1/12. Vanished twin and fetal alcohol syndrome in the surviving twin. A case report. BACKGROUND: The diagnosis of twin pregnancy can be made early in pregnancy by ultrasonography (US). Follow-up examination occasionally demonstrates the disappearance of one of the twins. CASE: A twin disappeared on US examination; the surviving twin exhibited signs of fetal alcohol syndrome and other congenital anomalies, accompanied by a placental form of fetus papyraceus. CONCLUSION: Early US examination is useful for diagnosing multiple gestation. However, a follow-up examination is required to alert the clinician to the disappearance of one twin. Careful examination of the placenta may document fetal remnants. In this case a small, atretic nodule on the placental surface was evidence of the vanished twin. ( info) |
2/12. A normal 46,XX infant with a 46,XX/69,XXY placenta: a major contribution to the placenta is from a resorbed twin. A predominantly triploid 69,XXY placenta was found associated with a normal 46,XX infant. Therefore, a triploid placenta is apparently capable of supporting normal fetal development. The chromosome and pathological results support the conclusion that the triploid placenta originates from a 'vanishing twin' pregnancy. This case is unusual in that persistence of the placenta from the vanished twin has virtually replaced most of the normal placenta. ( info) |
3/12. The vanishing twin: morphologic and cytogenetic evaluation of an ultrasonographic phenomenon. Twin pregnancy was observed by ultrasonographic examination in the 6th week of gestation. After singleton term delivery a thickening of the membranes opposite to the main placenta showed degenerated chorionic villi embedded between one layer of amnion and chorion; no fetal parts were observed. Villus cells from both placentas were mainly diploid; 2 of 30 were tetraploid. However, 19 of 30 cells from membranes overlying the satellite placenta were tetraploid. Marker analysis was consistent with duplication of a normal conception diploid chromosome complement as the mechanism for tetraploidy. Postconceptional nondisjunction leading to tetraploidy in one twin conceptus may explain demise in early pregnancy. tetraploidy observed by chorionic villus biopsy must be confirmed by amniocentesis before interruption of the pregnancy is considered. ( info) |
| A case of an 8-week fetus with ultrasound demonstrated heart beat, which was absorbed completely prior to abortion at 11 weeks' gestation, is reported. ( info) |
5/12. Resorbed co-twin as an explanation for discrepant chorionic villus results: non-mosaic 47,XX, 16 in villi (direct and culture) with normal (46,XX) amniotic fluid and neonatal blood. Non-mosaic trisomy 16 was observed in chorionic villus cytotrophoblasts (direct) as well as cultured mesenchymal core cells derived from the pregnancy of a 38-year-old woman. Chromosome preparations from amniotic fluid and neonatal cultures (cord blood) were 46,XX. Normal fetal growth as determined by serial ultrasound examinations occurred throughout the pregnancy, which resulted in a healthy 2724 g female. Multiple biopsies taken from the umbilical cord, placental cotyledons, and fetal membranes were 46,XX. However, a placental nodule and three of six cultures initiated from membranes (amnion and chorion) showed 46,XX/47,XX, 16 mosaicism. We propose that the trisomy 16 cells arose from residual villi derived from a trisomic co-twin that never developed. This case further demonstrates that normal fetal growth may presage normal outcome irrespective of cytogenetic findings in cytotrophoblasts (direct) and cultured mesenchymal core cells. ( info) |
6/12. Outcome of the surviving cotwin of a fetus papyraceus or of a dead fetus. Serial ultrasound examinations have demonstrated that one of two gestational sacs in a twin pregnancy may often disappear. When it disappears at an early stage of gestation, the pregnancy may advance without any disturbance and the cotwin can be delivered well developed and lively. When the intrauterine death occurs in the second trimester, the dead fetus usually results in a fetus papyraceus and the cotwin continues to be alive near term. However, when death occurs in the last trimester, the viable twin may be spontaneously delivered soon and be premature. In some cases of late fetal death, the dead fetus may induce intravascular thromboses in many organs of the surviving cotwin, so that the living infant may develop cerebral palsy later after birth. ( info) |
7/12. Nonoperative management of ectopic pregnancy. A preliminary report. The incidence of ectopic pregnancy is increasing throughout the western world; at present it is uncertain how much of this increase is due to the disease and/or its antecedents and how much due to better means of diagnosis. That the treatment of the obvious or ruptured ectopic pregnancy should be surgical is beyond doubt. However, in view of the natural tendency of some ectopic pregnancies to terminate in tubal abortion or complete resorption, it is questionable whether surgery is always necessary in every early case or whether some patients can be monitored by means of rising or falling levels of beta subunits of human chorionic gonadotropin (HCG) until tubal abortion or resorption occurs. This may be the best means of preserving tubal function and fertility. ( info) |
8/12. Induction of experimental antiphospholipid syndrome in naive mice with purified IgG antiphosphatidylserine antibodies. OBJECTIVE. It is accepted that antiphospholipid syndrome (APS) is due to the presence of anticardiolipin antibodies (aCL). Since phosphatidylserine is a negatively charged phospholipid, we tried to demonstrate the pathogenic role of antiphosphatidylserine in APS. methods. We used affinity purified IgG antiphosphatidylserine antibodies from sera of 2 patients with APS characterized by recurrent thromboembolic phenomena, recurrent fetal loss and prolonged activated partial thromboplastin time (aPTT). In one patient the antiphosphatidylserine Abs were the main antiphospholipid antibody (aPL) while the 2nd patient also had pathogenic aCL. The purified antibodies were passively infused into the tail vein of mice. The mice were mated and we followed them for manifestations of APS. RESULTS. Passive infusion of IgG but not IgM antiphosphatidylserine antibodies to pregnant ICR mice resulted in increased fetal resorption rate (40%), lower mean weights of the placentae and fetuses and prolonged aPTT (82 s). Antiphosphatidylserine antibodies were detected in the placentae. CONCLUSIONS. Our results point to the pathogenic role of antiphosphatidylserine antibodies and emphasize the importance of looking for the presence of antiphosphatidylserine Abs in sera of patients with clinical manifestations compatible with APS even in the absence of aCL Abs. ( info) |
9/12. Successful treatment of an advanced interstitial pregnancy by sequential systemic and local administration of methotrexate. A patient is presented with an advanced interstitial pregnancy, diagnosed by transvaginal ultrasound and confirmed by laparoscopy. Amenorrhoea at the time of diagnosis was 57 days. methotrexate was given systemically (4 x 50 mg i.m.). Because of persisting viability of the fetus, systemic methotrexate treatment was followed by local instillation of methotrexate into the gestational sac (50 mg). Follow-up revealed rapid human chorionic gonadotrophin regression but slow regression of fetal remnants. ( info) |
10/12. Non-surgical treatment of ectopic pregnancy in the sole remaining tube. We reported on three successive cases of intrauterine term pregnancy obtained in patients with an ectopic gestation in their solitary remaining tube who were treated by three different non-surgical conservative methods: parenteral methotrexate, local injection of methotrexate combined with systemic administration, and expectant management respectively. The opposite tube had been removed because of previous tubal ectopic pregnancy. The cases, which were at a high risk of repeated ectopic implantation, are unequivocal proof of intact function of a tube after conservative non-surgical procedures for ectopic pregnancy. Thus, our report adds further evidence favouring the feasibility, the safety and fertility potential of these procedures for selected unruptured tubal gestations. ( info) |