A administração de hCG incrementa a incidência de ovulações duplas e múltiplas em éguas da raça Campolina apresentando folículos codominantes? / Does hCG administration increase the incidence of double and multiple ovulations in Campolina mares with co-dominant follicles?

A gonadotrofina coriônica humana (hCG) é rotineiramente empregada na indução de ovulação em éguas. A incidência de duplas ovulações é variável, sendo comum em determinadas raças brasileiras, como Brasileiro de Hipismo e Campolina. O objetivo deste trabalho foi avaliar se a administração de hCG em éguas da raça Campolina incrementa a incidência de ovulações duplas e múltiplas. Através de palpação retal e ultrassonografia, foram avaliados dois ciclos estrais de 104 éguas, divididas em dois grupos. À detecção de um ou mais folículos ³35 mm e edema endometrial grau 2, 2.500 IU de hCG (IV) eram administrados às éguas do grupo I. O grupo II serviu como controle. Os resultados obtidos foram analisados pelo Qui-quadrado. A incidência de ovulações duplas nos grupos I e II foi de, respectivamente, 32,7% (34/104) versus 30,8% (32/ 104). Ambos os grupos obtiveram incidência semelhante de ovulações triplas (1,9% - 2/104). Apenas uma ovulação quádrupla (1,0% - 1/104) foi detectada, no grupo controle. A incidência de duplas e múltiplas ovulações foi similar entre os grupos (p > 0,05). Pelo fato das éguas da raça Campolina apresentarem, fisiologicamente, considerável incidência de ovulações duplas e múltiplas, é possível que a administração de hCG não tenha influenciado estes padrões ovulatórios.

The human chorionic gonadotrophin (hCG) has been routinely used in the equine species to induce ovulations for more than four decades. The incidence of multiple ovulations in horses is variable, being double ovulations a common occurrence in some Brazilian breeds, such as Brasileiro de Hipismo and Campolina. The aim of this work was to evaluate the role of hCG administration to increase, in Campolina mares, the incidence of double and multiple ovulations, which are desirable in embryo transfer programs. One hundred and four (104) mares had their estrous cycles recorded through rectal palpation and ultrasonographic evaluation during the breeding season of 2003 - 2004, in a total of two hundred and eight (208) cycles (two cycles per mare). Animals were allocated in two groups, with fifty two (52) horses each. In Group I mares, once one or more = 35 mm follicles and grade 2 uterine edema were present, 2.500 IU of hCG were intravenously administered. The untreated mares in Group II served as control. The Chi-Square test was used to analyze obtained results. The incidence of double ovulations in groups I and II was, respectively, of 32.7% (34/104) versus 30.8% (32/104). The incidence of triple ovulations was low in both groups, of 1.9% (2/104). Only once in the control group (1.0% - 1/104) was a quadruple ovulation detected. There was no difference in the incidence of double and multiple ovulations between both groups (p > 0.05). Possibly, hCG administration did not influence ovulation patterns in this work due to the fact that Campolina breed mares physiologically show a considerable incidence of double and multiple ovulations.

Retinopathy of prematurity: Single versus multiple-birth pregnancies

To compare the frequency and severity of retinopathy of prematurity [ROP] among singleton and multiple-birth neonates referred to Farabi Eye Hospital, Tehran-Iran. In this retrospective study, records of 99 consecutive neonates from multiplegestation pregnancies including 68 twins, 26 triplets and 5 quadruplets who were screened for ROP from 2002 to 2004 were reviewed. The frequency, severity and risk factors for ROP were determined and compared to a group of singletons who were matched in terms of gender, birth weight [BW], gestational age [GA], oxygen therapy, respiratory distress syndrome, blood transfusion, sepsis and phototherapy. ROP was present in 12.1% of multiple-birth neonates as compared to 15.1% of singletons [P=0.53]. Threshold ROP was present in 6.1% of multiple-birth neonates versus 7.1% of singletons [P=0.62]. ROP was detected in 60% of quadruplets versus 9.6% of twins and triplets; threshold disease was observed in 40% of quadruplets as compared to 4.2% of twins and triplets [P<0.03]. However, considering the effect of BW and GA, logistic regression analysis revealed no statistically significant difference in the frequency and severity of ROP among subgroups of multiple-gestation pregnancies. There was no significant difference between multiple-birth neonates and matched singletons in terms of frequency and severity of ROP. Any apparent higher rate may be due to independent risk factors such as low birth weight and gestational age rather than multiple pregnancies per se. Screening for ROP in multiple gestation births may be conducted according to standard protocols applied for singletons

The Successful Anesthetic Management ofCesarean Section for Quadruplets: A case report / 대한마취과학회지

Grand multifetal pregnancies (4 or more), usually caused by ovulation induction agents and assisted reproductive technologies, challenge all members of a perinatal team and put mothers and infants increased risk. Important anesthetic considerations include greater incidence of complications that in the singleton pregnancy, risks related to the large pregnant uterus, impaired uterine contraction prior to delivery secondary to fetal oxygenation, and preparation of sufficient man-power and instruments. The importance of neonatal resuscitation cannot be overemphasized. We report a successful general anesthetic management for an emergent quadruplet cesarean section at 31 weeks 5 days weeks gestational age.

