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Diriba A, Tilahun T, Gonfaa L, Gebi J, Lemi B, Fyera J, Suleiman Mazeng, Legesse A, Alemu D. Concordant fatal congenital anomaly in twin pregnancy: a case report and review of the literature. J Med Case Rep 2024; 18:406. [PMID: 39192333 DOI: 10.1186/s13256-024-04732-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/28/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND When a pregnant mother finds out she has a fetus with a congenital defect, the parents feel profound worry, anxiety, and melancholy. Anomalies can happen in singleton or twin pregnancies, though they are more common in twin pregnancies. In twins, several congenital defects are typically discordant. We present a rare case of concordant fatal anomaly in twin pregnancy in a 22-year-old African patient primigravida mother from Western Ethiopia who presented for routine antenatal care. An obstetric ultrasound scan showed anencephaly, meningomyelocele, and severe ventriculomegaly. After receiving the counseling, the patient was admitted to the ward, and the pregnancy was terminated with the medical option. Following a successful in-patient stay, she was given folic acid supplements and instructed to get preconception counseling before getting pregnant again. CONCLUSION The case demonstrates the importance of early obstetric ultrasound examination and detailed anatomic scanning, in twin pregnancies in particular. This case also calls for routine preconceptional care.
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Affiliation(s)
- Amenu Diriba
- Department of Obstetrics and Gynecology, School of Medicine, Wollega University, Nekemte, Ethiopia
| | - Temesgen Tilahun
- Department of Obstetrics and Gynecology, School of Medicine, Wollega University, Nekemte, Ethiopia.
| | - Lammii Gonfaa
- Department of Obstetrics and Gynecology, School of Medicine, Wollega University, Nekemte, Ethiopia
| | - Jemal Gebi
- Department of Obstetrics and Gynecology, School of Medicine, Wollega University, Nekemte, Ethiopia
| | - Bikila Lemi
- Department of Obstetrics and Gynecology, School of Medicine, Wollega University, Nekemte, Ethiopia
| | - Jiregna Fyera
- Department of Obstetrics and Gynecology, School of Medicine, Wollega University, Nekemte, Ethiopia
| | - Suleiman Mazeng
- Department of Obstetrics and Gynecology, School of Medicine, Wollega University, Nekemte, Ethiopia
| | - Aschalew Legesse
- Department of Obstetrics and Gynecology, School of Medicine, Wollega University, Nekemte, Ethiopia
| | - Dinaol Alemu
- Department of Obstetrics and Gynecology, School of Medicine, Wollega University, Nekemte, Ethiopia
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Wang R, Shi M, Zhang Q, Zhang J, Sun L, Jia Y, Zhu Z, Xu T, Zhang Y. The association of early life factors with depression and anxiety in adults aged 40-69 years: a population-based cohort study. Transl Psychiatry 2024; 14:299. [PMID: 39033162 PMCID: PMC11271466 DOI: 10.1038/s41398-024-03006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/23/2024] Open
Abstract
This study was aimed to explore the longitudinal association of five early life factors (breastfeeding, maternal smoking around birth, birth weight, being born in a multiple birth, and adoption) during the in-utero, perinatal, and early childhood development stages with incidence of depression and anxiety in adults aged 40-69 years. We used data from the UK biobank, 5,02,394 participants aged 40-69 years were recruited between 2006 and 2010. Participants provided information on early life exposures through touchscreen questionnaires or verbal interviews at baseline. The primary outcomes, depression, and anxiety, were defined according to the International Classification of Diseases, 10th Revision. Hazard ratios (HR) and 95% confidence intervals (CI) for each factor were reported. During a median follow-up of 13.6 years, 16,502 (3.55%) participants developed depression, and 15,507 (3.33%) developed anxiety. After adjusting for potential confounders, increased risk of depression was found to be significantly associated with non-breastfeeding (HR, 1.08; 95% CI, 1.04-1.13), maternal smoking around birth (HR, 1.19; 95% CI, 1.14-1.23), being born in multiple births (HR, 1.16; 95% CI, 1.05-1.27), low birth weight (HR, 1.14; 95% CI, 1.07-1.22), and being an adoptee (HR, 1.42; 95% CI, 1.28-1.58). Increased risk of anxiety was associated with non-breastfeeding (HR, 1.09; 95% CI, 1.04-1.13), maternal smoking around birth (HR, 1.11; 95% CI, 1.07-1.16), being born in a multiple births (HR, 1.05; 95% CI, 0.95-1.17), low birth weight (HR, 1.12; 95% CI, 1.05-1.20), and being an adoptee (HR, 1.25; 95% CI, 1.10-1.41). Each of these five early life factors can be considered as early life risk factors for incident depression and anxiety in adulthood independently. The dose-response relationship was also observed, suggesting that with an increase in the number of early life risk factors, the likelihood of experiencing depression and anxiety also increased. These findings highlighted the imperative consideration of early life factors in comprehending the susceptibility to mental health disorders later in life, including non-breastfeeding, maternal smoking around birth, being born in multiple births, low birth weight, and being an adoptee.
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Affiliation(s)
- Ruirui Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Mengyao Shi
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Qilu Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Jing Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Lulu Sun
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yiming Jia
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China.
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Boer LL, Winter E, Gorissen B, Oostra RJ. Phenotypically Discordant Anomalies in Conjoined Twins: Quirks of Nature Governed by Molecular Pathways? Diagnostics (Basel) 2023; 13:3427. [PMID: 37998563 PMCID: PMC10669976 DOI: 10.3390/diagnostics13223427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
A multitude of additional anomalies can be observed in virtually all types of symmetrical conjoined twins. These concomitant defects can be divided into different dysmorphological patterns. Some of these patterns reveal their etiological origin through their topographical location. The so-called shared anomalies are traceable to embryological adjustments and directly linked to the conjoined-twinning mechanism itself, inherently located within the boundaries of the coalescence area. In contrast, discordant patterns are anomalies present in only one of the twin members, intrinsically distant from the area of union. These dysmorphological entities are much more difficult to place in a developmental perspective, as it is presumed that conjoined twins share identical intra-uterine environments and intra-embryonic molecular and genetic footprints. However, their existence testifies that certain developmental fields and their respective developmental pathways take different routes in members of conjoined twins. This observation remains a poorly understood phenomenon. This article describes 69 cases of external discordant patterns within different types of otherwise symmetrical mono-umbilical conjoined twins and places them in a developmental perspective and a molecular framework. Gaining insights into the phenotypes and underlying (biochemical) mechanisms could potentially pave the way and generate novel etiological visions in the formation of conjoined twins itself.
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Affiliation(s)
- Lucas L. Boer
- Department of Medical Imaging, Section Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Eduard Winter
- Pathologisch-Anatomische Sammlung im Narrenturm-NHM, 1090 Vienna, Austria
| | - Ben Gorissen
- Department of Medical Imaging, Section Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Roelof-Jan Oostra
- Department of Medical Biology, Sections Clinical Anatomy & Embryology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Zwillingsschwangerschaften nach natürlicher Konzeption: wie stark ist die erbliche Komponente? GYNAKOLOGISCHE ENDOKRINOLOGIE 2023. [DOI: 10.1007/s10304-023-00500-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
ZusammenfassungDie Faszination, die von Zwillingen, Zwillingsschwangerschaften und deren Ätiologie ausgeht, ist über die Jahrhunderte unverändert groß geblieben. Beim Menschen sind Zwillinge nach natürlicher Konzeption ein relativ häufiges Ereignis. Aufgrund des steigenden maternalen Alters und der reproduktionsmedizinischen Technologien hat die Anzahl an Zwillingen in der industrialisierten Gesellschaft seit den 1980er-Jahren stetig zugenommen. Dank des besseren Verständnisses und der Fortschritte in der Pränataldiagnostik, klinischen Genetik, Molekulargenetik und Entwicklungsbiologie ist es mittlerweile ersichtlicher geworden, warum und wie Zwillingsschwangerschaften beim Menschen entstehen. Man unterscheidet zwei Arten von Zwillingen: monozygote („eineiige“) und dizygote („zweieiige“) Zwillinge, jede dieser Formen mit unterschiedlichen Inzidenzen, Häufungen und Ursachen. Die Tendenz, dizygote Zwillinge nach natürlicher Konzeption zu empfangen, ist ein komplexes Geschehen, das erheblichen geografischen, ethnischen, saisonalen und familiären Einflüssen unterliegt und eine klare genetische Komponente aufweist. Die Rate an monozygoten Zwillingen ist weltweit relativ konstant, wobei die Ursache noch nicht gänzlich geklärt ist. Wie man jetzt weiß, spielen auch bei dieser Entität erbliche Ursachen eine Rolle.
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A Case of Sex Discordant Dichorionic Diamniotic Twins after Single Embryo Transfer and the Importance of Zygosity Testing. REPRODUCTIVE MEDICINE 2023. [DOI: 10.3390/reprodmed4010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Single embryo transfer (SET) is a technique used in assisted reproductive treatment (ART) that is used to promote singleton pregnancies. To date, there are five reported cases of dizygotic twin pregnancies with mothers who underwent SET. Here, we present a sixth case of a dichorionic, diamniotic twin pregnancy with sex discordance. The patient is a 34-year-old woman with unexplained secondary infertility who underwent in vitro fertilization (IVF) and frozen-thawed embryo transfer from a SET. The ultrasonographic images from the first and second trimester scans identified dichorionic, diamniotic twin gestations. The delivery was full term and postnatal genetic testing confirmed 46, XX, and 46, XY offspring. Pathology reports of the placental and membrane findings reported diamniotic, dichorionic twins. There was no zygosity testing conducted, thus it is unknown if the twins are monozygotic or dizygotic. Two possible etiologies for sex-discordant twins, in this case, are concurrent natural conception via breakthrough ovulation at the time of SET, or discordant postzygotic nondisjunction of a single embryo. Multiple gestations may still occur in the setting of SET and zygosity testing in these instances would better elucidate our understanding of this occurrence. Moreover, improved data on the zygosity of multiple gestations following SET may enhance patient counseling.
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Liu S, Xu Q, Wang Y, Song B, Wei Z. Pregnancy incidence and associated risk factors of dichorionic triamniotic triplet under assisted reproduction: A large sample of clinical data analysis. Front Endocrinol (Lausanne) 2023; 14:1049239. [PMID: 37008934 PMCID: PMC10063967 DOI: 10.3389/fendo.2023.1049239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Dichorionic triamniotic (DCTA) triplet pregnancies are rare in spontaneous pregnancy. The aim was to characterize the incidence and risk factors of DCTA triplet pregnancies after assisted reproductive technology (ART). METHODS A retrospective analysis of 10,289 patients, including 3,429 fresh embryo transfer (ET) cycle and 6,860 frozen ET cycle, was performed from January 2015 to June 2020. The effect of different ART parameters on the incidence of DCTA triplet pregnancies was evaluated by multivariate logistic regression analyses. RESULTS Among all clinical pregnancies after ART, the incidence of DCTA was 1.24%. 1.22% occurred in the fresh ET cycle, while 1.25% occurred in the frozen ET cycle. The number of ET and cycle type has no effect on the occurrence of DCTA triplet pregnancies (p = 0.987; p = 0.056, respectively). There were significant differences in DCTA triplet pregnancies rate among receiving intracytoplasmic sperm injection (ICSI) and receiving in vitro fertilization (IVF) [1.92% vs. 1.02%, p < 0.001, OR = 0.461, 95% confidence interval (CI) 0.315-0.673], blastocyst transfer (BT) versus cleavage-ET (1.66% vs. 0.57%, P < 0.001, OR = 0.329, 95% CI 0.315-0.673), and maternal age ≥ 35 years versus maternal age < 35 years (1.00% vs. 1.30%, P = 0.040, OR = 1.773, 95% CI 1.025-3.066). Based on the regression analysis of cycle type, DCTA triplet pregnancies rate was higher in maternal age < 35 years than in maternal age ≥ 35 years (1.35% vs. 0.97%, P < 0.001, OR = 5.266, 95% CI 2.184-12.701), BT versus cleavage-ET (1.47% vs. 0.94%; P = 0.006, OR = 0.346, 95% CI 0.163-0.735), and receiving ICSI was higher than receiving IVF (3.82% vs. 0.78%, p < 0.001, OR = 0.085, 95% CI 0.039-0.189) in fresh ET cycle. However, DCTA triplet pregnancies rate did not show difference in maternal age, insemination methods, and number of ET, and only BT was found to be associated with a higher DCTA triplet pregnancies rate in the frozen ET cycle (1.73% vs. 0.30%, p < 0.001, OR = 0.179, 95% CI 0.083-0.389). CONCLUSION The prevalence of DCTA triplet pregnancies has increased after ART. Maternal age < 35 years, BT, and receiving ICSI are risk factors for DCTA triplet pregnancies, also in fresh ET cycle. However, in frozen ET cycle, BT is an independent risk factor for increased DCTA triplet pregnancies rate.
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Affiliation(s)
- Shuhua Liu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Obstetrics and Gynecology, Anhui Province Maternity and Child Health Hospital, Hefei, China
| | - Qianhua Xu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
| | - Yafen Wang
- First Clinical College, Anhui Medical University, Hefei, China
| | - Bing Song
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
- *Correspondence: Bing Song, ; Zhaolian Wei,
| | - Zhaolian Wei
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Ministry of Education Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
- *Correspondence: Bing Song, ; Zhaolian Wei,
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Negrato CA, Marques PR, Leite HB, Torigoe CN, Silva BF, Costa K, Kamei JM, Zampa CL, Toni ACRG, Pereira ICGS, Heinzelmann GL, Zajdenverg L. Glycemic and nonglycemic mechanisms of congenital malformations in hyperglycemic pregnancies: a narrative review. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:908-918. [PMID: 36191262 PMCID: PMC10118772 DOI: 10.20945/2359-3997000000521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Congenital malformations are more frequently found among children born to mothers with diabetes than in the background population. There are several complex mechanisms involved in the development of congenital malformations in the offspring of mothers with hyperglycemia, such as the overexpression of glucose transporters (GLUTs) 1 and 2, the increased activity of the hexosamine biosynthetic pathway and the reduced expression of the PAX3 gene with a consequent increase in p53 protein expression. These alterations can lead to increased glucose and free radical concentrations in the embryo, thus promoting the process of apoptosis and causing malformation. The most frequent malformations found in the offspring of mothers with diabetes are heart and neural tube defects, urinary tract and kidney malformations, and cleft lip with or without cleft palate. Strict glycemic control should be obtained before and during pregnancy, aiming to avoid or minimize the risk of congenital malformations in the offspring. Beyond hyperglycemia, several factors may also be associated with increased risks of malformations in the offspring of these women, such as obesity, multiple pregnancies, advanced maternal age, folic acid deficiency, use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers, assisted reproduction techniques, and exposure to different types of environmental pollutants.
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Li X, Xuan Y, Wang J, Wang L, Papageorghiou AT, Wu Q. Crown-Rump Length Discordance, Increased Nuchal Translucency, and Detection of Fetal Structural Anomalies in Twin Pregnancies in the First Trimester: 5 Years of Experience in a Tertiary Hospital in China. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:971-982. [PMID: 34289155 DOI: 10.1002/jum.15784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/21/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the efficacy of the first-trimester ultrasound scan in the detection of fetal structural anomalies in twin pregnancies. To examine the association between increased nuchal translucency (NT) thickness, crown-rump length (CRL) or NT discordance, and detection of structural anomalies in a large twin series in China. METHODS We performed retrospective analysis of twin pregnancies who underwent 11-13+6 -week and second-trimester anomaly scan and booked at Beijing Obstetrics and Gynecology Hospital between January 2012 and December 2016. Measurement of fetal CRL/NT and assessment of fetal anatomic structures were based on standard (not detailed) protocols. Conjoined twins and twin-reversed arterial perfusion sequence (TRAPS) were excluded from structural anomalies. The diagnostic performance of first-trimester ultrasound in detection of fetal structural anomalies in twins was determined and compared with that of second trimester. The accuracy of independent variates associated with structural anomaly detection was calculated. RESULTS A total of 1442 women with twin pregnancies were included. In 40 women and 45 fetuses, structural anomalies were found. Fetal structural anomalies verified at delivery were detected in 42.5% (17/40) of affected pregnancies in the first trimester and 92.5% (37/40) of affected pregnancies when added second trimester (P = .13). The survival rate of pregnancies detected in second trimester was higher than that of pregnancies detected in first trimester (11.8% vs 65.2%). The mean value of intertwin CRL/NT discordance in cases with fetal structural anomalies was larger in monochorionic twins than dichorionic twins, but monochorionicity was not associated with structural anomalies. CRL discordance ≥10% (OR 3.1, 95%CI 1.5-6.3) and NT ≥95th centile (OR 20.0, 95%CI 9.0-44.2) were associated with fetal structural anomalies. In both dichorionic (DC) and monochorionic (MC) twins, the percentages of CRL discordance ≥10% was larger in twins with structural anomalies than those without structural anomalies (37.5% vs 13.4% in DC twins and 50.0% vs 12.5% in MC twins), and this was also true for NT ≥95th centile (31.3% vs 1.7% in DC twins and 37.5% vs 2.2% in MC twins). In the setting of CRL discordance ≥10%, 40.0% (16/40) of twins with structural anomalies were found, in which the predominant fetal structural anomalies were cardiovascular defects, abdominal wall defects, and central nervous system defects. The AUC for detecting structural anomalies by CRL discordance ≥10% was 0.63. In the setting of NT ≥95th centile, 32.5% (13/40) of twins with structural anomalies were found, in which the predominant fetal structural anomalies were cardiovascular defects, cystic hygroma, and abdominal wall defects. The AUC for detecting structural anomalies by NT ≥95th centile was 0.65. CONCLUSIONS The detection rate of twins with fetal structural anomalies was 42.5% per pregnancy in the first trimester. CRL discordance ≥10% and NT ≥95th centile may indicate higher risk of fetal structural anomalies in twins, but their efficacy was limited.
