MyMedR

Fulltext Conjoined twins in a triplet pregnancy

Baskaran A

Med J Malaysia, 1997 Sep;52(3):291-2.

Conjoined twins in a triplet pregnancy is an extremely rare occurrence. We present here, a 27-year-old multigravida with gestational diabetes and a conjoined twins in a triplet pregnancy.

Matched MeSH terms: Pregnancy, Multiple*

Multiple pregnancy

LLEWELLYN-JONES D

Med J Malaya, 1958 Sep;13(1):59-61.

PMID: 13589370

Matched MeSH terms: Pregnancy, Multiple/statistics & numerical data*

Cervical pessary in the prevention of preterm births in multiple pregnancies with a short cervix: PRISMA compliant systematic review and meta-analysis

Thangatorai R, Lim FC, Nalliah S

J Matern Fetal Neonatal Med, 2018 Jun;31(12):1638-1645.

PMID: 28412851 DOI: 10.1080/14767058.2017.1319930

BACKGROUND: Preterm births occur frequently in multiple pregnancies with a short cervix. The cervical pessary is a potential intervention for prevention of preterm births.

OBJECTIVE: To assess the effectiveness of cervical pessary in the prevention of preterm births in multiple pregnancies with a short cervix (<25 mm).

SEARCH STRATEGY: Major databases from 2006 to 20th November 2016 were searched for relevant terms.

SELECTION CRITERIA: We included randomized controlled trials that assessed the effectiveness of cervical pessary on pregnancy outcomes in multiple pregnancies with a short cervix.

DATA COLLECTION AND ANALYSIS: Risk ratio was used as the summary measure with random effects model. We assessed heterogeneity between studies using the I2 index. Quality assessment was done based on Cochrane Handbook Method.

MAIN RESULTS: Pooled data showed no benefit of using cervical pessary in the prevention of preterm births, birth weights less than 1500 g, less than 2500 g, adverse neonatal events and fetal/neonatal deaths in twin pregnancies with a short cervix.

CONCLUSION: We are unable to show benefit of using cervical pessary in preventing preterm births in twin pregnancies with a short cervix. However, as cervical pessary is a reasonable intervention, there is a need for more randomized controlled trials in this area.

Matched MeSH terms: Pregnancy, Multiple*

Fulltext Spontaneous twin pregnancy in premature ovarian failure

Anna Liza R, Alik RZ, Ahmad Murad Z, Ghazali I

Med J Malaysia, 2008 Aug;63(3):263-4.

PMID: 19248707 MyJurnal

Premature Ovarian Failure (POF) is associated with subfertility. Despite efforts to induce ovulation, success rates are low. We report a case of POF spontaneously conceiving twins while on hormone replacement therapy.

Matched MeSH terms: Pregnancy, Multiple*

A retrospective study of the accuracy of sonographic chorionicity determination in twin pregnancies

Menon DK

Twin Res Hum Genet, 2005 Jun;8(3):259-61.

PMID: 15989753

The aim of this study was to determine the accuracy of sonographic chorionicity determination in the largest sample of twin pregnancies to date. We retrospectively analyzed 463 twin pregnancies delivered over a 6-year period to determine in each case what the antenatal sonographic prediction of chorionicity was, and then what the subsequent post partum pathological diagnosis of chorionicity was. Out of 436 twin pregnancies, 428 were correctly diagnosed for chorionicity as confirmed by pathology reports. Sonography as a screening tool for monochorionic twin pregnancies has a sensitivity of 100%, a specificity of 97.9% and a predictive value positive of 88.2%. Transvaginal scanning in the first trimester determined twin chorionicity with a sensitivity and a specificity of 100%. This study has confirmed in the largest sample to date that sonographic chorionicity determination is best done in the first trimester using vaginal scans, where it has 100% accuracy.

Matched MeSH terms: Pregnancy, Multiple*

Fulltext GIFT triplets and management problems--a case report

Wong KK, Lim CT

Med J Malaysia, 1991 Sep;46(3):294-6.

PMID: 1839929

Pregnancies conceived through assisted reproduction can present considerable management problems to the obstetric and paediatric staff. Multiple pregnancies are common. The complication of prematurity increases the morbidity and mortality rates of the neonates.

Matched MeSH terms: Pregnancy, Multiple*

Fulltext A study of triplet pregnancy--a Malaysian experience

Kulenthran A, Raman S, Sinnathuray TA

Med J Malaysia, 1984 Mar;39(1):73-7.