Gestación cuádruple espontánea: un desafío para el equipo multidisciplinario en un servicio de salud / Spontaneous quadruplet pregnancy

Damos a conocer un caso de gestación cuádruple espontánea, el manejo y su resolución.

A Case of Human Babesiosis Confirmed by Polymerase Chain Reaction and Treated with Atovaquone and Azithromycin

Human babesiosis is a tick-borne infectious disease caused by Babesia species. The clinical diagnosis is difficult because of nonspecific symptoms like flu. Rapid diagnosis of human babesiosis is microscopic examination in peripheral blood smear (Giemsa-stain) which reveals characteristic forms of an intracellular quadruplet parasite. But differentiation between Babesia microti and Plasmodium species can be quite difficult because of the morphologic similarity. We experienced a case of human babesiosis. The patient was a 62-year old Korean male who had been in New Jersey, U.S.A for 2 months. We initially diagnosed as malaria infection because the peripheral blood smear revealed intracellular single ring form organism. But the patient was not improved significantly by the treatment with chloroquine regimen. Finally we confirmed human babesiosis by polymerase chain reaction for Babesia microti. We treated the patient successfully with a regimen of atovaquone and azithromycin which has fewer adverse reactions than a regimen of clindamycin and quinine.

A Case of Human Babesiosis Confirmed by Polymerase Chain Reaction and Treated with Atovaquone and Azithromycin

Human babesiosis is a tick-borne infectious disease caused by Babesia species. The clinical diagnosis is difficult because of nonspecific symptoms like flu. Rapid diagnosis of human babesiosis is microscopic examination in peripheral blood smear (Giemsa-stain) which reveals characteristic forms of an intracellular quadruplet parasite. But differentiation between Babesia microti and Plasmodium species can be quite difficult because of the morphologic similarity. We experienced a case of human babesiosis. The patient was a 62-year old Korean male who had been in New Jersey, U.S.A for 2 months. We initially diagnosed as malaria infection because the peripheral blood smear revealed intracellular single ring form organism. But the patient was not improved significantly by the treatment with chloroquine regimen. Finally we confirmed human babesiosis by polymerase chain reaction for Babesia microti. We treated the patient successfully with a regimen of atovaquone and azithromycin which has fewer adverse reactions than a regimen of clindamycin and quinine.

Morbimortalidade de recém-nascidos trigêmeos e quadrigêmios comparada com recém-nascidos únicos / Compared Morbimortality of just-been born triplets and quadruplets with just-been born only

Nas últimas décadas, observamos um aumento no número de gestações múltiplas devido, principalmente, ao uso de técnicas de reprodução assistida. Informação de prognóstico neonatal é crucial para o aconselhamento e tomada de decisão na prática perinatal.Objetivo: O objetivo desse estudo é comparar a morbimortalidade entre recém-nascidos múltiplos e únicos.Materiais e métodos: Nós revisamos dados de todas as admissões de recém-nascidos múltiplos( trigêmeos e quadrigêmos) internados na UTI neonatal da Clínica Perinatal Laranjeiras no período de setembro de 1997 a julho de 2004.Para cada recém-nascido múltiplo selecionamos dois recém-nascidos únicos que constituíram o grupo de comparação. Os dados foram coletados da nossa base de dados computadorizada bem como dos prontuários médicos. As variáveis de prognóstico neonatal incluídas foram doença de membrana hialina (DMH), persistência do canal arterial (PCA), displasia broncopulmonar(DBP), hemorragia intraventricular (HIC),enterocolite necrosante (ECN), retinopatia da prematuridade (RTP),leucomalácia periventricular(LPV) e sobrevida. Nós também analisamos duração do suporte ventilatório e tempo de internação. A análise estatística foi feita com regressão logística.Resultados: Nós estudamos um total de 128 recém-nascidos múltiplos e 260 únicos. O peso de nascimento e a idade gestacional foram similares nos dois grupos(1470 mais ou menos 461g vs 1495 mais ou menos 540 g; 31,3 mais ou menos 2,5 semanas e 31,5 mais ou menos 2,8 semanas, respectivamente). O uso de corticóide antenatal foi mais comum no grupo dos múltiplos. Hipertensão materna e Doppler alterado foram mais prevalentes no grupo dos únicos. Não houve diferença entre os grupos na incidência das morbidades maiores como DMH,PCA, DBP, RTP, HIC e LPV, com exceção de ECN que foi menor no grupo dos múltiplos. Conclusão: Nossos dados mostram que o prognóstico neonatal é muito semelhante para recém-nascidos múltiplos e únicos na nossa população. Enterocolite necrosante permaneceu uma morbidade significante nos recém-nascidos de gestações múltiplas mesmo depois de ajustar para fatores de risco materno.

