Second-Trimester Asynchronous Multifetal Delivery Results in Poor Perinatal Outcome

Livingston, Jeffrey; Livingston, Lisa; Ramsey, Risa; Sibai, Baha M.

doi:10.1097/01.aog.0000103995.79536.9c

Cited by 26 publications

(27 citation statements)

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Section: Discussionmentioning

confidence: 96%

“…Livingston et al 8 reported five cases of triplet pregnancies, and in all but one case the first born did not survive. There was 60% survival in retained siblings, all had major sequelae from prematurity 8. No evidence of infection or periventricular leucomalacia was found postnatally in the infants of our case, which is likely to have contributed to their good outcomes.…”

Section: Discussionmentioning

confidence: 96%

“…Of 26 couples counselled by Arabin, none declined an attempt at delayed interval delivery, despite being advised of the known risks 1. In the series by Livingston,8 two of 14 couples declined.…”

Section: Discussionmentioning

confidence: 99%

“…Risk of adverse maternal outcomes is likely to be around 50% Arabin1 50%, Faroukh5 37% and Livingston8 57%. In our case there was no evidence of maternal complications.…”

Section: Discussionmentioning

confidence: 99%

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Delayed interval delivery in a triplet gestation

2012

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A 27-year-old Ghanaian primigravida with a known triamniotic trichorionic triplet pregnancy presented at 17 weeks gestation following a miscarriage of one triplet at home. Examination and investigation revealed no signs of imminent delivery or infection. After careful counselling with regard to prognosis and options available for management, the couple opted for intervention including rescue cerclage. The patient received antibiotic prophylaxis for five days and daily progesterone suppositories until delivery. An ultrasound scan was performed every three weeks to monitor fetal growth and cervical length. At 24 weeks corticosteroids for fetal lung maturity were given. At 31 weeks gestation she experienced spontaneous rupture of membranes followed by active labour and forceps delivery. There were no maternal complications. Both babies were born in a good condition, but required ventilatory support for 72 h.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

“…Risk of adverse maternal outcomes is likely to be around 50% Arabin1 50%, Faroukh5 37% and Livingston8 57%. In our case there was no evidence of maternal complications.…”

Section: Discussionmentioning

confidence: 99%

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Delayed interval delivery in a triplet gestation

2012

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“…Several studies have shown that delayed interval delivery can improve neonatal outcome when retained fetuses are compared with firstborn fetuses [21,22,23,24,25,26,27,28]. These data indicate that delayed interval delivery may improve neonatal outcome, although there is still a considerable number of neonatal and maternal complications to be expected [29]. …”

Section: Discussionmentioning

confidence: 99%

Lipopolysaccharide-Induced Chorioamnionitis Is Confined to One Amniotic Compartment in Twin Pregnant Sheep

et al. 2012

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Background: Chorioamnionitis is a major risk factor for preterm birth in multifetal pregnancies. However, there is little clinical data whether chorioamnionitis is restricted to one amniotic compartment in multifetal pregnancies. Objective: To explore whether chorioamnionitis is confined to the exposed compartment and does not cross to the unaffected fetus in twin pregnancy. Methods: In twin pregnant sheep, one of the twins was exposed to either 2 or 14 days of intra-amniotic lipopolysaccharide (LPS) while the co-twin was exposed to either 2 or 14 days of intra-amniotic saline (n = 3 for each exposure). Singletons were included in this study to compare the grade of inflammation with twins. All fetuses were delivered at 125 days of gestation (term = 150 days). Chorioamnionitis was confirmed by histological examination. Lung inflammation was assessed by cell count in bronchoalveolar lavage. Lung compliance was assessed at 40 cm H₂O. Results were compared using analysis of variance (ANOVA) with a post-hoc Tukey analysis. Results: Inflammation in placenta, membranes and lung of LPS-exposed twins was significantly higher after 2 and 14 days of exposure when compared to the saline-exposed co-twins. Lung compliance in LPS-exposed twins was significantly increased after 14 days when compared to saline-exposed co-twins. Intrauterine LPS exposure increased lung compliance and inflammation in the membranes, placenta and lung to the same extent in twins as in singletons. Conclusion: In twin pregnant sheep, inflammation of the membranes, placenta and fetal lung was strictly limited to the exposed fetus in the amniotic compartment in which the LPS was injected.

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