妊娠中晚期双绒毛膜双胎一胎胎死宫内妊娠结局分析

目的：比较双绒毛膜双胎之一选择性减胎与自发一胎胎死宫内（single intrauterine fetal death,SIUFD）的围生期结局,并比较不同减胎孕周对围生期结局的影响,探讨选择性减胎的临床应用。方法：纳入2011年1月—2019年12月在南京大学医学院附属鼓楼医院产科终止妊娠的55例双胎之一胎死宫内或行选择性减胎术将双胎减至单胎的临床资料,根据减胎或死胎原因将其分为选择性减胎组（39例）和自发SIUFD组（16例）,回顾性分析比较其围生期结局。结果：55例患者总妊娠丢失率为9.1%（5例流产）,活产率为90.9%。选择性减胎组的减胎/死胎孕周明显低于自发SIUFD组,总体终止孕周、活产率明显高于自发SIUFD组,而剖宫产率、流产率则低于自发SIUFD组,差异均有统计学意义（P<0.05）。2组的早产率、足月产率、存活儿出生体质量、出生体质量百分位数、新生儿健康出院率、新生儿重症监护病房（neonatal intensive care unit,NICU）入住率比较,差异均无统计学意义（均P>0.05）。根据选择性减胎的孕周将选择性减胎组再分为减胎孕周≤20周组（24例）和减胎孕周>20周组（15例）,2组新生儿出生体质量百分位数比较差异无统计学意义（P>0.05）,但与减胎孕周>20周组比较,减胎孕周≤20周组的早产率低、足月产率高,存活儿出生体质量更高,差异有统计学意义（均P<0.05）。结论：双胎妊娠发生SIUFD后会对存活儿围生期结局产生不良影响,对于有减胎指征者,选择性减胎有利于提高存活儿围生期的活产率及改善新生儿结局,对多胎妊娠的围生期结局有益。     

Influence of spontaneous fetal reduction on dichorionic diamniotic twin pregnancy outcomes after in vitro fertilization: a large-sample retrospective study

Objective: To examine the incidence of spontaneous fetal reduction during dichorionic diamniotic (DCDA) twin pregnancy after in vitro fertilization and embryo transfer (IVF-ET) and its influence on pregnancy outcomes.

Methods: This was a retrospective cohort study of 4447 DCDA twin pregnancies and 14,551 singleton pregnancies after IVF-ET at a single center between 2009 and 2015. The spontaneous pregnancy reduction (SPR) group included 759 women. The remaining 3688 women with DCDA twins showing no spontaneous reduction were included in the non-SPR group. Outcomes were compared to a singleton group (n?=?14,551) treated over the same period. The overall rate of spontaneous reduction and frequency distribution across gestational epochs were determined and pregnancy outcomes were compared among the three groups. Further regression analysis was conducted to investigate whether spontaneous reduction was an independent risk factor for decreased take-home baby rate.

Results: The overall rate of spontaneous DCDA twin reduction after IVF-ET was 17.1%, with most cases (89.8%) occurring in the first trimester. Pregnancy outcome measures, including miscarriage rate, premature delivery rate, live birth rate, take-home baby rate, gestational age of delivery, and neonatal birth weight, were significantly better in the SPR group than the non-SPR group. Live birth rate, take-home baby rate, neonatal birth weight, and other primary outcome measures in the SPR group were not inferior to the singleton group. Multivariate regression analysis showed that the take-home baby rate was significantly lower in the non-SPR group (OR =0.73, 95%CI: 0.44–0.92, p?=?.008) and that SPR did not decrease the take-home baby rate.

Conclusions: Spontaneous pregnancy reduction is common in DCDA twin pregnancy after IVF-ET, but has little adverse influence on pregnancy outcomes and does not reduce the probability of taking home live babies.     

Early fetal reduction to twin versus prophylactic cervical cerclage for triplet pregnancies conceived with assisted reproductive techniques

Objective

To compare the obstetric outcomes of triplet gestations managed by early fetal reduction to twins with those managed by prophylactic cervical cerclage in women conceived with assisted reproductive techniques (ART).

