRefGoogle Scholar
Chervenak, FA, Youcha, S, Johnson, RE, Berkowitz, RL, Hobbins, JC: Twin gestation: Antenatal diagnosis and perinatal outcome in 385 consecutive pregnancies. J Reprod Med 1984;29:727–730.Google ScholarPubMed
National Center for Health Statistics: Final natality data. www.marchofdimes.com/peristats.
Jacquemyn, Y, Martens, G, Ruyssinck, G, et al: A matched cohort comparison of the outcome of twin versus singleton pregnancies in Flanders, Belgium. Twin Res 2003;6:7–11.CrossRefGoogle ScholarPubMed
Ballabh, P, Kumari, J, Al-Kouatly, HB, et al: Neonatal outcome of triplet versus twin and singleton pregnancies: A matched case-control study. Eur J Obstet Gynecol Reprod Biol 2003;107:28–36.CrossRefGoogle ScholarPubMed
Dyson, D, Danbe, K, Bamber, J, et al: A multicentre randomised trial of three levels of surveillance in patients at risk for preterm labour – twin gestation subgroup analysis. Am J Obstet Gynecol 1997;176:S118.CrossRefGoogle Scholar
Goldenberg, R, Iams, J, Miodovnik, M, et al: The preterm prediction study: Risk factors in twin gestations. Am J Obstet Gynecol 1996;175:1047–1053.CrossRefGoogle ScholarPubMed
Terrone, DA, Rinehart, BK, Kraeden, U, Morrison, JC: Fetal fibronectin in symptomatic twin gestations. Prim Care Update Ob Gyn 1998;62:135–139.Google Scholar
Souka, AP, Heath, V, Flint, S, et al: Cervical length at 23 weeks in twins in predicting spontaneous preterm delivery. Obstet Gynecol 1999;94:450–454.Google ScholarPubMed
Mueller-Heubach, E: Complications of multiple gestation. Clin Obstet Gynecol 1984;27:1003–1013.CrossRefGoogle ScholarPubMed
Dickey, RP, Taylor, SN, Lu, PY, et al: Spontaneous reduction of multiple pregnancy: Incidence and effect on outcome. Am J Obstet Gynecol 2002; 186:77–83.CrossRefGoogle Scholar
Dickey, RP, Olar, TT, Curole, DN, et al: The probability of multiple births when multiple gestational sacs or viable embryos are diagnosed at first-trimester ultrasound. Hum Reprod 1990;5:880–882.CrossRefGoogle ScholarPubMed
Blickstein, I: Growth aberration in multiple pregnancy. Obstet Gynecol North Am 2005;32:39–54.CrossRefGoogle ScholarPubMed
Blickstein, I, Kalish, RB: Birth weight discordance in multiple pregnancy. Twin Res 2003;6:526–531.CrossRefGoogle ScholarPubMed
Blickstein, I, Keith, LG: Neonatal mortality rates among growth discordant twins, classified according to the birth weight of the smaller twin. Am J Obstet Gynecol 2004;190:170–174.CrossRefGoogle ScholarPubMed
Reece, EA, Yarkoni, S, Abdalla, M, et al: A prospective study of growth in twin gestations compared with growth in singleton pregnancies. I. The fetal head. J Ultrasound Med 1991;10:439.CrossRefGoogle ScholarPubMed
Graham, D, Shah, Y, Moodley, S, et al: Biparietal diameter femur length growth in normal twin pregnancies [abstract 112]. Society of Perinatal Obstetricians, Annual meeting, February, 1984.Google Scholar
Dudley, DK, D'Alton, ME: Single fetal death in twin gestation. Semin Perinatol 1986;10:65–72.Google ScholarPubMed
Hanna, JH, Hill, JM: Single intrauterine fetal demise in multiple gestation. Obstet Gynecol 1984;63: 126–130.Google ScholarPubMed
Carlson, NJ, Towers, CV: Multiple gestation complicated by the death of one fetus. Obstet Gynecol 1989;73:685–689.Google ScholarPubMed
Johnson, CD, Zhang, J: Survival of other fetuses after a fetal death in twin or triplet pregnancies. Obstet Gynecol 2002;99:698–703.Google ScholarPubMed
D'Alton, ME, Simpson, LL: Syndromes in twins. Semin Perinatol 1995;19:375–386.CrossRefGoogle ScholarPubMed
