Skip to main content
SpringerLink
Log in

Mehrlingsschwangerschaften

  • Chapter
  • First Online:
Reproduktionsmedizin

Part of the book series: Springer Reference Medizin ((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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 289.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Literatur

  • Alexander JM et al (1995) Multifetal reduction of high-order multiple pregnancy: Comparison of obstetrical outcome with non refused twin gestations. Fertil Steril 64:1201

    Article  CAS  PubMed  Google Scholar 

  • Berkowitz HL et al (1996) The current status of multifetal pregnancy reduction. Am J Obstet Gynecol 174:1265–1272

    Article  CAS  PubMed  Google Scholar 

  • Blickstein I (2004) Is it normal for multiples to be smaller than singletons? Best Pract Res Clin Obstet Gynaecol 18(4):613–623 (Review)

    Article  PubMed  Google Scholar 

  • 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):707–716

    Article  CAS  Google Scholar 

  • 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):1957–1973

    Article  CAS  PubMed  Google Scholar 

  • Deutsches IVF Register (2016) Jahrbuch. J Reproduktionsmed Endokrinol 2017 14(6)

    Google Scholar 

  • Dimitru G et al (2004) Cerebral palsy in triplet pregnancies with and without iatrogenic reduction. Eur J Pedriat 163:449–451

    Google Scholar 

  • Dodd JM, Dowswell T, Crowther CA (2015) Reduction of the number of fetuses for women with a multiple pregnancy. Cochrane Database Syst Rev (11):CD003932

    Google Scholar 

  • Doyle P (1996) The outcome of multiple pregnancy. Hum Reprod 11(Suppl 4):110–117

    Article  PubMed  Google Scholar 

  • Esinler I, Bozdag G, Karakoc Sokmensuer L (2014) Mandatory single embryo transfer policy dramatically decreases multiple pregnancy rates. J Obstet Gynaecol Res 40(1):75–79

    Article  PubMed  Google Scholar 

  • Evans MI et al (1999) Selective terminations for structural, chromosomal, and Mendelian anomalies: international experience. Am J Obstet Gynecol 181:893–897

    Article  CAS  PubMed  Google Scholar 

  • 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):517–520

    CAS  PubMed  Google Scholar 

  • Gardner MO et al (1995) The origin and outcome of preterm twin pregnancies. Obstet Gynecol 85(4):553–557

    Article  CAS  Google Scholar 

  • Gerris JM (2005) Single embryo transfer and IVF/ICSI outcome: a balanced appraisal. Hum Reprod Update 11(2):105–121

    Article  PubMed  Google Scholar 

  • Glinianaia SV, Rankin J, Wright C (2008) Congenital anomalies in twins: a register-based study. Hum Reprod 23(6):1306–1311

    Article  CAS  PubMed  Google Scholar 

  • Gortner L et al (2001) Ist die perinatale Sterblichkeit noch ein Qualitätsindikator für das Versorgungssystem? Gynakologe 34:118–122

    Article  Google Scholar 

  • Hillemanns P et al (2000) Risiken bei Sectio caesarea und vaginaler Geburt. Gynakologe 33:872–881

    Article  Google Scholar 

  • Jeanty P, Rodesch F, Struyven J (1981) The vanishing twin. Ultrasonics 2:25–31

    Google Scholar 

  • 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):91–95

    Article  PubMed  Google Scholar 

  • 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):521–527

    Article  PubMed  Google Scholar 

  • Lipitz S et al (1996) Outcome of twin pregnancies reduced from triplets compares with nonreduced twin gestations. Obstet Gynecol 87:511

    Article  CAS  PubMed  Google Scholar 

  • 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.e1–4

    Article  Google Scholar 

  • 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):661–666

    CAS  PubMed  Google Scholar 

  • 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:c6945

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Petridou E et al (1996) Risk factors for cerebral palsy: a case control study in Greece. Scand J Soc Med 24(1):14–26

    Article  CAS  PubMed  Google Scholar 

  • Pharoah PO (2006) Risk of cerebral palsy in multiple pregnancies. Clin Perinatol 33(2):301–313 (Review)

    Article  PubMed  Google Scholar 

  • 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)

    Article  CAS  PubMed  Google Scholar 

  • Powers WF, Kiely JL (1994) The risks confronting twins: a national perspective. Am J Obstet Gynecol 170(2):456–461

    Article  CAS  PubMed  Google Scholar 

  • Rustico MA, Baietti MG, Coviello D, Orlandi E, Nicolini U (2005) Managing twins discordant for fetal anomaly. Prenat Diagn 25(9):766–771

    Article  CAS  PubMed  Google Scholar 

  • Sebire NJ, Snijders RJM, Highes K et al (1997) The hidden mortality of monochorionic twin pregnancies. Br J Ostet Gynaecol 104:1203–1207

    Article  CAS  Google Scholar 

  • Senat MV et al (1998) How does multiple pregnancy affect maternal mortality and morbidity? Clin Obstet Gynecol 41(1):78–83

    Article  CAS  PubMed  Google Scholar 

  • 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):421–423

    Article  CAS  PubMed  Google Scholar 

  • Sheard C et al (2007) Impact of a multiple, IVF birth on post-partum mental health: a composite analysis. Hum Reprod 22(7):2058–2065

    Article  CAS  PubMed  Google Scholar 

  • 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):322–325

    Google Scholar 

  • 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):537–542

    Article  CAS  PubMed  Google Scholar 

  • 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–e1–6

    Article  PubMed  Google Scholar 

  • 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):2520–2525

    Article  CAS  Google Scholar 

  • Thurin et al (2004) Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med 351(23):2392–2402

    Article  CAS  PubMed  Google Scholar 

  • 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):2392–2395

    Article  CAS  PubMed  Google Scholar 

  • Verschuer O von (1932) Biologische Grundlagen der menschlichen Mehrlings-Forschung. Z Abstamm Vererbungslehre 61:147

    Google Scholar 

  • 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):49–56

    CAS  PubMed  Google Scholar 

  • 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):6–9

    Article  CAS  PubMed  Google Scholar 

  • Zhang XH, Qiu LQ, Huang JP (2011) Risk of birth defects increased in multiple births. Birth Defects Res A Clin Mol Teratol 91(1):34–38

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Zentrum für Pränataldiagnostik und Humangenetik, Berlin, Deutschland

    Andreas Schröer

  2. Bereich Pränatalmedizin und gynäkologische Sonographie, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    Jan Weichert

Authors
  1. Andreas Schröer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan Weichert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Schröer .

Editor information

Editors and Affiliations

  1. Facharzt-Zentrum für Kinderwunsch Pränatale Medizin, Endokrinologie und Osteologie Hamburg GmbH, amedes experts, Hamburg, Germany

    Klaus Diedrich

  2. SYNLAB Holding Deutschland GmbH, Augsburg, Germany

    Michael Ludwig

  3. Sektion für gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Schleswig-Holstein – Campus Lübeck, Lübeck, Germany

    Georg Griesinger

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Schröer, A., Weichert, J. (2020). Mehrlingsschwangerschaften. In: Diedrich, K., Ludwig, M., Griesinger, G. (eds) Reproduktionsmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-57636-6_33

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-57636-6_33

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-57635-9

  • Online ISBN: 978-3-662-57636-6

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation