Antepartum care in multiple gestation.

Abstract:

:Multiple gestation carries a significant risk of perinatal complications and mortality. Often twin neonates are delivered small and early with a perinatal mortality rate five to seven times that of singleton neonates. Increased morbidity and mortality is due to an increased incidence of antepartum complications, monozygotic pathology, preterm labor, and uteroplacental insufficiency. The key to management is early diagnosis, risk assessment, serial ultrasonography for fetal growth, and antepartum testing from 28 weeks until delivery. Prophylactic cerclage or tocolysis have not proven valuable. Reduction of maternal activity (bedrest) has theoretical advantages and is supported by retrospective studies, but not by prospective trials. The timing of delivery is based on the usual considerations. Third trimester uteroplacental insufficiency is identified by serial ultrasonographic exam and antepartum testing. Discordant fetal testing creates a dilemma: the risk of continued hypoxic damage to the sicker twin and the risks of premature delivery in the healthy twin. The management of this dilemma should be based on as much information as possible, ie, oxytocin challenge testing, biophysical profile and fetal lung maturity studies, and as much experience as possible, ie, a perinatal center, equipped to handle very sick premature infants.

journal_name

Semin Perinatol

journal_title

Seminars in perinatology

authors

Newton ER

subject

Has Abstract

pub_date

1986-01-01 00:00:00

pages

19-29

issue

1

eissn

0146-0005

issn

1558-075X

pii

0146-0005(86)90044-3

journal_volume

10

pub_type

杂志文章,评审
  • Diagnostic errors in the neonatal intensive care unit: State of the science and new directions.

    abstract::Diagnostic errors remain understudied in neonatology. The limited available evidence, however, suggests that diagnostic errors in the neonatal intensive care unit (NICU) result in significant and long-term consequences. In this narrative review, we discuss how the concept of diagnostic errors framed as missed opportun...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2019.08.004

    authors: Shafer G,Singh H,Suresh G

    更新日期:2019-12-01 00:00:00

  • Neuroblastoma in the neonate.

    abstract::Neuroblastoma is the most common malignant neoplasm occurring in the neonate and arguably the most variable in its presentation. This review examines differences in the tumor's clinical course in the context of known biologic determinants of behavior. Tumors that would go undetected except for prenatal ultrasonography...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1016/s0146-0005(99)80035-4

    authors: Lukens JN

    更新日期:1999-08-01 00:00:00

  • A new tool for prenatal diagnosis: ultrafast fetal MRI.

    abstract::The development of ultrafast magnetic resonance imaging scanners and sequences provides a new tool for the diagnosis of fetal anomalies. Magnetic resonance imaging is a valuable adjunct to prenatal ultrasound especially for the evaluation of suspected fetal brain anomalies, chest masses, abdominal masses, and renal di...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1016/s0146-0005(99)80023-8

    authors: Hubbard AM,Harty MP,States LJ

    更新日期:1999-12-01 00:00:00

  • Nutrition and maternal, neonatal, and child health.

    abstract::This article reviews the central role of nutrition in advancing the maternal, newborn, and child health agenda with a focus on evidence for effective interventions generated using randomized controlled trials in low- and middle-income countries (LMIC). The 1000 days spanning from conception to 2 years of life are a cr...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2015.06.009

    authors: Christian P,Mullany LC,Hurley KM,Katz J,Black RE

    更新日期:2015-08-01 00:00:00

  • Ichthyosis in the newborn.

    abstract::The ichthyoses encompass a variety of genetic disorders marked by abnormal epidermal differentiation. The neonatal period is critical for patients with ichthyosis because of the risk for significant associated morbidity and mortality, with the majority of complications arising as a result of impaired barrier function....

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2012.11.001

    authors: Craiglow BG

    更新日期:2013-02-01 00:00:00

  • Prevention of preterm birth based on a short cervix: cerclage.

    abstract::In an attempt to prevent preterm birth, clinicians have recommended cerclage for women with shortened cervical length and other worrisome sonographic cervical features in the mid-trimester, although randomized trials have not supported this practice. Emerging data suggest that preterm birth is a complex and poorly und...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2009.06.005

    authors: Mancuso MS,Owen J

    更新日期:2009-10-01 00:00:00

  • Traditional birth attendants and birth outcomes in low-middle income countries: A review.

    abstract::Traditional birth attendants (TBAs) provided delivery care throughout the world prior to the development of organized systems of medical care. In 2016, an estimated 22% of pregnant women delivered with a TBA, mostly in rural or remote areas that lacked formal health services. Still active in many regions of LMICs, the...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2019.03.013

    authors: Garces A,McClure EM,Espinoza L,Saleem S,Figueroa L,Bucher S,Goldenberg RL

    更新日期:2019-08-01 00:00:00

  • Immunosuppressant therapy in pregnant organ transplant recipients.

    abstract::Transplant recipients are becoming pregnant with increasing frequency, and successful pregnancy outcomes have now been reported for women with all types of solid organ transplants. To prevent rejection of the transplanted organ, these patients are maintained on a life-long immunosuppressive regimen that must also be c...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2007.09.006

    authors: Fuchs KM,Coustan DR

    更新日期:2007-12-01 00:00:00

  • Modulators of inflammation in Bronchopulmonary Dysplasia.

    abstract::Over 50 years after its first description, Bronchopulmonary Dysplasia (BPD) remains a devastating pulmonary complication in preterm infants with respiratory failure and develops in 30-50% of infants less than 1000-gram birth weight. It is thought to involve ventilator- and oxygen-induced damage to an immature lung tha...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2018.09.009

    authors: Savani RC

    更新日期:2018-11-01 00:00:00

  • Substrate metabolism in the developing heart.

    abstract::The developing heart undergoes a remarkable metabolic transformation as it adjusts to the higher-oxygen, extrauterine environment. During gestation, glycolysis and lactate oxidation constitute the major sources of adenosine triphosphate (ATP) for the fetal heart. After birth, however, there is a rapid shift from carbo...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1016/s0146-0005(96)80068-1

    authors: Ascuitto RJ,Ross-Ascuitto NT

    更新日期:1996-12-01 00:00:00

  • Prenatal diagnosis and multiple pregnancy.

    abstract::The incidence of twins, triplets, and high-order multiples has increased dramatically in the last two decades secondary to greater reliance on fertility treatments and to delayed childbearing. Offspring of a multiple gestation are at increased risk for both chromosomal and structural abnormalities. Prenatal diagnosis ...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2005.08.005

    authors: Cleary-Goldman J,D'Alton ME,Berkowitz RL

    更新日期:2005-10-01 00:00:00

  • Peri-viable birth: legal considerations.

    abstract::Peri-viable birth raises an array of complex moral and legal concerns. This article discusses the problem with defining viability, touches on its relationship to abortion jurisprudence, and analyzes a few interesting normative implications of current medical practice at the time of peri-viable birth. ...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2013.07.009

    authors: Sayeed SA

    更新日期:2014-02-01 00:00:00

  • Cesarean section on demand.

    abstract::The safety of cesarean section has improved dramatically over the past 50 years. During the past 20 years a greater awareness of and discussion about the symptomatic morbidity that can result for women following vaginal delivery has occurred and women's expectations for the outcome of pregnancy for them and their babi...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/sper.2003.50002

    authors: Morrison J,MacKenzie IZ

    更新日期:2003-02-01 00:00:00

  • A novel point-of-care device for measuring glucose-6-phosphate dehydrogenase enzyme deficiency.

    abstract::Extreme hyperbilirubinemia can cause bilirubin neurotoxicity. Infants with glucose-6-phosphate dehydrogenase (G6PD) deficiency can develop hemolysis and thus are at high risk. We evaluated a device that quantitatively measures G6PD activity kinetically using digital microfluidics (DMF). Intra- and inter-instrument and...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章

    doi:10.1016/j.semperi.2020.151356

    authors: Wong RJ,Montiel C,Kunda M,Stevenson DK,Bhutani VK

    更新日期:2021-02-01 00:00:00

  • Current approaches to the evaluation and management of the fetus and neonate with immune thrombocytopenia.

    abstract::Fetal and neonatal alloimmune thrombocytopenia is not a well-known disease, except among specialists in maternal-fetal medicine, neonatologists, and certain pediatricians (ie, hematologists). However, this is by far the most common cause of early severe thrombocytopenia in neonates and of intracranial hemorrhage in te...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2008.10.003

    authors: Bussel JB,Sola-Visner M

    更新日期:2009-02-01 00:00:00

  • Benefits and risks of MRI in pregnancy.

    abstract::Ultrasound remains the modality of choice in imaging the fetus due to its availability, safety, and low cost. With advances in technology, however, magnetic resonance imaging (MRI) has become an important adjuvant in the evaluation of the fetus. MRI is not limited by fetal lie, oligohydramnios, overlying bone, or obes...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2013.06.005

    authors: Bulas D,Egloff A

    更新日期:2013-10-01 00:00:00

  • Dilemmas initiating enteral feedings in high risk infants: how can they be resolved?

    abstract::In initiating enteral feedings for high-risk infants, clinicians struggle with three fundamental questions: When should enteral feedings be initiated? Should a period of trophic (minimal) feeding be provided? When feedings are advanced, how rapidly should the volume be increased? We present the findings of our systema...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2007.02.008

    authors: Tyson JE,Kennedy KA,Lucke JF,Pedroza C

    更新日期:2007-04-01 00:00:00

  • Overview of the mechanisms of induction of labor.

    abstract::Here we provide a brief overview of the natural process of labor and its biochemical, hormonal, and mechanical characteristics that can be exploited in methods employed for induction of labor. ...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2015.07.001

    authors: Irani RA,Foster S

    更新日期:2015-10-01 00:00:00

  • Seizures in pregnancy: epilepsy, eclampsia, and stroke.

    abstract::Seizures during pregnancy complicate <1% of all gestations; however, they are associated with increased adverse maternal and perinatal outcomes (acute and long term). The differential diagnosis of seizures in pregnancy is extensive. Determining the underlying etiology is crucial in the management of these patients. Me...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2013.04.001

    authors: Hart LA,Sibai BM

    更新日期:2013-08-01 00:00:00

  • Normal fetal physiology and behavior, and adaptive responses with hypoxemia.

