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Mehrlingsschwangerschaften

  • Andreas SchröerEmail author
  • Jan Weichert
Living reference work entry
Part of the Springer Reference Medizin book series (SRM)

Zusammenfassung

Die erhöhte Rate von Mehrlingen nach assistierter Reproduktion stellt unverändert ein hohes Risiko für diese Schwangerschaften dar. Sie gelten als Risikoschwangerschaften und bedürfen besonderer Aufmerksamkeit bei der Planung und Durchführung der erforderlichen Überwachungsmaßnahmen, der pränatalen Untersuchungen und Maßnahmen in der Schwangerschaft, bei der Geburt und in der nachgeburtlichen Phase. National und international wird durch Anpassung und Optimierung der Methoden der assistierten Reproduktion versucht, die Mehrlingsrate bei unverändert hohen Schwangerschaftsraten zu senken. Insbesondere im Ausland wird dazu eine Reduktion der transferierten Embryonen bis hin zum Single-Transfer angestrebt. Die konsequente Umsetzung dieser Methode wird in Deutschland aufgrund rechtlicher Restriktionen erheblich erschwert. Daher ist die Mehrlingsrate höher und die Schwangerschaftsrate niedriger als im benachbarten Ausland.

Literatur

  1. Alexander JM et al (1995) Multifetal reduction of high-order multiple pregnancy: Comparison of obstetrical outcome with non refused twin gestations. Fertil Steril 64:1201CrossRefGoogle Scholar
  2. Berkowitz HL et al (1996) The current status of multifetal pregnancy reduction. Am J Obstet Gynecol 174:1265–1272CrossRefGoogle Scholar
  3. Blickstein I (2004) Is it normal for multiples to be smaller than singletons? Best Pract Res Clin Obstet Gynaecol 18(4):613–623 (Review)CrossRefGoogle Scholar
  4. Boyle B, McConkey R, Garne E, Loane M, Addor MC, Bakker MK, Boyd PA, Gatt M, Greenlees R, Haeusler M, Klungsøyr K, Latos-Bielenska A, Lelong N, McDonnell R, Métneki J, Mullaney C, Nelen V, O'Mahony M, Pierini A, Rankin J, Rissmann A, Tucker D, Wellesley D, Dolk H (2013) Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984–2007. BJOG 120(6):707–716CrossRefGoogle Scholar
  5. Calhaz-Jorge C, De Geyter C, Kupka MS, de Mouzon J, Erb K, Mocanu E, Motrenko T, Scaravelli G, Wyns C, Goossens V (2017) Assisted reproductive technology in Europe, 2013: results generated from European registers by ESHRE. Hum Reprod 32(10):1957–1973CrossRefGoogle Scholar
  6. Deutsches IVF Register (2016) Jahrbuch. J Reproduktionsmed Endokrinol 2017 14(6)Google Scholar
  7. Dimitru G et al (2004) Cerebral palsy in triplet pregnancies with and without iatrogenic reduction. Eur J Pedriat 163:449–451Google Scholar
  8. Dodd JM, Dowswell T, Crowther CA (2015) Reduction of the number of fetuses for women with a multiple pregnancy. Cochrane Database Syst Rev 11Google Scholar
  9. Doyle P (1996) The outcome of multiple pregnancy. Hum Reprod 11(Suppl 4):110–117CrossRefGoogle Scholar
  10. Esinler I, Bozdag G, Karakoc Sokmensuer L (2014) Mandatory single embryo transfer policy dramatically decreases multiple pregnancy rates. J Obstet Gynaecol Res 40(1):75–79CrossRefGoogle Scholar
  11. Evans MI et al (1999) Selective terminations for structural, chromosomal, and Mendelian anomalies: international experience. Am J Obstet Gynecol 181:893–897CrossRefGoogle Scholar
  12. Fusi L, McParland P, Fisk N, Nicolini U, Wigglesworth J (1991) Acute twin-twin transfusion: a possible mechanism for brain-damaged survivors after intrauterine death of a monochorionic twin. Obstet Gynecol 78(3 Pt 2):517–520PubMedGoogle Scholar
  13. Gardner MO et al (1995) The origin and outcome of preterm twin pregnancies. ObstetGynecol 85(4):553–557Google Scholar
  14. Gerris JM (2005) Single embryo transfer and IVF/ICSI outcome: a balanced appraisal. Hum Reprod Update 11(2):105–121CrossRefGoogle Scholar
  15. Glinianaia SV, Rankin J, Wright C (2008) Congenital anomalies in twins: a register-based study. Hum Reprod 23(6):1306–1311CrossRefGoogle Scholar
  16. Gortner L et al (2001) Ist die perinatale Sterblichkeit noch ein Qualitätsindikator für das Versorgungssystem? Gynakologe 34:118–122CrossRefGoogle Scholar
  17. Hillemanns P et al (2000) Risiken bei Sectio caesarea und vaginaler Geburt. Gynakologe 33:872–881CrossRefGoogle Scholar
  18. Jeanty P, Rodesch F, Struyven J (1981) The vanishing twin. Ultrasonics 2:25–31Google Scholar
  19. Karageyim Karsidag AY, Kars B, Dansuk R, Api O, Unal O, Turan MC, Goynumer G (2005) Brain damage to the survivor within 30 min of co-twin demise in monochorionic twins. Fetal Diagn Ther 20(2):91–95CrossRefGoogle Scholar
  20. Lawlor DA, Nelson SM (2012) Effect of age on decisions about the numbers of embryos to transfer in assisted conception: a prospective study. Lancet 379(9815):521–527CrossRefGoogle Scholar
  21. Lipitz S et al (1996) Outcome of twin pregnancies reduced from triplets compares with nonreduced twin gestations. Obstet Gynecol 87:511CrossRefGoogle Scholar
  22. Lopriore E, Middeldorp JM, Sueters M, Oepkes D, Vandenbussche FP, Walther FJ (2007) Long-term neurodevelopmental outcome in twin-to-twin transfusion syndrome treated with fetoscopic laser surgery. Am J Obstet Gynecol 196(3):231–e1–4CrossRefGoogle Scholar
  23. Luke B, Keith LG (1992) The contribution of singletons, twins and triplets to low birth weight, infant mortality and handicap in the United States. J Reprod Med 37(8):661–666PubMedGoogle Scholar
  24. McLernon DJ, Harrild K, Bergh C et al (2010) Clinical effectiveness of elective single versus double embryo transfer: meta-analysis of individual patient data from randomised trials. BMJ 341:c6945CrossRefGoogle Scholar
  25. Petridou E et al (1996) Risk factors for cerebral palsy: a case control study in Greece. Scand J Soc Med 24(1):14–26CrossRefGoogle Scholar
  26. Pharoah PO (2006) Risk of cerebral palsy in multiple pregnancies. Clin Perinatol 33(2):301–313 (Review)CrossRefGoogle Scholar
  27. Pharoah PO, Cooke RW (1997) A hypothesis for the aetiology of spastic cerebral palsy – the vanishing twin. Dev Med Child Neurol 39(5):292–296 (Review)CrossRefGoogle Scholar
  28. Powers WF, Kiely JL (1994) The risks confronting twins: a national perspective. Am J Obstet Gynecol 170(2):456–461CrossRefGoogle Scholar
  29. Rustico MA, Baietti MG, Coviello D, Orlandi E, Nicolini U (2005) Managing twins discordant for fetal anomaly. Prenat Diagn 25(9):766–771CrossRefGoogle Scholar
  30. Sebire NJ, Snijders RJM, Highes K et al (1997) The hidden mortality of monochorionic twin pregnancies. Br J Ostet Gynaecol 104:1203–1207CrossRefGoogle Scholar
  31. Senat MV et al (1998) How does multiple pregnancy affect maternal mortality and morbidity? Clin Obstet Gynecol 41(1):78–83CrossRefGoogle Scholar
  32. Sepulveda W, Sebire NJ, Hughes K, Odibo A, Nicolaides KH (1996) The lambda sign at 10–14 weeks of gestation as a predictor of chorionicity in twin pregnancies. Ultrasound Obstet Gynecol 7(6):421–423CrossRefGoogle Scholar
  33. Sheard C et al (2007) Impact of a multiple, IVF birth on post-partum mental health: a composite analysis. Hum Reprod 22(7):2058–2065CrossRefGoogle Scholar
  34. Shoshani M, Rhea DJ, Keith LG, Blickstein I (2007) Comparison between singleton- and triplet-specific „growth“ curves to detect growth restricted triplet infants. J Perinat Med 5(4):322–325Google Scholar
  35. Spencer K, Salonen R, Muller F (1994) Down's syndrome screening in multiple pregnancies using alpha-fetoprotein and free beta hCG. Prenat Diagn 14(7):537–542CrossRefGoogle Scholar
  36. Stirnemann JJ, Nasr B, Quarello E, Ortqvist L, Nassar M, Bernard JP, Ville Y (2008) A definition of selectivity in laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome and its relationship to perinatal outcome. Am J Obstet Gynecol 198(1):62–e1–6CrossRefGoogle Scholar
  37. Strandell A et al (2000) Selection of patients suitable for one-embryo transfer may reduce the rate of multiple births by half without impairment of overall birth rates. Hum Reprod 15(12):2520–2525CrossRefGoogle Scholar
  38. Thurin et al (2004) Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med 351(23):2392–2402CrossRefGoogle Scholar
  39. Vilska S et al (1999) Elective transfer of one embryo results in an acceptable pregnancy rate and eliminates the risk of multiple birth. Hum Reprod 14(9):2392–2395CrossRefGoogle Scholar
  40. Verschuer O von (1932) BiologischeGrundlagen der menschlichen Mehrlings-Forschung. Z Abstammungs Vererbungslehre 61:147Google Scholar
  41. Wapner RJ, Johnson A, Davis G, Urban A, Morgan P, Jackson L (1993) Prenatal diagnosis in twin gestations: a comparison between second-trimester amniocentesis and first-trimester chorionic villus sampling. Obstet Gynecol 82(1):49–56PubMedGoogle Scholar
  42. Wood SL, St Onge R, Connors G, Elliot PD (1996) Evaluation of the twin peak or lambda sign in determining chorionicity in multiple pregnancy. Obstet Gynecol 88(1):6–9CrossRefGoogle Scholar
  43. Zhang XH, Qiu LQ, Huang JP (2011) Risk of birth defects increased in multiple births. Birth Defects Res A Clin Mol Teratol 91(1):34–38CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Zentrum für PränataldiagnostikBerlinDeutschland
  2. 2.Campus LübeckUniverstätsklinikum Schleswig-HolsteinLübeckDeutschland

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