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Affiliation(s)
- Xiaofei Li
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yinghua Xuan
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jingjing Wang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Li Wang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Beijing Maternal and Child Health Care Hospital, Beijing, China
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Burhamah W, Alnaqi A, Jafar Y, Taqi E. Emergency Separation of Extreme VLBW Omphalopagus Twins: Case Report. European J Pediatr Surg Rep 2022; 10:e84-e87. [PMID: 35795172 PMCID: PMC9252611 DOI: 10.1055/s-0042-1750134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/22/2022] [Indexed: 11/15/2022] Open
Abstract
The classification of conjoint twins is based according to the site of attachment. The challenges in management of such anomalies span the entire continuum of care from delivery to resuscitation to separation and finally discharge. Scheduled separation is ideal, occasionally the caring team is faced with no option but to perform an emergent separation. Omphalopagus is a type of conjoined twinning characterized by union of the peritoneal cavities through an infraumbilical abdominal wall defect. In this report we describe our experience with a successful emergency separation of extremely preterm omphalopagus twins. This is the first case of conjoint twins in Kuwait, we highlight the challenges faced, stressing the importance of adhering to antenatal care as well as management by a multidisciplinary team.
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Affiliation(s)
| | - Amar Alnaqi
- Department of Pediatric Surgery, Ibn Sina Hospital, Sabah Medical Center, Kuwait, Kuwait
| | - Yaqoub Jafar
- Department of Pediatric Surgery, Ibn Sina Hospital, Sabah Medical Center, Kuwait, Kuwait
| | - Esmaeel Taqi
- Department of Pediatric Surgery, Ibn Sina Hospital, Sabah Medical Center, Kuwait, Kuwait
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Special Considerations Regarding Antenatal Care and Pregnancy Complications in Dichorionic Twin Pregnancies. Am J Obstet Gynecol MFM 2021; 4:100500. [PMID: 34637959 DOI: 10.1016/j.ajogmf.2021.100500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/18/2021] [Accepted: 10/04/2021] [Indexed: 02/07/2023]
Abstract
Twin pregnancies account for about 3.3% of all deliveries in the United States with the majority of them being dichorionic diamniotic (DCDA). Maternal physiological adaption in twin pregnancies is exaggerated and the rate of almost every maternal and fetal complication is higher when compared to singleton pregnancies. Therefore, twin pregnancies necessitate closer antenatal surveillance by care providers who are familiar with the specific challenges unique to these pregnancies, and there is evidence that following women with twins in a specialized twin clinic can result in improved obstetrical outcomes. The importance of the first antenatal visit in twin pregnancies cannot be over emphasized and should preferably take place early in gestation as it is the optimal period to correctly identify the number of fetuses and the type of placentation (chorionicity and amnionicity). This will allow the patients, families, and caregivers to make the appropriate modifications and to tailor an optimal antenatal follow-up plan. This plan should focus on general recommendations such as weight gain and level of activity, education regarding complications specific to twin pregnancies along with the relevant symptoms and indications to seek care, as well as on close maternal and fetal monitoring. In this review, we summarize available evidence and current guidelines regarding antenatal care in DCDA twin pregnancies.
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Abstract
Recent scientific advances have indicated that it may be technically feasible to sustain human embryos in vitro beyond 14 days. Research beyond this stage is currently restricted by a guideline known as the 14-day rule. Since the advances in embryo culturing there have been calls to extend the current limit. Much of the current debate concerning an extension has regarded the 14-day rule as a political compromise and has, therefore, focused on policy concerns rather than assessing the philosophical foundations of the limit. While there are relevant political considerations, I maintain that the success of extension arguments will ultimately depend on the strength of the justifications supporting the current 14-day limit. I argue that the strongest and most prevalent justifications for the 14-day rule-an appeal to individuation and neural development-do not provide adequate support for the limit of 14 days. I instead suggest that an alternative justification based on sentience would constitute a more defensible basis for embryo protection and that a consideration of such grounds appears to support an amendment to the current limit, rather than the retention of it. While these conclusions do not establish conclusively that the current limit should be extended; they do suggest that an extension may be warranted and permissible. As such, this paper offers grounds on which a reassessment of the 14-day rule may be justified.
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Fetal oxygen supply can be improved by an effective cross-talk between fetal erythrocytes and vascular endothelium. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166243. [PMID: 34371111 DOI: 10.1016/j.bbadis.2021.166243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022]
Abstract
In twin/multiple pregnancy, siblings experience an adverse intrauterine environment which forms the major etiological factor leading to pathological conditions. The status of the developing fetus is highly determined by the nitric oxide (NO) level, that facilitates vasodilation which in turn modulates the oxygen and nutrition supply. As the umbilical cord (UC) lacks innervation, activation of the endothelial nitric oxide synthase (NOS3) is fundamental to maintain adequate NO production. Recent ground breaking fact showed that under stress conditions, circulating red blood cells (RBCs) can actively produces NO as a "rescue mechanism". Therefore, this study majorly focused on the molecular mechanisms that affected the redox environment by altering NOS3 activation - both in the UC arteries and vein endothelium and RBCs - that have impacts on developmental parameters, like birth weight. In connection to that, we pursued the communication efficiency between the vessels' endothelium and the circulating RBCs in demand of bioavailable NO. Our results indicated that twinning itself at stage 33-35 weeks, does not reduce the NOS3 level and its phosphorylation status in the cord vessels. However, RBC-NOS3 activation is highly upregulated during this period - providing additional evidence for the active regulatory role of fetal RBCs in the rate of blood flow - and this functional activity highly correlates with the birth weight of the fetuses. Detailed analysis on NOS3 signalling at different time points of gestation could establish a benchmark in understanding of the pathophysiological mechanisms involved in the process of developing neonatal vascular diseases.
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Boer LL, Schepens-Franke AN, Winter E, Oostra RJ. Characterizing the coalescence area of conjoined twins to elucidate congenital disorders in singletons. Clin Anat 2021; 34:845-858. [PMID: 33533057 PMCID: PMC8451816 DOI: 10.1002/ca.23725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/08/2021] [Accepted: 01/23/2021] [Indexed: 12/17/2022]
Abstract
Shared anomalies, always located close to the area of coalescence and observable in virtually every type of conjoined twinning, are currently seen as separate anomalies caused by mostly unknown and seemingly unrelated pathways rather than being connected to the twinning mechanism itself. Therefore, most (case) reports about conjoined twins are mere descriptions of (external) dysmorphologies lacking reflections on the possible origin of their concomitant anomalies. As we will demonstrate in this article, shared anomalies are influenced, and in some cases solely and sequentially explained, by interaction aplasia and neo‐axial orientation; two embryological mechanisms to which each set of conjoined twins is subjected and are responsible for their ultimate phenotypical fate. In this review, we consider how the ventral, lateral and caudal conjunction types and their intermediates determine the phenotypic presentation of the twins, including patterns of shared malformations and anomalies, which in themselves can be indistinguishable from those encountered in singleton cases. Hence, it can be hypothesized that certain anomalies in singletons originate in a fashion similar to that in conjoined twins.
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Affiliation(s)
- Lucas L Boer
- Department of Imaging, Section Anatomy and Museum for Anatomy and Pathology, Radboud University, Medical Center, Nijmegen, Netherlands
| | - Annelieke N Schepens-Franke
- Department of Imaging, Section Anatomy and Museum for Anatomy and Pathology, Radboud University, Medical Center, Nijmegen, Netherlands
| | - Eduard Winter
- Pathologisch-anatomische Sammlung im Narrenturm-NHM, Vienna, Austria
| | - Roelof-Jan Oostra
- Department of Medical Biology, Sections Clinical Anatomy & Embryology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Netherlands
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15
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Corroenne R, Wesley L, Kailin JA, Yilmaz Furtun B, Sanz Cortes M, Shamshirsaz AA, Nassr AA, Belfort MA, Espinoza J. Inter-twin differences in fetal echocardiographic findings are associated with decreased dual twin survival in twin-twin transfusion syndrome. J Matern Fetal Neonatal Med 2021; 35:4935-4941. [PMID: 33455509 DOI: 10.1080/14767058.2021.1873268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine if inter-twin differences in fetal echocardiographic findings are associated with fetal survival in monochorionic pregnancies complicated by twin-to-twin transfusion syndrome (TTTS). METHODS This study included women who underwent laser surgery for TTTS between 2012 and 2018 at a single institution. Echocardiographic cardiac parameters in the donor and recipient twins were compared using Z-scores and regression analyses (adjusted for confounding variables) to determine whether any measurable inter-twin differences were associated with neonatal survival at birth. Results are expressed as (Odds ratio [95% confidence interval], p-value). RESULTS Fetal echocardiography and delivery information was available in 124 TTTS cases. Dual live-birth occurred in 72% and at least one live-birth was seen in 89% of cases. Sixty-four percent (51/79) of recipient twins had evidence of cardiac dysfunction compared to 10% (8/79) of the donor twins (p < .01). In the logistic regression, inter-twin differences in left ventricle short axis dimension (0.62[0.44-0.87], p < .01), aortic valve diameter (0.67[0.45-0.99], p = .047), peak systolic velocity across the pulmonary artery (PA-PSV) (0.09[0.01-0.53], p < .01) and mitral valve diameter (0.56[0.38-0.84], p < .01) were associated with lower dual twin survival at birth. CONCLUSION Inter-twin differences in left cardiac geometry and function are associated with decreased survival at delivery in TTTS.