The association between maternal pre-pregnancy body mass index and pregnancy outcomes of preeclampsia

ObjectiveTo evaluate the effects of pre-pregnancy maternal body mass index (BMI) to pregnancy outcomes in patients diagnosed as preeclampsia.Materials and methodsThis was a retrospectively study on women who had been diagnosed as preeclampsia and delivered at Seoul National University Bundang Hospital between June 2017 and March 2020. Multifetal gestation, major fetal anomaly, and fetal death in utero were excluded. A total of 150 singleton pregnancies were included and divided into four groups according to the pre-pregnancy BMI classification: underweight (<18.5 kg/m², n = 6), normal (18.5–22.9 kg/m², n = 66), overweight (23.0–24.9 kg/m², n = 26), and obese (≥25.0 kg/m², n = 52). Pregnancy outcomes including gestational age at delivery, birthweight, and delivery modes were reviewed.ResultsThe rates of preterm birth before 34 weeks of gestation were 67%, 49%, 35%, and 27% for underweight group, normal BMI group, overweight group, and obese group, respectively (p-trend = 0.006). The birthweight of newborn increased significantly as pre-pregnancy BMI increased (p-trend<0.001). The proportions of small for gestational age (SGA) were highest in underweight group and decreased as pre-pregnancy BMI increased (67%, 41%, 42%, and 10% for each group, respectively, p-trend<0.001).ConclusionThe rates of preterm birth before 34 weeks and SGA increased as pre-pregnancy BMI decreased in patients with preeclampsia.Implications for practiceWomen with underweight before pregnancy are at the highest risk for preterm birth and SGA, therefore they need to be monitored more intensively when diagnosed as preeclampsia.     

九例射频消融选择性减胎术的疗效及观察

目的:探讨射频消融减胎术(radio frequency ablation,RFA)对复杂性多胎妊娠的疗效.方法:回顾性分析2017年4月—2019年5月在武汉大学人民医院行RFA治疗的9例患者的临床资料,总结其临床疗效,包括流产、早产、足月产、活产、分娩方式和新生儿体质量等.结果:9例患者中有2例是双绒毛膜三羊膜囊妊...     

The Combined Effect of Maternal Obesity and Fetal Macrosomia on Pregnancy Outcomes

ObjectiveTo examine the combined effect of macrosomia and maternal obesity on adverse pregnancy outcomes using a retrospective cohort.MethodsInfants with a birth weight of ≥ 4000g (macrosomia) were identified from an institutional birth cohort. Demographic characteristics and maternal, fetal, neonatal, and pregnancy outcomes of macrosomic infants whose mothers were obese were compared with those whose mothers were non-obese.ResultsPregnancies in obese women resulting in macrosomic infants are more likely to be complicated by gestational diabetes, gestational hypertension, and smoking than pregnancies in non-obese women with macrosomic infants. Mothers whose infants are macrosomic are significantly more likely to require induction of labour (OR 1.42; 95% CI 1.10 to 1.98) and delivery by Caesarean section (OR 1.45; 95% CI 1.04 to 2.01), particularly for maternal indications (OR 3.7; 95% CI 1.47 to 9.34), if they are obese. Finally, macrosomic infants of obese mothers are significantly more likely to require neonatal resuscitation in the form of free flow oxygen (OR 1.57; 95% CI 1.03 to 2.42) than macrosomic infants of non-obese mothers.ConclusionWhen both maternal obesity and macrosomia are present, adverse pregnancy outcomes are more common than when fetal macrosomia occurs in a woman of normal weight.     

Pregnancy and perinatal outcomes of first-trimester crown−rump length discordant IVF dichorionic twin pregnancies – a retrospective cohort study

Research QuestionThis study aimed to evaluate the association between discordance in crown–rump length (CRL) and adverse pregnancy and perinatal outcomes in dichorionic twin pregnancies.DesignThis was a retrospective cohort study of dichorionic twin pregnancies after IVF that showed two live fetuses at the first ultrasound scan between 6 ⁺⁵ and 8 weeks gestational age from 1 January 2015 to 31 December 2016. Study groups were defined by the presence or absence of 20% or more discordance in CRL. The primary outcomes were early fetal loss of one or both fetuses before 12 weeks and birthweight discordance. Secondary outcomes included fetal anomalies, fetal loss between 12 and 28 weeks, stillbirth, small for gestational age (SGA) at birth, low birthweight (LBW), very low birthweight (VLBW), admission to the neonatal intensive care unit (NICU) and preterm delivery (PTD).ResultsCRL-discordant twin pregnancies were more likely to end in the loss of one fetus before 12 weeks’ gestation (odds ratio [OR] 15.877, 95% confidence interval [CI] 10.495–24.019). Discordant twin pregnancies with twin deliveries had a significantly higher risk of birthweight discordance (OR 1.943, 95% CI 1.032–3.989). There was no significant difference in perinatal outcomes including fetal anomalies, PTD, LBW, VLBW, SGA, neonatal death and admission to NICU between singleton or twin deliveries.ConclusionsDiscordant twin pregnancies were at increased risk of one fetal loss prior to 12 weeks’ gestation. Except for birthweight discordance, there was no significant difference between CRL discordance and other adverse perinatal outcomes.     

Pregnancy and birth outcomes of multiple gestations with PPROM occurred within 24 h after fetal reduction: A case series

ObjectiveThe study aims to analyze the pregnancy outcomes of multiple gestations with preterm premature rupture of membranes (PPROM) that occurred within 24 h after fetal reduction with potassium chloride (KCL).Materials and methodsWe identified and evaluated the outcomes of 16 retrospectively recorded multigestational pregnancies that met the inclusion criteria between 2006 and 2016, from the Obstetrics Department of Shandong Provincial Hospital. A total of 16 patients carrying twins or higher order multiple gestations experienced PPROM within 24 h after fetal reduction, and all of them received expectant management after understanding the relevant risks. The maternal and neonatal records were retrospectively collected and reviewed. Every surviving child was followed up to at least 2 years old.ResultOf the 16 cases, 12 cases (75%) ended in successful pregnancy, resulting in the delivery of at least 1 child surviving from a multiple gestational pregnancy. All cases of successful pregnancies were either term (≥37 weeks) or near-term (36⁺⁵ weeks) at delivery. And of those 20 infants delivered, only 3 were low birth weight infants (<2500g) (15%), None of the 16 women had fever, or other clinical symptoms and signs of chorioamnionitis during hospital stay. Postnatal follow-up of the surviving babies showed no obvious sequelae thus far. No newborn baby had neonatal complications, or needed to be transferred to neonatal intensive care unit.ConclusionOverall, our data demonstrate that dichorionic diamniotic (DCDA) twins or higher-order gestations who experienced PPROM of the reduced fetus within 24 h after selective reduction with KCL had relatively good outcomes with expectant management alone.     

Emergency cervical cerclage after miscarriage of the first fetus in dichorionic twin pregnancies: obstetric and neonatal outcomes of delayed delivery interval

Purpose

To study the effectiveness of emergency cervical cerclage in order to delay the delivery interval after miscarriage of the first fetus in dichorionic twin pregnancies.

Methods

Dichorionic twin pregnancies after miscarriage of the first fetus (<24?weeks) were exclusively included in the present analysis. Prolongation of delivery interval was managed with additional emergency cervical cerclage in the already initiated tocolytic therapy. Obstetric outcomes (cervical dilatation, gestational age at delivery of the first twin, interval between miscarriage and delivery of the second fetus) and neonatal outcomes [neonatal birth weight, Apgar score in the first and fifth minute, admission to Neonatal Intensive Care Unit (NICU)] of the second twin were analyzed.

Results

Five cases of dichorionic twin pregnancies were included in our study. Cervical dilatation (mean?±?SD) at admission time was 3.7?±?1.4?cm. The gestational week at delivery of the first twin was 20.6?±?2.6. The median delivery interval was 72?days and the maximum 121?days. Mean gestational age at delivery of the second twin was 28.8?±?7.2?weeks and mean birth weight 1,772.5?±?742?g. The rate of live birth was 80?%, while NICU admission was demanded in 75?% of the live births. All neonates discharged from NICU remained alive after 1?month of life.

Conclusion

The present study demonstrated beneficial effect concerning obstetric and neonatal outcomes of the second twin after performing emergency cervical cerclage to postpone the delivery interval in premature dichorionic twin pregnancies.     

Comparison of perinatal outcomes of selective termination in dichorionic twin pregnancies performed at different gestational ages

Objective: To determine the perinatal outcomes of selective termination in dichorionic twin pregnancies discordant for major but non-lethal fetal anomalies performed at different gestational ages.

Methods: Thirty-one dichorionic twin pregnancies that underwent selective termination for discordant major but non-lethal fetal anomalies between January 2004 and February 2015 were retrospectively reviewed. The patients were grouped into three, according to the gestational age at which selective termination of pregnancies was performed; Group 1 (15–19 weeks), Group 2 (20–24 weeks) and Group 3 (30–33 weeks). Perinatal outcomes in all the three groups were reviewed and analyzed.

Results: The overall live birth, term birth and pregnancy loss rate were 93.6%, 54.8% and 9.6%, respectively. The overall live birth rate was 66.6% in Group 1, this rate was 100% in Group 2 and Group 3 (p?=?0.01). The rate of pregnancy loss was significantly higher in Group 1 (p?=?0.01). The overall preterm delivery rate was 38.7%. While the overall preterm delivery rate was significantly higher in Group 3 (p?=?0.04), the rate of extremely and very preterm birth was significantly lower (p?=?0.03).

Conclusion: Late selective feticide performed during the third trimester of pregnancy seems to be a safe approach and can be offered as an alternative method to reduce the total pregnancy loss and extremely and early pre-term birth rates.     

Prenatal diagnosis and obstetric outcomes in triplet pregnancies in relation to chorionicity

OBJECTIVE: This study describes the frequency, pregnancy complications and outcomes of non-trichorionic triplet pregnancies. DESIGN: A retrospective observational study. SETTING: Two tertiary level referral centres of Obstetrics and Prenatal Medicine, Germany. POPULATION: All women booked to receive targeted ultrasound screening between January 1998 and June 2003. The mixed low and high risk population included 36,430 women with ultrasound examinations between 11 and 24 weeks of gestation. Of those with available outcome, 176 were triplet pregnancies with three viable fetuses. METHODS: Analysis of ultrasound data and perinatal outcome in triplet gestations who had first and second trimester targeted ultrasound examination. Pregnancies with monochorionic or dichorionic placentation were identified and pregnancy outcome was compared to trichorionic triplets. MAIN OUTCOME MEASURES: Intrauterine fetal death, fetal growth restriction (FGR), mean discordance and survival rate in non-trichorionic versus trichorionic triplets. RESULTS: Triplets were trichorionic in 81.8% and had a monochorionic or dichorionic placentation in the remaining 18.2%. The rate of monochorionicity and dichorionicity was significantly higher after spontaneous conception than after assisted reproductive technologies (44.8%vs 12.9%, P < 0.001). In non-reduced monochorionic and dichorionic triplets compared with non-reduced trichorionic triplets, there was a higher rate of intrauterine fetal death (8.8%vs 1.5%, P < 0.01), FGR (33.3%vs 25.5%), mean discordance (20.5%vs 12.7%, P < 0.01), discordance >30% (26.3%vs 2.9%, P < 0.01) and delivery <32 weeks of gestations (47.4%vs 32.2%). There was a lower survival rate in non-trichorionic triplets (84.2%) than in trichorionic ones (91.7%). CONCLUSION: Triplet pregnancies with a monochorionic or dichorionic placentation are at significantly higher risk of adverse pregnancy outcome compared with trichorionic pregnancies. First trimester evaluation of chorionicity is strongly emphasised.     

Advanced maternal age and adverse pregnancy outcomes: A cohort study

ObjectivesTo assess the association between advanced maternal age and adverse perinatal outcomes in single pregnancies.Materials and methodsA cohort study was conducted using data from 27,455 singleton births attended at our hospital between 2007 and 2018. Three maternal age groups were established, and perinatal outcomes were compared between-groups (<35 years (n = 19,429; 70.7%), 35–40 years (n = 7189; 26.2%), and >40 years (n = 846; 3.1%). The data were compared using chi-square analysis and the results were adjusted using a logistic regression model. Decision trees were designed to examine the fetal mortality and caesarean section variables. We used the SPSS 23 statistical software program for the statistical analysis.ResultsThe mean age of the women was 31.21 years. No differences were found associated with age for neonatal acidosis, an Apgar score <7 at 5 min after birth, threatened preterm labour, preterm rupture of membranes, or high-grade perineal tear. The analyses found statistically significant increases in the rates of hypertensive disorders, diabetes mellitus, induction of labour, and caesarean section, after 35 years of age. The risks of fetal death, neonatal admission, small for gestational age, placenta previa, instrument delivery, maternal ICU admission, and postpartum haemorrhage were greater after 40 years of age.ConclusionsThe results of our study indicated that women >35 years of age had worse perinatal outcomes, compared with younger women. This finding was more evident in patients >40 years of age, which highlighted the greater risk of fetal death and serious maternal complications in this group.     

