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American Journal of Obstetrics and... Sep 2022This systematic review and meta-analysis aimed to compare the fetal survival rate and perinatal outcomes of triplet pregnancies after selective reduction to twin... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis aimed to compare the fetal survival rate and perinatal outcomes of triplet pregnancies after selective reduction to twin pregnancies vs singleton pregnancies.
DATA SOURCES
PubMed, Web of Science, Scopus, and Embase were systematically searched from the inception of the databases to January 16, 2022.
STUDY ELIGIBILITY CRITERIA
Studies comparing the survival and perinatal outcomes between reduction to twin pregnancies and reduction to singleton pregnancies were included. The primary outcomes were fetal survival, defined as a live birth at >24 weeks of gestation. The secondary outcomes were gestational age at birth, preterm birth at <32 and <34 weeks of gestation, early pregnancy loss (<24 weeks of gestation), low birthweight, and rate of neonatal demise (up to 28 days after birth).
METHODS
The random-effect model was used to pool the mean differences or odds ratios and the corresponding 95% confidence intervals. To provide a range of expected effects if a new study was conducted, 95% prediction intervals were calculated for outcomes presented in >3 studies.
RESULTS
Of note, 10 studies with 2543 triplet pregnancies undergoing fetal reduction, of which 2035 reduced to twin pregnancies and 508 reduced to singleton pregnancies, met the inclusion criteria. Reduction to twin pregnancies had a lower rate of fetal survival (odds ratio, 0.61; 95% confidence interval, 0.40-0.92; P=.02; 95% prediction interval, 0.36-1.03) and comparable rates of early pregnancy loss (odds ratio, 0.89; 95% confidence interval, 0.58-1.38; P=.61; 95% prediction interval, 0.54-1.48) and neonatal demise (odds ratio, 0.57; 95% confidence interval, 0.09-3.50; P=.55) than reduction to singleton pregnancies. Reduction to twin pregnancies had a significantly lower gestation age at birth (weeks) (mean difference, -2.20; 95% confidence interval, -2.80 to -1.61; P<.001; 95% prediction interval, -4.27 to -0.14) than reduction to singleton pregnancies. Furthermore, reduction to twin pregnancies was associated with lower birthweight and greater risk of preterm birth at <32 and <34 weeks of gestation.
CONCLUSION
Triplet pregnancies reduced to twin pregnancies had a lower fetal survival rate of all remaining fetuses, lower gestational age at birth, higher risk of preterm birth, and lower birthweight than triplet pregnancies reduced to singleton pregnancies; reduction to twin pregnancies vs reduction to singleton pregnancies showed no substantial difference for the rates of early pregnancy loss and neonatal death.
Topics: Abortion, Spontaneous; Birth Weight; Female; Gestational Age; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal; Pregnancy, Triplet; Pregnancy, Twin; Premature Birth; Retrospective Studies
PubMed: 35351408
DOI: 10.1016/j.ajog.2022.03.050 -
International Journal of Nursing... Oct 2015Adolescent pregnancy is an international dilemma affecting not just the adolescent and her infant, but entire societies. Of almost 300 million female adolescents...
Adolescent pregnancy is an international dilemma affecting not just the adolescent and her infant, but entire societies. Of almost 300 million female adolescents worldwide, 16 million give birth yearly, accounting for 11% of all births worldwide. The Millennium Development Goal # 5 incorporates reducing adolescent births worldwide. The purpose of this paper is a comprehensive critique of findings on a global perspective on adolescent pregnancy and evaluation of strategies to reduce this international concern. In Latin America and the Caribbean, unmet need for family planning made little change in 20 years. In Dutch and Scandinavian countries, there are national sex education programmes and family planning clinics run by nurse midwives with direct authority to prescribe contraceptives. In Japan, strong conservative norms exist about premarital sex. In the UK, a lack of consistent targeted sex education, delay in access to contraception and contraceptive use failure are associated with high teen pregnancy rates. In the United States, 750,000 teen pregnancies occur yearly, costing $9 billion per year. Health disparities exist: Whites had 11, Blacks had 32 and Hispanics had 41 per 1000 births. Programmes to reduce teen pregnancy should incorporate family, contraception and abstinence education, and sustained commitment of media, businesses, religious and civic organizations.
