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1/5. Intrauterine treatment for an acardiac twin with alcohol injection into the umbilical artery.

    An acardiac twin is a unique complication of monochorionic twinning, in which a normal pump twin perfuses the acardiac twin. The mortality rate of the pump twin is greater than 50%. Herein we present the successful treatment of an acardiac twin with alcoholization as follows. An acardiac twin was diagnosed at 24 weeks gestation. Circulation interruption of the acardiac twin was successfully achieved by injection of absolute alcohol (5 mL) into the intra-abdominal umbilical artery. Serial ultrasound after the procedure revealed normal growth of the pump twin, whereas the acardiac twin was shrinking. Spontaneous premature delivery at 34 weeks gestation resulted in a normal surviving female baby weighing 2410g and an acardiac female fetus weighing 300g. This experience suggests that this simple technique may be an alternative treatment for an acardiac twin.
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2/5. Anhydramnios and maternal thrombocytopenia after prolonged use of nimesulide.

    Prostaglandin synthesis inhibition have been proposed as an effective alternative to prevent preterm labour. This case report shows a pregnancy with anhydramnios and maternal thrombocytopenia, as side effects of the nimesulide therapy.
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3/5. Long-term use of magnesium sulfate as a tocolytic agent.

    Two patients in premature labor were treated continuously for six and 13 weeks with intravenous magnesium sulfate (MgSO4) for tocolysis. In each case, conventional therapy with intravenous and oral ritodrine failed to abate uterine contractions, and attempts to taper the MgSO4 were unsuccessful. Both pregnancies proceeded uneventfully otherwise, with normal fetal growth. Long-term MgSO4 may be a safe and efficacious alternative for occasional patients not responding to other modes of therapy for the treatment of premature labor.
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4/5. A prospective, randomized trial of nifedipine vs. ritodrine in threatened preterm labor.

    OBJECTIVES: To compare the tocolytic efficacy and maternal tolerance of nifedipine with ritodrine in the management of threatened preterm labor. methods: Prospective randomized study of 52 singleton pregnancies with preterm labor between 26 and 34 week's gestation. The capacity to delay delivery 48 h, 7 days, until week 36 or until fetal weight reached 2500 g were the outcome variables assessed. Doppler ultrasound studies were performed on the fetal umbilical artery as control. RESULTS: No significant differences were found in the delay of delivery, but significantly fewer maternal side-effects were found in the nifedipine group. Doppler ultrasound results were similar in both groups. CONCLUSIONS: nifedipine is a valid and well-tolerated alternative among the tocolytic drugs, and apparently does not significantly alter fetal vascular blood flow.
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5/5. Delayed interval delivery and survival of the two fetuses after second trimester loss of one triplet.

    Due to the implementation of assisted reproduction techniques, the incidence of multiple pregnancies associated with fetal and neonatal complications has significantly increased. A woman in the 24th week of a triplet pregnancy came to the hospital because of premature rupture of membranes of one amniotic sack and she had a miscarriage of one of the fetuses the same day. After confirmation of the viability of the two fetuses, she was kept under observation with antibiotic therapy only. The woman gave live birth to these remaining fetuses in her 32nd week of pregnancy. The outcome of this case demonstrates that watchful expectancy may be a feasible alternative to invasive intervention. The aim of this report is to add to the currently very limited literature of an expectant (conservative) policy with regard to pregnancy outcome after the early loss of a fetus from a multiple pregnancy.
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