Pregnancy outcome after multifetal pregnancy reduction

Objective: To study the effects of multifetal pregnancy reduction (MFPR) as a means to reduce the adverse outcome of multiple gestations.

Methods: This was a retrospective study evaluating the outcome of 334 multiple pregnancies after embryo reduction.

Results: In 313 multiple pregnancies in which MFPR was performed before 15 weeks, the rates of miscarriage, preterm delivery <?33 weeks, preterm delivery <?36 weeks and total fetal loss were 9.12%, 13.33%, 38.60% and 16.25%, respectively, and median gestational age at delivery was 35 weeks. There was a significant correlation between miscarriage and the finishing number of fetuses. In 185 triplets reduced to twins, miscarriage, preterm delivery <?33 weeks, preterm delivery <?36 weeks and total fetal loss occurred in 8.25%, 11.18%, 40.59% and 15.41% of cases, respectively, and median gestational age at delivery was 36 weeks. In the subgroup of 32 reduced triplet pregnancies that also had second-trimester amniocentesis, the risk of miscarriage (3.13%) was not significantly different from that in the rest of the group. Among 21 twin pregnancies that had selective termination at or after 15 weeks, the risk of preterm delivery <?33 weeks was three times higher than in the group of 22 twin pregnancies with first-trimester procedures.

Conclusion: MFPR resulted in at least one live neonate in 83.75% of cases and was effective in reducing the risks of pregnancy loss and severe prematurity in quadruplets and higher-order pregnancies. The risk of miscarriage increased with increasing finishing number of fetuses. In reduced triplets gestation was prolonged in comparison with average figures reported in the literature. In twin pregnancies selective termination in the first trimester carries a lower risk of severe preterm delivery and this emphasizes the need for first-trimester diagnosis.     

Adolescent Pregnancy Outcomes in the Province of Ontario: A Cohort Study

ObjectiveFew Canadian studies have examined the association between adolescent pregnancy and adverse pregnancy outcomes The objective of this cohort study was to characterize the association between adolescent pregnancy and specific adverse maternal, obstetrical, and neonatal outcomes, as well as maternal health behaviours.MethodsWe conducted a retrospective population-based cohort study of all singleton births in Ontario between January 2006 and December 2010, using the Better Outcomes Registry & Network database Outcomes for pregnant women < 20 years of age (adolescent) were compared with those of women 20 to 35 years old (adult).ResultsThis study included 551 079 singleton birth records, 23 992 (4.35%) of which derived from adolescent pregnancies. Adolescents had a higher rate of smoking and substance use than adult women and were within the lowest education and family income quintiles. Adolescents had a significantly lower risk of gestational hypertension (adjusted relative risk [aRR] 0.73) and gestational diabetes (aRR 0.34), placental abruption (aRR 0.80), and placenta previa (aRR 0.36), but their risk of preterm premature rupture of membranes was significantly higher (RR 1.16). Adolescents had a significantly higher proportion of spontaneous vaginal delivery (aRR 1.76), significantly lower rates of use of epidural analgesia (aRR 0.93), of Caesarean section (aRR 0.57), and of assisted vaginal delivery (aRR 0.76), but a significantly higher risk of emergency CS (aRR 1.31). Neonates with an adolescent mother had significantly higher risks of admission to NICU (aRR 1.08) and very preterm birth (aRR 1.16). There was no significant difference between the two groups in rates of small for gestational age babies, low birth weight, preterm birth, and fetal death. Adolescents had significantly lower rates of prenatal class attendance, prenatal visits in the first trimester, and breastfeeding.ConclusionThis large Canadian cohort study confirms that, compared with adults, adolescents have improved outcomes such as lower rates of gestational hypertension, gestational diabetes, antepartum hemorrhage, and operative deliveries However, adolescents also have higher sociodemographic risk factors and seek prenatal care later than adults These risk factors in combination with young age, lead to other important maternal, obstetrical, and neonatal adverse outcomes. These findings highlight the importance of multidisciplinary prenatal management in the adolescent population to address their high-risk needs, to ensure healthy pregnancies, and to reduce adverse perinatal outcomes.     

