Twinning rate in buffaloes: A case report.

The information of twin pregnancy frequencies in buffaloes is scarce in the literature. Evidence even indicates that twin pregnancies are not carried to term, but it does not seem to be the case. In this case report, the event of twin pregnancy in buffaloes is reported as well as its frequency. Twin birth is the presence of two or more embryos in a single gestation. Multiple births are uncommon in buffaloes since the species is uniparous. We studied a population of Murrah buffaloes in which slightly more than 13,000 births were observed. In this study, the frequency of occurrence of twin births in Murrah buffaloes was 0.14%. This low incidence impaired the estimation of genetic parameters. Twins can have advantages and disadvantages depending on the production system, which are discussed in this case report.

Retenção placentária em égua primípara após aborto de gestação gemelar: relato de caso / Placental retention in primiparous mare after abortion of twin pregnancy: a case report / Retención placentaria en yegua primíparas después de un aborto de embarazo gemelar: reporte de un caso

A retenção placentária é um distúrbio caracterizado pela inércia na expulsão parcial ou total da placenta durante o parto. O presente trabalho relata o caso de uma retenção placentária em uma égua da raça Quarto de Milha, de quatro anos de idade, que teve um aborto de gêmeos ao nono mês de gestação. No primeiro atendimento o animal apresentava-se fraco, com temperatura corporal de 39°C e visivelmente com parte dos anexos fetais pendentes na vulva. O tratamento foi realizado com medicação antibiótica, anti-inflamatória, aplicação de ocitocina e lavagem uterina. Foi realizado ainda um tratamento preventivo e auxiliar para laminite. Ambos os procedimentos obtiveram resultados satisfatórios.

Placental retention is a disorder characterized by the partial or total inertia of the placenta during childbirth. This paper reports the case of a retained placenta in a Quarter Horses Mare, four year old who had anabortion of twins to the ninth month of pregnancy. In the first treatment the animal had to be weak, with a bodytemperature of 39°C and visibly part of the outstanding fetal membranes in the vulva. The patient was treated with antibiotic drugs, ann- inflammatory, and uterine oxytocin injection wash. We also carried out a preventive treatmentand help for laminitis. Both procedures satisfactory results.

Retención placentaria es un trastorno caracterizado por Ia inercia total o parcial de Ia placentadurante el parto. Se comunica el caso de una placenta retenida en un cuarto Caballos Mare , de cuatro anos deedad que tuvo un aborto de gemelos para el noveno mes de embarazo. En el primer tratamiento el animal teniaque ser débil, con una temperatura corporal de 39°C y visiblemente parte de Ias membranas fetales en circulaciónen Ia vulva . EI paciente tue tratado con antibióticos, anti-inflamatorios, y de lavado de inyección de oxitocina uterino. También lIevó a cabo un tratamiento preventivo y ayuda para Ia laminitis. Ambos procedimientos resultados satisfactorios.

Brazilian multicentre study on preterm birth (EMIP): prevalence and factors associated with spontaneous preterm birth.

BACKGROUND: Preterm birth rate is increasing and is currently a worldwide concern. The purpose of this study was to estimate the prevalence of preterm birth in a sample of health facilities in Brazil and to identify the main risk factors associated with spontaneous preterm births. METHODS AND FINDINGS: This was a multicentre cross sectional study on preterm births in 20 referral obstetric hospitals with a case-control component to identify factors associated with spontaneous preterm birth. Surveillance was implemented at all centres to identify preterm births. For eligible consenting women, data were collected through a post-delivery questionnaire completed with information from all mother-newborn medical records until death or discharge or at a maximum of 60 days post-delivery, whichever came first. The risk of spontaneous preterm birth was estimated with OR and 95%CI for several predictors. A non-conditional logistic regression analysis was then performed to identify independently associated factors. The overall prevalence of preterm birth was 12.3%. Among them, 64.6% were spontaneous and 35.4% therapeutic. In the case-control component, 2,682 spontaneous preterm births were compared to a sample of 1,146 term births. Multivariate analyses identified the following as risk factors for spontaneous preterm birth among women with at least one previous birth: a previous preterm birth (ORadj = 3.19, 2.30-4.43), multiple pregnancy (ORadj = 29.06, 8.43-100.2), cervical insufficiency (ORadj = 2.93, 1.07-8.05), foetal malformation (ORadj = 2.63, 1.43-4.85), polyhydramnios (ORadj = 2.30, 1.17-4.54), vaginal bleeding (ORadj = 2.16, 1.50-3.11), and previous abortion (ORadj = 1.39, 1.08-1.78). High BMI (ORadj = 0.94, 0.91-0.97) and weight gain during gestation (ORadj = 0.92, 0.89-0.95) were found to be protective factors. CONCLUSIONS: The preterm birth rate in these health facilities in Brazil is high and spontaneous preterm births account for two thirds of them. A better understanding of the factors associated with spontaneous preterm birth is of utmost importance for planning effective measures to reduce the burden of its increasing rates.

Low tolerance for complications.

