tailieunhanh - Obstetrics and Gynecology Clinics of North America, 2005

As recently as the early 1980s, twin pregnancy and birth was a relatively rare event, and higher-order multiples were of negligible consequence. However, this did not deter clinicians as well as researchers from evaluating the clinical management of multiples. Obviously, the validity of many of these studies was hampered because of small sample size and underpowered statistics. Beginning in the early 1980s, all we knew about the natural history of multiples has been profoundly changed. Physician-made (iatrogenic) multiple pregnancies are now seen in most developed countries with frequencies approaching 50% in twins and more than 75% in higher-order multiples | ELSEVIER VUADtRt OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA ELSEVIER SAUNDERS Obstet Gynecol Clin N Am 32 2005 xiii-xiv OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA Preface Multiple Gestations Isaac Blickstein MD Louis G. Keith MD PhD Guest Editors As recently as the early 1980s twin pregnancy and birth was a relatively rare event and higher-order multiples were of negligible consequence. However this did not deter clinicians as well as researchers from evaluating the clinical management of multiples. Obviously the validity of many of these studies was hampered because of small sample size and underpowered statistics. Beginning in the early 1980s all we knew about the natural history of multiples has been profoundly changed. Physician-made iatrogenic multiple pregnancies are now seen in most developed countries with frequencies approaching 50 in twins and more than 75 in higher-order multiples. The resultant demographic trends and now a serious public health issue may be summarized in two major points First the frequency of twins has almost doubled and that of higher-order multiples has increased 400 to 600 . These changes translate immediately into a greater and significant proportion of multiples among premature and low-birth weight infants. Preterm birth and growth aberrations are indeed the most important adverse consequences of the so-called epidemic of multiple gestations. Second whereas in the past mothers had their last child in their late 30s at present these mothers are giving birth to their firstborn. This trend associated with a greater need for assisted conceptions disproportionately 0889-8545 05 - see front matter 2005 Elsevier Inc. All rights reserved. doi xiv PREFACE increases the number of mothers of multiples among elderly parturients. Inevitably those mothers are in greater need for invasive and noninvasive diagnostic measures to exclude aneuploidy. In this issue of the .

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