[Embryo-fetal diseases in multiple pregnancies].
BACKGROUND
Embryo-fetal diseases are the consequence of prenatal (progenetic and metagenetic or environmental) and intranatal (of a traumatic, infective, toxic nature) pathological factors. In multiple pregnancies this complex etiopathogenesis also includes an altered didymous embriogenesis. This study aimed to evaluate the pathologies affecting the fetus in multiple pregnancy, a special biological situation leading to the potential onset of severe fetal and neonatal damage.


METHODS
The authors studied 205 patients with multiple pregnancies, including 199 bigeminal, 5 trigeminal and 1 quadrigeminal, admitted to the Department  B  of the Obstetrics and Gynecological Clinic of Turin University between 1989-1999. Possible embyro-fetal damage was examined using a chronological criterion: namely following the development of the multiple fetuses from the zygotic to the neonatal phase.


RESULTS
Pregnancies were biamniotic bichorionic in 54% of cases, biamniotic monochorionic in 45% and monochorionic monoamniotic in 1%. There were a total of 154 (79.38%) premature births out of 194 and neonatal birth weight was always SGA (small for gestational age). 66.84% of newborns were LBW (<2500 g) and 7.14% were VLBW (<1500 g). Fetal mortality (2.29%) was higher than early neonatal mortality (1.53%). Perinatal mortality (3.82%) was three times higher than in all neonates from the same period (1.03%).


CONCLUSIONS
The severe embryo-fetal and neonatal damage found in multiple pregnancies is a clinical reality that calls for adequate diagnostic and therapeutic measures, and above all specific medical and social prevention to limit maternal pathogenic risks.
Colla
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F
Dipartimento di Discipline Ginecologichee Ostetriche, Cattedra B, Università degli Studi, Turin, Italy.
Alba
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E
Grio
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R
D001724:Birth Weight; D000013:Congenital Abnormalities / Q000209:etiology*; D005314:Embryonic and Fetal Development; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005315:Fetal Diseases / Q000209:etiology*; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D019102:Infant, Very Low Birth Weight; D007746:Labor Presentation; D011247:Pregnancy; D011272:Pregnancy, Multiple; D011783:Quadruplets; D012307:Risk Factors; D014310:Triplets; D014427:Twins