Assisted reproductive techniques can lead to medical complications such as multiple pregnancy and ovarian hyperstimulation syndrome. A critical appraisal and strategies to reduce the occurrence of these complications are discussed in this manuscript.

Successful multiple pregnancy (triplets) in a kidney transplant recipient: a case report.

Renal failure generally accompanies an alteration in reproduction function. Even though a renal transplantation does in fact improve this function, there are few cases described in medical literature of multiple pregnancies in transplant patients that ended in a successful manner. In addition, there is a greater incidence of complications such as hypertension, preeclampsia, and premature delivery. This article describes a 31-year-old patient who became pregnant with triplets at 3 years and 6 months after receiving a renal transplant from a cadaver. The patient received treatment with cyclosporine, azathioprine, and prednisolone. During the pregnancy, there was a increase in hypertension, proteinuria, cholestasia gravidic symptoms, and premature delivery. Pregnancy control included evaluation of the fetoplacental unit together with hypertensive management and adjustment of immunosuppressant treatment, especially the cyclosporine dose, seeking to facilitate greater fetal maturity. Three newborns of 840, 860, and 1020 were delivered by cesarean section. The newborns spent 6 to 8 weeks in the neonatal unit and were released without complications. The newborns have presented adequate psychomotor and physical development to date. The triplets are now 4 years old. The transplant recipient has a creatinine clearance of 81 mL/min at 7 years after transplantation.

Multigestación desde un punto de vista pediátrico / Multiple birth from a pediatric point of view

La multigestación o embarazo múltiple es poco frecuente en forma espontánea y en la actualidad se asocia a técnicas de Medicina Reproductiva. El enfrentamiento de esta condición requiere de un enfoque multidisciplinario para apoyar a una familia que espera un nacimiento múltiple. Este enfoque debe ser continuo desde el embarazo y parto para luego continuar durante la etapa de hospitalización de los niños en Neonatología y luego una vez de alta. El objetivo de esta publicación es presentar la experiencia en nacimientos múltiples, abarcando aspectos de la evolución clínica de embarazos triples, cuádruples y quíntuples acumulada en el Servicio de Neonatología de Clínica Las Condes, comparando su evolución con embarazos dobles y presentar además algunos aspectos psicosociales de las familias que han vivido la difícil experiencia de la multigestación.

Multiple birth, often related to assisted fertilization rather than spontaneous fact, is actually a difficult situation requiring a multidisciplinary approach, beginning during the pregnancy to follow along on birth and hospitalization, and later at home. Our goal is to show our experience on triplets, quadruplets and quintuplets, in Neonatology Wards, Clinica Las Condes, Chile, compared with twins. Also, we will present some psychosocial features on these families.

Feto papiráceo: Presentación de un caso / Fetus papyraceous; Case review

RESUMEN. El embarazo gemelar con un feto papiráceo es una entidad rara. Ocurre generalmente durante el segundo trimestre, dependiendo de la corionicidad de ambos gemelos, así se afectará al feto vivo. Aqui se presenta el caso de una mujer granmultípara con embarazo détermino y con pocos controles prenatales. La pasiente se presentó en trabajo de parto y con ruptura prematura de membranas. Se le realizó cesárea por desproporción cepalopélvica y posible distocia de partes blandas, obteniéndose dos productos, uno vivo sin alteraciones y otro muerto o papiráceo de más o menos 18 semanas de gestación.

Perinatal outcome, placental pathology, and severity of discordance in monochorionic and dichorionic twins.

OBJECTIVE: To evaluate differences in pregnancy outcomes and placental findings among severely discordant monochorionic and dichorionic twins. METHODS: We studied retrospectively a cohort of 382 twin pregnancies with gestational ages that ranged from 24 to 40 weeks. Pregnancies were classified as dichorionic or monochorionic by histologic examination of placentas. Infants were subdivided into concordant (less than 5% difference in birth weight), mildly discordant (5-25% difference), and severely discordant groups (more than 25% difference), and their clinical characteristics and findings at placental examination were analyzed and compared. RESULTS: Severe discordance occurred significantly more often in monochorionic than in dichorionic twins and was associated with significantly more deliveries before 36 weeks and more newborns remaining more than 10 days in the neonatal intensive care unit. Severely discordant monochorionic and dichorionic twins had significantly worse perinatal mortality and morbidity than mildly discordant and concordant twins. The weight of the placenta of the smaller fetus in severely discordant dichorionic twins with separate placentas and the total placental weight in severely discordant monochorionic twins were significantly smaller than the weights of the placentas in their concordant and mildly discordant counterparts. The umbilical cords of the smaller fetuses in both dichorionic and monochorionic pregnancies exhibited significantly more velamentous insertions and single umbilical arteries than in concordant or mildly discordant twins of similar chorionicity. CONCLUSION: Severe discordance is more frequent and has greater morbidity in monochorionic than dichorionic twins. The most frequent findings in the placentas of severely discordant twins were small placental weight and umbilical cord abnormalities.

