The clinical outcome of preterm premature rupture of membranes in twin versus singleton pregnancies

Initial findings of panic disorder as an independent risk factor for suicidal ideation and behavior could not be replicated in studies with psychiatric patients. Instead, it was concluded that panic and anxiety disorders are risk factors when they co-occur with a primary mood disorder. In the present study, the effect of diagnostic comorbidity on rates of suicidality is analyzed on depressive inpatients treated at special depression wards. In a prospective follow-up study, suicidality and anxiety were assessed by means of a modified German version of the Diagnostic Interview Schedule (DIS). Patients with the symptom of panic attacks showed significantly elevated lifetime prevalence rates of suicidality in comparison with patients who did not report this additional symptom. For the follow-up period, however, there were no significant differences between these two groups. According to these results, the group of depressives with additional panic attacks is not more at risk for suicidal behavior, after being treated in an adequate manner.     

The effect of smoking cessation during pregnancy on preterm delivery and low birthweight

BACKGROUND: Evidence exists that maternal cigarette smoking is associated with preterm birth. Our purpose was to investigate the relation between maternal smoking cessation at different points during pregnancy and the preterm delivery rate and low birthweight. METHODS: Data from the 1988 National Health Interview Survey were analyzed. The study included women who gave birth to children within 6 years of the 1988 interview date (N = 4876). Preterm delivery and infant low birthweight were the main outcome measures. These measures were compared with maternal smoking status during pregnancy. Logistic regression models were computed to control for maternal age at the time of birth, parity, race, and total family income. RESULTS: Women who did not smoke cigarettes during pregnancy were less likely to give birth prematurely (5.9% vs 8.2%, P = .003) or give birth to a low-birthweight baby (5.5% vs 8.9%, P < .001) than women who smoked at some time during the year before giving birth. A significant association existed between maternal smoking status and both preterm delivery and low birthweight. Compared with those who smoked beyond the first trimester, those who quit smoking within the first trimester had reductions in the proportion of preterm deliveries (6.7% vs 9.1%) and low birthweight infants (7.9% vs 9.6%). CONCLUSIONS: Low birthweight and preterm delivery are reduced in women who stop smoking in the first trimester of pregnancy.     

Delayed-interval delivery in a quadruplet pregnancy after intrauterine death of a partial molar pregnancy and preterm delivery. A case report

BACKGROUND: Delayed-interval delivery is infrequent in twin gestation and more rare in triplet and quadruplet gestation. Coexistence of a triploid pregnancy with a normal fetus has not previously been reported to have resulted in survival of the normal fetus. CASE: A 26-year-old woman, gravida 2, para 0-0-1-0, was diagnosed with a quadruplet pregnancy. At 16 1/2 weeks' gestation she developed preeclampsia and severe hyperemesis. Ultrasound was consistent with partial molar pregnancy in quadruplet D. Quadruplet D died in utero, and the preeclampsia and hyperemesis resolved. At 19 5/7 weeks, spontaneous rupture of the membranes and preterm labor occurred, and quadruplet A, stillborn female weighing 260 g, was delivered. With the use of antibiotic therapy, tocolysis and bed rest, the remaining two fetuses were maintained in utero until 32 6/7 weeks' gestation, when quadruplet B, a 1,470-g female, and quadruplet C, a 1,700-g female, were delivered. CONCLUSION: This was the first reported case of surviving fetuses coexisting with a partial molar pregnancy. This case was also complicated by preterm delivery and successful delayed-interval birth in a quadruplet pregnancy.     

