Therefore, antenatal care involves more intensive monitoring and protocols are different to those for a singleton pregnancy.
DEFINITION • Multiple pregnancy- occurs when more than one fetus simultaneously develop in the uterus. Many physicians underestimate the negative consequences of multiple pregnancies, even of twins. Maternal risks such as hypertension and maternal mortality are 3- to 7-fold higher in multiple pregnancies than in singleton pregnancies.
Multiple pregnancies occur in 1-2% of pregnancies. (1994) estimates are deemed to be sufficiently representative to use for modelling. Too much weight gain, especially in early pregnancy. Ovulation induction should be carried out when possible with specific treatments such as bromocriptine and pulsatile GnRH which tend to induce single ovulations. et al. The national cost of HMG/IUI in 2000 is projected at US$176.5 million. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Transferring two embryos would have an important effect on reducing the MGP costs of IVF, but the projected year 2000 costs of twins alone are slightly greater than the total IVF procedure costs. The provider may make the diagnosis with a health history, physical exam, and the following tests: Pregnancy blood testing. Triplet, quadruplet, and higher gestation pregnancies are usually a result of commonly used fertility drugs. Documentation of the economic consequences of a health care condition may lead to a number of interpretations. The goal of infertility therapy is a healthy child, and since the complications of multiple pregnancy put that goal at risk, multiple pregnancy is a serious complication of IVF and ICSI procedures. She had been struggling with her weight pretty much all her life.
Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Multiple gestation pregnancy rates are high in assisted reproductive treatment cycles because of the perceived need to stimulate excess follicles and transfer excess embryos in order to achieve reasonable pregnancy rates. The HMG/IUI success rate used is that of Guzick et al. Therefore, iron supplementation and stricter surveillance of haemoglobin concentration is required. However, just as siblings often look alike, fraternal multiples may look very similar. They loaded these costs onto the initial IVF cycle cost (US$8000), adding US$480 to the initial cost of all cycles to cover the cost of twins and US$720 to cover costs of higher orders of multiple gestation. Looks like you’ve clipped this slide to already. A major factor affecting the likelihood of a multiple birth was the number of embryos replaced and subsequent analysis has demonstrated that an increase in the number of embryos transferred invariably results in a higher likelihood of multiple birth, but without necessarily improving the overall success rate of IVF (Templeton and Morris, 1998).
Specific risks are discussed further below in the 'Complications' section. A multiples pregnancy can run in certain families. Learn more. (, Lambalk, C.B., Boomsma, D.I., De Boer, L. et al. In Adashi, E.Y., Rock, J.A.
Determine zygosity by sex, chorionicity or (in like-sex dichorionic twins) DNA analysis (of blood or placenta) or multiple blood genetic markers.
IVF with ICSI when necessary is the treatment of choice for virtually all difficult cases of infertility. Children may suffer long-term consequences of these perinatal complications. Baird, D.T.
The dilutional anaemia associated with pregnancy is often aggravated by the iron deficiency generally accentuated in multiple gestations. Alpha-fetoprotein. In couples with unexplained infertility and male subfertility, the pregnancy rate per cycle is increased following intrauterine insemination (IUI), particularly if treatment is combined with ovarian stimulation (ESHRE Workshop, 1996). For full access to this pdf, sign in to an existing account, or purchase an annual subscription. (1991) dichorionic diamniotic twins had a perinatal mortality rate of 4.8%, monochorionic diamniotic twins of 9.6%, and monochorionic monoamniotic twins of 29%. This phenomenon appears to be limited to DZ twins (Landy et al., 1986). Denton, J.
A more important interpretation arises from the implications about the severity or burden of the subjects' health condition. New polymorphisms at MTNR1A gene and their association with reproductive resumption in sarda breed sheep. and Rosenwaks, Z. by late (blastocyst) embryo transfer. Many women suspect they are pregnant with more than 1 baby. While treatment with gonadotrophins in combination with GnRH analogues gives a high yield of oocytes, there are several disadvantages, including the risk of hyperstimulation, the unpredictability of response and the necessity to store spare embryos.
Preeclampsia is more common in women who are carrying twins, triplets or other multiples.
205–216. In addition, twins are exposed to a 6.6-fold increased risk of dying before the end of the first year of life. Such births are often named according to the number of offspring, as in twins and triplets. The financial concerns arise mainly from the direct costs of prematurity: neonatal intensive care, drug therapy, inhalation therapy, imaging and other diagnostic procedures. showed that fetal mortality for twins is lower than the mortality for singletons weighing <2500 g. Some protective factor seems to be involved in twins. 0000004356 00000 n
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0000032004 00000 n Early determination of placentation (the ultrasonographic finding of the so-called lambda sign has a 100% sensitivity and 86% specificity in diagnosing a dichorionic placenta) (Wood et al., 1996) is fundamental and allows optimum subsequent clinical management.
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