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Affiliation(s)
- Romain Corroenne
- Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital-Pavilion for Women, Houston, TX, USA.,Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Lee Wesley
- Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital-Pavilion for Women, Houston, TX, USA
| | - Joshua A Kailin
- Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital-Pavilion for Women, Houston, TX, USA
| | - Betul Yilmaz Furtun
- Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital-Pavilion for Women, Houston, TX, USA
| | - Magdalena Sanz Cortes
- Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital-Pavilion for Women, Houston, TX, USA
| | - Alireza A Shamshirsaz
- Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital-Pavilion for Women, Houston, TX, USA
| | - Ahmed A Nassr
- Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital-Pavilion for Women, Houston, TX, USA
| | - Michael A Belfort
- Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital-Pavilion for Women, Houston, TX, USA
| | - Jimmy Espinoza
- Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital-Pavilion for Women, Houston, TX, USA
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16
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Du XZ, Del Bigio MR, Stefanovici C, Miller E, Fan C, Bunge M, Rozovsky K. A case of diprosopus: a rare form of twinning radiology-pathology correlation. CASE REPORTS IN PERINATAL MEDICINE 2020. [DOI: 10.1515/crpm-2020-2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Diprosopus is a rare subtype of conjoined twinning, with approximately 30 reported cases in English literature. Due to the rarity of conjoined twins, the mechanism leading to this developmental anomaly is not yet understood.
Case presentation
We present a case of diprosopus with multimodality imaging (prenatal and postnatal), and with pathological correlations. Developmental anomalies include partial duplication of frontal lobes, formation of a midline “third” frontal lobe, as well as orofacial and cardiac anomalies. The constellation of anomalies coincide with development during embryonic days 23–26, where the anterior prosencephalon, prechordal plate/oropharyngeal membrane, and cardiogenic plate are in very close proximity to each other.
Conclusions
This case offers an opportunity to better appreciate the radiologic and pathologic manifestations of diprosopus, and adds to the current body of evidence.
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Affiliation(s)
- Xiao-Zhou Du
- Department of Pediatric Radiology , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Marc R. Del Bigio
- Department of Pathology , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Camelia Stefanovici
- Department of Pathology , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Elka Miller
- Department of Pediatric Radiology , University of Ottawa , Ottawa, Ontario , Canada
| | - Charity Fan
- Department of Genetics , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Martin Bunge
- Department of Pediatric Radiology , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Katya Rozovsky
- Department of Pediatric Radiology , University of Manitoba , Winnipeg , Manitoba , Canada
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17
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Complications of Monochorionic Diamniotic Twins: Stepwise Approach for Early Identification, Differential Diagnosis, and Clinical Management. MATERNAL-FETAL MEDICINE 2020. [DOI: 10.1097/fm9.0000000000000076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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McPherson E, Korlesky C, Hebbring S. Cardiac Anomalies in Liveborn and Stillborn Monochorionic Twins. Clin Med Res 2020; 18:58-67. [PMID: 31959670 PMCID: PMC7428205 DOI: 10.3121/cmr.2019.1478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/25/2019] [Accepted: 10/17/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cardiovascular anomalies are more common in monochorionic twins, especially with twin-twin transfusion, compared to other twin types and to singletons. Because previous studies are based on fetal and neonatal echocardiography, more information is needed to study prevalence of cardiac anomalies in twin miscarriages, stillbirths, and children after the immediate neonatal period. METHODS With specific attention to cardiac anomalies, we reviewed the medical records of 335 selected liveborn twin pairs from the Marshfield Clinic Twin Cohort (enriched for twin-twin transfusion) and all twins (175 pairs) identified in the Wisconsin Stillbirth Service Program cohort of late miscarriages and stillbirths. RESULTS Structural cardiac defects occurred in 12% of liveborn monochorionic twin infants and 7.5% of stillborn infants with twin-twin transfusion compared to only 2% of liveborn dizygotic twins and no stillborn dizygotic infants. The most common cardiac lesion in liveborn twins was ventricular septal defect, which was usually isolated and discordant, preferentially affecting the smaller twin in monochorionic pairs. Among stillborn and miscarried monochorionic twins, the most common cardiac lesion was acardia. CONCLUSIONS Monochorionic twins, particularly those with TTT, are at increased risk for a spectrum of structural cardiac malformations which we suggest may be related to asymmetry of the inner cell mass resulting in a smaller poorly perfused twin. In severe cases, limited cardiac and circulatory development in the affected twin leads to acardia. In less severe cases, the smaller infant has deficient septal growth that sometimes results in ventricular septal defect.
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Affiliation(s)
- Elizabeth McPherson
- Center for Human Genetics, Marshfield Clinic Research Institute, Marshfield, Wisconsin USA
| | - Colin Korlesky
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Scott Hebbring
- Center for Human Genetics, Marshfield Clinic Research Institute, Marshfield, Wisconsin USA
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19
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Barnes‐Davis ME, Cortezzo DE. Two cases of atypical twinning: Phenotypically discordant monozygotic and conjoined twins. Clin Case Rep 2019; 7:920-925. [PMID: 31110715 PMCID: PMC6509934 DOI: 10.1002/ccr3.2113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 12/13/2022] Open
Abstract
Atypical twinning highlights that complex mechanisms responsible for twinning are not fully understood and may give further insight into the mechanisms involved. To assume that phenotypic difference is the result of dizygotic twinning would be erroneous and could have significant implications in the care and counseling provided to these patients.
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Affiliation(s)
- Maria E. Barnes‐Davis
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhio
- Division of Neonatal and Pulmonary BiologyCincinnati Children’s Hospital Medical CenterCincinnatiOhio
| | - DonnaMaria E. Cortezzo
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhio
- Division of Neonatal and Pulmonary BiologyCincinnati Children’s Hospital Medical CenterCincinnatiOhio
- Department of AnesthesiologyUniversity of Cincinnati College of MedicineCincinnatiOhio
- Division of Pain and Palliative MedicineCincinnati Children’s Hospital Medical CenterCincinnatiOhio
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20
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Boer LL, Schepens-Franke AN, Oostra RJ. Two is a Crowd: Two is a Crowd: On the Enigmatic Etiopathogenesis of Conjoined Twinning. Clin Anat 2019; 32:722-741. [PMID: 31001856 PMCID: PMC6849862 DOI: 10.1002/ca.23387] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 12/31/2022]
Abstract
In this article, we provide a comprehensive overview of multiple facets in the puzzling genesis of symmetrical conjoined twins. The etiopathogenesis of conjoined twins remains matter for ongoing debate and is currently cited-in virtually every paper on conjoined twins-as partial fission or secondary fusion. Both theories could potentially be extrapolated from embryological adjustments exclusively seen in conjoined twins. Adoption of these, seemingly factual, theoretical proposals has (unconsciously) resulted in crystallized patterns of verbal and graphic representations concerning the enigmatic genesis of conjoined twins. Critical evaluation on their plausibility and solidity remains however largely absent. As it appears, both the fission and fusion theories cannot be applied to the full range of conjunction possibilities and thus remain matter for persistent inconclusiveness. We propose that initial duplication of axially located morphogenetic potent primordia could be the initiating factor in the genesis of ventrally, laterally, and caudally conjoined twins. The mutual position of two primordia results in neo-axial orientation and/or interaction aplasia. Both these embryological adjustments result in conjunction patterns that may seemingly appear as being caused by fission or fusion. However, as we will substantiate, neither fission nor fusion are the cause of most conjoined twinning types; rather what is interpreted as fission or fusion is actually the result of the twinning process itself. Furthermore, we will discuss the currently held views on the origin of conjoined twins and its commonly assumed etiological correlation with monozygotic twinning. Finally, considerations are presented which indicate that the dorsal conjunction group is etiologically and pathogenetically different from other symmetric conjoined twins. This leads us to propose that dorsally united twins could actually be caused by secondary fusion of two initially separate monozygotic twins. An additional reason for the ongoing etiopathogenetic debate on the genesis of conjoined twins is because different types of conjoined twins are classically placed in one overarching receptacle, which has hindered the quest for answers. Clin. Anat. 32:722-741, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Lucas L Boer
- Department of Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annelieke N Schepens-Franke
- Department of Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roelof Jan Oostra
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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21
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Korlesky C, McPherson E. Early demise of twins in a cohort of stillbirths and second trimester miscarriages. Am J Med Genet A 2019; 179:350-355. [PMID: 30663217 DOI: 10.1002/ajmg.a.61014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/08/2018] [Accepted: 11/16/2018] [Indexed: 11/11/2022]
Abstract
Twins, particularly monochorionic (MC) pairs, are at increased risk for fetal death. Whereas previous work has sought to understand the mechanisms for this increased mortality, most studies analyze viable twin pregnancies or liveborn twin cohorts. In the Wisconsin Stillbirth Service Program cohort of 3,137 stillbirths and second trimester miscarriages, we identified 175 twin pregnancies for a twinning rate of 56/1,000, which is approximately double the general population. The excess of twins among miscarriages and stillbirths was attributable to MC pairs as the incidence of dizygotic (DZ) twinning was not increased compared to livebirth data. The leading causes of fetal demise among twins were twin-twin transfusion, acardia, and twin-twin disruption. Maternal causes of death, primarily premature rupture of membranes, were moderately increased in both MC and DZ twins relative to singletons. Although deceased twins were smaller than expected for viable twins at comparable gestational ages, placenta weights of deceased MC pairs were large compared to combined fetal weight, which indicates placental inefficiency likely due to vascular shunting. Co-twin survival was much lower for MC than for DZ pairs. Therefore, earlier diagnosis and treatment of MC twinning complications may decrease prenatal mortality.
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Affiliation(s)
- Colin Korlesky
- Center for Human Genetics, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Elizabeth McPherson
- Center for Human Genetics, Marshfield Clinic Research Institute, Marshfield, Wisconsin
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22
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Andres K, Orel J, Lis MW. The phenomenon of the monovular twinning in the endangered zatorska goose. Poult Sci 2018; 97:4425-4432. [PMID: 29992327 DOI: 10.3382/ps/pey293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/14/2018] [Indexed: 11/20/2022] Open
Abstract
The phenomenon of multiple embryos in birds and other oviparous vertebrates is very rare and thus poorly studied. Some populations of wild birds or lines of poultry, including the zatorska goose, may be particularly predisposed to developing monovular twin embryos (MTE). The aim of the study was to investigate the frequency of single yolk twin embryos in the zatorska goose and to establish whether these embryos are generated as a result of polyembryony or other developmental anomalies.Embryopathological analysis, which included identification of the developmental stages of all MTEs at the time of death, was carried out on 1,955 unhatched eggs obtained from 20 pedigree breeding flocks of the zatorska goose. Post-mortem examinations revealed as many as 13 MTEs (0.66% compared to embryonated eggs) at varying developmental stages.The results of genotyping of the microsatellite loci of 7 pairs of twins demonstrated genetic similarity in 6 of them; this suggests that they developed from 1 blastoderm, while differences in 2 loci of 1 pair show that the MTE originates from 2 blastodiscs. Pedigree analysis of the MTEs does not provide evidence that predisposition toward twinning results from the genetic background. However, more frequent MTE occurrence could be seen in eggs stored for more than 8 d. It seems that embryos of the zatorska goose are more susceptible to duplication under special conditions, such as prolonged egg storage.
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Affiliation(s)
- Krzysztof Andres
- Department of Swine and Small Animal Breeding, University of Agriculture in Krakow, Mickiewicz Alley 24/28, 30-059 Krakow, Poland
| | - Joanna Orel
- Department of Veterinary, Animal Reproduction and Welfare, University of Agriculture in Krakow, Mickiewicz Alley 24/28, 30-059 Krakow, Poland
| | - Marcin W Lis
- Department of Veterinary, Animal Reproduction and Welfare, University of Agriculture in Krakow, Mickiewicz Alley 24/28, 30-059 Krakow, Poland
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23
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Summers AD, Reefhuis J, Taliano J, Rasmussen SA. Nongenetic risk factors for holoprosencephaly: An updated review of the epidemiologic literature. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018; 178:151-164. [PMID: 29761639 DOI: 10.1002/ajmg.c.31614] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/17/2022]
Abstract
Holoprosencephaly (HPE) is a major structural birth defect of the brain that occurs in approximately 1 in 10,000 live births. Although some genetic causes of HPE are known, a substantial proportion of cases have an unknown etiology. Due to the low birth prevalence and rarity of exposure to many potential risk factors for HPE, few epidemiologic studies have had sufficient sample size to examine risk factors. A 2010 review of the literature identified several risk factors that had been consistently identified as occurring more frequently among cases of HPE, including maternal diabetes, twinning, and a predominance of females, while also identifying a number of potential risk factors that had been less widely studied. In this article, we summarize a systematic literature review conducted to update the evidence for nongenetic risk factors for HPE.
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Affiliation(s)
- April D Summers
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennita Reefhuis
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joanna Taliano
- LAC Group, Contractor to US Centers for Disease Control and Prevention, Library Science Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Atlanta, Georgia
| | - Sonja A Rasmussen
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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24
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Zhang Y, Huang L, Huang X, He Z, Lin S, Wang Y, Li L, Luo Y, Fang Q. Chromosomal aberrations and CNVs in twin fetuses with cardiovascular anomalies: Comparison between monochorionic diamniotic and dichorionic diamniotic twins. Prenat Diagn 2018; 38:318-327. [PMID: 29460287 DOI: 10.1002/pd.5238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Yi Zhang
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Linhuan Huang
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Xuan Huang
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Zhiming He
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Shaobin Lin
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Ye Wang
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Lin Li
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Yanmin Luo
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Qun Fang
- Fetal Medicine Center, Department of Obstetrics and Gynecology; The First Affiliated Hospital of Sun Yat-sen University; Guangzhou China
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25
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Mallen JR, Hunter JB, Auerbach C, Wexler L, Vambutas A. Characterization of newborn hearing screening failures in multigestational births. Int J Pediatr Otorhinolaryngol 2018; 105:158-162. [PMID: 29447805 DOI: 10.1016/j.ijporl.2017.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To define the rate and characterize the type of newborn hearing screening failures in multigestational births. METHODS Retrospective chart review of all multigestational births that occurred in a 10-year period (2002-2012) in which at least one newborn failed newborn hearing screening at two tertiary care hospitals in the Northwell Health System. RESULTS Out of 125,405 total births, we identified 2961 multigestational births, of which 59 (2.0%) newborns failed newborn hearing screening. None of their 66 twin/triplet siblings failed their newborn hearing screens. Of 43 newborns that returned for follow-up, 56.0% (24/43) had confirmed hearing loss, resulting in an overall rate of 0.81% in all multigestational newborns with hearing loss. Of 19 infants that passed repeat testing, two were judged to need myringotomy tube placement. Twenty-four infants had a confirmed hearing loss, 11 of which had sensorineural hearing loss (0.37%), and 13 with a conductive or mixed hearing loss (0.44%). CONCLUSIONS We identified a greater than expected risk of conductive hearing loss, not attributable to otitis media, than sensorineural hearing loss in this population. These observations are consistent with the increased risk of birth defects in multigestational births.
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Affiliation(s)
- Jonathan Ross Mallen
- Department of Otolaryngology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA.
| | - Jacob B Hunter
- Department of Otolaryngology, Albert Einstein College of Medicine, Greene Medical Arts Pavilion, 3400 Bainbridge Avenue, 3rd Floor, Bronx, NY 10467, USA.
| | - Charles Auerbach
- Department of Social Work, Wurzweiler School of Social Work, Yeshiva University, Yeshiva University Wilf Campus, Belfer Hall, 2495 Amsterdam Avenue, New York, NY 10033, USA
| | - Leslie Wexler
- Department of Otolaryngology, Hofstra-Northwell School of Medicine, 430 Lakeville Rd, New Hyde Park, NY 11040, USA
| | - Andrea Vambutas
- Department of Otolaryngology, Hofstra-Northwell School of Medicine, 430 Lakeville Rd, New Hyde Park, NY 11040, USA; Department of Otolaryngology, Albert Einstein College of Medicine, Greene Medical Arts Pavilion, 3400 Bainbridge Avenue, 3rd Floor, Bronx, NY 10467, USA.
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26
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Tisler M, Schweickert A, Blum M. Xenopus, an ideal model organism to study laterality in conjoined twins. Genesis 2017; 55. [PMID: 28132423 DOI: 10.1002/dvg.22993] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 11/11/2022]
Abstract
Conjoined twins occur at low frequency in all vertebrates including humans. Many twins fused at the chest or abdomen display a very peculiar laterality defect: while the left twin is normal with respect to asymmetric organ morphogenesis and placement (situs solitus), the organ situs is randomized in right twins. Although this phenomenon has fascinated already some of the founders of experimental embryology in the 19th and early 20th century, such as Dareste, Fol, Warynsky and Spemann, its embryological basis has remained enigmatic. Here we summarize historical experiments and interpretations as well as current models, argue that the frog Xenopus is the only vertebrate model organism to tackle the issue, and outline suitable experiments to address the question of twin laterality in the context of cilia-based symmetry breakage.
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Affiliation(s)
- Matthias Tisler
- University of Hohenheim, Institute of Zoology, Stuttgart, D-70593, Germany
| | | | - Martin Blum
- University of Hohenheim, Institute of Zoology, Stuttgart, D-70593, Germany
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27
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Harris BS, Bishop KC, Kemeny HR, Walker JS, Rhee E, Kuller JA. Risk Factors for Birth Defects. Obstet Gynecol Surv 2017; 72:123-135. [PMID: 28218773 DOI: 10.1097/ogx.0000000000000405] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Major congenital abnormalities, or birth defects, carry significant medical, surgical, cosmetic, or lifestyle consequences. Such abnormalities may be syndromic, involving multiple organ systems, or can be isolated. Overall, 2% to 4% of live births involve congenital abnormalities. Risk factors for birth defects are categorized as modifiable and nonmodifiable. Modifiable risk factors require thorough patient education/counseling. The strongest risk factors, such as age, family history, and a previously affected child, are usually nonmodifiable. Objective This review focuses on risk factors for birth defects including alcohol consumption, illicit drug use, smoking, obesity, pregestational diabetes, maternal phenylketonuria, multiple gestation, advanced maternal age, advanced paternal age, family history/consanguinity, folic acid deficiency, medication exposure, and radiation exposure. Evidence Acquisition Literature review via PubMed. Results There is a strong link between alcohol use, folic acid deficiency, obesity, uncontrolled maternal diabetes mellitus, uncontrolled maternal phenylketonuria, and monozygotic twins and an increased risk of congenital anomalies. Advanced maternal age confers an increased risk of aneuploidy, as well as nonchromosomal abnormalities. Some medications, including angiotensin converting enzyme inhibitors, retinoic acid, folic acid antagonists, and certain anticonvulsants, are associated with various birth defects. However, there are few proven links between illicit drug use, smoking, advanced paternal age, radiation exposure, and statins with specific birth defects. Conclusions and Relevance Birth defects are associated with multiple modifiable and nonmodifiable risk factors. Obstetrics providers should work with patients to minimize their risk of birth defects if modifiable risk factors are present and to appropriately counsel patients when nonmodifiable risk factors are present.
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Affiliation(s)
| | | | - Hanna R Kemeny
- Medical Student, Duke University School of Medicine, Durham
| | - Jennifer S Walker
- Research Librarian, Health Sciences Library, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jeffrey A Kuller
- Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
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Tisler M, Thumberger T, Schneider I, Schweickert A, Blum M. Leftward Flow Determines Laterality in Conjoined Twins. Curr Biol 2017; 27:543-548. [PMID: 28190730 DOI: 10.1016/j.cub.2016.12.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 02/02/2023]
Abstract
Conjoined twins fused at the thorax display an enigmatic left-right defect: although left twins are normal, laterality is disturbed in one-half of right twins [1-3]. Molecularly, this randomization corresponds to a lack of asymmetric Nodal cascade induction in right twins [4]. We studied leftward flow [5, 6] at the left-right organizer (LRO) [7, 8] in thoracopagus twins in Xenopus, which displayed a duplicated, fused, and ciliated LRO. Cilia were motile and produced a leftward flow from the right LRO margin of the right to the left margin of the left twin. Motility was required for correct laterality in left twins, as knockdown of dynein motor dnah9 prevented Nodal cascade induction. Nodal was rescued by parallel knockdown of the inhibitor dand5 [9, 10] on the left side of the left twin. Lack of Nodal induction in the right twin, despite the presence of flow, was due to insufficient suppression of dand5. Knockdown of dand5 at the center of the fused LRO resulted in asymmetric Nodal cascade induction in the right twin as well. Manipulation of leftward flow and dand5 in a targeted and sided manner induced the Nodal cascade in a predictable manner, in the left twin, the right one, both, or neither. Laterality in conjoined twins thus was determined by cilia-driven leftward fluid flow like in single embryos, which solves a century-old riddle, as the phenomenon was already studied by some of the founders of experimental embryology, including Dareste [11], Fol and Warynsky [12], and Spemann and Falkenberg [13] (reviewed in [14]).
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Affiliation(s)
- Matthias Tisler
- Institute of Zoology, University of Hohenheim, Garbenstrasse 30, 70593 Stuttgart, Germany
| | - Thomas Thumberger
- Institute of Zoology, University of Hohenheim, Garbenstrasse 30, 70593 Stuttgart, Germany
| | - Isabelle Schneider
- Institute of Zoology, University of Hohenheim, Garbenstrasse 30, 70593 Stuttgart, Germany
| | - Axel Schweickert
- Institute of Zoology, University of Hohenheim, Garbenstrasse 30, 70593 Stuttgart, Germany
| | - Martin Blum
- Institute of Zoology, University of Hohenheim, Garbenstrasse 30, 70593 Stuttgart, Germany.
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Panagiotopoulou O, Fouzas S, Sinopidis X, Mantagos SP, Dimitriou G, Karatza AA. Congenital heart disease in twins: The contribution of type of conception and chorionicity. Int J Cardiol 2016; 218:144-149. [PMID: 27232926 DOI: 10.1016/j.ijcard.2016.05.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/07/2016] [Accepted: 05/12/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Increased incidence of congenital heart disease (CHD) has been reported in the offspring of monochorionic twin gestations. Assisted reproductive technology (ART), which is related to increased rates of twinning, has also been associated with higher risk of birth defects. We studied the incidence of CHD in a cohort of twins to clarify the contribution of type of conception and chorionicity. METHODS Data concerning 874 live-born twins of which at least one was admitted in our Neonatal Unit during 1995-2012 were analysed. Forty-five % (N=197) of the gestations resulted from ART (in vitro fertilisation or intracytoplasmic sperm insertion). RESULTS In the ART group 32/389 (8.2%) had CHD compared to 21/485 (4.3%) infants conceived naturally (OR 1.90, 95%CI 1.08-3.34, p=0.024). Spontaneous-conception gestations had higher incidence of monochorionic placentation (47/245 versus 4/197, p<0.001), and included younger mothers (29.1±5.2 versus 33.9±5.5years, p<0.001) who had higher parity (median 2 [range 1-7] versus 1 Pinborg (2005), Blondel and Kaminski (2002), Knopman et al. (2014), Kyvik and Derom (2006) ; p<0.001). Multivariable logistic regression analysis showed that ART (OR 2.60, 95% CI 1.24-5.45) and monochorionicity (OR 3.49, 95% CI 1.57-7.77) were significant determinants of CHD, independently of maternal age, parity, and the gender of the offspring. CONCLUSIONS We confirmed that monochorionic twins have increased risk of CHD and we documented a higher incidence of CHD in ART twins independently of chorionicity. We suggest improvement of echocardiographic skills of health care professionals involved in prenatal screening and foetal cardiology referral of ART dichorionic twins with suspicious findings at screening, in addition to all monochorionic gestations.
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Affiliation(s)
- Olga Panagiotopoulou
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Sotirios Fouzas
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Xenophon Sinopidis
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Stefanos P Mantagos
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Gabriel Dimitriou
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece
| | - Ageliki A Karatza
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Patras Medical School, Patras, Greece.
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Abstract
This review addresses the physiology of monochorionic diamniotic (MC/DA) twins and the potential for twin–twin transfusion syndrome (TTTS). It focuses on the underlying cardiovascular pathophysiology of TTTS and the cardiovascular impact of TTTS for both the recipient and the donor twin. It explains the principles for assessment and monitoring of these cardiovascular changes and how these may be used to guide pregnancy management. Finally, it describes the effect of treatment on the altered hemodynamics and how this can influence pregnancy and perinatal management, as well as longer-term follow-up.
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Guidelines for scanning twins and triplets with US and MRI. Pediatr Radiol 2016; 46:155-66. [PMID: 26829946 DOI: 10.1007/s00247-015-3455-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/07/2015] [Accepted: 08/14/2015] [Indexed: 10/22/2022]
Abstract
Multiple-fetus gestations have an increased risk of discordant anomalies, aneuploidy and growth restriction compared to singleton pregnancies. In addition, twins sharing the same placenta are at risk for developing specific conditions that are potentially amenable to surgical management. In those scenarios, patients might need to be evaluated not only with US but with fetal MRI as well. This paper outlines basic guidelines to consider when imaging complicated multiple-fetus gestations during the 2nd and 3rd trimesters.
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McNamara HC, Kane SC, Craig JM, Short RV, Umstad MP. A review of the mechanisms and evidence for typical and atypical twinning. Am J Obstet Gynecol 2016; 214:172-191. [PMID: 26548710 DOI: 10.1016/j.ajog.2015.10.930] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 12/11/2022]
Abstract
The mechanisms responsible for twinning and disorders of twin gestations have been the subject of considerable interest by physicians and scientists, and cases of atypical twinning have called for a reexamination of the fundamental theories invoked to explain twin gestations. This article presents a review of the literature focusing on twinning and atypical twinning with an emphasis on the phenomena of chimeric twins, phenotypically discordant monozygotic twins, mirror-image twins, polar body twins, complete hydatidiform mole with a coexistent twin, vanishing twins, fetus papyraceus, fetus in fetu, superfetation, and superfecundation. The traditional models attributing monozygotic twinning to a fission event, and more recent models describing monozygotic twinning as a fusion event, are critically reviewed. Ethical restrictions on scientific experimentation with human embryos and the rarity of cases of atypical twinning have limited opportunities to elucidate the exact mechanisms by which these phenomena occur. Refinements in the modeling of early embryonic development in twin pregnancies may have significant clinical implications. The article includes a series of figures to illustrate the phenomena described.