Early prenatal direct gene diagnosis of cystic fibrosis in a twin pregnancy and subsequent selective termination

This study was designed to demonstrate a role of serotonin in the anticonvulsant effect of fluoxetine, a serotonin reuptake inhibitor, in genetically epilepsy-prone rats. When varied doses of 5-hydroxytryptophan (12.5, 25, 50 mg/kg) were administered i.p. along with a fixed dose of fluoxetine (15 mg/kg) to severe seizure genetically epilepsy-prone rats, the severity of audiogenic seizures was decreased dose-dependently, and the combination treatment also produced a marked potentiation of the anticonvulsant effect when compared with administration of either drug alone. Pretreatment of severe seizure genetically epilepsy-prone rats with p-chlorophenylalanine depleted brain serotonin and reduced the anticonvulsant effectiveness of fluoxetine. By using intracerebral microdialysis, the depletion of serotonin after p-chlorophenylalanine treatment was confirmed by measuring thalamic extracellular serotonin and 5-hydroxyindoleacetic acid concentrations during basal release and in response to a challenge dose of fluoxetine. We concluded that serotonergic transmission may be involved in the anticonvulsant effect of fluoxetine in severe seizure genetically epilepsy-prone rats.     

Influence of mode of delivery on twin births

One of the most deleterious side effects of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) is gastric injury. In order to prevent this, attempt has been made to make novel nitric oxide (NO) releasing NSAIDs. The NO-releasing moiety (nitroxybutylester), which is combined with NSAIDs, has been shown to be responsible for gastrointestinal protection. Various NO-releasing NSAIDs have been compared with their parent compounds and marked decrease in gastrointestinal side effects were observed in the former case. Various animal studies have been done in this context. However, exact mechanism of action of NO-releasing NSAIDs is not clear.     

Spread of spinal anaesthesia for caesarean section in singleton and twin pregnancies

We have compared the spread of spinal anaesthesia in parturients with singleton and those with twin pregnancies. Fifty-five unpremedicated patients with uncomplicated pregnancy scheduled for Caesarean section were allocated to two groups: group I = 35 singleton mothers; group II = 20 with twin pregnancy. Both groups received spinal anaesthesia with hyperbaric bupivacaine 10 mg (2 ml of 0.5%). Mean birthweight was 3290 (SD 452) g and 5008 (495) g in groups I and II (combined birthweights), respectively. We found a statistically significant difference in onset and maximal cephalad spread of spinal anaesthesia (group I median T5, range T8-T4; group II T3, range T6-T2). The mechanisms of higher cephalad spread of spinal anaesthesia in parturients may be a decrease in cerebrospinal fluid volume secondary to shunting of blood from the obstructed inferior vena cava to the extradural venous plexus and increased nerve sensitivity to local anaesthetics because of increased concentrations of progesterone. The twin pregnancy group had heavier, larger uteri and greater daily production of progesterone.     

Effects of prior cocaine exposure on subsequent neuronal responsiveness

In vivo electrophysiological experiments were conducted to examine the responses of single, spontaneously-active neostriatal neurons to repeated cocaine exposure. The second of two administrations in a 30 min interval, attenuated the magnitude and duration of cocaine-induced depression in discharge rate, and enhanced the same variables for cocaine-evoked excitation. These findings indicate that the responsiveness of striatal neurons to cocaine may vary predictably as a function of previous exposure.     

Abnormal twin pregnancy--early resorption of a single fetus in a twin pregnancy pregnancy]

