Resultados perinatales de las gestaciones triples comparadas con las gestaciones gemelares

Objectives

To determine and compare the perinatal results of 104 multiple pregnancies (97 twin pregnancies and 97 triple pregnancies).

Patients and methods

The perinatal results of 97 triple pregnancies attended in our hospital between January 1989 and December 2004 were retrospectively studied. As a control group, 97 twin pregnancies attended during the same period were used. In all cases, the twin pregnancy closest to the delivery date of the triple pregnancy analyzed was chosen.

Results

Triple pregnancies tended to occur more frequently after assisted reproduction techniques than twin pregnancies. Gestational age (34 ± 2.9 versus 36 ± 3.5 weeks) and birth weight (1782 ± 523 versus 2215 ± 619 g) were significantly lower in triple pregnancies than in twin pregnancies. However, extreme prematurity (< 28 weeks) was similar in both groups. No differences were found in the rate of malformations, neonatal evaluation at birth or perinatal mortality. Among obstetric complications, the threat of preterm delivery was similar in both groups. Only the incidence of intrahepatic cholestasis was higher among triple pregnancies than among twin pregnancies (9 cases among triple pregnancies and none among twin pregnancies).

Conclusions

Morbidity and mortality amongneonates of multiple pregnancies depends mainly on prematurity and therefore on pregnancy duration. Consequently, pregnancy follow-up should aim to achieve the longest duration possible. All multiple pregnancies are high-risk. However, triple and twin pregnancies have a similar prognosis when adjusted by gestational age.     

Influencia de la edad y de las técnicas de reproducción asistida en nuestros resultados obstétricos y perinatales

Objective

To evaluate the influence of age ≥ 40 years and ART in our obstetric and perinatal outcomes.

Material and methods

Retrospective study of 14805 singleton pregnancies in our Institute from January 1, 2000 to December 31, 2006. We compared obstetric and perinatal outcome between: Age group: women ≥ 40 years (N = 557) vs. group of women < 40 years (N = 14248); ART group < 40 years: ART pregnancies (N = 1150) vs. spontaneous pregnancies (N = 13098); ART group ≥ 40 years: ART pregnancies (N = 126) vs. spontaneous pregnancies (N = 431).Results: Age ≥ 40 years is significantly associated with preterm birth under 34 weeks (odds ratio [OR] = 2.148 [1.237-3.730]), gestational diabetes (OR = 2.25 [1.799-2.815]), placenta previa (OR = 3.346 [1.516-7.386]), caesarean delivery (OR = 1.831 [1.539-2.177]), and peripartum hysterectomy (OR = 6.414 [1.359-2.177]). In the ART group < 40 years assisted conception (ART) is significantly associated with preterm birth under 37 (OR = 1.67 [1.337-2.088]) and 34 weeks (OR = 1.8 [1.162-2.822]), with gestational diabetes (OR = 1.5 [1.273-1.844]), pre-eclampsia (OR = 2.1 [1.456-3.164]), placenta previa (OR = 5.29 [2.973-9.437]), choriamniotic infection (OR = 3.8 [1.029-14.072]), caesarean delivery (OR = 1.5 [1.346-1.737]) and low birth weight ≤ 2500 g. (OR = 1.67 [1.329-2.114]) and ≤ 1500 g. (OR = 2.44 [1.442-4.135]). In the ART group ≥ 40 years we only find a significantly increased rate of caesarean delivery (OR = 1.76 [1.183-2.635]) in ART group vs. spontaneous pregnancy group.

Conclusions

Age ≥ 40 years increases the risk of adverse obstetric outcome. ART increase the risk of adverse obstetric and perinatal outcome in the group < 40 years, but not in the group of women aged 40 years and older, probably due to the small size of the sample.     

Análisis de la finalización de la gestación y morbilidad materna en las gestaciones de 41 semanas

Objective

To evaluate the mode of delivery and maternal morbidity associated with pregnancies ending at 41 weeks.

Material and methods

We designed a retrospective cohort study. The mode of delivery and maternal complications of 230 pregnancies ending at 41 weeks were compared with those in 234 pregnancies ending between 37 and 40 weeks at the Miguel Servet University Hospital in 2005.