Embarazo múltiple en la unidad de hipertensión inducida por el embarazo: 1991-1993 / Multiple pregnancy in the pregnancy induced hypertension unit: 1991-1993

Evaluar la evolución de las madres que ingresan a laMaternidad "Concepción Palacios" con embarazo múltiple asociado a las formas graves de la hipertensión inducida por el embarazo. Estudio retrospectivo de 35 embarazos múltiples: 34 gemelares y 1 triple entre 1150 pacientes que ingresaron con preeclampsia severa. Unidad de Hipertensión inducida por el embarazo en Sala de Partos de la Maternidad "Concepción Palacios". Hubo 24 (69,57 por ciento) embarazos pretérmino y 11 (31,43 por ciento) a término. Partos vaginales 20 (57,14 por ciento) y 15 (42,86 por ciento) cesáres. La morbilidad materna fue de 51,42 por ciento (18 casos). Mortalidad materna 2,86 por ciento. La morbilidad neonatal fue 46,15 por ciento (30 casos) mortalidad perinatal 11 casos-169,23 x 1000 nacidos vivos. El embarazo múltiple se asocia más frecuentemente a la hipertensión inducida por el embarazo, la cual aparece en etapas más tempranas y se asocia a cifras mas altas de morbimortalidad materna y neonatal

Suplemento de calcio en gestantes multiparas: con antecedentes de trastornos hipertensivos como factor predictivo para su aparición / Supplement of calcium in multiparous gestating with antecedents of hypertensive disorder as predictive factor for the its apparition

El propósito de la presente investigación es conocer la importancia que tiene el calcio como factor preventivo de la hipertensión arterial gestacional en embarazadas multíparas. Determinar la influencia del calcio en la prevención de la hipertensión arterial gestacional en embarazadas multíparas. Establecer los posibles mecanismos por los que el calcio actúa en la prevención de la hipertensión arterial gestacional. Informar a médicos y estudiantes de Medicina acerca de los medios para la prevención de la HTA gestacional utilizando un suplemento de calcio. Señalar las consecuencias de una ingesta inadecuada de calcio en la dieta de la mujer embarazada

Gestación triple: análisis de 14 casos: años 1987-1992 / Triplet pregnancy: analysis of the 14 cases

Durante el lapso 1987-1992, de 49.572 partos, 14 fueron embarazos triples (0,02) o sea 1 por 3.540 partos. La edad materna promedio fue 26 años con extremos de 15 y 39. El 7,14 por ciento fueron primigestas y 78,58 por ciento multigestas. El 92,86 por ciento de los embarazos duró menos de 37 semanas y 7,14 por ciento llegó a término. Durante el control prenatal se diagnosticaron 92,86 por ciento: ultrasonográficamente 57,14 por ciento y clínicamente 35,71 por ciento; durante el parto 7,14 por ciento. La presentación fue cefálica en 24 fetos (57,14 por ciento), de hombro en 12 (28,57 por ciento) y podálica en 6 (14,28 por ciento). El embarazo se resolvió por cesárea en 78,57 por ciento y en 21,43 por ciento por vía vaginal, empleándose la anestesia peridural en 78,5 por ciento y el tiopental sódico en 21,43 por ciento. La puntuación de Apgar al minuto fue de 4 a 6 en 71,43 por ciento y a los 5 minutos de 7 a 9 en 69,05 por ciento. Las malformaciones fetales se presentaron en 9,52 por ciento: 2 fimosis prepuciales, 1 atresia anal y 1 hernia umbilical. La morbilidad materna fue de 78,57 por ciento debida a sepsis y la mortalidad perinatal llegó a 35,00 por ciento debida a sepsis, hemorragia y prematuridad

Differential fertility of mothers of twins and mothers of singletons: study in Limon, Costa Rica.

The reproductive performance of mothers of twins is of interest from an evolutionary perspective. Because mothers of twins have the potential of leaving a greater number of offspring, they could be favored by natural selection. At the same time, twin pregnancies are known to be associated with higher pre- and postnatal mortality. Thus mothers of twins at least have potentially higher fertility, a potential that may be hampered by greater mortality of twins. Here, I examine the completed fertility of 149 females, 50 years of age and older, from Limon, Costa Rica. In particular, the number of surviving children of mothers of twins and mothers of singletons at the time of the interview is compared. In this sample mothers of twins have a higher fertility at the end of their reproductive career. Their selection coefficient indicates that natural selection favors them through differential fertility.

Feto papiráceo: presentación de un caso / Papyracedus fetus: report of a case

Se trata de una paciente de 33 años de edad, IVG-III P, quien ingresa con el diagnóstico de embarazo de 37 semanas de edad menstrual en trabajo de parto, embarazo gemelar con feto papiráceo. El examen de anatomía patológica mostró una placenta monocorial biamniótica, con una zona en forma de semiluna, la cual correspondió al feto momificado, unido a través de un cordon umbilical de inserción excéntrica. En el examen microscópico de la placenta donde se encontraba el feto momificado se observó hialinización y calcificación focal más congestión vascular acentuada