INTRODUCTION: Twin pregnancy presents a condition of development of two fetuses in the uterus and can be monozygotic (single ovum) and dizygotic (two ova). In case of fertilization and segmentation of one ovum monozygotic twins are produced, while in case of fertilization of two ova, which can originate from one or two Graff follicles, dizygotic twins are developed. The ratio of twin and single pregnancies is 1:89 (according to Hellin's law) (1). The incidence of twin and other multiple pregnancies is influenced by: race of parents, age and parity of mother, use of clomid and gonadotrophin to stimulate ovulation, discontinued use of contraceptive pills and certain seasons (exposure to sunlight) (1). Due to occurrence of numerous complications twin pregnancy and parturition are considered to be highly risky. This is supported by clinical data on more frequent spontaneous abortions--especially in monozygotic pregnancies, hypertension in pregnancy, hemorrhage of various etiologies, anemias, early rupture of amniotic membranes, hydramnios, premature deliveries, etc. Nowadays diagnosis of both twin and other multiple pregnancies in the early stage is required, in order to establish normal or pathological development of such pregnancies. As early as 6 gestation week in twin pregnancies it is possible to sonographically visualize two gestation sacs in the uterus, while in 7-8 gestation weeks it is possible to see two embryos with evidence of fetal heart rate. In early pregnancy a differentially-diagnosed uterus may be clinically enlarged due to: hydratidaform mole, uterine mioma or ovarian cyst. In later gestation confirmation of twin pregnancy is possible by clinical and sonographic examination and biochemical analyses (elevated values of HPL and -fetoprotein) and less frequently, by x-ray. Repeated sonographic examinations can reveal the following anomalies of twin pregnancies: one normal pregnancy with one sac containing no embryo, one sac containing no embryo and one sac with a dead fetus, fetuses without vitality in both gestation sacs, two ultrasound echoes from which only one normal fetus and one dead mummified fetus (fetus papiraceus) result within the uterus. One gestation sac may be resorbed during pregnancy, while the undamaged fetus continues to develop normally in the uterus. In certain cases the loss of one fetus is not accompanied by any clinical symptoms, and in others this can be accompanied by light hemorrhage. An initial twin pregnancy after the loss of one twin may end by a birth of one healthy infant. CASE REPORT: A patient aged 35 years, came for gynecological examination due to missed menstruation. Ananmesis showed that she had a nascent uterine myoma which was removed by myomectomy six months earlier, had one parturition four years earlier, and no abortions. The last menstrual period was on February 12, 1991. Clinical examination showed a somewhat larger uterus than would be normal for amenorrhea of 9-gestation week. By sonographic examination two regular gestation sacs were found in the uterus with fetal echoes present as well as heart rate in both fetuses (Figure 1). Embryo measurements were as follows: Fetus 1-CRL-22.5 mm, NEG-8 + 4, heart rate present. Fetus 2-CRL-23.6 mm, NEG-9, heart rate present (Figure 2). The patient was cautiously informed that two fetuses are visible in the uterus and that this is a sign of twin pregnancy, but for certain diagnosis a control examination was scheduled two weeks later. The sonographic examination after 14 days later showed discord in fetal growth (Figure 3). Embryo measurement in 11-gestation week rendered the following parameters: Fetus 1-CRL-22.8 mm, NEG 8 + 6, no heart rate registered (Figure 4), while the second fetus continued to develop and had the following characteristics: Fetus 2-CRL-50.5 mm, NEG 11 + 4, heart rate and fetal movement registered (Figure 5). During entire pregnancy the patient suffered no pain or any kind of hemorrhage. She took no drugs. (ABST     

Effects of prior group memberships on subsequent reconnaissance activities.

1,134 college freshmen completed an orientation questionnaire assessing their experiences in high school groups and expectations about college groups. 220 Ss were also interviewed later about their behavior toward campus groups at an activities fair. Ss whose experiences in high school groups were more positive tried harder to identify potentially desirable college groups, primarily because they believed that belonging to such groups would be useful for achieving personal goals. Ss with prior experience in relevant high school groups used that experience to evaluate similar college groups and thus made more realistic (less optimistic) evaluations of those groups than did Ss without prior experience. Among Ss who wanted to join a college group, those who had belonged to a relevant high school group behaved differently at the activities fair than did those who had not. Ss with prior experience were more likely to approach their chosen group at the activities fair and to avoid other groups there of a similar sort. (52 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of the expressive communication skills of triplet, twin and singleton children

Few studies have focused on the language acquisition of higher multiple birth sets. In this study, the communication skills of 51 triplet children are described. The measures used were: mean length of utterance; type-token ratio; conversational acts; phoneme repertoire; and number of different types of phonological processes used. The data gained were used to compare the communication skills of triplets with those of twins, singletons and normative data available in the literature. Siblings within triplet sets were also compared using language samples obtained from adult-child interactions and when the three children were playing together. The results indicated that the triplets' early communication skills were different from those of both singletons and twins. The triplets' difficulties included delayed syntactic development, limited use of different language functions and delayed phonological development. In contrast, twins' communication profile is characterised by disordered phonological development.     