Results

Women delivering at 41 weeks had an increased risk of membrane sweep, unfavorable Bishop score at admission, induction and longer duration of labor. These increases were also seen in the rates of operative vaginal delivery (25.6 vs 17.6%, p < 0.001) and cesarean section (21.7 vs 8.5%, p < 0.001).

Conclusions

The rates of maternal peripartum complications increase as pregnancy reaches 41 weeks. Accurate investigation of these rates is important to determine the gestational age at which the risk of continuing the pregnancy outweighs the risk of labor induction.     

La edad materna como factor de riesgo obstétrico. Resultados perinatales en gestantes de edad avanzada

Objective

To compare perinatal outcomes in women aged 35 years or over with those in a control group aged less than 35 years.

Design

Historical cohort study.

Setting

Valladolid (Spain).

Methods

Univariate analysis was performed with estimation of relative risks (RR). Variables related to epidemiology, pregnancy course and perinatal outcomes were analyzed.

Results

A total of 1,455 deliveries were analyzed, of which 355 involved women aged 35 years or over (24.39%). Older women more frequently showed pregnancy-associated disorders (29.2 vs 15.8%, p < 0.001): gestational diabetes (6.2%, p < 0.0029), first-trimester metrorrhagia (5.6%, p < 0.01), and risk of preterm birth (3.9%, P < 0.007); pregnancy-induced hypertension was also more frequent in this group but this difference was not statistically significant. Induction of labor was more frequently required in the older group (RR = 1.42; 95% CI:1.08-1.87). Cesarean section was required in 47% of older nulliparous women (RR = 1.63; 95% CI: 1.24-2.15). The overall perinatal mortality rate in older patients was 16.5‰, compared with 2.77‰ in the control group. Maternal morbidity was higher in the group of older patients (RR 5.98; 95% CI 1.35-26.54) and mainly consisted of hemorrhagic complications.

Conclusions

Advanced maternal age is associated with a higher frequency of pregnancy-related disorders and a greater incidence of medically-induced delivery and cesarean sections, especially in primiparous mothers. Age therefore influences maternal and fetal morbidity and mortality. Consequently, these women constitute an obstetric risk population requiring special attention which, given the number of older pregnant women, goes beyond the scope of health provisions in our environment.     

Relación entre los valores de hemoglobina materna anteparto y los resultados perinatales

Objective

To evaluate the association between maternal hemoglobin levels and perinatal outcomes.

Subjects and methods

Seven hundred twenty-eight pregnant women attended in the Hospital Universitario de Canarias, Tenerife (Spain) between January and April 2004 were studied. The women were divided into three groups: women with anemia (n = 61), women with normal hemoglobin levels (n = 587) and those with hemoconcentration (n = 80).An observational retrospective study was performed. Perinatal outcomes were compared among the groups studied and the possible correlations among hemoglobin levels and perinatal variables were analyzed.

Results

A significant quadratic relationship was found between maternal hemoglobin levels and both gestational age at delivery and birthweight. Multiple regression analysis showed that these variables were independent predictors of maternal hemoglobin concentration.

Conclusions

Gestational age at delivery and birthweight were lower in both the anemia and hemoconcentration groups. Maternal anemia is associated with a higher risk of having a small-forgestational- age neonate regardless of the risk of preterm delivery.     

Resultados perinatales en 492 presentaciones podálicas: cesárea vs. parto vaginal

Objective

To analyze the perinatal results in our hospital comparing vaginal delivery and cesarean section in breech presentation singleton pregnancies at term.

Material and Methods

All live ante-partum singleton fetuses in breech presentation, at 37 to 41+6 weeks and days who delivered between July 2006 and August 2010 were included in the study. We compared perinatal results between cesarean section and vaginal delivery.

Results

There were no differences in Apgar score at 5 minutes < 7, pH umbilical cord < 7, base deficits and lactate, neonatal intensive care unit admission or perinatal mortality.

Conclusions

With appropriate maternal and fetal conditions and a qualified medical team, a breech vaginal delivery could be propose obtaining good perinatal outcomes.     

