I Blickstein

..The document represents the view and opinion of individuals who composed this ad hoc committee and discusses various aspects that are specific and relevant to the care of MC twin gestations...

..More data are needed to establish the frequency and extent of intraoperative disengagement dystocia and to determine the management protocol that carries the lowest risk in such circumstances...

..The risk of CP should be acknowledged not only when a multiple pregnancy is diagnosed, but also when counseling infertility patients in whom iatrogenic multiple pregnancies are an actual risk...

..However, the improved outcomes of triplets in recent years might call for second thoughts about the frequent recommendation of multifetal pregnancy reduction of triplets to twins...

..The key in these circumstances might be found in the ability to recognize the transition from the physiologic adaptation into the pathologic process of growth restriction...

..This hypothetical explanation does not negate the already existing and genetically sound hypotheses, but places them into a broader perspective that respects recent observations from modern infertility treatment...

..97 and R2=0.94, respectively) as well as with high ponderal indices (R2=0.95 and R2=0.94, respectively). The regression analyses suggest, however, different patterns for infants with low or high ponderal indices...

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..Not infrequently, discordance may represent an adaptation to the limited intrauterine space in order to increase gestational age...

..To outline maternal and perinatal consequences of iatrogenic pregnancies...

..To estimate the likelihood of adverse outcomes in triplet pregnancies by a score comprising pregravid maternal characteristics...

..To determine if discordant twins are delivered at a more advanced gestational age than concordant twins of the same total twin birth weight...

..To study the effect of maternal height on gestational age and birth weight of triplets born to nulliparous women with a normal pregravid body mass index (BMI)...

..Differences in the incidence of multiples between the Arab and Jewish populations are partly explained by the younger age at first delivery of Arab women...

..This statement was endorsed by the International Society of Twin Studies (Ghent, Belgium, June, 2007) and by the World Association of Perinatal Medicine (Florence, Italy, September, 2007)...

..Because a substantial deviation from the standard procedure is required before a sample is alleged to be imprecise, it is unlikely that standard sampling methods would be ineligible in litigation...

..To describe current knowledge related to the association between oral contraception and the thrombophilias...

..In this article, several examples are discussed in which departure from the standard of care of multiple pregnancies were the basis of the allegation...

..In any case, the most appropriate endpoint after assisted reproduction should also include preterm or term birth as measure of success...

..Care should be exercised in the interpretation of various risks and the potential of anticoagulation as a remedy to reduce that risk...

..We propose that this new measure could be a useful proxy for the uteroplacental efficiency in a similar way that the SGA designation works for singleton infants...

..To evaluate the relation between placental proximity and frequency of birth weight discordance and small-for-gestational age (SGA) infants...

..However, the presence of other factors in addition to parity is needed for a triplet pregnancy to be included in the 10th decile...

..This will improve understanding of the zygotic splitting phenomenon and its relation to pathologic processes...

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..When a small-for-gestational-age fetus is suspected in a multiple pregnancy, it is advisable to follow or to treat the pregnancy as if it was an SGA singleton...

..This study was undertaken to evaluate intertriplet birth weight discordance...

..We tested the hypothesis that the frequency of growth discordance among twins is not related to the uterine capacity for carrying twins...

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..Maternal age of nulliparas is not associated with different birth weight characteristics of their twins...

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..6%. We concluded that the coiling index should be established in two distinct segments and that the spatial configuration of the coils, which protects the blood flow in the umbilical cord, might not be measured by coil density only...

..Thus the Löwen etching opens a window to the past from which modern medicine can be appreciated...

..To compare the incidence of twin births and their birth weight characteristics in mothers aged > or = 40 years with those of mothers aged 35-39 years...

..To calculate the frequencies of very low birth weight (VLBW) neonates among twins in a large population database...

..Thus, the decision for a CS in twins, intentionally or not, is based on qualitative variables that were not quantified and on quantitative variables that suggest no advantage for CS in the majority of cases...

..To assess the risk of vaginal birth of breech first twins by Apgar scores and mortality...

..When the uterine environment competently nurtures multiples, total birth weight increases and discordance decreases. Failed adaptation, however, may result in significant growth discordance and restriction...

..Nulliparas are at significantly increased risk of delivering one or two ELBW triplets. This observation is no less than alarming and highlighted by the exceptionally high risk of major neurological deficits reported among ELBW infants...

..To present data related to the outcome of triplets and high-order multiple pregnancies...

..We believe that eliminating procedures associated with unavoidable IMPs and controlling the number of transferred embryos can achieve a significant reduction in the adverse perinatal outcomes and costs associated with IMPs...

..To study the effect of birth order on the risk for respiratory distress syndrome (RDS), chronic lung disease (CLD), adverse neurological findings, and death in very low birthweight (VLBW; < 1500 g) twins...

..All neonates had a 5-min Apgar score of 10. The data suggest that an intrauterine balloon catheter appears to be safe and effective to induce labor in twin gestations...

..Neonatal morbidity and mortality differ between singletons, twins, and triplets...

..Although these tiny infants comprise only a small proportion of all births, the ravages of prematurity make them by far the most challenging group of infants who require our attention in the neonatal intensive care unit...