PMID: 6513844

A retrospective study of nine consecutive cases of triplet pregnancy delivered at the University Hospital showed an incidence of one in 6,349 deliveries. In seven cases the diagnosis was suspected, and confirmed either by radiography or ultrasonography. Pre-eclampsia and polyhydramnios were common ante-natal complications. The perinatal mortality rate was 74 per thousand. Overall, the first triplet had the best outcome in terms of Apgar scores. There were no perinatal deaths in those cases that were delivered by Caesarean section.

Matched MeSH terms: Pregnancy, Multiple*

Twin pregnancy -- a study of the local pattern

Teoh SK, Wong WP

Med J Malaysia, 1977 Sep;32(1):90-5.

PMID: 609353

Matched MeSH terms: Pregnancy, Multiple*

A CONCEPT IN THE MANAGEMENT OF TWIN DELIVERY

MARZUKI A

Med J Malaysia, 1963 Jun;17:288-91.

PMID: 14060506

Matched MeSH terms: Pregnancy, Multiple*

Fulltext Complete hydatidiform mole and surviving coexistent twin--a case report

Japaraj RP, Sivalingam N

Singapore Med J, 2000 Mar;41(3):126-8.

PMID: 11063197

Hydatidiform mole with a coexistent fetus is a rare occurrence with an incidence of I per 22,000-100,000 pregnancies. It is associated with persistent gestational trophoblastic tumour. Hence an early and correct diagnosis is imperative to plan subsequent management of such patients. We report a case of a primigravida who presented with vaginal bleeding at early second trimester. Expectant management was carried out for her pregnancy which finally ended in an abortion. The pathology, clinical findings and current management of this rare entity is discussed.

Matched MeSH terms: Pregnancy, Multiple*

Fulltext Sociodemographic and foetal charateristics of mothers with premature deliveries in Hospital Tuanku Jaafar Seremban, Negeri Sembilan, Malaysia

Zaini I, Ghani SN, Moy FM

JUMMEC, 2008;11(2):59-65.

MyJurnal

This is a retrospective case control study conducted between 1 January 2005 and 30 June 2006 at the Hospital Tuanku Jaafar, Seremban, Malaysia. The objective was to study the maternal sociodemographics and foetal characteristics associated with premature delivery. There were 387 cases selected universally and 387 controls selected by using systematic random sampling involving every 13 cases. The patients were women who had delivered their babies before 37 completed weeks, while the control were women who had term deliveries during the same period. Data were collected using structured questionnaire through secondary data. Results showed that having multiple pregnancies (OR=8.33, 95% CI: 2.91, 23.84), congenital abnormality (OR=4.6, 95% CI: 0.98, 21.84) and intrauterine growth retardation (OR=15.59, 95% CI: 3.69, 65.82) were the risk factors of premature delivery. Being an ethnic Indian also raised the odds (OR=1.67, 95% CI: 1.14, 2.43) but this was not significant in the multivariate analysis. Other sociodemographic characteristics did not contribute significantly to the risk factors for premature delivery in this sample. In conclusion, foetal characteristics were found to be significantly associated with premature delivery after adjustment for other confounding factors.
Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia

Matched MeSH terms: Pregnancy, Multiple

MPA given orally during the first trimester for threatened miscarriage carries no specific risk for foetal abnormalities albeit the rate is higher than non-threatened pregnancies

Yovich JL, Mariappen U, Hinchliffe PM, Dhaliwal SS, Keane KN

Reprod Biol, 2020 Sep;20(3):424-432.

PMID: 32389607 DOI: 10.1016/j.repbio.2020.03.008

This observational study examines the outcomes of pregnancies arising in women referred for infertility, where those who experienced threatened miscarriage were treated with medroxyprogesterone acetate (MPA) tablets. The 14-year study period covers comprehensive real-time data entries into the validated electronic database including details of the infertility management, pregnancy outcomes and any foetal anomalies among the infants, each being tracked and recorded. Of 4057 clinical pregnancies, 1343 received MPA for threatened miscarriage; 934 (69.6 %) of which continued to livebirths. These were compared with the remaining 2714 clinical pregnancies without threatened miscarriage or MPA and which resulted in 2075 (76.5 %) livebirths. There were 134 developmental abnormalities recorded among the 3009 livebirths of which 78 (2.6 %) were categorised appropriate for the Western Australian Developmental Abnormalities Register; WARDA. These comprised 55 in the MPA group, 36 of which were categorised as serious (being 2.7 % of clinical pregnancies and 3.9 % of births). In the group without MPA, there were 79 abnormalities, of which 42 were categorised as serious (being 1.7 % of clinical pregnancies and 2.2 % of births). Specifically, there were no cases of androgenisation noted among the female infants. The abnormality rates were low overall and well within the annual WARDA ranges. We cautiously suggest that oral MPA can be considered for studies throughout pregnancy including the early first trimester to assess a potential role in reducing miscarriage, as well as advanced pregnancies to evaluate a potential role in reducing stillbirths and preterm delivery.

Matched MeSH terms: Pregnancy, Multiple

Predicting successful live birth from single serum hCG measurement in assisted reproductive technology (ART) cycle

Rahilah AS, Murizah MZ

Med J Malaysia, 2023 Jan;78(1):14-19.

PMID: 36715185

INTRODUCTION: Assisted reproductive technology may result in various outcomes, causing a significant stress both physically and emotionally to the patients. This study aims to determine the level of serum human chorionic gonadotrophin (hCG) following embryo transfer in predicting successful live births in in vitro fertilisation (IVF) cycles.

MATERIALS AND METHODS: This is a retrospective analysis of 407 IVF pregnancies in Hospital Sultanah Bahiyah Kedah from 2014 to 2019. Serum hCG was withdrawn on either (i) day 16 post-oocyte retrieval for fresh IVF cycle or (ii) day 16 from the addition of progesterone in frozen embryo cycles. Outcomes of IVF pregnancies were analysed in relation to the level of serum hCG.

RESULTS: The overall median hCG level in singleton live birth was 304.7 IU/L, 547.10 IU/L for multiple live births, and early pregnancy loss level was 77 IU/L. When the ROC graphs were plotted, serum hCG level of 152.85 IU/L predicted singleton livebirth with a sensitivity of 81.3%. Serum hCG of 322.40 IU/L predicted multiple live births with sensitivity of 78.6% and a specificity of 64.3%. In the subgroup analysis comparing prediction hCG level in singleton live birth; the cut-off point in frozen cycle was found to be higher as compared to fresh cycle, 277.05 IU/L vs 117.5 IU/L. Blastocyst pregnancies recorded overall higher predictor hCG level as compared to cleavage state in all the outcomes measured; singleton live birth (372.30 IU/L), early pregnancy loss (107.60 IU/L), and multiple pregnancies (711.40 IU/L).

CONCLUSION: A single reading of serum hCG taken at day 16 post-oocyte retrieval or day 16 from the addition of progesterone in a frozen cycle will help to determine the outcomes of IVF pregnancies and direct the physicians during counselling sessions and plan for further follow-up of the patients.

Matched MeSH terms: Pregnancy, Multiple

Fulltext Acardius amorphus: magnetic resonance imaging (MRI) can be helpful in the diagnosis when ultrasound (US) is inconclusive

Azian AA, Roslani AL

Med J Malaysia, 2011 Dec;66(5):510-2.

PMID: 22390115 MyJurnal

An acardiac twin is rare and the diagnosis is commonly achieved from antenatal ultrasound (US) scans. However there have been cases where the appearances of the acardiac twin can be confusing and mimics a mass or tumour, for example, a teratoma. We experienced a case where the findings were unclear from the antenatal ultrasound scans and we had to resort to Magnetic Resonance Imaging (MRI), where we finally made the correct diagnosis based on the identification of two umbilical cords, supplying the normal fetus and the 'mass' (acardiac twin) respectively.

Matched MeSH terms: Pregnancy, Multiple

Fulltext Twin reverse arterial perfusion sequence

Nik Lah NA, Che Yaakob CA, Othman MS, Nik Mahmood NM

Singapore Med J, 2007 Dec;48(12):e335-7.

PMID: 18043831

Twin reverse arterial perfusion sequence occurs in approximately one percent of monochorionic twins. This condition is always fatal for the recipient twin and carries a high mortality rate for the pump twin. Various treatment options are described, but management is continually evolving with the publication of new data. We report an acardiac acephalic monochorionic twin who was diagnosed at 31 weeks gestation. Serial ultrasonographical examinations of the normal pump twin showed intrauterine growth restriction but with no evidence of heart failure. A healthy pump twin was delivered by caesarean section at 34 weeks.

Matched MeSH terms: Pregnancy, Multiple

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