MANAGEMENT OF PREGNANCY AND DELIVERY IN MULTIPLE PREGNANCY

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Abstract

The problem of multiple pregnancy management is of scientific and pragmatic interest, because in the last years, there is an increase of numbers of multiple pregnancies, especially due to wider use of assisted reproductive technologies. As a female organism has been evolutionally adapted to carriage of a single fetus, the multiple pregnancy is a classic model of fetoplacental insufficiency. Multiple pregnancy is a high risk pregnancy, with a high percentage of preterm deliveries, high perinatal mortality and infant morbidity. In pregnancy with two and more fetuses a certain observational algorithm is necessary that would allow timely performing of diagnostic and treatment activities, as well as taking adequante strategic decisions to ensure prolongation of pregnancy. The review deals with literature data summarizing a many years’ international experience of management of women with multiple pregnancies, as well as the results of the author’s own studies.

About the authors

V. I. Krasnopol'skiy

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Email: fake@neicon.ru

MD, PhD, Academician of Russian Academy of Sciences, Director

Россия

S. V. Novikova

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Author for correspondence.
Email: sv_novikova@list.ru

MD, PhD, Head of Observational Obstetric Department

Россия

E. B. Tsivtsivadze

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Email: fake@neicon.ru

PhD, Research Fellow, Observational Obstetric Department

Россия

A. A. Zharova

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Email: fake@neicon.ru

PhD, Junior Research Fellow, Observational Obstetric Department

Россия

References

  1. Кэмпбелл С, Лиз К, ред. Акушерство от десяти учителей. М.: МИА; 2004. 464 c. (Campbell S, Lees C, editors. Obstetrics by ten teachers. Moscow: MIA; 2004. 464 p. Russian).
  2. Kline-Fath BM, Calvo-Garcia MA, O'Hara SM, Crombleholme TM, Racadio JM. Twin-twin transfusion syndrome: cerebral ischemia is not the only fetal MR imaging finding. Pediatr Radiol. 2007;37(1):47–56.
  3. Краснопольский ВИ, Новикова СВ, Капустина МВ, Титченко ЛИ, Аксенов АН, Жарова АА. Современные проблемы многоплодной беременности. Российский вестник акушера-гинеколога. 2009;(2):79–82. (Krasnopol'skiy VI, Novikova SV, Kapustina MV, Titchenko LI, Aksenov AN, Zharova AA. [Current problems of multiple pregnancy]. Rossiyskiy vestnik akushera-ginekologa. 2009;(2):79–82. Russian).
  4. Botting BJ, Davies IM, Macfarlane AJ. Recent trends in the incidence of multiple births and associated mortality. Arch Dis Child.
  5. ;62(9):941–50.
  6. Kamat S, Veena P, Rani R. Comparison of nifedipine and progesterone for maintenance tocolysis after arrested preterm labour. J Obstet Gynaecol. 2014;34(4):322–5.
  7. Levine D. Case 46: encephalomalacia in surviving twin after death of monochorionic cotwin. Radiology. 2002;223(2):392–5.
  8. Rode L, Tabor A. Prevention of preterm delivery in twin pregnancy. Best Pract Res Clin Obstet Gynaecol. 2014;28(2):273–83.
  9. Aziz S, Soomro N. Twin births and their complications in women of low socioeconomic profile. J Pak Med Assoc. 2012;62(11):1204–8.
  10. Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev. 2009;(1):CD004661.