Successful twin pregnancy and delivery following free rectus abdominis muscle flap at 15 weeks gestational age

Although a vertical rectus abdominis flap would not have been selected for reconstruction of the patient's defect had her pregnancy been detected preoperatively, the present case does demonstrate the remarkable resiliency and integrity of the anterior abdominal wall after rectus abdominis muscle flap surgery. Meticulous closure of the abdominal wall is of utmost importance in maintaining abdominal wall competence. Although the merits of muscle splitting techniques and the use of mesh are beyond the scope of this report, there is no evidence that modification of technique should be performed in the patient considering future pregnancy. Our case supports other reports that rectus abdominis flap surgery is not a contraindication to future pregnancy. Intuitively waiting at least 1 year, as recommended by Chen et al., seems reasonable, although the present case demonstrated a successful pregnancy and delivery of twins after a vertical rectus abdominis flap was harvested during pregnancy.     

Maternal hematologic changes during pregnancy and the effect of iron status on preterm delivery in a West Los Angeles population

This study was conducted to document the prevalence of anemia and high hematocrit during pregnancy and examine their effect on delivering preterm in a predominantly Hispanic population. The sample consisted of women receiving prenatal care from the public health clinics in the West Los Angeles from 1983 to 1986 (n = 7589). Multivariate logistic regression was used to isolate the role of anemia and high hematocrit from other factors that may influence birth outcome. The prevalence of anemia was approximately 9% at the initiation of prenatal care and at 28-32 weeks' gestation. Only anemia at 28-32 weeks was significantly associated with a preterm birth, even after adjusting for several confounders [Adjusted Odds Ratio (AOR) 1.83 95% Cl = 1.21, 2.77]. A high hematocrit that occurred in 9.6% of the population at 28-32 weeks was inversely associated with a preterm birth (AOR 0.78, 95% Cl = 0.44, 1.39). There was little differentiation of these risk factors when analyzing the etiological pathways of a preterm birth. These results indicate for the first time in a predominantly Hispanic population that despite routine iron supplementation, anemia still occurs in pregnant women and it can predict a preterm delivery.     

A cohort study of pregnancy outcome after amniocentesis in twin pregnancy

We conducted a retrospective cohort study to assess the risk of amniocentesis in twin pregnancy for adverse outcomes. The study base consisted of women who had an amniocentesis performed during twin pregnancy and a comparison representative sample of women who carried a twin pregnancy, but did not have invasive prenatal diagnosis. The 227 women in each of the exposed and non-exposed groups were residents of the state of New South Wales, Australia, over the period 1980-92, and were matched on maternal age and period of the infant's birth. Nearly 10% of twin pregnancies among the women having an amniocentesis were affected by a stillbirth, and the stillbirth rate among exposed fetuses (5.3%) was nearly twice as high as among non-exposed fetuses (3.1%). After adjustment for confounding and excluding abnormalities, there was a non-significant elevated relative risk of stillbirth after exposure to amniocentesis. The analysis by type of amniocentesis (with and without methylene blue dye) was limited by small numbers, but the burden of risk was primarily among women who had dye exposure during amniocentesis (relative risk = 3.64, 95% confidence interval = 1.15, 11.48). This increase remained after adjusting for confounding, although the confidence interval was wide. In conclusion, we were unable to establish with certainty whether an increased risk of stillbirth could be ruled out among women who had any type of amniocentesis in twin pregnancy.     

The significance of appendectomy for appendicitis on subsequent fertility

A study was undertaken to determine fertility in a group of females who as children had been operated on for appendicitis. The 134 women operated on for appendicitis were reviewed. Their ages ranged from 2-18 years at the time of appendectomy. Our data show that perforated appendicitis before puberty has little if any role in the etiology of tubal infertility.     