Maternal and Perinatal Outcomes Among Adolescents and Mature Women: A Hospital-Based Study in the North of Mexico

Study ObjectiveTo compare maternal and newborn pregnancy outcomes from adolescents and mature women.Design, Setting, and ParticipantsA cross-sectional study was carried out in a public hospital, including women with singleton pregnancies, who were classified according to their age, as follows: group 1: younger than 16 years old (n = 37), group 2: 16-19 years old (n = 288), and group 3: 20-34 years old (n = 632).Interventions and Main Outcome MeasuresInformation on clinical characteristics, gynecological and obstetric history, pregnancy complications, and perinatal outcomes was obtained through interviews and from clinical records.ResultsThirty-four percent of deliveries were from adolescents. Mature women were more likely to have prepregnancy overweight or obesity than adolescents (odds ratio [OR] = 2.4, 95% confidence interval [CI], 1.7-3.4). The frequency of maternal complications during pregnancy or delivery was not different between groups. Birth asphyxia was more frequent in group 2 (P = .02). Women with inadequate prenatal care had an increased risk of preterm deliveries (OR = 1.64; 95% CI, 1.06-2.54) and of having newborns with low birth weight (OR = 2.02; 95% CI, 1.22-3.35). Weight of newborns from noncomplicated pregnancies was lower in group 1 (P = .02), after adjustment for prepregnancy body mass index, gestational weight gain, preterm delivery, and newborn sex.ConclusionThe frequency of maternal and perinatal complications was similar in adolescents and mature women. Birth weight was decreased in noncomplicated pregnancies of adolescents younger than 16 years of age. Adequate prenatal care might be helpful in prevention of some adverse perinatal outcomes.     

Does pregnancy interval after laparoscopic sleeve gastrectomy affect maternal and perinatal outcomes?

Background: Obesity is a global health epidemic and is associated with many maternal and neonatal complications. Laparoscopic sleeve gastrectomy (LSG) is among the surgical treatments for obesity. The appropriate timing of pregnancy following LSG remains controversial and few studies have evaluated this public health issue.

Objective: To evaluate the effect of pregnancy timing after LSG on maternal and perinatal outcomes.

Study design: We performed a retrospective observational study of 23 pregnant women who underwent LSG at a tertiary hospital in Turkey. Women who became pregnant within 18 months of undergoing LSG were included in the early pregnancy after LSG group, and those who became pregnant after 18 months were included the late pregnancy after LSG group. Maternal and perinatal outcomes were evaluated, including gestational diabetes mellitus (GDM), pregnancy-associated hypertensive disorders, preterm birth, mode of delivery, small and large for gestational age births (small for gestational age (SGA), large for gestational age (LGA)), birth injury, and congenital malformations.

Results: Body mass index (BMI) at conception was higher in the early pregnancy after LSG group than in the late pregnancy after LSG group (30.48 versus 27.25, respectively; p?=?.03). Pregnancy interval after LSG did not impact maternal–fetal complications or mode of delivery. After a 75?g oral glucose tolerance test (OGTT) for GDM, 75% (n?=?6) of the early pregnancy group presented with early dumping syndrome, compared to only 13.3% (n?=?2) of the late pregnancy after LSG group (p?=?.009).

Conclusions: LSG may reduce obesity-related gestational complications, such as GDM and LGA. The interval between LSG and conception did not impact maternal or neonatal outcomes. Screening for GDM can result in dumping syndrome in pregnancies after LSG.     

Pregnancy outcome after multifetal pregnancy reduction of triplets to twins versus reduction to singletons

