Multiple Pregnancies: Optimal Follow-Up, Early Detection and Management of Complications, and Appropriate Mode and Time of Delivery

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Personalized Therapy and Drug Delivery".

Deadline for manuscript submissions: 20 August 2025 | Viewed by 938

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Guest Editor
1 Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
2 Department of Medicine, CEU Cardenal Herrera University, 12006 Castellón de la Plana, Castellón, Spain
Interests: twin pregnancy; multiple pregnancy; TTTS; fetoscopy; preterm birth; preeclampsia; placental dysfunction; fetal ultrasound; maternal-fetal medicine; high-risk pregnancy
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Dear Colleagues,

The frequency of multiple pregnancies has risen, primarily attributed to factors such as postponed parenthood and the increased age of mothers at the time of conception, along with the prevalent use of assisted reproductive technologies. Additionally, compared to singleton gestations, multiple pregnancies carry a higher risk of perinatal mortality and morbidity. For instance, the occurrence of preterm births—defined as births before 37 weeks of gestation—is seen in up to 60% of multiple pregnancies. This significantly contributes to the heightened risk of neonatal mortality. Moreover, multiple pregnancies face a higher risk of iatrogenic preterm delivery compared to singleton gestations, due to the more frequent occurrence of complications affecting the mother and fetus. This risk is notably greater in monochorionic pregnancies than in dichorionic ones.

Ultrasound serves as a crucial instrument enabling clinicians to monitor multiple pregnancies effectively. International guidelines address the optimal follow-up of multiple pregnancies and the role of ultrasound in the early detection of pregnancy complications. Nonetheless, further research is needed regarding the management of specific pregnancy complications, such as selective fetal growth restriction or twin anemia-polycythemia sequence (TAPS), and concerning the appropriate mode and time of delivery. Thus, this Special Issue aims at gathering the latest insights on the management, follow-up, and delivery strategies for both uncomplicated and complicated multiple pregnancies.

Dr. Alicia Martínez-Varea
Guest Editor

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Keywords

  • multiple pregnancy
  • twin pregnancy
  • triplet pregnancy
  • monochorionic pregnancy
  • monochorionic twins
  • monochorionic monoamniotic pregnancy
  • monochorionic diamniotic pregnancy
  • dichorionic diamniotic pregnancy
  • quadruplet pregnancy
  • chorionicity
  • amnionicity
  • conjoined twins
  • in vitro fertilization
  • assisted reproductive techniques
  • advanced maternal age
  • natural conception
  • pregnancy dating
  • aneuploidy screening
  • twin-to-twin transfusion syndrome (TTTS)
  • fetal growth restriction (FGR)
  • selective fetal growth restriction (sFGR)
  • twin anemia-polycythemia sequence (TAPS)
  • twin reversed arterial perfusion sequence (TRAP)
  • fetoscopy
  • laser ablation
  • fetal laser therapy
  • laser therapy
  • bipolar cord coagulation
  • radiofrequency ablation
  • selective feticide
  • elective fetal reduction
  • elective termination of pregnancy
  • discordant fetal anomaly
  • structural abnormalities
  • single intrauterine fetal demise
  • cerclage
  • threatened preterm labor
  • preterm birth
  • preeclampsia
  • gestational hypertension
  • gestational diabetes
  • fetal ultrasound
  • fetal therapy
  • delivery
  • vaginal delivery
  • operative vaginal delivery
  • cesarean section
  • adverse perinatal outcomes

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Published Papers (1 paper)

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Research

12 pages, 520 KiB  
Article
Predictive Value of First Amniotic Sac IL-6 and Maternal Blood CRP for Emergency Cerclage Success in Twin Pregnancies
by Diana María Diago-Muñoz, Alicia Martínez-Varea, Ricardo Alonso-Díaz, Alfredo Perales-Marín and Vicente José Diago-Almela
J. Pers. Med. 2025, 15(1), 37; https://doi.org/10.3390/jpm15010037 - 19 Jan 2025
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Abstract
Objectives: To assess the usefulness of first amniotic sac Interleukin-6 (IL-6) to rule out intra-amniotic inflammation (IAI), as well as maternal blood c-reactive protein (CRP), to select patients with a twin pregnancy who may benefit from an emergency cerclage. Materials and Methods: [...] Read more.
Objectives: To assess the usefulness of first amniotic sac Interleukin-6 (IL-6) to rule out intra-amniotic inflammation (IAI), as well as maternal blood c-reactive protein (CRP), to select patients with a twin pregnancy who may benefit from an emergency cerclage. Materials and Methods: Retrospective, descriptive study among all patients with a twin pregnancy and mid-trimester bulging membranes admitted to a tertiary Hospital from January 2012 to September 2023. According to the Hospital’s Protocol, all patients received a vaginal and abdominal ultrasound, a maternal blood test, and an amniocentesis of the first sac to rule out IAI, defined by IL-6 ≥ 2.6 ng/dL. Results: A total of 28 patients with a twin pregnancy and mid-trimester bulging membranes were included. Among them, 18 patients (64.28%) had IL-6 levels ≥ 2.6 ng/dL. Cerclage was placed in 10 patients with IL-6 < 2.6 ng/dL. Perinatal mortality in pregnancies with IL-6 ≥ 2.6 ng/dL was 77.22%. The gestational age at delivery of patients with IL-6 < 2.6 ng/dL was 34 ± 3 weeks, compared to 23 ± 4 weeks when IL-6 was ≥2.6 ng/dL (p < 0.001). The latency to delivery with IL-6 < 2.6 ng/dL was 88.1 ±31.56 days, compared to 13.11 ± 20.43 days when IL-6 was ≥2.6 ng/dL (p < 0.001). Significant differences were found in maternal blood CRP levels in both study groups (no IAI 4.32 ± 3.67 vs. IAI 13.32 ± 15.07, p < 0.05). The area under the curve with an ROC curve was 0.799 (IC 95% 0.596–0.929), with a cut-off of 3.9 mg/L (S 94.4%, % E 62.5%). The gestational age at delivery with CRP < 3.9 mg/L was 33 ± 5 weeks, while in cases with CRP ≥ 3.9 mg/L, it was 24 ± 5 weeks (p < 0.001). The latency days to delivery were 86.5 ± 44.88 and 21.95 ± 30.97 days (p < 0.01), respectively. A positive correlation between the IL-6 values of both amniotic sacs was obtained, along with the Spearman coefficient correlation rank (rho = 0.835, p < 0.001). Conclusions: Compared to those with IAI, patients with a twin pregnancy and mid-trimester bulging membranes without IAI who underwent emergency cerclage had a significantly higher interval from diagnosis to delivery, as well as a significantly lower incidence of preterm birth < 34 weeks and perinatal death. Further studies are needed to assess whether the IL-6 of the first amniotic sac and maternal blood CRP might constitute a useful parameter to select patients who may benefit from an emergency cerclage. Full article
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