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Affiliation(s)
- Helen C McNamara
- Department of Maternal-Fetal Medicine, Royal Womens Hospital, Melbourne, Victoria, Australia
| | - Stefan C Kane
- Department of Maternal-Fetal Medicine, Royal Womens Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey M Craig
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Roger V Short
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark P Umstad
- Department of Maternal-Fetal Medicine, Royal Womens Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
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Abehsera D, de la Calle M, Rodríguez R, Revello R, Brunel I, Bartha J. Bipolar cord coagulation for selective feticide in a monochorionic twin pregnancy complicated by pentalogy of Cantrell. Taiwan J Obstet Gynecol 2016; 55:135-7. [DOI: 10.1016/j.tjog.2014.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/16/2022] Open
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Vannappagari V, Koram N, Albano J, Tilson H, Gee C. Association between in utero zidovudine exposure and nondefect adverse birth outcomes: analysis of prospectively collected data from the Antiretroviral Pregnancy Registry. BJOG 2015; 123:910-6. [PMID: 26269220 PMCID: PMC5042033 DOI: 10.1111/1471-0528.13542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2015] [Indexed: 11/30/2022]
Abstract
Objective To examine the association between nondefect adverse birth outcomes and in utero exposure to zidovudine (ZDV)‐containing regimens versus non‐ZDV antiretroviral (ARV) regimens. Design Analysis of prospectively‐collected data. Setting Global. Population HIV‐infected pregnant women prenatally exposed to antiretrovirals. Methods Estimation of prevalence of and risk for nondefect adverse birth outcomes among HIV‐infected women. Main outcome measures Prevalence of and risk for nondefect adverse birth outcomes. Results Among 12 780 singleton birth outcomes with in utero ZDV exposure, 96.1% were live births; 3.9% were spontaneous abortions, induced abortions or stillbirths. Among live births, 16.4% were low birthweight (LBW); 12.3% were premature. Among 1904 outcomes with in utero exposure to non‐ZDV ARV regimens, 85.8% were live births; 14.2% were spontaneous abortions, induced abortions or stillbirths. Among live births, 14.1% were LBW; 12.4% were premature. Relative risk comparing exposure to ZDV‐containing ARV regimens to non‐ZDV ARV regimens for spontaneous abortions was 0.18 (95% confidence interval [95% CI] 0.14–0.22); induced abortions 0.28 (95% CI 0.22–0.36); stillbirths 0.76 (95% CI 0.51–1.12); premature births 1.00 (95% CI 0.87–1.15) and LBW 1.17 (95% CI 1.02–1.33). Conclusion Prevalence of nondefect adverse birth outcomes is lower among outcomes with in utero ZDV exposure versus in utero non‐ZDV ARV exposure. The risks for spontaneous and induced abortions were no different for ZDV‐containing regimens versus non‐ZDV ARV regimens. For premature births and stillbirths, there was no significant difference in risk between the two regimens. The risk of LBW was statistically significantly higher among ZDV‐containing regimens versus non‐ZDV ARV regimens. Tweetable abstract ZDV‐containing regimens do not increase the risk for nondefect adverse birth outcomes. ZDV‐containing regimens do not increase the risk for nondefect adverse birth outcomes.
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Affiliation(s)
- V Vannappagari
- Epidemiology and Real World Evidence, ViiV Healthcare, Research Triangle Park, Raleigh, NC, USA.,Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - N Koram
- Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, Raleigh, NC, USA
| | - J Albano
- INC Research, Post Approval & Strategic Services, Raleigh, NC, USA
| | - H Tilson
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - C Gee
- INC Research, Biostatistics, Wilmington, NC, USA
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Pepe F, Teodoro MC, Luca C, Privitera F. Conservative management in a case of uncomplicated trap sequence: a case report and brief literature review. J Prenat Med 2015; 9:29-34. [PMID: 27358695 PMCID: PMC4909109 DOI: 10.11138/jpm/2015.9.3.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION twin reversed arterial perfusion (TRAP) sequence is a rare anomaly that occurs in monochorionic twins with overall mortality rate ranging from 50% to 70% in the normal fetus, above all for congestive cardiac failure. CASE REPORT a 31-year-old Caucasian gravida was referred to our fetomaternal medicine unit in the 25 gestational age. Ultrasound examination revealed a monochorionic, biamniotic twin pregnancy with a donor fetus showing normal morphology and growth corresponding to gestational age. The recipient twin appeared grossly abnormal with no head, upper limbs, heart, or thoracic structures and massive, diffuse, soft tissue edema. Fetal Doppler and fetal echocardiography revealed normal parameters. The patient refused any treatment and was monitored with weekly ultrasonography and Doppler ultrasound examination. She underwent cesarean section due to premature labor/rupture of membranes secondary to a mild polyhydramnios, at 36 weeks gestational age and delivered an apparent normal female live baby weighing 2550 gr, and another female acardius acephalus twin, birth weight 1300 gr. This baby had rudimental edematous lower limbs, pelvic bone, lower sacral vertebrae, and absence of thorax and cephalic structures. CONCLUSION although the literature suggest that early intrafetal laser treatment of TRAP sequence is advantageous, our case shows that pregnancies referred late would still require a tailored approach after a risk-benefit assessment.
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Sacrococcygeal appendage with femur: exoparasitic pyropagus twin, mature teratoma, or disorganization-like syndrome? Clin Dysmorphol 2015; 24:173-5. [PMID: 25945455 DOI: 10.1097/mcd.0000000000000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Twin birth rates have increased dramatically over the past three decades, and twins currently account for 3% of all pregnancies. Twin pregnancies of any type are at risk for prematurity. In addition, monochorionic twin pregnancies (25-30% of all twin pregnancies) are predisposed to a specific set of complications, including twin-to-twin transfusion syndrome (TTTS), twin reversed arterial perfusion syndrome (TRAP), malformations, and intertwin growth discordance. This article reviews the basic mechanisms underlying the twinning process, the relationship between zygosity and chorionicity, and the various types of twinning. We describe the major complications of monochorionic twinning in association with their reported placental characteristics (or lack thereof). Finally, a rational, evidence-based approach to examination of the twin placenta is presented. It is essential for the pathologist to understand the value, strengths, and limitations of examination of the twin placenta in order to provide a meaningful clinicopathological correlation in complicated (monochorionic) twin pregnancies.
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Affiliation(s)
- Monique E De Paepe
- Department of Pathology, Women and Infants Hospital, 101 Dudley St, Providence, RI 02905; Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, RI.
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Prefumo F, Fichera A, Pagani G, Marella D, Valcamonico A, Frusca T. The natural history of monoamniotic twin pregnancies: a case series and systematic review of the literature. Prenat Diagn 2015; 35:274-80. [DOI: 10.1002/pd.4538] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 10/12/2014] [Accepted: 11/08/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Federico Prefumo
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology; University of Brescia; Brescia Italy
| | - Anna Fichera
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology; University of Brescia; Brescia Italy
| | - Giorgio Pagani
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology; University of Brescia; Brescia Italy
| | - Daria Marella
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology; University of Brescia; Brescia Italy
| | - Adriana Valcamonico
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology; University of Brescia; Brescia Italy
| | - Tiziana Frusca
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology; University of Brescia; Brescia Italy
- Department of Obstetrics and Gynaecology; University of Parma; Parma Italy
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Mahalingam S, Dighe M. Imaging concerns unique to twin pregnancy. Curr Probl Diagn Radiol 2014; 43:317-30. [PMID: 25239076 DOI: 10.1067/j.cpradiol.2014.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 11/22/2022]
Abstract
The incidence of multiple gestations is increasing with rising maternal age and the utilization of artificial reproductive techniques. Twinning confers an increased risk to the pregnancy, with higher incidence of structural anomalies, preterm delivery, and perinatal morbidity and mortality. Certain conditions are unique to twin pregnancy, such as the twin-to-twin transfusion syndrome and the acardiac twin, secondary to vascular sharing between both the fetuses. Conjoined twinning is a phenomenon occurring because of late splitting of the zygote. Advances in imaging have increased our ability to manage multiple pregnancies with accurate prenatal diagnosis, better antenatal surveillance, and novel image-guided procedures. The purpose of this article is to provide an overview of the twinning process, including the pathophysiology, diagnostic pearls, and dilemmas and to briefly outline the outcomes and available treatment options to assist the radiologist in better management of multiple gestations.
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Affiliation(s)
| | - Manjiri Dighe
- Department of Radiology, University of Washington Medical Center, Seattle, WA
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Tararbit K, Lelong N, Houyel L, Bonnet D, Goffinet F, Khoshnood B. Assessing the role of multiple pregnancies in the association between tetralogy of Fallot and assisted reproductive techniques: a path-analysis approach. Orphanet J Rare Dis 2014; 9:27. [PMID: 24555734 PMCID: PMC3933480 DOI: 10.1186/1750-1172-9-27] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/03/2014] [Indexed: 01/21/2023] Open
Abstract
Background Assisted reproductive techniques (ART) are associated with a higher risk of tetralogy of Fallot (TOF) and multiple pregnancies may be associated with a higher risk of congenital anomalies. We assessed the extent to which the association between ART and risk of TOF may be mediated by the higher risk of multiple pregnancies associated with ART. Methods We conducted a case–control study using population-based data from the Paris Registry of Congenital Malformations for the period 1987–2009 and a cohort study of congenital heart defects (EPICARD). The study population included 395 cases of TOF and 4104 malformed controls with no known associations with ART. The analysis was based on a path-analysis model using a counterfactual approach, which allows decomposition of the total effect of ART into an indirect effect (that mediated by the association between ART and multiple pregnancies) and a direct effect. Results ART (all methods combined) were associated with a 2.6-fold higher odds of TOF after adjustment for maternal and paternal characteristics and year of birth (adjusted OR 2.6, 95% CI, 1.5-4.5). Most (79%) of the effect associated with ART was a direct effect (i.e., not mediated by multiple pregnancies), whereas 21% of the effect of ART was due to its association with multiple pregnancies (i.e., the indirect effect). In vitro fertilization with intracytoplasmic sperm injection was associated with a 3.5-fold higher odds of TOF (adjusted OR 3.5, 95% CI, 1.1-11.2); 11% of this effect was mediated through the association of ICSI with multiple pregnancies. Conclusions By far, most of the higher risk of TOF associated with ART is a direct effect and only a small proportion of the effect may be mediated by multiple pregnancies.
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Affiliation(s)
- Karim Tararbit
- Inserm, UMR S953, Epidemiological research on perinatal health, mothers and children health, Port-Royal Maternity, 6ème étage 53 avenue de l'Observatoire, Paris 75014, France.
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Abstract
Fumarase deficiency is a rare autosomal recessive inborn error of metabolism of the Krebs Tricarboxylic Acid cycle. A heavy neurological disease burden is imparted by fumarase deficiency, commonly manifesting as microcephaly, dystonia, global developmental delay, seizures, and lethality in the infantile period. Heterozygous carriers also carry an increased risk of developing hereditary leiomyomatosis and renal cell carcinoma. We describe a non-consanguineous family in whom a dichorionic diamniotic twin pregnancy resulted in twin boys with fumarase deficiency proven at the biochemical, enzymatic, and molecular levels. Their clinical phenotype included hepatic involvement. A novel mutation in the fumarate hydratase gene was identified in this family.
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Rider RA, Stevenson DA, Rinsky JE, Feldkamp ML. Association of twinning and maternal age with major structural birth defects in Utah, 1999 to 2008. ACTA ACUST UNITED AC 2013; 97:554-63. [PMID: 23913417 DOI: 10.1002/bdra.23156] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/10/2013] [Accepted: 05/14/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Twinning is a risk factor for birth defects. Using population-based data from the Utah Birth Defect Network and the Utah Department of Health Vital Records, we investigated whether twinning increases the risk of major structural birth defects in live-born opposite-sex (OS) and same-sex (SS) twins as proxies for monozygotic and dizygotic twins, respectively. We also assessed whether maternal age modified the association between twinning and birth defects. METHODS All resident live-born singleton (n = 492,143) and twin (n = 13,596) infants issued a Utah birth certificate and delivered from 1999 through 2008 were included. Unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals were calculated for each birth defect using unconditional logistic regression. RESULTS Birth defects were slightly more likely to occur in SS (aOR = 1.94; 95% confidence interval, 1.70-2.21) than OS (aOR = 1.55; 95% confidence interval, 1.27-1.90) twins. The aORs stratified by maternal age did not show a trend for any twin type when calculated for all birth defects combined. However, trends were observed for coarctation, pyloric stenosis, and shaft or penoscrotal hypospadias in OS twins; microcephaly, anotia/microtia, conotruncal defects, membranous ventricular septal defects, pyloric stenosis, all hypospadias, and craniosynostosis in SS twins; and tetralogy of Fallot, right ventricular outflow tract obstructions, renal agenesis/hypoplasia, and craniosynostosis in all twins. CONCLUSION All twin types have an increased risk for birth defects compared with singletons. SS twins have the highest risk, presumably due to the influence of monozygotic twins. The risk for birth defects in twins was not significantly modified by the mother's age.
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Affiliation(s)
- Renee A Rider
- Genomic Medicine Service, Department of Veterans Affairs, Salt Lake City, Utah 84148, USA.
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Abstract
AbstractThe science of genetics is undergoing a paradigm shift. Recent discoveries, including the activity of retrotransposons, the extent of copy number variations, somatic and chromosomal mosaicism, and the nature of the epigenome as a regulator of DNA expressivity, are challenging a series of dogmas concerning the nature of the genome and the relationship between genotype and phenotype. According to three widely held dogmas, DNA is the unchanging template of heredity, is identical in all the cells and tissues of the body, and is the sole agent of inheritance. Rather than being an unchanging template, DNA appears subject to a good deal of environmentally induced change. Instead of identical DNA in all the cells of the body, somatic mosaicism appears to be the normal human condition. And DNA can no longer be considered the sole agent of inheritance. We now know that the epigenome, which regulates gene expressivity, can be inherited via the germline. These developments are particularly significant for behavior genetics for at least three reasons: First, epigenetic regulation, DNA variability, and somatic mosaicism appear to be particularly prevalent in the human brain and probably are involved in much of human behavior; second, they have important implications for the validity of heritability and gene association studies, the methodologies that largely define the discipline of behavior genetics; and third, they appear to play a critical role in development during the perinatal period and, in particular, in enabling phenotypic plasticity in offspring. I examine one of the central claims to emerge from the use of heritability studies in the behavioral sciences, the principle of minimal shared maternal effects, in light of the growing awareness that the maternal perinatal environment is a critical venue for the exercise of adaptive phenotypic plasticity. This consideration has important implications for both developmental and evolutionary biology.
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Maurer B, Geyer SH, Weninger WJ. A chick embryo with a yet unclassified type of cephalothoracopagus malformation and a hypothesis for explaining its genesis. Anat Histol Embryol 2012; 42:191-200. [PMID: 22971166 DOI: 10.1111/ahe.12002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 08/06/2012] [Indexed: 12/12/2022]
Abstract
Cephalothoracopagus embryos are conjoined twins, who share parts of their heads, necks and bodies. Our study aims at presenting a detailed morphological analysis of a cephalothoracopagus chick embryo of developmental stage 31. Because none of the existing theories can explain the genesis of the phenotype of this embryo, we also suggest a hypothesis, which explains it. Beside the cephalothoracopagus embryo, we investigated five control embryos. With the aid of the high-resolution episcopic microscopy (HREM) technique, we created digital volume data and three-dimensional (3D) computer models of the organs and arteries of the embryos. We used the 3D models for topological analysis and for measuring the diameters of the great intrathoracic arteries. The malformed embryo showed two body backs, each containing a notochord, spinal cord and dorsal aorta. The body backs continued into separated lower bodies. The embryo had a single, four-chambered heart, single respiratory tract and single upper alimentary tract. The topology of the pharyngeal arch arteries was normal, and the diameters of these arteries were similar to that of the control embryos. We classified the embryo we investigated as a yet unknown malformation and suggest a hypothesis explaining its genesis.
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Affiliation(s)
- B Maurer
- Integrative Morphology Group, Centre for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
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Ince DA, Ecevit A, Kurt A, Varan B, Tarcan A. Dicephalic parapagus conjoined twins. Indian J Pediatr 2012; 79:818-9. [PMID: 22147544 DOI: 10.1007/s12098-011-0619-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 11/15/2011] [Indexed: 10/14/2022]
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Gratacós E, Ortiz J, Martinez J. A Systematic Approach to the Differential Diagnosis and Management of the Complications of Monochorionic Twin Pregnancies. Fetal Diagn Ther 2012; 32:145-55. [DOI: 10.1159/000342751] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 08/04/2012] [Indexed: 11/19/2022]
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Mutchinick OM, Luna-Muñoz L, Amar E, Bakker MK, Clementi M, Cocchi G, da Graça Dutra M, Feldkamp ML, Landau D, Leoncini E, Li Z, Lowry B, Marengo LK, Martínez-Frías ML, Mastroiacovo P, Métneki J, Morgan M, Pierini A, Rissman A, Ritvanen A, Scarano G, Siffel C, Szabova E, Arteaga-Vázquez J. Conjoined twins: a worldwide collaborative epidemiological study of the International Clearinghouse for Birth Defects Surveillance and Research. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2011; 157C:274-87. [PMID: 22002822 DOI: 10.1002/ajmg.c.30321] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Conjoined twins (CT) are a very rare developmental accident of uncertain etiology. Prevalence has been previously estimated to be 1 in 50,000 to 1 in 100,000 births. The process by which monozygotic twins do not fully separate but form CT is not well understood. The purpose of the present study was to analyze diverse epidemiological aspects of CT, including the different variables listed in the Introduction Section of this issue of the Journal. The study was made possible using the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) structure. This multicenter worldwide research includes the largest sample of CT ever studied. A total of 383 carefully reviewed sets of CT obtained from 26,138,837 births reported by 21 Clearinghouse Surveillance Programs (SP) were included in the analysis. Total prevalence was 1.47 per 100,000 births (95% CI: 1.32-1.62). Salient findings including an evident variation in prevalence among SPs: a marked variation in the type of pregnancy outcome, a similarity in the proportion of CT types among programs: a significant female predominance in CT: particularly of the thoracopagus type and a significant male predominance in parapagus and parasitic types: significant differences in prevalence by ethnicity and an apparent increasing prevalence trend in South American countries. No genetic, environmental or demographic significant associated factors were identified. Further work in epidemiology and molecular research is necessary to understand the etiology and pathogenesis involved in the development of this fascinating phenomenon of nature.
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Affiliation(s)
- Osvaldo M Mutchinick
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Departamento de Genética, Registro y Vigilancia Epidemiológica de Malformaciones Congénitas, México City, Mexico.
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