Research questionDoes fetal reduction of triplet pregnancies to singleton result in superior obstetric and neonatal outcomes compared with triplets reduced to twins?DesignA historical cohort study including 285 trichorionic and dichorionic triplet pregnancies that underwent abdominal fetal reduction at 11–14 weeks in a single tertiary referral centre. The study population comprised two groups: reduction to twins (n = 223) and singletons (n = 62). Main outcome measures were rates of pregnancy complications, preterm delivery and neonatal outcomes. Non-parametric statistical methods were employed.ResultsTriplet pregnancies reduced to twins delivered earlier (36 versus 39 weeks, P < 0.001) with higher prevalence of Caesarean section (71.1% versus 32.2%, P < 0.001) compared with triplets reduced to singletons. Preterm delivery rates were significantly higher in twins compared with singletons prior to 37 weeks (56.9% versus 13.6%, P < 0.001), 34 weeks (20.2% versus 3.4%, P = 0.002) and 32 weeks (9.6% versus 0%, P = 0.01). No significant difference was found in the rate of pregnancy loss before 24 weeks (1.3% in twins versus 4.8% in singletons, P = 0.12) or in the rate of intrauterine fetal death after 24 weeks (0.4% versus 0%, P = 1.0). Both groups had comparable obstetrical complications and neonatal outcomes, except for higher rates of neonatal intensive care unit admission in twins (31.9% versus 6.8%, P < 0.001).ConclusionsReduction of triplets to singletons rather than twins resulted in superior obstetric outcomes without increasing the procedure-related complications. However, because the rate of extreme prematurity in pregnancies reduced to twins was low, the overall outcome of those pregnancies was favourable. Therefore, the option of reduction to singletons should be considered in cases where the risk of prematurity seems exceptionally high.     

An Analysis of Pregnancy Outcome in Dichorionic and Monochorionic Twins Given Special Antenatal and Intranatal Care: A Four-Year Survey

Objective

The present study aims to analyze perinatal outcomes in twins given special care during pregnancy and labor and to compare fetal and neonatal outcomes in dichorionic twins with monochorionic twins.

Study Design

Eighty eight (88) twin pregnancies booked for care at a tertiary care Fetal Medicine centre were included in this study. The maternal demographic variables, course of pregnancy, fetal problems, and specialized fetal therapeutic and diagnostic interventions were noted. The above parameters were compared in the sub-groups of dichorionic and monochorionic twin pregnancies and related to the perinatal outcome. Statistical analysis was done using the student’s t test and the two-tailed chi sqaure tests with Yate’s continuity correction. A p value <0.05 was considered as significant.

Results

Mean maternal age was 30.34 + 4.81 years (range 19–48). 81 % of the twins were DCDA, and 19 % were MCDA. The mean gestational age at delivery was 34.4 ± 3.5 weeks, and this was not significantly different in MCDA and DCDA groups. Serious fetal problems warranting intervention at the time of initial referral were significantly higher in MCDA twins although overall perinatal outcome in both groups were not different.

Conclusion

Specialized care during pregnancy and labor including active fetal surveillance and therapeutic intervention when indicated improves the perinatal outcome in twin pregnancies and ensured at least one healthy live birth in over 90 % cases, although with an increase in late prematurity.     

The Association of Inadequate and Intensive Prenatal Care With Maternal,Fetal, and Infant Outcomes: A Population-Based Study in Manitoba,Canada

ObjectiveLittle is known about how prenatal care influences health outcomes in Canada. The objective of this study was to examine the association of prenatal care utilization with maternal, fetal, and infant outcomes in Manitoba.MethodsThis retrospective cohort study conducted at the Manitoba Centre for Health Policy investigated all deliveries of singleton births from 2004-2005 to 2008-2009 (N = 67 076). The proportion of women receiving inadequate, intermediate/adequate, and intensive prenatal care was calculated. Multivariable logistic regression was used to examine the association of inadequate and intensive prenatal care with maternal and fetal-infant health outcomes, health care use, and maternal health-related behaviours.ResultsThe distribution of prenatal care utilization was 11.6% inadequate, 84.4% intermediate/adequate, and 4.0% intensive. After adjusting for sociodemographic factors and maternal health conditions, inadequate prenatal care was associated with increased odds of stillbirth, preterm birth, low birth weight, small for gestational age (SGA), admission to the NICU, postpartum depressive/anxiety disorders, and short interpregnancy interval to next birth. Women with inadequate prenatal care had reduced odds of initiating breastfeeding or having their infant immunized. Intensive prenatal care was associated with reduced odds of stillbirth, preterm birth, and low birth weight and increased odds of postpartum depressive/anxiety disorders, initiation of breastfeeding, and infant immunization.ConclusionInadequate prenatal care was associated with increased odds of several adverse pregnancy outcomes and lower likelihood of health-related behaviours, whereas intensive prenatal care was associated with reduced odds of some adverse pregnancy outcomes and higher likelihood of health-related behaviours. Ensuring women receive adequate prenatal care may improve pregnancy outcomes.