Influence of chemotherapy for gestational trophoblastic disease on subsequent pregnancy outcome

The aim of this study was to determine the influence of cytotoxic chemotherapy on subsequent reproductive performance. Details of post-treatment reproductive intent and outcome were requested from 1211 survivors registered at The Charing Cross Hospital gestational trophoblastic disease centre; a response rate of 96% was achieved. Seven hundred and twenty-eight women had tried to become pregnant; 607 reported at least one live birth, 73 conceived but had not registered a live birth, and 48 did not conceive. No differences were apparent between the 392 women who received methotrexate as single agent chemotherapy and the 336 treated with multi-agent chemotherapy. Women who had registered a live birth were younger (P < 0.0001) and the duration of follow up was significantly less among those who did not achieve pregnancy at all (P < 0.0003). A higher than expected rate of caesarean section and stillbirth was recorded. The chemotherapy protocols used by this unit have minimal impact on the subsequent ability to reproduce.     

Facilitative and disruptive effects of prior exposure to shock on subsequent avoidance performance.

Subjected 40 male rats from each of 5 strains to 10 signaled inescapable 1-ma shock presentations. Shock facilitated subsequent 1-way and shuttle-avoidance performance (1-ma shock) in Charles River hooded, Wistar, Holtzman, and Sasco Ss, but did not significantly affect avoidance learning in Sprague-Dawley Ss. A 2nd experiment employing 120 male Holtzman rats indicated that inescapable shock of 1 ma. facilitated subsequent 1-way and shuttle-avoidance performance, while exposure to shock of 2 ma. facilitated 1-way and interfered with shuttle-avoidance performance. Movement ratings recorded during both CS and intershock intervals in pretraining were found to be good predictors of subsequent avoidance performance in preshocked Ss. Results are interpreted in terms of response repertoire changes produced by shock in conjunction with the defense reaction necessary in acquiring the avoidance response. (22 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social groups and prevention of preterm births in a population of twin mothers

Prenatal care was equally distributed to all twin pregnant women of the district of Haut de Seine in France in 1989-91, without differences by socio-economic level. No difference in rates of preterm births and very early preterm births (26-31 weeks) was measured by socioeconomic level among twin pregnancies.     

Actively continued twin pregnancy with intrauterine death of one fetus

A case of twin pregnancy with intrauterine death of one fetus in the 28 th week of pregnancy been described. The pregnancy was actively continued. The following procedure was introduced: 1. Tocolysis, 2. Drugs accelerating lung maturation of the alive fetus, 3. Antinfectious and anticoagulopathy prophylaxis, 4. Special care of the mother and the alive fetus. In the 30 th week of pregnancy spontaneus labor occurred "per via naturales". The macerated dead fetus and the alive premature newborn were born. The baby was charged home in good condition in the 45 th day after delivery.     

Neonatal outcome depending on the mode of delivery and fetal presentation in twin gestation

A retrospective analysis of 301 twin deliveries managed at The Second Department of Obstetrics and Gynecology, Warsaw Medical Academy, from January 1, 1986 to December 31, 1995 was undertaken in order to investigate the impact of the mode of delivery and twin presentation on neonatal outcome. Vertex presentation of both twins was the most common with an incidence of 47.5% followed by vertex-non-vertex (27.6%) and nonvertex presentation of the first twin (24.9%). 186 (61.8%) patients delivered vaginally, while 115 (38.2%) women underwent caesarean section including 6 operations performed after the vaginal delivery of the first twin. In vertex presentation of the first twin and breech second twin there was no significant difference in neonatal outcome measured by 5-minute Apgar score and birth trauma incidence between second twins delivered vaginally and second twins delivered by caesarean section. Vaginal delivery with internal podalic version of the second twin in vertex-transverse presentations was related to increased risk of lower 5-minute Apgar score and increased risk of birth trauma occurrence compared to caesarean section. Time interval between vaginal delivery of twins had no significant impact on neonatal outcome.