  11. Sebire NJ, Snijders RJ, Hughes K, Sepulveda W, Nicolaides KH. The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynaecol. 1997;104(10):1203–7.
  12. Shek NW, Hillman SC, Kilby MD. Single-twin demise: pregnancy outcome. Best Pract Res Clin Obstet Gynaecol. 2014;28(2):249–63.
  13. Lee H, Wagner AJ, Sy E, Ball R, Feldstein VA, Goldstein RB, Farmer DL. Efficacy of radiofrequency ablation for twin-reversed arterial perfusion sequence. Am J Obstet Gynecol. 2007;196(5):459.e1–4.
  14. Lewi L, Jani J, Blickstein I, Huber A, Gucciardo L, Van Mieghem T, Done E, Boes AS, Hecher K, Gratacos E, Lewi P, Deprest J. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. Am J Obstet Gynecol. 2008;199(5):514.e1–8.
  15. Lutfi S, Allen VM, Fahey J, O'Connell CM, Vincer MJ. Twin-twin transfusion syndrome: a population-based study. Obstet Gynecol. 2004;104(6):1289–97.
  16. Chang YL. Fetoscopic laser therapy for twintwin transfusion syndrome. Taiwan J Obstet Gynecol. 2006;45(4):294–301.
  17. Chescheir NC. Twin-to-twin transfusion syndrome: a model for the fetal origins of adult health. Paediatr Perinat Epidemiol. 2005;19 Suppl 1:32–6.
  18. Yamasmit W, Chaithongwongwatthana S, Tolosa JE, Limpongsanurak S, Pereira L, Lumbiganon P. Prophylactic oral betamimetics for reducing preterm birth in women with a twin pregnancy. Cochrane Database Syst Rev. 2012;9:CD004733.
  19. Ариас Ф. Беременность и роды высокого риска. М.: Медицина; 1989. 656 c. (Arias F. High-risk pregnancy and delivery.
  20. Moscow: Meditsina; 1989. 656 p. Russian).
  21. Naeye RL, Tafari N, Judge D, Marboe CC. Twins: causes of perinatal death in 12 United States cities and one African city. Am J Obstet Gynecol. 1978;131(3):267–72.
  22. Rock JА. Surgery for anomalies of the mullerianducts. In: Rock JA, Thompson JD, editors. The Linde’s operative gynecology. 8th ed. Philadelphia: Lippincott-Raven; 1997. p. 687–729.
  23. Klauser CK, Briery CM, Keiser SD, Martin RW, Kosek MA, Morrison JC. Effect of antenatal tocolysis on neonatal outcomes. J Matern Fetal Neonatal Med. 2012;25(12):2778–81.
  24. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75–84.
  25. Lang CT, Iams JD. Goals and strategies for prevention of preterm birth: an obstetric perspective. Pediatr Clin North Am. 2009;56(3):537–63. 24. Blickstein I, Keith LG. Multiple gestations. Obstet Gynecol Clin North Am. 2005;32(1): xiii–xiv.
  26. Akbar M, Ikram M, Talib W, Saeed R, Saeed M. Foetus papyraceus: demise of one twin in second trimester with successful outcome in second twin at term. Professional Med J. 2005;12(3):351–3.
  27. Salvat J, Schmidt MH, Guilbert M, Martino A. Vascular ligation for severe obstetrical hemorrhage: review of the literature. J Gynecol Obstet Biol Reprod (Paris). 2002;31(7):629–39.
  28. Clerici G, Luzietti R, Di Renzo GC. Monitoring of antepartum and intrapartum fetal hypoxemia: pathophysiological basis and available techniques. Biol Neonate. 2001;79(3-4):246–53.
  29. Boente Mdel C, Frontini Mdel V, Acosta MI, Saleme C, Barrionuevo S, Asial R. Extensive symmetric truncal aplasia cutis congenita without fetus papyraceus or macroscopic evidence of placental abnormalities. Pediatr Dermatol. 1995;12(3):228–30.
  30. Quintero RA, editor. Twin-twin transfusion syndrome. New York: Informa Healthcare; 2007. 256 p.
