Page 4 - Jcog-July 2017
P. 4
rnal of Cases in
Ob s te tri cs & G yn e co l o g y

LH, estradiol, prolactin and TSH levels were 2.13 mIU/ for any of them. The patient and her babies have been dis-
ml, 0.63 mIU/ml,10 pg/ml, 9.04 ng/ml and 2.39 uIU/ ml charged from the hospital on the second day of operation.
respectively. The caryotype analysis of the patient has been
detected as 46,XX and she was diagnosed with HH based Discussion
on her laboratory and clinical results. Histrorically, she has
not presented with any visual symptoms or headache re- Due to the increase in availability of assisted repro-
garding an intracranial space occupying lesion and a cra-
nial imaging sudy has been deferred. She was currently duction techniques worldwide, the incidence of multiple
using daily 4000 IU/ 0.4 ml low molecular weight heparin pregnancies has increased significantly in recent years.
because of the existing thrombophil- Multiple pregnancies pose increased risks of worse fe-
ia status with Factor V Leiden homozygous tal and maternal outcome measures so multiple preg-
and prothrombin gene homozygous mutations. nancy is an unwanted obstetric entity and also consid-
Ultrasonographic examination revealed a triamniotic tricho- ered to be a complication in the infertility treatment [2].
rionic pregnancy of 12 weeks of gestation. Any gross fetal When the number of fetuses increase in the multiple preg-
abnormality has not been detected and the nuchal translu- nancies, length of the pregnancy and birthweight of the
cent (NT) and nasal bone measurements of each fetus has newborn decreases also. The average length of pregnancy
been determined within normal scale regarding gestational is considered between 33rd and 34th weeks of gestation
week of pregnancy. Second trimester anomaly scan of the in triplet pregnancies. Average birth weight is 2500 grams
patient at 16th and 20th week of pregnancy has not reveled in twins and 1800 grams in triplets [3]. The most common
any abnormal findings. Her cervical length has been deter- complication of higher order pregnancies is preterm la-
mined as of 38 mm. After this stage, the patient had received bor and serial cervical length measurement, prophylactic
antenatal care for every two weeks. Finally, at 28th weeks cerclage application and progesterone treatment have not
of gestation, the patient was hospitalized with the diagnosis been shown to prevent early birth. RDS (respiratory dis-
of preterm labor. In addition to intravenous fluid therapy two tress syndrome) is a major complication of preterm birth
doses of 6 mg betamethasone was administered 24 hours and 40-50% of preterm infants struggle with this clini-
apart. Following treatment, her preterm labor symptoms cal situation. Antenatal corticosteroid therapy to accel-
have resolved and she was discharged from the hospital erate the fetal lung maturation decreases the incidence of
with precautions regarding close follow-up until delivery. RDS, the risk of intraventricular hemorrhage (IVH), the
During follow-up, a 2 weeks size discordance has been de- length of stay in the neonatal intensive care. Based on
tected between a fetus and other two foetuses. However, the these clinical positive effects, corticosteroid administra-
pregnancy has been followed up until 34th weeks of gesta- tion has been shown to increase fetal survival rates [4].
tion by reassurance of biophysical profile scores of 8 for all The clinical usefulness of second-trimester screening tests is
fetuses. Due to the decrease in the amniotic fluid volume, low in multiple pregnancies and Down syndrome detection
loss of diastolic flow in the evaluation of umbilical artery, rate is reduced to about 47% for multiple pregnancies [5] . This
and observing late deceleration seen in the non- stress test is attributed to the fact that abnormal fetal markers are shad-
(NST) of the small for gestational age fetus, the pregnancy owed by the normal fetus. Clinical utility of screening tests
was terminated by caesarean section in emergency condi- made in multiple pregnancies are limited and many centers
tions. The babies have been delivered as breech, foot and don’t offer this test to women that have multiple pregnancy.
head presentation in turn. Their birthweights were 2100,1880 Although preterm birth is the most common complication
and 1980 grams in turn. During Apgar score evaluation, 1th in the triplet pregnancies, route of birth is also a determin-
minute (min) apgar scores were 8 and 5th min apgar scores ing factor for perinatal mortality and morbidity. Although
were 9 for all newborns. Arterial blood gas evaluations of the situation is controversial in terms of mode of delivery,
the three newborns have been performed and pH levels of many writers support caesarean delivery for triplet preg-
7.43, 7.42 and 7.28 were determined respectively. During nancies [6]. In a study conducted by Weismann et al., mor-
the postpartum period, the newborns were observed to be tality rate has been determined as doubled in the vaginal
in good condition their neonatal period was uneventful and delivery against to cesarean section in triplet pregnancy.
a transfer to neonatal intensive care unit was not necessary In the same study they also reported that Apgar scores are

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