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Revista Brasileira de Ginecologia e Obstetrícia. 07-11-2003;22(8):511-517
DOI 10.1590/S0100-72032000000800007
Purpose: to demonstrate the types of fetal malformations in multiple pregnancy and their relation to chorionicity. Methods: one hundred and sixty-nine multiple pregnancies were evaluated. In all cases prenatal ultrasound examination was performed during antenatal care. Chorionicity was defined by: first trimester ultrasound evaluation (absence of lambda sign); presence of two separate placentas; different fetal sex; pathological placental examination. Results: twenty-four (14.2%) fetal malformations were observed, 22 in twin and 2 in triplet pregnancy. In the group with fetal malformations 13 were monochorionic, 4 dichorionic and in 5 the chorionicity was unknown. Some malformations were unique to twins (conjoined twins n = 5, acardiac twin n = 3) and others were nonunique to twins. The gestational age at delivery was lower in the group with fetal malformations compared to the group without fetal malformations. Conclusion: the majority of malformations occurred in the monochorionic pregnancies. In multiple pregnancies early determination of chorionicity is helpful to establish the prognosis and to plan the management of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 07-11-2003;22(8):511-517
DOI 10.1590/S0100-72032000000800007
Purpose: to demonstrate the types of fetal malformations in multiple pregnancy and their relation to chorionicity. Methods: one hundred and sixty-nine multiple pregnancies were evaluated. In all cases prenatal ultrasound examination was performed during antenatal care. Chorionicity was defined by: first trimester ultrasound evaluation (absence of lambda sign); presence of two separate placentas; different fetal sex; pathological placental examination. Results: twenty-four (14.2%) fetal malformations were observed, 22 in twin and 2 in triplet pregnancy. In the group with fetal malformations 13 were monochorionic, 4 dichorionic and in 5 the chorionicity was unknown. Some malformations were unique to twins (conjoined twins n = 5, acardiac twin n = 3) and others were nonunique to twins. The gestational age at delivery was lower in the group with fetal malformations compared to the group without fetal malformations. Conclusion: the majority of malformations occurred in the monochorionic pregnancies. In multiple pregnancies early determination of chorionicity is helpful to establish the prognosis and to plan the management of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 09-23-2002;24(6):377-381
DOI 10.1590/S0100-72032002000600004
Purpose: to establish a reference range for cervical length measurement throughout gestation in twin pregnancies and to correlate cervical length with gestational age at delivery. Methods: retrospective analysis of prospectively collected data between 1994 and 2000, involving 149 twin pregnancies undergoing transvaginal ultrasound examination every four weeks for measurement of cervical length. Results: one hundred and twenty-seven women (85.2%) delivered after 34 weeks, 20 (13.4%) between 24 and 33 weeks and two pregnancies resulted in fetal loss before 24 weeks. The mean gestational age at delivery was 36.3 weeks. A total of 497 ultrasound examinations with cervical length measurement were performed in 127 patients with twin pregnancies who delivered after 34 weeks (mean = 4 examinations per patient). All scans were carried out between 9 and 39 weeks (mean = 29.4 weeks). There was an inverse correlation between cervical length measurement and gestational age at the scan in twin pregnancies (r=-0.44; p < 0.0001). The mean value was 44 mm at 10 weeks and 28 mm at 36 weeks. The corresponding fifth percentile values of these gestations were 28 mm and 12 mm, respectively. Cervical length measurement changes were more pronounced in the second half of the pregnancy (Kruskal-Wallis test, p=0.0006). Mean cervical length measurement and 90% prediction interval values were established throughout gestation by regression analysis. Twenty-six cases delivered before 34 weeks, nine of these cases (34.6%) had at least one cervical length measurement below the 5th percentile. Conclusions: cervical length shortens gradually throughout gestation in twin pregnancies but changes are more significant in the second half of the pregnancy. Approximately one-third of the pregnancies that delivered before 34 weeks had at least one cervical length measurement below the 5th percentile for the gestational age.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 09-23-2002;24(6):377-381
DOI 10.1590/S0100-72032002000600004