D'Alton, ME, Newton, ER, Cetrulo, CL. Intrauterine fetal demise in multiple gestation. Acta Genet Med Gemellol (Roma) 1984;33:43–49.CrossRefGoogle ScholarPubMed
Dudley, DK, D'Alton, ME: Single fetal death in twin gestation. Semin Perinatol 1986;10:65–72.Google ScholarPubMed
Pharaoh, POD, Adi, Y: Consequences of in-utero death in a twin pregnancy. Lancet 2000;355:1597–1602.CrossRefGoogle Scholar
Pompler, HJ, Madjar, H, Klosa, W, et al: Twin pregnancies with single fetal death. Acta Obstet Gynecol Scand 1994;73:205–208.CrossRefGoogle Scholar
Fusi, L, Gordon, H: Twin pregnancy complicated by single intrauterine death: Problems and outcome with conservative management. Br J Obstet Gynaecol 1990;97:511–516.CrossRefGoogle ScholarPubMed
Onyskowova, A, Dolezal, A, Jedlicka, V: The frequency and the character of malformations in multiple births. Acta Universitatis Carolinae 1970;16: 333–376.Google ScholarPubMed
Hall, JG: Twinning. Lancet 2003;362:735–743.CrossRefGoogle ScholarPubMed
Mohammed, SN, Swan, MC, Wall, SA, Wilkie, AOM: Monozygotic twins discordant for frontonasal malformation. Am J Med Genet 2004;130:384–388.CrossRefGoogle Scholar
Rodis, JF, Egan, JF, Craffey, A, Ciarleglio, L, Greenstein, RM, Scorza, WE: Calculated risk of chromosomal abnormalities in twin gestations. Obstet Gynecol 1990;76:1037–1041.Google ScholarPubMed
Gilbert, B, Yardin, C, Briault, S, et al: Prenatal diagnosis of female monozygotic twins discordant for Turner syndrome: Implication for prenatal genetic counseling. Prenat Diagn 2002;22:697–702.CrossRefGoogle Scholar
Jenkins, TM, Wapner, RJ: The challenge of prenatal diagnosis in twin pregnancies. Curr Opin Obstet Gynecol 2000;12:87–92.CrossRefGoogle ScholarPubMed
Evans, MI, Goldberg, JD, Horenstein, J, et al: Selective termination for structural, chromosomal, and Mendelian anomalies: International experience. Am J Obstet Gynecol 1999;181:893–897.CrossRefGoogle ScholarPubMed
Nicolini, U, Poblete, A, Boschetto, C, Bonati, F, Roberts, A: Complicated monochorionic twin pregnancies: Experience with bipolar cord coagulation. Am J Obstet Gynecol 2001;185:703–707.CrossRefGoogle ScholarPubMed
Challis, D, Gratacos, E, Deprest, JA: Cord occlusion techniques for selective termination in monochorionic twins. J Perinat Med 1999;27:327–338.CrossRefGoogle ScholarPubMed
Deprest, JA, Van, Ballaer PP, Evrard, VA, et al: Experience with fetoscopic cord ligation. Eur J Obstet Gynecol Reprod Biol 1998;81:157–164.CrossRefGoogle ScholarPubMed
James, WH: A note on the epidemiology of acardiac monsters. Teratology 1977;16:211–216.CrossRefGoogle ScholarPubMed
Wong, AE, Sepulveda, W: Acardiac anomaly: Current issues in prenatal assessment and treatment. Prenat Diagn 2005;25:796–806.CrossRefGoogle ScholarPubMed
Bajoria, R, Wigglesworth, J, Fisk, NM: Angioarchitecture of monochorionic placentas in relation to the twin-twin transfusion syndrome. Am J Obstet Gynecol 1995;172:856–863.CrossRefGoogle ScholarPubMed
Denboow, M, Cox, P, Taylor, M et al: Placental angioarchitecture in monochorionic twin pregnan-cies: Relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. Am J Obstet Gynecol 2000;182:417–426.CrossRefGoogle Scholar
Mahieu-Caputo, D, Dommergues, M, Delezoide, A, et al: Twin-to-twin transfusion syndrome: Role of the fetal renin-angiotensin system. Am J Pathol 2000;156:629–636.CrossRefGoogle ScholarPubMed
Quintero, RA, Morales, WJ, Allen, MH, et al: Staging of twin-twin transfusion syndrome. J Perinatol 1999;19:550–555.CrossRefGoogle ScholarPubMed
Denbow, M, Foglian, R, Kyle, P, et al: Hematological indices at fetal blood sampling in monochorionic pregnancies complicated by feto-fetal transfusion syndrome. Prenat Diagn 1998;18:941–946.3.0.CO;2-G>CrossRefGoogle Scholar
