Neonatology pp 129-146 | Cite as

In Vitro Fertilization and Multiple Pregnancies

  • Maria Angela Rustico
  • Mariano Lanna
  • Enrico FerrazziEmail author
Reference work entry


Multiple pregnancies may arise because of modified reproductive strategies (i.e., delayed parenthood) and the availability of assisted reproductive technologies. Dizygotic twinning rate is affected by different factors (race, genetic factors, seasonality, maternal age and parity, endogenous gonadotropins, fertility drugs, and sex of the embryo), while monozygotic twinning is largely determined by genetic mechanisms. Ultrasound techniques are very accurate (100% sensitivity and 99% specificity) for determining chorionicity and assessing the obstetric risk which is significantly different in dichorionic and monochorionic twins. The twin pregnancy is associated with an increased rate of fetal complications, such as miscarriage and fetal loss, intrauterine growth restriction (IUGR), and preterm birth. Twins present with an excess of structural anomalies compared to singletons. All monochorionic twin pregnancies are at risk of complications such as twin-twin transfusion syndrome, selective IUGR, and twin anemia-polycythemia sequence because of the presence of vascular anastomoses between the circulation of both twins on the shared placenta. The death of one twin, which occurs in about 6% of all MC twin pregnancies, puts the co-twin at greater risk of mortality and morbidity.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Maria Angela Rustico
    • 1
  • Mariano Lanna
    • 1
  • Enrico Ferrazzi
    • 1
    Email author
  1. 1.Prenatal Diagnosis and Fetal Surgery Unit, Dept. of Woman, Mother and Neonate, Buzzi Children’s Hospital Department of Clinical SciencesUniversity of MilanMilanItaly

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