Pregnancy Prelims.qxd 11/24/2006 9:37 PM Page i Second Edition MULTIPLE Pregnancy Epidemiology, Gestation & Perinatal outcome Pregnancy Prelims.qxd 11/24/2006 9:37 PM Page ii 3D Ultrasound image of monoamniotic twins at 28 weeks’gestation.Image courtesy of Asim Kurjak MD, Zagreb, Croatia Pregnancy Prelims.qxd 11/24/2006 9:37 PM Page iii Second Edition MULTIPLE Pregnancy Epidemiology, Gestation & Perinatal outcome Edited by ISAAC BLICKSTEIN MD The Hadassah-Hebrew University School of Medicine Jerusalem and LOUIS G. KEITH MD PhD The Feinberg School of Medicine Northwestern University, Chicago Associate Editor DONALD M. KEITH MBA LTC USA (RET) The Center for Study of Multiple Birth, Chicago Special photography by DAVID TEPLICA MD MFA Saint Joseph Hospital, Chicago Pregnancy Prelims.qxd 11/24/2006 9:37 PM Page iv © 2005 Informa UK Ltd First published in the United Kingdom in 2005 by Taylor & Francis, 4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN. Informa Healthcare is a trading division of Informa UK Ltd. Registered Office: 37/41 Mortimer Street, London W1T 3JH. Registered in England and Wales number 1072954. Tel: +44 (0)20 7017 6000 Fax: +44 (0)20 7017 6699 Email: [email protected] Website: www.informahealthcare.com Second printing 2006 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP. Photographs used on the cover and section divider pages are copyright of David Teplica MD, MFA, 2004. They may not be reproduced in any format without prior permission from the photographer at 803 West Hutchinson Street, Chicago, IL 60613, USA. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. A CIP record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Data available on application ISBN-10: 1 84214 239 9 ISBN-13: 978 0 1 84214 239 4 Distributed in North and South America by Taylor & Francis 6000 Broken Sound Parkway, NW, (Suite 300) Boca Raton, FL 33487, USA Within Continental USA Tel: 1 (800) 272 7737; Fax: 1 (800) 374 3401 Outside Continental USA Tel: (561) 994 0555; Fax: (561) 361 6018 Email: [email protected] Distributed in the rest of the world by Thomson Publishing Services Cheriton House North Way Andover, Hampshire SP10 5BE, UK Tel: +44 (0)1264 332424 Email: [email protected] Composition by C&M Digitals (P) Ltd, Chennai, India Printed and bound in Replika Press Pvt. Ltd Pregnancy Prelims.qxd 11/24/2006 9:37 PM Page v Contents Contributors xi Preface xxiii Foreword xxvii John J. Sciarra Foreword xxix Sabaratnam Arulkumaran SECTION I EPIDEMIOLOGICAL AND DEMOGRAPHIC CONSIDERATIONS 1 A. Population-based data 1. Perinatal outcomes of singleton and multiple births in the United States, 1995–98 3 G. R. Alexander and H. M. Salihu 2. Demographic trends in Western European countries 11 A. Macfarlane and B. Blondel 3. Demographic trends in Nordic countries 22 J. Kaprio and R. Marttila 4. Multiple births in Australia 26 M. P. Umstad and P. A. L. Lancaster 5. Demographic trends in Japan and Asia 33 Y. Imaizumi 6. The East Flanders Prospective Twin Survey 39 C. Derom and R. Derom 7. Multiple births in Israel 48 I. Blickstein and L. Baor B. Non-population-based data 8. Multiple births in the Philippines 51 C. Yabes-Almirante and B. B. Bautista-Zamora 9. Multiple gestations: an Argentinian point of view 55 L. S. Voto, J. Ortí and M. Uranga-Imaz C. ART registry data 10. Multiple births resulting from assisted reproductive technologies in the United States, 1997–2001 58 J. Markovitz and A. Hershlag 11. Multiple births and infertility treatments in France: results from the FIVNAT registry 68 E. Papiernik, J. de Mouzon and B. Blondel D. Caveats in epidemiological assessment 12. Errors in gestational age: implications in studies of perinatal epidemiology 76 C. V. Ananth and R. W. Platt v Pregnancy Prelims.qxd 11/24/2006 9:37 PM Page vi MULTIPLE PREGNANCY SECTION II BIOLOGICAL CONSIDERATIONS 83 13. Definition of multiple pregnancy 85 I. Blickstein A. Natural twinning 14. Natural factors influencing multiple gestation: perspectives from long-term observations in Scotland 87 D. M. Campbell 15. The phenomenon of monozygosity: spontaneous zygotic splitting 94 O. Bomsel-Helmreich and W. Al Mufti 16. Superfecundation and superfetation 102 I. Blickstein 17. The vanishing fetus 108 H. J. Landy and L. G. Keith 18. Uncommon causes of twinning: complete hydatidiform mole with coexistent twin 113 E. Vaisbuch and A. Ben-Arie B. Iatrogenic twinning 19. The impact of ovulation induction and in vitrofertilization on the incidence of multiple gestations 119 R. P. Dickey and B. M. Sartor 20. Micromanipulation and the risk of multiple pregnancy 140 R. Aurell, I. Belil, A. Veiga and P. N. Barri 21. Cloning 145 I. Blickstein 22. Natural history of multiples conceived by in vitrofertilization 148 G. B. La Sala, A. Gallinelli, G. Nucera and M. T. Villani 23. Heterotopic pregnancy 151 Y. Or and A. Barash C. Placentation 24. Placentation 157 R. Derom and C. Derom 25. Placental examination in the delivery room 168 J. J. de Sousa Barros 26. Advanced placental examination of twins and high-order multiple pregnancies 179 G. A. Machin 27. Vascular anatomy of monochorionic twin placentas 193 G. A. Machin D. Monozygosity 28. The phenomenon of monozygosity 201 G. A. Machin 29. The phenomenon of monozygosity in iatrogenic pregnancies 214 S. D. Spandorfer and Z. Rosenwaks 30. Monozygosity following assisted reproduction: unanswered questions 218 I. Blickstein 31. The phenomenon of monozygosity: monozygotic twins in high-order multiples 222 G. A. Machin 32. Phenotypic and genotypic discordance in monozygotic twins 226 A. Cao and G. Monni vi Pregnancy Prelims.qxd 11/24/2006 9:37 PM Page vii CONTENTS 33. Conjoined twins 233 J. J. Oleszczuk and A. K. Oleszczuk E. Fetal malformations and mortality 34. Trends in congenital malformations, chromosomal anomalies and infant mortality among twin births 246 C. V. Ananth and J. C. Smulian 35. Pregnancy loss: multiple pregnancy versus multiple birth 252 M. S. Verp F. Genetic perspectives 36. The biology of human twinning: a needed change of perspective 255 C. E. Boklage 37. Twins in genetic research 265 A. Busjahn and D. Boomsma 38. The mirror phenomenon in monozygotic twins 277 D. Teplica and K. Peekna SECTION III PRENATAL DIAGNOSIS 289 A. General ultrasound assessment 39. Diagnosis of chorionicity and amnionicity 291 I. E. Timor-Tritsch and A. Monteagudo 40. Three-dimensional sonography 309 A. Kurjak and N. Vecˇek B. Specific ultrasound assessment 41. The role of Doppler blood flow velocimetry 322 M. Ropacka and G. H. Br¸eborowicz 42. Fetal echocardiography 332 M. Respondek-Liberska and A. Wloch 43. Sonographic assessment of fetal anomalies 342 I. Meizner and R. Hackmon 44. Sonographic diagnosis of twin-to-twin transfusion syndrome 351 A. Matias and N. Montenegro C. Aneuploidy assessment 45. Genetic counseling: overview 363 Z. Appelman 46. Non-invasive screening tests 368 K. Spencer 47. Nuchal translucency measurement 385 R. Maymon and A. Herman 48. Diagnostic genetic testing 393 E. Pergament SECTION IV PREGNANCY MANAGEMENT: MATERNAL 403 49. Routine antepartum care of twins 405 R. B. Newman 50. Routine antepartum care of triplets and more 420 J. P. Elliott vii Pregnancy Prelims.qxd 11/24/2006 9:37 PM Page viii MULTIPLE PREGNANCY 51. Nutritional adaptation 427 G. Sharma and K. Ziubrak 52. Maternal cardiovascular adaptation 436 J. Nizard and B. Arabin 53. Hypertensive disorders 444 M. Smith-Levitin and N. Vohra 54. Diabetes 451 Y. Hazan and I. Blickstein 55. Pregnancy management: assessment of cervical status 456 B. Arabin, J. Nizard and J. van Eyck 56. Fetal fibronectin 470 D. A. Netta and C. V. Ananth 57. Preterm rupture of the membranes 476 M. Mazor, A. Bashiri and A. Smolin 58. Psychological adaptation 483 E. Noble 59. Maternal mortality 492 I. Blickstein SECTION V PREGNANCY MANAGEMENT: FETAL GROWTH AND WELL-BEING 501 60. Intrauterine growth 503 I. Blickstein 61. Ultrasound assessment of growth 514 E. R. Sabbagha, T. Chyczewski and R. E. Sabbagha 62. Techniques of biophysical assessment 521 G. C. Di Renzo, M. M. Mignosa, G. Clerici, A. Rosati and R. Luzietti SECTION VI PREGNANCY MANAGEMENT: INTERVENTIONS 533 A. Reduction procedures 63. Multifetal pregnancy reduction 535 M. I. Evans, D. Ciorica, D. W. Britt and J. C. Fletcher 64. Selective termination of the anomalous fetus 544 R. Peltz and S. Lipitz B. Monozygosity-related complications 65. Management of twin–twin transfusion syndrome 552 M. J. O. Taylor and N. M. Fisk 66. Pathophysiology of twin–twin transfusion syndrome: a general model 571 M. J. C. van Gemert and A. Umur 67. Monoamniotic twins 574 C. M. Bilardo and B. Arabin 68. Pseudo-monoamniotic twins 583 I. Blickstein 69. Placental vasculature in the pathogenesis of fetal mortality and morbidity in multiple pregnancies 586 M. J. C. van Gemert and P. G. J. Nikkels 70. Management of single fetal death 589 I. Blickstein 71. Twin reversed arterial perfusion (TRAP) sequence 594 I. Blickstein viii Pregnancy Prelims.qxd 11/24/2006 9:37 PM Page ix CONTENTS C. Measures to reduce preterm delivery 72. Inhibition of preterm labor and subcutaneous terbutaline therapy 601 F. Lam and P. Gill 73. Preterm delivery: a review of the evidence-based literature 626 D. J. Owen and Z. Alfirevic 74. Preventing preterm birth in twins and triplets 631 E. Papiernik 75. Delayed-interval delivery 640 J. van Eyck, B. Arabin and R. A. van Lingen SECTION VII PREGNANCY MANAGEMENT: DELIVERY 645 76. Timing of delivery 647 S. T. Chasen 77. Impact of obstetric intervention on trends in perinatal mortality 651 C. V. Ananth and K. S. Joseph 78. The optimum route of delivery 660 R. B. Kalish and F. A. Chervenak 79. Delivery of the term twin: a Canadian perspective 668 J. F. R. Barrett 80. Delivery of multiples: a dissenting view 677 I. Blickstein 81. Special situations in labor and delivery of multiples 680 I. Blickstein 82. Pregnancy management: anesthesia 683 C. A. Wong 83. Epidemiology of bleeding and hemorrhage in multiple gestations 692 D. Levin and R. Levy 84. Management of uteroplacental bleeding disorders 698 L. Yeo and C. V. Ananth 85. Twin pregnancy and delivery: the role of the midwife in Sweden 706 L. J. Kvist and H. Rydhström SECTION VIII POSTPARTUM CONCERNS 713 A. Puerperal concerns 86. Puerperal complications 715 D. W. Skupski 87. Incontinence and pelvic floor dysfunction 724 R. P. Goldberg 88. Breast-feeding multiples 726 O. Flidel-Rimon and E. S. Shinwell 89. Psychological morbidity: diagnosis and treatment 734 N. H. Cirino and N. Dresner B. Neonatal concerns 90. The very- and extremely-low-birth-weight infant 743 E. S. Shinwell and A. Nahum ix