5. TNT … Wen et al. Mortality and morbidity seem to be related with preterm delivery, and high-order infants have comparable rates compared to singletons and twins of the same gestational age [70, 100]. The management of such a pregnancy is also challenging since its beginning and to the end.
in 2001 in a study of 464 multiple gestations showed that in multiple gestations arising from artificial reproduction treatments, there is a correlation between the number of fetuses and the rates of monochorionic pairs [62]. Some data suggest that the use of modern infertility treatment methods is associated with monozygotic twinning, although the data for some of these methods are conflicting [60].
For multiple pregnancies, Liem et al. We share our knowledge and peer-reveiwed research papers with libraries, scientific and engineering societies, and also work with corporate R&D departments and government entities. 20 Comments.
In any case, more studies are necessary in order to have results that are more reliable. By Stelios Fiorentzis, Styliani Salta, Michail Pargianas, Artemis Pontikaki, Dimitrios P. Koutsoulis, Christodoulos Akrivis, Dimitrios Akrivis and Ioannis Kosmas, Submitted: March 2nd 2018Reviewed: July 16th 2018Published: November 5th 2018, Home > Books > Multiple Pregnancy - New Challenges. Superfecundation raises the issue of paternity among separately fertilized ova. Available from: Predisposing factors for a high-order pregnancy, Complications and management of quadruplet/quintuplet pregnancies, Delivery of a quadruplet or quintuplet pregnancy, Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938 and Institut Universitaire de Cancérologie, Faculté de Médecine, Sorbonne Université, France, Service d'Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris (AP-HP), France, Medical School, University of Ioannina, Obstetrics and Gynecology, Greece, Department of Obstetrics and Gynecology, University Hospital of Heraklion, Greece, Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Chatzikosta, Greece. Publishing on IntechOpen allows authors to earn citations and find new collaborators, meaning more people see your work not only from your own field of study, but from other related fields too. in 2001 [115] studied the evolution of pregnancy outcomes across time: before 1991, from 1991 to 1994, and after 1994. Despite that, a single course of corticosteroids is recommended for all multifetal pregnant women at risk of preterm delivery between 24 and 0/7 weeks and 33 and 6/7 weeks of gestation. The theory behind this affirmation is an increase in the secretion of gonadotropins shortly after the cessation of the pill that could result in multiple pregnancies. Nnadi in 2013 [ 20 ] described a case of monozygotic quadruplet pregnancy conceived naturally that ended in an elective cesarean section of a set of monochorionic tetra-amniotic quadruplets at 37 weeks of gestation. Quadruplets and quintuplets have higher neonatal and perinatal mortality compared to triplets. Neubecker in 1962 [21] and Rau in 1940 [22] reported two cases of monozygotic quintuplet pregnancies, indicating the possibility of a quadruplet and quintuplet pregnancy arising from a single ovum. Nnadi in 2013 [20] described a case of monozygotic quadruplet pregnancy conceived naturally that ended in an elective cesarean section of a set of monochorionic tetra-amniotic quadruplets at 37 weeks of gestation. Built by scientists, for scientists. We are a community of more than 103,000 authors and editors from 3,291 institutions spanning 160 countries, including Nobel Prize winners and some of the world’s most-cited researchers. Women carrying multiples are at increased risk for urinary tract infection, with the rates for multiple pregnancies to be up to 4.6% compared to 3.7% for singleton pregnancies [90], possibly because of the larger size of the uterus or the levels of progesterone in the maternal circulation.
Adeghite et al. Chow et al. There was no difference in regard to perinatal or obstetric complications.
In the same study, however, they found that women who were drinking ≥15 alcohol units per week and those who were smoking ≥10 cigarettes per day were more likely to conceive a multifetal pregnancy. There are also some rare complications which have been reported in high-order pregnancies, but due to the limited number of cases, no guidelines are available.