..9). CONCLUSION: Higher pregravid BMI and parity seem to reduce the occurrence of SGA triplets. However, lean mothers, especially nulliparas, may be the most important target population for nutritional intervention in triplet pregnancies...

..To evaluate whether triplet- or singleton-specific growth standards should be used to define the growth restricted triplet fetus/neonate...

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..1-35, and )35%), and three types (according to the birth weight of the middle-sized triplet) of birth weight discordance in triplets...

..0-1.7 for twins and OR 1.5, 95% CI 0.9-2.3 for triplets. CONCLUSION: Complete course of antenatal corticosteroid therapy was independently associated with decreased risk for severe IVH in singleton and in multiple preterm VLBW infants...

..The "unnatural" connotation of a pregnancy at an advanced maternal age should be accepted as a consequence of the combined effect of social changes and medical progress and not as a counter-evolutionary phenomenon...

..CONCLUSIONS: The relationships support a model of two distinct growth periods for triplets: an age- and growth-promoting period until 33 weeks and an age-promoting growth-restricting period thereafter...

..We conclude that the site of cord blood sampling should be standardized and the umbilical artery should be sampled at a site nearest to the neonate...

..This study evaluates the impact of an average change in body mass index (BMI) during the first 16-25 weeks on outcomes of triplet pregnancies...

..Identification of this group is an imperative step in the management of birth weight discordance in twin gestations...

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..As long as the incidence of twins is not reduced, the decreasing incidence of higher-order multiples, per se, does not herald the end of the epidemic of multiple births...

..To examine if the recommended weight gain of >680 g/week during the first 24 weeks of pregnancy decreases the frequency of adverse birth weight outcomes in triplet mothers with a normal pregravid BMI...

..At the same time, it is unjustified to avoid assisted reproductive technologies because of potential adverse outcome, however necessary it is to acknowledge the risk of multiple births...

..It is necessary to provide these couples with detailed information on the risks of multiple pregnancy and birth...

..83.7%). CONCLUSIONS: Fetal risks associated with Warfarin anticoagulation during pregnancy have not been overestimated. Warfarin should not be given in cases where other anticoagulants do not increase the risk for the expecting mother...

..Our study supports a definite intrauterine effect of the male twin on birth weight of its female co-twin. This consequence may potentially be associated with fetal programming of adult disease...

..The five year survival in this series was 100%. Our study emphasizes the need for a prospective study to evaluate the value of adjuvant therapy in the various stages of these ovarian neoplasms...

..Although a tailored approach is required in the case of cord clamping, the balance of available data suggests that delayed cord clamping should be the method of choice...

..These results indicate that THF-gamma 2, a synthetic octapeptide, modulates the immune state and response of human umbilical cord blood lymphocytes...

..One of the most significant complications following genetic amniocentesis is rupture of membranes, reported to occur in 1.15-1.7% of cases. Management of such cases is controversial...

..8) vs 7.7 hours (2.9)). CONCLUSIONS: In women who undergo cervical ripening with a Foley catheter, augmentation of labour by oxytocin followed by amniotomy during active labour results in a lower rate of caesarean delivery for dystocia...

..Maternal and fetal complications rates appear to be currently lower than in the past. Given that relapse cannot be predicted, close surveillance during pregnancy is warranted...

..In five cases, the anomalous twin was selectively reduced by cord coagulation. All pregnancies ended with a phenotypically normal liveborn and all children are developing normally at 1-7 years of age...

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..CONCLUSIONS: The transition to parenthood following assisted reproduction is demanding for both parents of twins. In particular, first-time mothers may require qualified emotional support to facilitate adjustment to twin parenthood...

..Our findings suggest that it may be the size of largest triplet that determines the presence or absence or discordance in triplet gestations...

..Other factors might be involved in the outcome of ART multiple pregnancies...

..In the more advanced process that involves the umbilical cord, only the subset of separate dichorionic placentas confers this protective effect against the spread of inflammation...

..The purpose of this study was to evaluate whether ethnicity is associated with differences in perinatal outcome in randomly selected, matched-controlled Israeli Jewish and Muslim mothers of twins...

..Factors other than the initial number of embryos, maternal age, and IVF technique, such as embryo quality or uterine environment, might be involved in the outcome of multiple pregnancies in assisted reproductive technology procedures...

..The difference between the respective regressions was significant (p=0.03). We conclude that taller mothers deliver longer infants, irrespective of parity, whereas the effect of maternal height on the ponderal index is parity-dependent...

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..5, 95% CI 1.1-6.0), but this was observed in top-quality embryos only. CONCLUSION(S): Top-quality but not intermediate-quality ETs are associated with lower early spontaneous loss rates among twin pregnancies after IVF/ICSI...

..Case-control studies on plurality dependent spontaneous embryonic loss rates after assisted reproduction found that twin pregnancies have a two to five times lower miscarriage rate of the entire pregnancy compared with singletons...

..This similarity persisted when conventional IVF and IVF plus ICSI cases were separately evaluated...

..To evaluate the effect of the 2004 Italian regulations (insemination of <or=3 oocytes/cycle, transfer of all embryos, prohibition of embryo cryopreservation) on outcomes of assisted reproduction treatment (ART)...