Rychik, J: Fetal cardiovascular physiology. Pediatr Cardiol 2004;25:201–209.CrossRefGoogle ScholarPubMed
Barrea, C, Alkazaleh, F, Greg, G, et al: Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol 2005;192:892–902.CrossRefGoogle ScholarPubMed
Saunders, NJ, Snijders, RJM, Nicolaides, KH: Therapeutic amniocentesis in twin-twin transfusion syndrome appearing in the second trimester of pregnancy. Am J Obstet Gynecol 1992;166:820–824.CrossRefGoogle ScholarPubMed
Pinette, MG, Yuqun, P, Pinette, SG: Treatment of twin-twin transfusion syndrome. Obstet Gynecol 1993;82:841–846.Google ScholarPubMed
Mari, G, Roberts, A, Detti, L, et al: Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome: Results of the International Amnioreduction Registry. Am J Obstet Gynecol 2001;185:708–715.CrossRefGoogle ScholarPubMed
Mari, G, Detti, L, Oz, U, Abuhamad, AZ: Long-term outcome in twin-twin transfusion syndrome treated with serial aggressive amnioreduction. Am J Obstet Gynecol 2000;183:211–217.CrossRefGoogle ScholarPubMed
Dickinson, JE, Evans, SF: Obstetric and perinatal outcomes from The Australian and New Zealand Twin-Twin Transfusion Syndrome Registry. Am J Obstet Gynecol 2000;182:706–712.CrossRefGoogle ScholarPubMed
Quintero, R, Morales, W, Mendoza, G, et al: Selective photocoagulation of placental vessels I twin-twin transfusion syndrome: Evolution of a surgical technique. Obstet Gynecol Surv 1998;53:s97–103.CrossRefGoogle ScholarPubMed
Senat, MV, Deprest, J, Boulvain, M, et al: Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med 2004;351:136–144.CrossRefGoogle ScholarPubMed
Fisk, NM, Galea, P: Twin-twin transfusion – as good as it gets?N Engl J Med 2004;351:182–184.CrossRefGoogle ScholarPubMed
Quintero, RA, Dickinson, JE, Morales, WJ, et al: Stage-based treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol 2003;188:1333–1340.CrossRefGoogle ScholarPubMed
Saade, G, Moise, K, Dorman, K, et al: A randomized trial of septostomy versus amnioreduction in the treatment of twin oligohydramnios polyhydramnios sequence (TOPS). Am J Obstet Gynecol 2002;187:S54.Google Scholar
De, Lia JE, Kuhlmann, RS, Lopez, KP: Treating previable twin-twin transfusion syndrome with fetoscopic laser surgery: Outcomes following the learning curve. J Perinat Med 1999;27:61–67.Google Scholar
Hecher, K, Diehl, W, Zikulnig, L, Vetter, M, Hackeloer, BJ: Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid-trimester twin-to-twin transfusion syndrome. Eur J Obstet Gynecol Reprod Biol 2003;92:135–139.CrossRefGoogle Scholar
Moise, JM Jr, Dorman, K, Lamvu, G, et al: A randomized trial of amnioreduction versus septostomy in the treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol 2005;193:701–707.CrossRefGoogle ScholarPubMed
Hartung, J, Chaoui, R, Bollman, R: Amniotic fluid pressure in both cavities of twin-to-twin transfusion syndrome: A vote against septostomy. Fetal Diagn Ther 2000;15:79–82.CrossRefGoogle ScholarPubMed
Cook, TL, Shaugnessy, R: Iatrogenic creation of a monoamniotic twin gestation in severe twin-to-twin transfusion syndrome. J Ultrasound Med 1997;16:853–855.CrossRefGoogle Scholar
Allen, VM, Windrim, R, Barrett, J, Ohlsson, A: Management of monoamniotic twin pregnancies: A case series and systematic review of the literature. Br J Obstet Gynaecol 2001;108:931–936.Google ScholarPubMed
Demaria, F, Goffinet, F, Kayem, G et al: Monoamniotic twin pregnancies: Antenatal management and perinatal results of 19 consecutive cases. Br J Obstet Gynaecol 2004;111:22–26.CrossRefGoogle ScholarPubMed
Roque, H, Gillen-Goldstein, , Funai, E, et al: Perinatal outcomes in monoamniotic twin gestations. J Matern Fetal Neonat Med 2003;13:414–421.CrossRefGoogle Scholar
Benirschke, K, Kim, CK: Multiple pregnancy: 1. N Engl J Med 1973;288:1276–1284.CrossRefGoogle ScholarPubMed
Meyer, B, Elimian, A, Royek, A: Comparison of clinical and financial outcomes of triplet gestations managed by maternal-fetal medicine versus community physicians. Am J Obstet Gynecol 2001;184:S102.CrossRefGoogle Scholar
Giles, W, Bisits, A, O'Callaghan, S, et al: The Doppler Assessment in multiple pregnancy randomized controlled trial of ultrasound biometry versus umbilical artery Doppler ultrasound and biometry in twin pregnancy. Br J Obstet Gynaecol 2003;110:593–597.CrossRefGoogle ScholarPubMed
Megann, E, Chauhan, S, Whitworth, N, et al: Determination of amniotic fluid volume in twin pregnancies: Ultrasonographic evaluation versus operator estimation. Am J Obstet Gynecol 2000; 182:1606–1609.CrossRefGoogle Scholar
Pandya, PP, Snijders, RJM, Johnson, SJ, Brizot, MJ, Nicolaides, KH: Nuchal translucency thickness, crown-rump length in twin pregnancies with chromosomally abnormal fetuses. J Ultrasound Med 1995;14:565–568.CrossRefGoogle ScholarPubMed
Jeanty, P, Shah, D, Roussis, P: Single-needle insertion in twin amniocentesis. J Ultrasound Med 1990; 9:511–517.CrossRefGoogle ScholarPubMed
Buscaglia, M, Ghisoni, L, Bellotti, M, et al: Genetic amniocentesis in biamniotic twin pregnancies by a single transabdominal insertion of the needle. Prenat Diagn 1995;15:17–19.CrossRefGoogle Scholar
Crowther, CA: Hospitalization and bed rest for multiple pregnancy. Cochrane Database of Systematic Reviews 2001;1:CD000110.Google ScholarPubMed
Newman, R, Krombach, R, Myers, M, et al: Effect of cerclage on obstetrical outcome in twin gestations with a shortened cervical length. Am J Obstet Gynecol 2002;186:634–640.CrossRefGoogle ScholarPubMed
Grant A: Cervical cerclage to prolong pregnancy. In Chalmers, I, Enkin, M, Keirse, M (eds.): Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press, 1989, pp. 633–645.Google Scholar
Bernasko, J, Lee, Robert, Pagano, M, Kohn, N: Is routine prophylactic cervical cerclage associated with significant prolongation of triplet gestation?J Matern Fetal Neonatal Med 2006;19:575–578.CrossRefGoogle ScholarPubMed
Rouse, DJ, Caritis, SN, Peaceman, AM, et al: A trial of 17 alpha-hydroxyprogesterone caproate to prevent prematurity in twins. N Engl J Med 2007;357:454–461.CrossRefGoogle ScholarPubMed
Blickstein, I, Shinwell, ES, Lusky, A, et al: Plurality-dependent risk of respiratory distress syndrome among very-low-birth-weight infants and antepartum corticosteroid treatment. Am J Obstet Gynecol 2005;192:360–364.CrossRefGoogle ScholarPubMed
Blickstein, I, Reichman, B, Lusky, A, et al: Plurality-dependent risk of severe intraventricular hemorrhage among very-low-birth-weight infants and antepartum corticosteroid treatment. Am J Obstet Gynecol 2006;194:1329–1333.CrossRefGoogle ScholarPubMed
Caughey, AB, Parer, JT: Tocolysis with beta-adrenergic receptor agonists. Semin Perinatol 2001; 25(4):248–255.CrossRefGoogle ScholarPubMed
Elliott, J, Istwan, N, Rhea, D, Stanziano, G: The occurrence of adverse events in women receiving continuous subcutaneous terbutaline therapy. Am J Obstet Gynecol 2004;191:1277–1282.CrossRefGoogle ScholarPubMed
Antenatal Corticosteroids Revisited: Repeat Courses – National Institutes of Health Consensus Development Conference Statement, August 17–18, 2000. Obstet Gynecol 2001;98:144–150.
Bianco, AT, Lapinski, R, Lockwood, C, Lynch, L, Berkowitz, RL: The clinical outcome of preterm premature rupture of membranes in twin versus singleton pregnancies. Am J Perinatol 1996;13(3):135–138.CrossRefGoogle ScholarPubMed
Hseih, YY, Chang, CC, Tsai, HD, Lee, CC, Tsai, CH: Twin vs. singleton pregnancy: Clinical characteristics and latency periods in preterm premature rupture of membranes. J Reprod Med 1999;44(7):616–620.Google Scholar
Cheung, YB, Yip, P, Karlberg, J: Mortality of twins and singletons by gestational age: A varying-coefficient approach. Am J Epidemiol 2000;152: 1107–1116.CrossRefGoogle ScholarPubMed
Hartley, RS, Emanuel, I, Hitti, J: Perinatal mortality and neonatal morbidity rates among twin pairs at different gestational ages: Optimal delivery timing at 37 to 38 weeks' gestation. Am J Obstet Gynecol 2001;184:451–458.CrossRefGoogle Scholar
Sairam, S, Costeloe, K, Thilaganathan, B: Prospective risk of stillbirth in multiple-gestation pregnancies: A population-based analysis. Obstet Gynecol 2002; 100:638–641.Google ScholarPubMed
Multiple gestation: Complicated twin, triplet, and high-order multifetal pregnancy. ACOG Practice Bulletin 2004;56:1–15.
Leveno, KJ, Quirk, JG, Whalley, PJ, Herbert, WM, Trubey, R: Fetal lung maturation in twin gestation. Am J Obstet Gynecol 1984;148:405–411.CrossRefGoogle ScholarPubMed
McElrath, TF, Norwitz, ER, Robinson, JM, et al: Differences in TDx fetal lung maturity assay values between twin and singleton gestations. Am J Obstet Gynecol 2000;182:110–112.CrossRefGoogle ScholarPubMed
Whitworth, NS, Magann, EF, Morrison, JC: Evaluation of fetal lung maturity in diamniotic twins. Am J Obstet Gynecol 1999;180:1438–1441.CrossRefGoogle ScholarPubMed
Chervenak, FA, Johnson, RE, Youcha, S, Hobbins, JC, Berkowitz, RL: Intrapartum management of twin gestation. Obstet Gynecol 1985;65:119–124.Google ScholarPubMed
Rayburn, WF, Lavin, JP, Midovnik, M Jr, Varner, MW: Multiple gestation: Time interval between delivery of the first and second twins. Obstet Gynecol 1984;63(4):502–506.Google ScholarPubMed
Brown, HL, Miller, JM Jr, Neumann, , et al: Umbilical cord blood gas assessment of twins. Obstet Gynecol 1990;75(5):826–829.Google Scholar
Rydhstrom, H, Ingemarsson, I: Interval between birth of the first and the second twin and its impact on second twin perinatal mortality. J Perinat Med 1990;18(6):449–453.CrossRefGoogle ScholarPubMed
Leung, TY, Lok, IH, Tam, WH, et al: Deterioration in cord blood gas status during the second stage of labour is more rapid in the second twin than the first twin. Br J Obstet Gynaecol 2002;109:63–67.CrossRefGoogle Scholar
Wells, SR, Thorp, JM Jr, Bowes, WA Jr: Management of the nonvertex second twin. Surg Gynecol Obstet 1991;172:383.Google ScholarPubMed
Chervenak, FA, Johnson, RE, Berkowitz, RL, et al: Intrapartum external version of the second twin. Obstet Gynecol 1983;62:160–165.Google ScholarPubMed
Acker, D, Leiberman, M, Holbrook, H, James, O, Phillipe, M, Edelin, KC: Delivery of the second twin. Obstet Gynecol 1982;59:710–711.Google ScholarPubMed
American Society for Reproductive Medicine: Guidelines on Number of Embryos Transferred. Birmingham, AL, American Society for Reproductive Medicine, 1998.