They concluded that women with triplets and more were in greater risk for pregnancy associated hypertension, eclampsia, anemia, diabetes mellitus, placental abruption, premature rupture of the membranes, and cesarean delivery, even after the adjustment for important confounding factors. Preterm labor has been proven the most common maternal complication in high-order pregnancies [67], and it is directly associated with the increased perinatal morbidity and mortality observed in these pregnancies, while the rates of pregnancy complications seem to be raised alongside the increase of the number of fetuses [14]. Altogether, the reduction of a high-order pregnancy with more than four fetuses to twins holds the best outcome. Tocolysis is also another method for the prevention or delay of preterm labor. When he compared the outcomes of reduced twins between the 10th and 11th week of gestation from triplet or quadruplet pregnancies, there were still no significant differences between the two groups.
Since placenta plays an important role in preeclampsia [82], the increased mass of the placenta in multifetal pregnancies is probably associated with the occurrence of preeclampsia. The limited space in uterus and the limited nutrient supply might be responsible for low birth weight [103].
Multiples are at increased risk of growth problems compared to singletons, with the degree of intrauterine growth restriction to increase as the number of fetuses increase. High-order pregnancies hold a significant risk of miscarriage as well as neonatal and maternal morbidity and mortality. For monozygotic pregnancies, the timing of the fertilized ovum splitting dictates the pregnancy chorionicity. There is evidence that a woman’s somatometric parameters are associated with a multiple pregnancy. It’s based on principles of collaboration, unobstructed discovery, and, most importantly, scientific progression. Cord prolapse, hemorrhage, and abruption of the placenta are undesirable possible complications for any vaginal delivery, but in a high-order pregnancy where the mother and the fetuses are more vulnerable are even more undesirable. The mean gestational age for quadruplets reduced to twins in the second trimester was higher compared to quadruplets reduced to twins in the first trimester (36.7 ± 1.2 vs. 33.6 ± 3.9 weeks respectively, p = 0.01). It’s a six part series, that shows God’s faithfulness through our very uncertain days. I abandoned it for fear of seeming lackluster or coming off as conceited. 15 Comments.
The prevalence of high-order pregnancies after the rise until 1996 is tending to normalize, making—again—unique and rare such cases. In the same study, the proportion of preterm birth attributable to premature rupture of the membranes for extremely preterm gestational ages (before 28 weeks of pregnancy) was 50% for quadruplets and 100% for higher order pregnancies compared to 26.9, 34.6, and 26.5% for triplets, twins, and singletons, respectively (p < 0.001). Some lifestyle choices have also been proposed as predisposing factors for multiple pregnancy. Another strategy used to prolong a multiple pregnancy is the use of progesterone, with vaginal distribution to be preferred than the intramuscular one in terms of fewer maternal side effects [76]. Our Quadruplet Birth Story. Multiple studies have concluded that the birth weight, gestational age at delivery, and perinatal mortality rate were directly correlated with the final number of fetuses [112, 128, 129]. The cost of a quadruplet and quintuplet pregnancy can be unbearable, not only financially but also psychologically. Chibber in 2003 [102] highlighted the differences between triplet and higher pregnancies when the Apgar scores of the first and fifth minute were compared. Bed rest, either hospitalization or home rest, is a method still widely used. Wenk et al. Since 1999, a decline is observed, and in 2016, there were 1014 per 100,000 triplets or higher order births, 217 quadruplet and 31 quintuplet and other higher order births [12]. This case reported was correctly diagnosed at approximately 17 weeks of gestation, by a combination of clinical and x-ray findings, apparently the earliest diagnosis on record. [44] in 2004 compared the outcomes in women with twins, triplets, quadruplets, and high-order pregnancies from 1995 to 1997. Although some researchers considered bed rest the most important mode of treatment and it was used to be advised to all patients [53], Crowther in 2001 [68] for a Cochrane review synthesized seven controlled trials including twin and triplet gestations. No guidelines for the management of a multiple pregnancy coexisting with a complete hydatidiform mole and live fetuses occur.
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