Implementación de la terapia láser endoscópica para las complicaciones de gestaciones gemelares monocoriales

Objective

To evaluate the outcomes of monochorionic diamniotic (MCDA) twin pregnancies with severe twin-to-twin transfusion syndrome (TTTS) or selective fetal growth restriction (FGR) treated by endoscopic laser separation of placental vessels in our unit.

Material and methods

Fetoscopic laser therapy was performed in 22 MCDA pregnancies, including 17 for severe TTTS, and five for selective FGR. Presurgical severity, obstetric complications, and fetal survival were analyzed.

Results

In 15 of the 17 (88%) cases of severe TTTS, at least one twin survived. In the five cases of selective FGR, the fetus with normal growth survived in three cases, including one in which the growth restricted fetus also survived.

Conclusions

The results demonstrate the successful implementation of endoscopic laser surgery in a fetal medicine center in Spain after appropriate training of the operator.     

Pronóstico perinatal y materno de las gestaciones gemelares concebidas mediante fecundación in vitro,en relación con las obtenidas espontáneamente

Objective

To determine the outcomes of twin pregnancies resulting from in vitro fertilization (IVF) compared with those resulting from spontaneous conception.

Material and methods

We performed a historical cohort study comparing neonatal outcomes of twin pregnancies resulting from IVF (n = 44) with those resulting from spontaneous conception (n = 109) in the Complejo Hospitalario Universitario de Albacete (Spain) in 2001, 2001 and 2003. The primary variable was perinatal mortality. Secondary variables were fetal morbidity (neonatal abnormalities, Apgar < 7, acidotic arterial pH, admission to the neonatal unit), preterm delivery, maternal complications, and type of delivery.

Results

No differences in perinatal mortality and morbidity were found between spontaneous twin pregnancies and twins resulting from assisted reproductive techniques. The rate of preterm labor was significantly higher in spontaneous twin pregnancies (75.2 versus 52%; p = 0.006). The incidence of gestational diabetes was significantly higher in twin pregnancies resulting from IVF than in spontaneous twin pregnancies (25.5 versus 9.7%;p = 0.01).

Conclusions

Perinatal and maternal outcomes in twin pregnancies resulting from IVF are similar to those of spontaneous twin pregnancies.     

Pronóstico perinatal y materno de la gestación múltiple en función del protocolo intraparto

Objectives

To evaluate maternal and fetal outcomes of multiple pregnancy according to route of delivery.

Material and methods

We performed a retrospective study of all twin deliveries in the previous 5 years and evaluated the route of delivery, especially in the final year. The information was recorded with Microsoft EXCEL and was analyzed with the statistical program SPSS 12.0 for Windows.

Results

The mean gestational age was 35.3 weeks. Route of delivery was through cesarean section in 59.8%. The mean interval between twins was 7.82 minutes when the first twin was delivered vaginally. Neonatal morbidity was found in 49%, and was higher in the second twin and in preterm deliveries.

Conclusions

Multiple pregnancies are associated with a large number of maternal and perinatal complications, as well as with a greater number of cesarean sections. Consequently, correct intrapartum management is required to reduce neonatal morbility as far as possible.     

Resultados obstétricos y perinatales de la implementación de un programa de versión externa cefálica

Objectives

To evaluate the effectiveness of the external cephalic version, the time required for its completion, the safety of the technique, its effectiveness in reducing the rate of caesarean sections and the perinatal outcomes.

Methods

The study included 180 pregnant women with pelvic presentation at term. Routine cardiotocographic monitoring and an ultrasound were used pre-and post-release version for foetal welfare and presentation.

Results

Success was achieved in 30% of the external cephalic version (ECV) cases during the first year, while 61.90% was successfully achieved during the fourth year. Vaginal births accounted for 61 out of the 93 successful versions, the spontaneous reversal rate was 5.37% and the spontaneous version rate following failed external version, was 3.44%. In 45 cases (25%) some kind of minor adverse effect was found and in 18 cases it was due to the use of uterine relaxants.

Conclusions

The ECV is safe and useful for reducing caesarean rates. The experience of the obstetrician who performed the technique plays a key role in ensuring success.     

Análisis de la relación entre riesgo gestacional y ansiedad materna

Objective

To evaluate levels of maternal anxiety in third trimester pregnancies according to pregnancy risk, classified as low, medium and high-risk/very high-risk.