The Practice Committee of the Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine: Guidelines on the number of embryos transferred. Fertile Steril 2004; 82(Suppl 1):S1–S2.
Evans, MI, Ciorica, D, Britt, DW, Fletcher, JC: Update on selective reduction. Prenat Diagn 2005;25:807–813.CrossRefGoogle ScholarPubMed
Evans, MI, Berkowitz, RL, Wapner, RJ, et al: Improvement in outcomes of multifetal pregnancy reduction with increased experience. Am J Obstet Gynecol 2001;184:97–103.CrossRefGoogle ScholarPubMed
Yaron, Y, Bryant-Greenwood, P, Dave, N, et al: Multifetal pregnancy reductions of triplets to twins: Comparison with nonreduced triplets and twins. Am J Obstet Gynecol 1999;180:1268–1271.CrossRefGoogle ScholarPubMed
Boulot, P, Vignal, J, Vergnes, C, et al: Multifetal reduction of triplets to twins: A prospective comparison of pregnancy outcome. Hum Reprod 2000; 15:1619–1623.CrossRefGoogle ScholarPubMed
Assisted Reproductive Technology Success Rates: National Summary of Fertility Clinic Reports. Atlanta, Centers for Disease Control and Prevention, December 2005.
Evans, MI, Kaufman, MI, Urban, AJ, et al: Fetal reduction from twins to a singleton: A reasonable consideration?Obstet Gynecol 2004;104:102–109.CrossRefGoogle ScholarPubMed
Rorty, MV, Pinkerton, JV: Elective fetal reduction: The ultimate elective surgery. J Contemp Health Law Policy 1996;13:53–77.Google ScholarPubMed
Ryan, GL, Zhang, SH, Dokras, A, et al: The desire of infertile patients for multiple births. Fertil Steril 2004;81(3):500–504.CrossRefGoogle ScholarPubMed
Child, TJ, Henderson, AM, Tan, SL: The desire for multiple pregnancy in male and female infertility patients. Hum Reprod 2004;19(3):558–561.CrossRefGoogle ScholarPubMed
Schreiner-Engel, P, Walther, VN, Mindes, J, et al: First-trimester multifetal pregnancy reduction: Acute and persistent psychologic reactions. Am J Obstet Gynecol 1995;172:541–547.CrossRefGoogle ScholarPubMed

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  • Multiple Gestation
    • By V. Ravishankar, Clinical Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences State University of New York at Stony Brook Stony Brook University School of Medicine Stony Brook, New York, J. Gerald Quirk, Professor and Chair, Department of Obstetrics, Gynecology, and Reproductive Medicine State University of New York at Stony Brook
  • John Patrick O'Grady, Tufts University, Massachusetts, Martin L. Gimovsky, Lucy A. Bayer-Zwirello, Kevin Giordano
  • Book: Operative Obstetrics
  • Online publication: 07 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511580987.015
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  • Multiple Gestation
    • By V. Ravishankar, Clinical Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences State University of New York at Stony Brook Stony Brook University School of Medicine Stony Brook, New York, J. Gerald Quirk, Professor and Chair, Department of Obstetrics, Gynecology, and Reproductive Medicine State University of New York at Stony Brook
  • John Patrick O'Grady, Tufts University, Massachusetts, Martin L. Gimovsky, Lucy A. Bayer-Zwirello, Kevin Giordano
  • Book: Operative Obstetrics
  • Online publication: 07 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511580987.015
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Multiple Gestation
    • By V. Ravishankar, Clinical Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences State University of New York at Stony Brook Stony Brook University School of Medicine Stony Brook, New York, J. Gerald Quirk, Professor and Chair, Department of Obstetrics, Gynecology, and Reproductive Medicine State University of New York at Stony Brook
  • John Patrick O'Grady, Tufts University, Massachusetts, Martin L. Gimovsky, Lucy A. Bayer-Zwirello, Kevin Giordano
  • Book: Operative Obstetrics
  • Online publication: 07 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511580987.015
Available formats
×