10 –18 Union Street It may be indicated in cases of particularly high-order multiple pregnancies but can never be justified for reduction of twins. It may also be referred to as a combined ectopic pregnancy, multiple‑sited pregnancy, or coincident pregnancy. Post-injury infection has not been reported.
The alarming rise in multiple pregnancies resulting from the use of assisted reproductive technologies (ARTs) has led to many publications highlighting the significant maternal, fetal and neonatal risks associated with these pregnancies. Mr T El-Toukhy MRCOG, London: None declared. There is insufficient evidence to recommend the use of prophylactic antibiotics.
Recent evidence suggests that the surviving twin(s) is at increased risk for LBW, preterm birth, and possibly cerebral impairment (Pinborg et al., 2005, 2007; Anand et al., 2007a, 2007b; Luke et al., 2009).
Furthermore, patients with complex issues unique to multiple gestations should be referred to a tertiary care center with maternal fetal medicine, neonatology, and pediatric specialists proficient at caring for such patients.
From 10–14 weeks onwards, a thick septum and a triangular tissue projection at the placental base of the separating membrane (lambda sign) predict dichorionicity27 (see Fig. Ultrasound imaging is the cornerstone of management in these patients.
A monochorionic pregnancy is a multiple pregnancy, most commonly a twin pregnancy, in which babies are dependent on a single, shared placenta.
Please be advised: All patients attending appointments at NCCRM must wear a mask. Multiple pregnancy leads to a strong increase in obstetric complications, perinatal morbidity, maternal and child mortality rate, congenital malformations, pre-term birth, and long-term social, psychological and financial difficulties. Later during pregnancy, identification of fetal gender may also be helpful in the assessment of chorionicity, although overall two-thirds of twins are of the same sex: one-third consists of all monochorionic twins and the other one of 50% of all dichorionic twins.
However, occasionally we ‘over-succeed’ and find that a patient has a triplet pregnancy. Theoretically, endometrial scratching in the luteal phase could be harmful to a spontaneous pregnancy, ocurring at that moment.
The next step in these non-responding women is the use of gonadotropins (GonalF, follistim, humagon etc).
Having a multiple pregnancy means that you will need more antenatal appointments than women carrying 1 baby.
You are more likely to have your babies early if you have a multiple pregnancy. For updates on practice operations, click here. Ovarian hyperstimulation syndrome (OHSS).
The incidence of progression from stage I to more severe disease is 15%; the survival rate in those that don't progress is 86% (Bebbington et al., 2010; Rossi and D'Addario, 2013). It is quite unusual to have more than twins, but high order multiples may occur even with clomiphene citrate. The incidence varies from 1 in 22,000 to 1 in 100,000 pregnancies [62,63]. Monochorionic multiples experience higher rates of morbidity and mortality, largely because of placental factors (Table 7.3) (Hack et al., 2008; Cunningham and Williams, 2010; Glinianaia et al., 2011). Negative outcomes such as stillbirth, neonatal mortality, congenital malformations, and cerebral palsy are higher in monochorionic twins compared with dichorionic twins (Lewi et al., 2010; Glinianaia et al., 2011; Burgess et al., 2014).
It is not possible to assure a woman that she will not have a multiple pregnancy when she is taking any of these drugs. Multiple pregnancy, caused by the practice of transferring more than one embryo into the uterus, is the commonest treatment-related adverse outcome of in vitro fertilisation (IVF). In general, an MVP less than 2 cm is used to define oligohydramnios, and an MVP greater than 8 cm to define polyhydramnios.24 For monochorionic twins, an MVP greater than 10 cm is used to define polyhydramnios after 20 weeks’ gestation.25, Randall S. Hines MD, Bryan D. Cowan MD, in Clinical Gynecology, 2006, Multiple pregnancies are also associated with infant and childhood morbidity such as cerebral palsy and mental retardation.41 Two recent studies of the incidence of cerebral palsy reported dramatically increased risks in multiple births: twins had risks approximately 5 times higher and triplets 17 times higher than singletons, and the risk of producing at least one child with cerebral palsy was estimated to 1% to 5% for twin, 8% for triplet, and almost 50% for quadruplet pregnancies.42,43. Multiple pregnancy, caused by the practice of transferring more than one embryo into the uterus, is the commonest treatment-related adverse outcome of in vitro fertilisation (IVF).
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