Patients and methods

We performed an observational, analytical and cross-sectional study of anxiety levels in 174 pregnant women followed-up in our hospital. Levels of both state anxiety and trait anxiety were evaluated in the three groups of pregnant women.

Results

Of the 174 participants in the study, 98 (56.3%) had low risk pregnancies, 40 showed medium risk (23%) and 36 (20.7%) had high risk or very high risk pregnancies. We obtained a mean of 32.8 points for state anxiety and of 27.3 points for trait anxiety. Mean anxiety levels scores were 44.1 points in the high/very high risk group, 33 points in the medium risk group, and 28.5 points in the low risk group, with statistically significant differences (P = .0001 for the high risk group and P = .038 for the medium risk pregnancies). A significant correlation was found between trait anxiety and state anxiety (P = .0001). Statistically significant differences were observed in anxiety related to the number of children (P = .0001).

Conclusions

In pregnant women, anxiety levels were higher than average levels in the general population. Anxiety levels increased in accordance with greater risk in the pregnancy. The greater the number of children the mother already had the lower her anxiety level.     

Entrecruzamiento de cordones en la gestación gemelar monocorial monoamniótica

Monochorial monoamniotic twins are at high risk of fetal death due to the general complications seen in multiple gestations, as well as those specific to this type of pregnancy. The most severe complication in these pregnancies is fetal death due to cord entanglement, which occurs in almost all cases.Early ultrasonographic diagnosis and intensive prenatal surveillance are essential for the early detection of cord entanglement and the prevention of fetal death.The need for in-hospital management and the exact gestational age for delivery continue to generate controversy in the literature.     

Exposición prenatal a ftalatos. Anemia materna,duración de la gestación y somatometría del recién nacido

Phthalic acid esters, commonly known as phthalates, are ubiquitous pollutants in foods, air, ground, sediments, beauty products and construction materials to which pregnant women are exposed.     

Amnioinfusión en rotura prematura de membranas en gestaciones pretérmino

Objective

To study the possibility of prenatal amnioinfusion as a therapeutic measure in premature rupture of membranes in preterm pregnancies.

Material and methods

We performed serialized transabdominal amnioinfusions in two patients with premature rupture of membranes in preterm pregnancy. Ringer's solution was instilled by abdominal puncture.

Results

We performed serialized transabdominal amnioinfusions until the 23rd week of pregnancy, after which time both patients showed normal amniotic fluid.

Conclusions

Transabdominal amnioinfusion is a valid therapeutic option in premature rupture of membranes in preterm pregnancy.     

Clasificación de cesáreas por Grupos de Robson en dos periodos comparativos en el Hospital de Manacor

Objective

To identify groups of women with changes in cesarean rates in two different periods.

Subjects and methods

Deliveries in the Manacor Hospital in 2000-2001 and 2005-2006, were analyzed through a retrospective review of clinical records and were grouped using Robsońs classification.

Results

The cesarean rate increased from 14 to 18.6% with a statistically significant increase among women with a single cephalic pregnancy at term who underwent labor induction or elective cesarean section. These two groups were the major contributors to the cesarean rate at our hospital.

Conclusion

A trend towards an increase in the rates of cesarean section was found during the study period. Robson's Classification allowed us to identify the groups of women contributing to this increase.     

Actitud ante el diagnóstico prenatal de las complicaciones del cordón umbilical en gemelos monoamnióticos

Monoamniotic twin pregnancies are rare (1/10,000 pregnancies), but are associated with a high perinatal mortality rate (30-70%). Fetal death usually results from cord entanglement and/or knots, which are the most representative and hazardous complications. Currently, early and accurate ultrasound diagnosis of this type of twinning can be performed. Furthermore, several ultrasound signs have recently been reported that aid recognition of umbilical cord abnormalities and identification of blood flow compromise. Intensive monitoring with nonstress tests and ultrasonographic follow-up combined with improved neonatal care can decrease the mortality rate in monoamniotic pregnancies by 10%. However, the management of these pregnancies remains controversial. We report a case of knotting of the cords, prenatally detected at 31 weeks. The ultrasonographic findings allowed the obstetric management to be reconsidered, with excellent neonatal outcomes.     

