Management of Delayed-Interval Delivery in Multiple Gestations

Abstract

Preeclampsia has been associated with an increased risk of cardiovascular disease and also with a lowered risk of breast cancer later in life. These associations may represent underlying metabolic changes. The investigators undertook a case-control study in which metabolic profiles were examined in women who completed their pregnancies at age 30 and older and had no serious chronic disorders. Thirteen women had experienced preeclampsia in their first pregnancies, whereas 13 others had no complications. Preeclampsia was defined as newly developed hypertension of pregnancy exceeding 140/90 mm Hg and proteinuria of at least 0.3 g/24 hours. The groups were matched for race/ethnicity, current age at the time of delivery, and current age.Women having preeclampsia were likelier than control women to be primiparous, tended to be heavier, and had higher resting diastolic blood pressure. There were no significant group differences in age at first delivery, age at first menses, current age, racial/ethnic distribution, a history of breast feeding, or a family history of breast cancer. In the overall group, body mass index correlated positively with serum levels of triglycerides, insulin, and glucose as well as with the fasting insulin resistance index. Women with a history of preeclampsia had significantly higher levels of fasting serum triglycerides, insulin, and glucose, and lower levels of fasting high-density lipoprotein than women without complications. In addition, they had a higher fasting insulin resistance index. A history of preeclampsia correlated with increased levels of insulin-like growth factor-binding protein-3 (IGFBP-3) and a higher ratio of IGFBP-3 to IGF-1 (insulin-like growth factor-1). Controlling for obesity did not substantially alter these associations. Adjusting for obesity or parity did not significantly alter the relationship between past preeclampsia and markers of dyslipidemia or reduced levels of IGF-1. No major differences emerged after excluding obese women. The case and control women had comparable fasting serum levels of total cholesterol and IGF-1.In women having preeclampsia in a former pregnancy, reduced bioavailability of IGF-1, relative insulin resistance, and dyslipidemia may persist. These changes may account, at least in part, for the increased risk of cardiovascular disease as well as the lowered risk of breast cancer observed in these women. ABSTRACTAlthough immediate termination of pregnancy in cases of preeclampsia does benefit the mother, it often is not in the best interest of the fetus, especially if carried out long before term. A program of temporizing management has been adopted for use in severe early-onset preeclampsia, the goal being to correct maternal hemodynamics through plasma expansion and pharmacologic vasodilatation. Short-term benefit has been demonstrated with this approach. The question of whether this benefit is sustained was examined in 222 consecutive infants who lived at least 12 months and whose mothers had severe preeclampsia (diastolic blood pressure of ...

Term life birth after late abortion of the first twin

“…We limited our search to reports in English, twin pregnancies and uteri without anomalies. We found a review from 2005 which describes 14 case reports and 10 cohort studies [3]. An additional nine case reports and three cohort studies were found [4–15], i.e.…”

Delayed Interval Delivery of a Second Twin: A Case Report and Review of the Literature

“…Survival of the first born was clearly linked to its gestational age and birth-weight (13). The survival of the second born was dependent upon a number of factors, including the delivery interval between the first and second twin and the presence of obstetric problems appearing during the latency period; the longer the interval, the greater was the chance for surviving (10)(11)14).…”

“…In highorder multiple pregnancy, delayed interval delivery is strongly recommended, provided that there are no signs of chorioamnionitis, fetal distress or maternal compromise. In multiple pregnancies with imminent preterm birth, delayed delivery may offer survival chances and a favorable outcome for the remaining fetus(es) (11)(12)(13). The results gained from pregnancy prolongation are a clinically significant benefit to the second-born twin, without significant morbidity in the mother.…”

“…Vaginal examinations should be avoided; however the length and dilatation of the cervix should be followed ultrasonographically (13). There is no evidence that retention of placenta causes disseminated intravascular coagulation (11,15).…”

“…Even a large placental mass can be retained in the uterus and produce no demonstrable clinical symptoms (12,15). Monitoring should be carried out and limited to a weekly full blood count, CRP, prothrombin time and fibrin degradation product (FDP) (13).…”