  31. Kaufman HK, Hume RF Jr, Calhoun BC, Carlson N, Yorke V, Elliott D, Evans MI. Natural history of twin gestation complicated by in utero fetal demise: associations of chorionicity, prematurity, and maternal morbidity. Fetal DiagnTher. 2003;18(6):442–6.
  32. Alfirevic Z, Allen-Coward H, Molina F, Vinuesa CP, Nicolaides K. Targeted therapy for threatened preterm labor based on sonographic measurement of the cervical length: a randomized controlled trial. Ultrasound Obstet Gynecol. 2007;29(1):47–50.
  33. Conde-Agudelo A, Romero R, Hassan SS, Yeo L. Transvaginal sonographic cervical length for the prediction of spontaneous preterm birth in twin pregnancies: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010;203(2):128.e1–12.
  34. Royal College of Obstetricians and Gynaecologists. Management of monochorionic twin pregnancy. Green-top Guideline. 2008;51. Available from: http://www.rcog.org.uk/globalassets/documents/guidelines/t51managementmonochorionictwinpregnancy2008a.pdf
  35. Ходжаева ЗС, Сидельникова ВМ. Эффективность применения новых диагностических тестов для определения начала родовой деятельности и несвоевременного излития околоплодных вод. Вопросы гинекологии, акушерства и перинатологии. 2007;6(1):47–50. (Khodzhaeva ZS, Sidel'nikova VM. [Efficacy of using new diagnostic tests to determine the onset of labor and premature discharge of the amniotic fluid]. Voprosy ginekologii, akusherstva i perinatologii. 2007;6(1):47–50. Russian).
  36. Leitich H, Brunbauer M, Kaider A, Egarter C, Husslein P. Cervical length and dilatation of the internal cervical os detected by vaginal ultrasonography as markers for preterm delivery: a systematic review. Am J Obstet Gynecol. 1999;181(6):1465–72.
  37. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006;(3):CD004454.
  38. Lasswell SM, Barfield WD, Rochat RW, Blackmon L. Perinatal regionalization for very lowbirthweight and very preterm infants: a metaanalysis. JAMA. 2010;304(9):992–1000.
  39. Conde-Agudelo A, Romero R. Antenatal magnesium sulfate for the prevention of cerebral palsy in preterm infants less than 34 weeks' gestation: a systematic review and metaanalysis. Am J Obstet Gynecol. 2009;200(6):595–609.
  40. Doyle LW. Antenatal magnesium sulfate and neuroprotection. Curr Opin Pediatr.2012;24(2):154–9.
  41. Министерство здравоохранения и социального развития Российской Федерации. Методическое письмо № 15-4/10/2-12700 от 16 декабря 2011 г. «Преждевременные роды». Available from: http://www.uzo.kurgan-med.ru/files/downloads/rodi.doc. (The Ministry of Health and Social Development of the Russian Federation. Methodical Letter No. 15-4/10/2-12700 from December
  42. , 2011 “Preterm delivery”. Available from: http://www.uzo.kurgan-med.ru/files/downloads/rodi.doc. Russian).
  43. Catalano LN, Villar Diaz M, Vazquez Guz man M, Negron I, Rivera Rosa E. Pregnancy outcomes and successful rate of nifedipine therapeutic protocol implementation in a hospital of San Juan. Bol Asoc Med P R. 2013;105(3):13–6.
  44. Naik Gaunekar N, Raman P, Bain E, Crowther CA. Maintenance therapy with calcium channel blockers for preventing preterm birth after threatened preterm labour. Cochrane Database Syst Rev. 2013;10:CD004071.
  45. Ohlsson A, Walia R, Shah S. Ibuprofen for the treatment of patent ductusarteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2008;(1):CD003481.
  46. Winn HN, Gabrielli S, Reece EA, Roberts JA, Salafia C, Hobbins JC. Ultrasonographic criteria for the prenatal diagnosis of placental chorionicity in twin gestations. Am J Obstet Gynecol. 1989;161(6 Pt 1):1540–2.