Crecimiento paradójico y complicaciones de la embolización arterial de miomas uterinos. Presentación de 2 casos

Uterine myoma is the most common nonmalignant pelvic tumor in women, occurring in 30%. Menorrhagia, pelvic pain, hypogastric distress, infertility and rapid growth are indications for hysterectomy. Uterine artery embolization has been proposed as a therapeutic alternative for menorrhagia caused by uterine myoma.     

Epidemiología del aborto de repetición

Objective

To determine the possible causes of recurrent miscarriage in our environment and the pregnancy rate in these couples.

Material and methods

An observational retrospective study was carried out in 172 women who attended our unit for two or more recurrent miscarriages between 2002 and 2008.

Results

A total of 80.2% of the women became pregnant. Of these, 81.2% carried the fetus to term. The results of clinical study were normal in 70.9%. The alterations found were uterine in 48%, genetic in 2% and coagulation alterations in 44%. These alterations were associated in 6% of the patients.

Conclusions

Most of the couples consulting for recurrent miscarriage will not receive an etiologic diagnosis after clinical study. Reproductive prognosis worsens as the number of miscarriages increases. However, up to 80.2% of these women become pregnant again, of whom 81.1% will deliver a healthy neonate.     

Cribado de aneuploidía en gestación gemelar: resultados de la aplicación del test combinado

Objective

To evaluate the effectiveness of the Combined Test for trisomy 21 screening in twin pregnancies. To assess the performance of biochemical markers and nuchal translucency (NT) measurement in pregnancies with euploid fetuses and in twin pregnancies with one or two affected fetuses. To compare the value of markers according to chorionicity and the mode of conception.

Material and methods

Retrospective study including 161 twin pregnancies. Maternal serum fß-hCG and PAPP-A were determined at 8 to 12 weeks and fetal NT was measured at 11 to 14 weeks. The individual risk of trisomy 21 was calculated in each fetus using the Combined Test. In monochorionic pregnancies, the single risk for the pregnancy was obtained with the largest NT. An invasive diagnostic procedure was offered when the risk was 1:250 or more in one or both of the fetuses.

Results

All trisomy 21 pregnancies were identified (three pregnancies and four fetuses) by the combined testfor a false-positive rate of 6.4% of pregnancies and 3.5% of fetuses. The median fß-hCG level, expressed in MoM, was 1.72 and the median PAPP-A level was 2.01. The median NT was 1.05 MoM. Both fß-hCG and PAPP-A levels were significantly decreased in monochorionic pregnancies and PAPP-A was significantly decreased in pregnancies resulting from assisted reproduction. No significant differences were observed in NT measurement between monochorionic and dichorionic fetuses or between those conceived naturally or by assisted reproduction.

Conclusions

The combined test shows high sensitivity and specificity in screening for trisomy 21 in twin pregnancies. The differences obtained in the biochemical markers according to chorionicity or the mode of conception require confirmation in further studies with a larger number or cases.     

Influencia de la gestación de bajo riesgo en la calidad de vida relacionada con la salud percibida por las gestantes

Objectives

The aims of the present study were four-fold: to assess health-related quality of life (QoL) perceived by women with low-risk pregnancies in comparison with reference population values for women in the same age group; to determine whether low risk pregnancy by itself can modify perceived QoL; to determine the association between the physiological changes of pregnancy and perceived loss of QoL; to obtain reference values for QoL from the questionnaire Medical Outcomes Study (MOS) 36-Item Short Form (SF-36) for expectant mothers in their first or third trimester, given that to date we have found no Spanish publications on the topic.

Material and methods

We performed a cross-sectional survey of prevalence, with comparison of two independent groups. Measuring instrument: SF-36.

Conclusions

The expectant mothers showed a statistically significant loss in physical dimensions in comparison with the reference population values for women in the same age group; this loss was more significant as the pregnancy progressed, that is, the chronological progression of a normal pregnancy is, by itself, able to alter the quality of life perceived by the pregnant women, especially in the physical domain. No changes in the dimensions related to social or emotional functions were observed.The typical symptoms of pregnancy such as nausea and vomiting are able to alter physical and emotional functions.