Meternal and neonatal outcome of high order gestation

To study maternal and neonatal outcome of triplets, quadruplets and quintuplets gestations. This retrospective review of 21 triplets, 3 quadruplets and 3 quintuplet's delivered between 1st January 1990 and 31st of August 2001. Preterm labour was the most common maternal complication [96.3%]. The 27 high order gestations resulted in 88 live bir ths and two stillbir ths. The early neonatal mor tality rate for the entire group was 91, 45 late neonatal deaths and 57 infant deaths. 71 [80.7%] of the 88 live born infants survived to discharge.The incidence of respiratory distress syndrome was 69.3% and mechanical ventilation had also been necessary in 69.3% of newborns, patent ductus ar teriosis was diagnosed in 7.9% of cases. Intraventricular hemorrhage had been diagnosed in 13.6% of cases. Nercotizing enterocolitis occurred in 8 cases. Neonatal sepsis was diagnosed in 24 cases [27.3%]. Early diagnosis, meticulous antenatal care, early hospitalization, frequent evaluation of fetal well being, delivery by cesarean section and on site availability of trained neonatologists and a highly functional intensive care unit are essential for better outcome

Transvaginal Selective Fetal Reduction in Multifetal Pregnancy induced by Assisted Reproductive Technology / 대한산부인과학회잡지

OBJECTIVE: The prevalence of multifetal pregnancies has increased up to 30% as a result of the introduction of ovulation inducing agents for assisted reproductive teclmology(ART). An exttemely poor pognosis could be expected for viable pregnancies in multifetal gestation. So, to decrease the consequence of multiple pregnancies and prevent complications, especially premature baby irreversibly damaged, selective fetal reduction to the smaller number of fetuses should be considered in an early gestational period. METHODS: From May 1994 to Apr 1998, transvaginal selective fetal reduction in 13 pati including 9 triplet, 3 quadruplet and 1 quintuplet. Of the 13 patients, 4 were obtained by controlled ovarian hyperstimulation with intrauterine insemination (COH with IUI), 6 were by IVF-ET, 2 wae by controlled ovarian hyperstimulation with natural contact and 1 was by natural conception. Selective fetal reduction using intracardiac KC1 injection and aspiration of amniotic fluid carried out in 8-11 weeks of gestation. RESULTS: After procedures, 8 patients were remained as twin pregnancies, 5 patients as singleton pregnancies and 1 of the remaining twin embryos vanished after procedure. There have been 7 sets of twin delivery including 1 stillbirth and 3 singleton delivery. 1 cases are ongoing state. All of the singleton delivery were completed after 37 weeks of gestation. Of the twin delivery, 2 cases were delivered after 37 weeks of gestation, 2 cases in 35-37 weeks, and 3 cases before 35 weeks of gestation. Unfortunately, 1 stillbirth occurred in 20 weeks of gestation and 2 cases of singleton were aborted. As 3 losses(2 singleton, 1 twin) occurred, the delayed fetal loss rate in this selective fetal reduction was 25.0%(3/12). There was no fetal anomaly related to the procedure. CONCLUSION: Selective fetal reduction in multifetal pregnancies is a rather safe procedure and it may improve the outcome of multiple pregnancies.

An Imported Case of Babesiosis / 감염

Babesiosis is a tick-borne, malaria-like illness caused by Babesia species that infect erythrocytes of mammals incidentally. The family Babesiidae is characterized by consisting of non-pigmented intraerythrocytic parasites that reproduce within erythrocytes by asynchronous, asexual budding into two or four daughter cells (tetrad). We experienced a case of human babesiosis presenting fever and chills. The patient was a 49-year old man, who had been in Africa (Ethiopia, Uganda). Three weeks before admission intermittent spiking fever had developed, which had been accompanied by severe chills. The peripheral blood smear (Giemsa-stain) revealed characteristic forms of an intracellular quadruplet parasite compatible with Babesia. The patient was improved significantly by the treatment with quinine and clindamycin for a week.

Transabdominal Selective Fetal Reduction in Multifetal Pregnancy / 대한산부인과학회잡지

Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.

Transabdominal fetal reduction in quadruplet pregnancy during first trimester: a case report.

Multifetal pregnancy reduction was performed in a patient with quadruplet pregnancy at the 12th week of gestation. Reduction of the fetuses to two was carried out by injecting potassium chloride solution into the fetal chest under transabdominal ultrasound guidance. No complications were encountered and the woman was delivered of healthy twins at 37 weeks of gestation.