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Diagnosis and Treatment of Twin Pregnancy

Published online by Cambridge University Press:  01 August 2014

Per-Håkan Persson  and
Lars Grennert
Per-Håkan Persson
Affiliation:
Diagnostic Ultrasound Laboratory, Department of Obstetrics and Gynecology, University Hospital, Malmö, Sweden
Lars Grennert
Affiliation:
Diagnostic Ultrasound Laboratory, Department of Obstetrics and Gynecology, University Hospital, Malmö, Sweden

Abstract

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Early detection is a prerequisite for the active management of twin pregnancy. Detection rate was not, or was only slightly, increased by improved anamnesis or more alert physical examination. General placental lactogen screening selected 95% of the twins but implied a subsequent ultrasonic screening examination of 16% of the pregnant population for the definitive diagnosis. A general screening programme with ultrasound detected 90% of the twin pregnancies (methodological error 1.7%; not participating 8%) in the mid-trimester. Extensive restriction of maternal physical activity from the 29th to the 36th gestational week by bed rest in hospital reduced perinatal mortality to the level of singletons and also decreased the incidence of neurological and mental handicap among the surviving twins. For the supervision of twin pregnancy, urinary estriol estimates predict birth weight rather than fetal distress. Monitoring with repeated ultrasonic biparietal diameter measurements seem limited in value; even large intertwin BPD differences are not indicators of fetal distress in the smallest twin. The decrease of perinatal mortality and morbidity among twins subjected to special antenatal supervision suggests that large gains can be made by early detection and antenatal hospitalization. The earlier finding that impairment of the intrauterine supply line is closely associated with neurological sequelae gives added importance to the reduction of CNS handicap and of growth-retarded fetuses observed during such a programme.

Keywords

Twin pregnancyUltrasoundEarly diagnosisMonitoringTreatment
Type
Session III: Management of Twin Pregnancy
Information
Acta geneticae medicae et gemellologiae: twin research , Volume 28 , Issue 4 , October 1979 , pp. 311 - 317
Copyright
Copyright © The International Society for Twin Studies 1979

References

REFERENCES

1. Bagger, P, Einerth, Y, Jacobson, K (1979): S-cystylaminopeptidas som screening för tvillingsgraviditet. Läkartidningen 76:418.Google Scholar
2. Brown, JB, MacLeod, SC, MacNeughtan, C, Smith, MA, Smyth, B (1968): A rapid method for estimating oestrogens in urine using as semi-automatic extractor. J Endocrinol 42:5.Google Scholar
3. Dohnt, M, Thiery, M, Vandekerckhove, D (1976): Hormonal screening for detection of twin pregnancies. Lancet 2:861.CrossRefGoogle Scholar
4. Duff, GB, Brown, JB (1974): Urinary oestriol excretion in twin pregnancies. J Obstet Gynaecol Br Commonw 81:695.Google Scholar
5. Gennser, G, Ohrlander, S, Eneroth, P (1977): Fetal Cortisol and the initiation of labour in the human. In “The Fetus and Birth,” Ciba Foundation Symposium 47:401.Google Scholar
6. Grennert, L, Persson, P-H, Gennser, G, Kullander, S (1976): Ultrasound and human-placental-lactogen screening for early detection of twin pregnancies. Lancet 1:4.CrossRefGoogle ScholarPubMed
7. Grennert, L, Persson, P-H, Gennser, G (1978): Intrauterine growth of twins judged by BPD measurements. Acta Obstet Gynaecol Scand Suppl 78:28. Google Scholar
8. Hagberg, G, Hagberg, B, Olow, I (1976): The changing panorama of cerebral palsy in Sweden 1954–1970. III. The importance of foetal deprivation of supply. Acta Paediatr Scand 65:403.CrossRefGoogle ScholarPubMed
9. Ho, SK, Wu, PK (1975): Perinatal factors and neonatal morbidity in twin pregnancy. Am J Obstet Gynecol 122:979.CrossRefGoogle ScholarPubMed
10. Jovanovic, L, Landesman, R, Saxena, B (1977): Screening for twin pregnancy. Science 198:738.Google Scholar
11. Koivisto, M, Jouppila, P, Kauppila, A, Moilanen, J, Ylikorkala, (1975): Twin pregnancy. Neonatal morbidity and mortality. Acta Obstet Gynecol Scand Suppl 44:21.Google Scholar
12. Lidbjörk, G, Kjessler, B, Johansson, SGO (1977): Alfa-fetoprotein levels in maternal serum in early multiple pregnancy. Acta Obstet Gynecol Scand 69:45.Google Scholar
13. MacGillivray, J, Campbell, D, Duffus, GM (1971): Maternal metabolic response to twin pregnancy in Primigravidae. J Obstet Gynecol Br Commonw 78:530.Google Scholar
14. Minogue, M (1974): A review of twin pregnancies. National Maternity Hospital (1967–1971). J Irish Med Assoc 67:181.Google Scholar
15. Morris, N, Osborn, SB, Wright, HP (1955): Effective circulation of the uterine wall in late pregnancy measures with 24NaCl. Lancet 1:323.Google Scholar
16. Morrison, J, Kohorn, EI, Blackwell, RJ (1970): Ultrasonic scanning in obstetrics for the diagnosis of multiple pregnancy. Aust NZ J Obstet Gynaecol 10:4.Google Scholar
17. Persson, P-H, Grennert, L, Gennser, G (1978): Impact of fetal and maternal factors on the normal growth of the biparietal diameter. Acta Obstet Gynecol Scand Suppl 78:21.Google Scholar
18. Persson, P-H, Grennert, L, Gennser, G (1978): Diagnosis of intrauterine growth retardation by serial ultrasonic cephalometry. Acta Obstet Gynecol Scand Suppl 78:40.Google Scholar
19. Persson, P-H, Grennert, L, Gennser, G, Kullander, S (1979): On improved outcome of twin pregnancies. Acta Obstet Gynecol Scand 58:3.CrossRefGoogle ScholarPubMed
20. Sabel, KG, Olegård, R, Victorin, L (1976): Remaining sequelae with modern perinatal care. Pediatrics 57:652.CrossRefGoogle ScholarPubMed
21. Stewart, AL, Reynolds, EOR (1974): Improved prognosis for infants of very low birth weight. Pediatrics 54:724.Google Scholar
22. Sundén, B (1965): Ultrasound in the diagnosis of twins and hydramnios. J Obstet Gynecol Br Commnw 72:952.Google Scholar
23. Unnérus, C-E (1959): Heart volume and prematurity. Acta Obstet Gynecol Scand 38:340.CrossRefGoogle ScholarPubMed
24. Weller, PH, Jenkins, PA, Gupta, J, Baum, JD (1976): Pharyngeal lecithin/sphingomyelin ratios in newborn infants. Lancet 1:12.Google Scholar
25. Westin, B (1977): Gravidogram and fetal growth. Acta Obstet Gynecol Scand 56:273.Google Scholar