Purpose: to establish a reference range for cervical length measurement throughout gestation in twin pregnancies and to correlate cervical length with gestational age at delivery. Methods: retrospective analysis of prospectively collected data between 1994 and 2000, involving 149 twin pregnancies undergoing transvaginal ultrasound examination every four weeks for measurement of cervical length. Results: one hundred and twenty-seven women (85.2%) delivered after 34 weeks, 20 (13.4%) between 24 and 33 weeks and two pregnancies resulted in fetal loss before 24 weeks. The mean gestational age at delivery was 36.3 weeks. A total of 497 ultrasound examinations with cervical length measurement were performed in 127 patients with twin pregnancies who delivered after 34 weeks (mean = 4 examinations per patient). All scans were carried out between 9 and 39 weeks (mean = 29.4 weeks). There was an inverse correlation between cervical length measurement and gestational age at the scan in twin pregnancies (r=-0.44; p < 0.0001). The mean value was 44 mm at 10 weeks and 28 mm at 36 weeks. The corresponding fifth percentile values of these gestations were 28 mm and 12 mm, respectively. Cervical length measurement changes were more pronounced in the second half of the pregnancy (Kruskal-Wallis test, p=0.0006). Mean cervical length measurement and 90% prediction interval values were established throughout gestation by regression analysis. Twenty-six cases delivered before 34 weeks, nine of these cases (34.6%) had at least one cervical length measurement below the 5th percentile. Conclusions: cervical length shortens gradually throughout gestation in twin pregnancies but changes are more significant in the second half of the pregnancy. Approximately one-third of the pregnancies that delivered before 34 weeks had at least one cervical length measurement below the 5th percentile for the gestational age.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 07-10-2002;24(4):247-251
DOI 10.1590/S0100-72032002000400006
Purpose: to compare cervical length measurements in twin pregnancies obtained by transvaginal ultrasound examination in the recumbent and standing positions. Methods: fifty twin pregnancies underwent transvaginal ultrasound examinations to measure the cervical length with the women in recumbent and standing positions. The study was carried out between May 1999 and December 2000. The scans were repeated every 4 weeks and the total number of evaluations was 136. Two groups were analyzed: one included only the first ultrasound examinations carried out in each woman and the second group included all evaluations. Results: in the first group, cervical length measurements in the standing and recumbent positions correlated inversely with the gestational age (recumbent: r=-0.60; p<0.001; standing: r=-0.46; p=0.008). The mean measure in the recumbent position was 35.2 mm (SD=9.9 mm) and 33.4 mm (SD=9.5 mm) in the standing position. When the difference between the measure obtained in the standing and recumbent positions was expressed as percentage of the measure in the recumbent position, there was no significant association with gestational age (p=0.07). When all evaluations were considered, there was a significant association between cervical length in the recumbent and standing positions (r=0.79; p<0.001). The measures in recumbent and standing positions were inversely correlated with gestational age (recumbent: p<0.0001; standing: p<0.0001). The mean cervical length in the recumbent position was 33.5 mm (SD=10.8 mm) and 31.8 mm (SD=9.6 mm) in the standing position. There was no significant association between cervical length difference expressed as percentage of the measure in the recumbent position and gestation. Conclusion: cervical length measure obtained with the patients in the recumbent and standing positions provided similar information.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 07-10-2002;24(4):247-251
DOI 10.1590/S0100-72032002000400006
Purpose: to compare cervical length measurements in twin pregnancies obtained by transvaginal ultrasound examination in the recumbent and standing positions. Methods: fifty twin pregnancies underwent transvaginal ultrasound examinations to measure the cervical length with the women in recumbent and standing positions. The study was carried out between May 1999 and December 2000. The scans were repeated every 4 weeks and the total number of evaluations was 136. Two groups were analyzed: one included only the first ultrasound examinations carried out in each woman and the second group included all evaluations. Results: in the first group, cervical length measurements in the standing and recumbent positions correlated inversely with the gestational age (recumbent: r=-0.60; p<0.001; standing: r=-0.46; p=0.008). The mean measure in the recumbent position was 35.2 mm (SD=9.9 mm) and 33.4 mm (SD=9.5 mm) in the standing position. When the difference between the measure obtained in the standing and recumbent positions was expressed as percentage of the measure in the recumbent position, there was no significant association with gestational age (p=0.07). When all evaluations were considered, there was a significant association between cervical length in the recumbent and standing positions (r=0.79; p<0.001). The measures in recumbent and standing positions were inversely correlated with gestational age (recumbent: p<0.0001; standing: p<0.0001). The mean cervical length in the recumbent position was 33.5 mm (SD=10.8 mm) and 31.8 mm (SD=9.6 mm) in the standing position. There was no significant association between cervical length difference expressed as percentage of the measure in the recumbent position and gestation. Conclusion: cervical length measure obtained with the patients in the recumbent and standing positions provided similar information.