The aim of the study was to compare a variety of neonatal outcome variables of growth concordant twin gestations (CT) to that of growth discordant twins (DT). Maternal and neonatal charts of live, non-anomalous twins > 25 weeks' gestation from 1984-2000 with no evidence of twin-twin transfusion syndrome were reviewed for several variables. DT occurred in (N = 81) 11.9% of all twin pregnancies. In 61.7% of DT, twin B was the smaller of the twins. There was no difference in maternal age, admission indications, or antepartum complications between both groups. DT had a significantly higher incidence of growth restriction compared to CT (88.9% vs 43.5%, p < 0.001). More mothers of DT required oxytocin (37.0% vs 26.3%, p = 0.024); however, cesarean delivery rate and indications were similar in both groups. A similar percentage of infants had AS < 4 at 1 min and AS < 7 at 5 min in both groups. There was no difference between the 2 groups in neonatal complications including: trauma, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, pneumonia, seizures, or neonatal mortality. However, DT had a significantly higher incidence of hyperbilirubinemia, need for mechanical ventilation and a longer nursery stay. The neonatal outcome of growth discordant twins is worse than that of concordant twins even in pregnancies uncomplicated by twin-twin transfusion syndrome or congenital anomalies.
A case of pregnancy in a rudimentary uterine horn is presented. The pregnancy ended in fetal demise at the end of the second trimester. The diagnosis was missed by ultrasonography on two occasions and was made only at laparotomy following failure to initiate uterine contractions. Histologic examination of the myometrium of the rudimentary horn revealed extensive interstitial fibrosis. A high index of suspicion of pregnancy in a rudimentary horn is recommended whenever adequate ecbolic infusions fail to induce myometrial contractions.
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