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Major Fetal Hazards in Multiple Pregnancy

Published online by Cambridge University Press:  01 August 2014

F. Leroy
F. Leroy*
Affiliation:
Department of Obstetrics and Gynecology, St. Pierre Hospital, Free University of Brussels, Belgium
*
Laboratoire de Gynécologie, Hôpital Universitaire Saint-Pierre, Rue Haute 322, 1000 Bruxelles, Belgium

Abstract

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Fetal risk in twin pregnancy is recognized as being about 2 to 4 times higher than in singletons. The main factors of this increased mortality are reviewed. Pathological effects associated with MZ origin are mainly due to the “third circulation” occurring in monochorial twins. Three situations can be distinguished: (a) hemodynamic equilibrium resulting in fetal growth impairment, (b) strong hemodynamic imbalance inducing fetal death, (c) moderate imbalance as the cause of “intertwin transfusion syndrome”. The acardiac and to some extent the papyraceus fetus can be considered as particular cases of the same problem. Other risks associated with MZ twins are the higher rate of malformations and umbilical cord entanglement in monoamniotic twins. The conjoined effects of prematurity and intrauterine growth retardation are undoubtedly the main cause of fetal death in multiple births. Therefore, some consideration is given to the underlying physiopathogenic factors. Prevention of twin weight defects demands early diagnosis of multiple pregnancy. As little can be expected from classical clinical methods, the obstetrician has to rely on more sophisticated techniques such as fetal ultrasonography. Even with an early diagnosis, at the present time there is no satisfactory treatment capable of preventing prematurity and retarded fetal growth. In this specific context, bed rest would appear as a fallacy.

Type
9. Science for Twins/Twins for Science
Information
Acta geneticae medicae et gemellologiae: twin research , Volume 25 , Issue 1 , January 1976 , pp. 299 - 306
Copyright
Copyright © The International Society for Twin Studies 1976

References

REFERENCES

Aherne, W., Strong, S.J., Corney, G. 1968. The structure of the placenta in the twin transfusion syndrome. Biol. Neonate, 12: 121–135.Google Scholar
Bender, S. 1952. Twin pregnancy. A review of 472 cases. J. Obstet. Gynaecol. Br. Emp., 59: 510–517.Google Scholar
Benirschke, K. 1961. Twin placenta in perinatal mortality. N.Y. State J. Med., 61: 1499–1508.Google Scholar
Benirschke, K. 1972. Origin and clinical significance of twinning. Clin. Obstet. Gynecol., 15: 220–235.Google Scholar
Benirschke, K., Driscoll, S. 1967. The placenta of multiple pregnancy. In: Handbuch der speziellen pathologische Anatomie und Histologie. 5ter Teil: Placenta. Berlin: Springer Verlag.Google Scholar
Bulmer, M.G. 1970. The Biology of Twinning in Man. Oxford: Clarendon Press.Google Scholar
Cameron, A.H. 1968. The Birmingham twin survey. Proc. R. Soc. Med., 61: 229–234.Google Scholar
Comline, R.S., Nathanielsz, P.W., Silver, M. 1973. Foetal cortisone production and parturition in the sheep. In Pierrepoint, C.G. (ed.): The Endocrinology of Pregnancy and Parturition. Cardiff: Alpha Omega Alpha Publ.Google Scholar
Csapo, A. 1961. Progesterone and the defense mechanism of pregnancy. In Wolstenholme, G.E.W. and Cameron, M.P. (eds.): Ciba Fn. Study Group N. 9. London: Churchill.Google Scholar
Donnely, M.M. 1956. The influence of multiple births on perinatal loss. Am. J. Obstet. Gynecol., 72: 998–1003.Google Scholar
Dunn, B. 1961. Bed rest in twin pregnancy. J. Obstet. Gynaecol. Br. Commonw., 68: 685–687.CrossRefGoogle ScholarPubMed
Gaves, L.R., Adams, J.Q., Schreier, P.C. 1962. The fate of the second twin. Obstet. Gynecol., 19: 246–250.Google Scholar
Guttmacher, A.F. 1939. An analysis of 573 cases of twin pregnancy. II. The hazards of pregnancy itself. Am. J. Obstet. Gynecol., 38: 277–288.Google Scholar
Kloosterman, G.J. 1963. The “third circulation” in identical twins. Ned. Tijdschr. Verlosk., 63: 395–410.Google Scholar
Kurtz, G.R., Keating, W.J., Loftus, J.B. 1955. Twin pregnancy and delivery. Analysis of 500 twin pregnancies. Obstet. Gynecol., 6: 370–378.Google Scholar
Leroy, F. 1962. A propos d'un cas de grossesse gémellaire monoamniotique. Bull. Soc. R. Belge Gynecol. Obstet., 32: 269–271.Google Scholar
Leroy, F. 1974. Management of some aspects of twin labor and delivery. Acta Genet. Med. Gemell. (Roma) [Suppl.], 22: 62–69.Google Scholar
Mc Keown, L., Record, R.G. 1952. Observations on foetal growth in multiple pregnancy in man. J. Endocrinol., 8: 386–401.Google Scholar
Mc Keown, L., Record, R.G. 1953. The influence of placental size on foetal growth in man, with special reference to multiple pregnancy. J. Endocrinol., 9: 418–426.Google Scholar
Metrakos, J.D. 1951. The twin method and its application to the study of genetic and environmental factors of some human diseases. Thesis, Montreal, Mc Gill University.Google Scholar
Montagu, M.A.F. 1952. Perinatal Influences. Springfield: C.C. Thomas.Google Scholar
Morris, N., Osborn, S.B., Wrigth, H.P. 1955. Effective circulation of the uterine wall in late pregnancy measured with 24NaCl.Google Scholar
Rosa, P. 1967. Efficacité et innocuité du caproate de 17-hydroxyprogestérone et du valerianate d'oestradiol dans le traitement préventif de la fausse couche habituelle. Gynec. Obstetr., 66: 549–568.Google Scholar
Russel, J.K. 1952. Maternal and foetal hazards associated with twin pregnancy. J. Obstet. Gynaecol. Br. Emp., 59: 208–213.Google Scholar
Surway, J.G. 1962. The fate and management of the second twin. Am. J. Obstet. Gynecol. 83: 1377–1388.Google Scholar
Strong, S.J., Corney, G. 1967. The Placenta in Twin Pregnancy. Oxford: Pergamon Press.Google Scholar
Tow, S.H. 1959. Foetal wastage in twin pregnancy. J. Obstet. Gynecol. Br. Emp., 66: 444–451.Google Scholar
Walker, J., Turnbull, E.P.P. 1955. The environmen of the foetus in human multiple pregnancy. Etud. Neo-Natal, 4: 123–148.Google Scholar