  47. Brubaker SG, Gyamfi C. Prediction and prevention of spontaneous preterm birth in twin gestations. Semin Perinatol. 2012;36(3):190–4.
  48. Fuchs F, Audibert F, Senat MV. Progesterone and preterm delivery: back to the future? Gynecol Obstet Fertil. 2014;42(2):112–22.
  49. Schaap AH, van den Wijngaard JP, Nikkels PG, van den Broek AJ, Snieders I, van Gemert MJ. Significance of donor anuria differs between monoamniotic and diamniotic twin-twin transfusion syndrome. Placenta. 2007;28(5–6): 523–6.
  50. Suzuki S, Okudaira S, Sawa R, Yoneyama Y, Asakura H, Shin S, Kaneko K, Araki T. Characteristics of monochorionic-diamniotic growth-retarded twins during the third trimester. NihonIka Daigaku Zasshi. 1999;66(5):300–4.
  51. da Fonseca EB, Bittar RE, Carvalho MH, Zugaib M. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study. Am J Obstet Gynecol. 2003;188(2):419–24.
  52. Dodd JM, Flenady V, Cincotta R, Crowther CA. Prenatal administration of progesterone for preventing preterm birth. Cochrane Database Syst Rev. 2006;(1):CD004947.
  53. Meis PJ, Klebanoff M, Thom E, Dombrowski MP, Sibai B, Moawad AH, Spong CY, Hauth JC, Miodovnik M, Varner MW, Leveno KJ, Caritis SN, Iams JD, Wapner RJ, Conway D, O'Sullivan MJ, Carpenter M, Mercer B, Ramin SM, Thorp JM, Peaceman AM, Gabbe S; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesteronecaproate. N Engl J Med. 2003;348(24):2379–85.
  54. Meis PJ; Society for Maternal-Fetal Medicine. 17 hydroxyprogesterone for the prevention of preterm delivery. Obstet Gynecol. 2005;105 (5 Pt 1):1128–35.
  55. Norman JE, Mackenzie F, Owen P, Mactier H, Hanretty K, Cooper S, Calder A, Mires G, Danielian P, Sturgiss S, MacLennan G, Tydeman G, Thornton S, Martin B, Thornton JG, Neilson JP, Norrie J. Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT):a randomised, double-blind, placebo-controlled study and meta-analysis. Lancet. 2009;373(9680):2034–40.
  56. Аржанова ОН, Пайкачева ЮМ. Гормональная поддержка многоплодной беременности. Журнал акушерства и женских болезней. 2009;58(5):М96–7. (Arzhanova ON, Paykacheva YuM. [Hormonal support of a multiple pregnancy]. Zhurnal akusherstva i zhenskikh bolezney.2009;58(5):M96–7. Russian).
  57. Steen EE, Kallen K, Maršal K, Norman M, Hellstrom-Westas L. Impact of sex on perinatal mortality and morbidity in twins. J Perinat Med. 2014;42(2):225–31.
  58. Dodd JM, Crowther CA, Middleton P. Oral betamimetics for maintenance therapy after threatened preterm labour. Cochrane Database Syst Rev. 2012;12:CD003927.
  59. Neilson JP, West HM, Dowswell T. Betamimetics for inhibiting preterm labour. Cochrane Database Syst Rev. 2014;2:CD004352.
  60. Zork N, Biggio J, Tita A, Rouse D, Gyamfi-Bannerman C. Decreasing prematurity in twin gestations: predicaments and possibilities. Obstet Gynecol. 2013;122(2 Pt 1):375–9.
  61. Mercer BM, Miodovnik M, Thurnau GR, Goldenberg RL, Das AF, Ramsey RD, Rabello YA, Meis PJ, Moawad AH, Iams JD, Van Dorsten JP, Paul RH, Bottoms SF, Merenstein G, Thom EA, Roberts JM, McNellis D. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. JAMA. 1997;278(12):989–95.
  62. Чернуха ЕА. Родовой блок. М.: Триада-Х; 2005. 353 с. (Chernukha EA. Delivery unit. Moscow: Triada-X; 2005. 353 p. Russian).

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