    abstract::The principal objective of antenatal testing is to detect fetal hypoxia before the fetus has suffered lasting harm. This article summarizes some of the mechanisms by which fetal oxygen consumption is maintained under normal conditions, and adaptations that occur in response to hypoxemia. Alterations in the fetal heart...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2008.04.003

    authors: Martin CB Jr

    更新日期:2008-08-01 00:00:00

  • What we have learned from an antibiotic trial in fetal fibronectin positive women.

    abstract::Clinically silent upper genital tract microbial infections have been strongly associated with spontaneous preterm delivery, especially prior to 32 weeks gestational age. This condition represents a potentially preventable or reversible cause of preterm birth using safe, readily available, and inexpensive antibiotics. ...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1016/s0146-0005(03)00006-5

    authors: Andrews WW,Goldenberg RL,National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.

    更新日期:2003-06-01 00:00:00

  • The evolving relationship between conservative states and access to contraception.

    abstract::Poor access to contraception can lead to several undesired health outcomes, including high rates of unintended pregnancy, high rates of teen pregnancy, spontaneous preterm delivery, preeclampsia and maternal death. Properly addressing these public health issues often require a coordinated response at the state governm...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1016/j.semperi.2020.151272

    authors: Jackson AD,Sherpa ML

    更新日期:2020-08-01 00:00:00

  • After shoulder dystocia: managing the subsequent pregnancy and delivery.

    abstract::Among risk factors for shoulder dystocia, a prior history of delivery complicated by shoulder dystocia is the single greatest risk factor for shoulder dystocia occurrence, with odds ratios 7 to 10 times that of the general population. Recurrence rates have been reported to be as high as 16%. Whereas prevention of shou...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2007.03.009

    authors: Gurewitsch ED,Johnson TL,Allen RH

    更新日期:2007-06-01 00:00:00

  • Suppression of lactation.

    abstract::Medical and psychological indications for lactation suppression are discussed, and methods for lactation suppression are evaluated. Medical indications for lactation suppression include 1) maternal anatomical abnormalities, such as inadequate secretory tissue and inverted nipples; 2) maternal breast infections and tu...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:

    authors: Harrison RG

    更新日期:1979-07-01 00:00:00

  • Other factors/conditions associated with cerebral palsy.

    abstract::The cause for most cases of cerebral palsy is unknown. There are however, risk factors that have been associated with this chronic neuromuscular disease. The objective of this article is to review the maternal and fetal conditions (other than asphyxia and infection) strongly associated with increased rate of cerebral ...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/sper.2000.7052

    authors: Ramin SM,Gilstrap LC 3rd

    更新日期:2000-06-01 00:00:00

  • Placental transfer of selected substances of abuse.

    abstract::The placenta was classically considered a barrier, but in 1957 this notion was shattered. This organ is only a selective filter and metabolic site. In this review, the placental transfer of the top 17 substances of abuse are analyzed. In the National Library of Medicine only 41 papers that documented placental transfe...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1016/s0146-0005(96)80082-6

    authors: Little BB,VanBeveren TT

    更新日期:1996-04-01 00:00:00

  • Immunosuppressant therapy during gestation.

    abstract::Use of immunosuppressants during pregnancy is indicated for anti-rejection therapy in transplantation patients and treatment of autoimmune diseases. Maternal side effects include nephrotoxocity and hepatotoxicity. All immunosuppressant drugs cross the placenta. Immunosuppressant use during the first trimester is not s...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1016/s0146-0005(97)80057-2

    authors: Little BB

    更新日期:1997-04-01 00:00:00

  • Measuring and communicating meaningful outcomes in neonatology: A family perspective.

    abstract::Medium- and long-term outcomes have been collected and described among survivors of neonatal intensive care units for decades, for a number of purposes: (1) quality control within units, (2) comparisons of outcomes between NICUs, (3) clinical trials (whether an intervention improves outcomes), (4) end-of-life decision...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2016.09.009

    authors: Janvier A,Farlow B,Baardsnes J,Pearce R,Barrington KJ

    更新日期:2016-12-01 00:00:00

  • The medical and legal aspects of maternal mortality.

    abstract::Sudden unexpected changes in the life of a family create many different emotions in various family members. The death of a young woman during or after her pregnancy is especially difficult because of the strain it places on family dynamics. One of the consequences is that there is, commonly, a newborn, and perhaps oth...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章

    doi:10.1053/j.semperi.2011.09.014

    authors: Elliott JP

    更新日期:2012-02-01 00:00:00

  • Industry perspectives on prenatal genetic testing.

    abstract::Until recent years, prenatal genetic tests have been almost exclusively developed and implemented by academic physicians and laboratories. In the last several years, industry has led the development of novel prenatal genetic tests, funded clinical trials and implemented these tests into clinical practice. That these e...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审

    doi:10.1053/j.semperi.2018.07.021

    authors: Swanson A,Goldberg JD

    更新日期:2018-08-01 00:00:00