Topics: Adolescent; Female; Humans; Internationality; Pregnancy; Pregnancy in Adolescence
PubMed: 24674421
DOI: 10.1111/ijn.12278 -
Annual International Conference of the... Jul 2023Fetal phonocardiogram (fPCG), or the electronic recording of fetal heart sounds, is a safe and easily available signal that can be used to monitor fetal wellbeing. In...
Fetal phonocardiogram (fPCG), or the electronic recording of fetal heart sounds, is a safe and easily available signal that can be used to monitor fetal wellbeing. In the proposed work an attempt is made to identify twin pregnancies using fPCG data recorded from the fetus with 1/3 power in octave band filtered output as features to train K-Nearest Neighbor (KNN) and support vector machine (SVM) classifiers. The SVM classifier with the quadratic kernel is able to identify singletons and twins with a positive predictive value of 100% and 79.1% respectively. The KNN classifier with k=10 neighbors is able to identify singletons and twins with a positive predictive value of 100% and 81.8% respectively.Clinical Relevance: Identifying twin pregnancies from singleton is an essential clinical protocol followed during late pregnancy as there may be complications like twin-twin transfusion syndrome, selective fetal growth restriction, and preterm labor in twin pregnancy [1], [2]. Ultrasound imaging is the most commonly used technique for twin pregnancy detection, though it is often not affordable or available in rural or low-income populations. Utilization of fPCG in such circumstances has immense clinical potential.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Pregnancy, Twin; Twins; Fetus; Obstetric Labor, Premature; Fetofetal Transfusion
PubMed: 38083638
DOI: 10.1109/EMBC40787.2023.10340342 -
BJOG : An International Journal of... Feb 2016The introduction of fetoscopic laser surgery of placental anastomoses has led to a significant improvement of perinatal outcome of twin pregnancies affected by... (Review)
Review
OBJECTIVES
The introduction of fetoscopic laser surgery of placental anastomoses has led to a significant improvement of perinatal outcome of twin pregnancies affected by twin-to-twin-transfusion syndrome (TTTS). To quantify the perinatal outcome and neurological morbidity in triplet pregnancies complicated by TTTS, which were treated with fetoscopic laser surgery.
SEARCH STRATEGY
Medline, Embase, Cinahl and Cochrane were searched.
SELECTION CRITERIA
The outcomes observed were: fetal and perinatal survival, preterm birth and abnormal neurological outcome.
DATA COLLECTION AND ANALYSIS
Two authors reviewed all abstracts independently. Meta-analyses of proportions were used to combine data.
MAIN RESULTS
Eight studies (126 triplet pregnancies, 104 dichorionic-triamniotic [DCTA] and 22 monochorionic-triamniotic [MCTA]) treated with fetoscopic laser surgery were included in this review. In DCTA and MCTA pregnancies, fetal losses were 18.9% and 28.9%, respectively; perinatal losses were 23.6% and 75.0%; preterm births <28 weeks of gestation were 16.9% and 37.1%; preterm births <32 weeks of gestation were 50.0% and 69.5%; at least one fetus survived in 95.4% and 88.9% of the pregnancies; at least two fetuses survived in 81.8% and 68.3% of the pregnancies; and in 55.9% and 48.4% pregnancies all triplets survived. Finally, the incidence of abnormal neurological outcomes ranged from 0 to 37% in DCTA and from 0 to 50% in MCTA triplets.
CONCLUSIONS
Both DTCA and MCTA triplet pregnancies affected by TTTS are at high risk of adverse perinatal outcome.
TWEETABLE ABSTRACT
Both DTCA and MCTA triplet pregnancies affected by TTTS are at high risk of adverse perinatal outcome.
Topics: Female; Fetofetal Transfusion; Fetoscopy; Humans; Infant, Newborn; Laser Therapy; Pregnancy; Pregnancy Outcome; Pregnancy, Triplet
PubMed: 26265264
DOI: 10.1111/1471-0528.13553 -
PloS One 2018It is unclear whether unintended pregnancies are associated with adverse outcomes. Data are predominantly from high-income countries and have methodological limitations,...
BACKGROUND
It is unclear whether unintended pregnancies are associated with adverse outcomes. Data are predominantly from high-income countries and have methodological limitations, calling the findings into question. This research was designed to overcome these limitations and assess the relationships between pregnancy intention and miscarriage, stillbirth, low birthweight, neonatal death and postnatal depression in a low-income country.
METHODS
The pregnancy intention of 4,244 pregnant women in Mchinji District, Malawi, was measured using the validated Chichewa version of the London Measure of Unplanned Pregnancy (LMUP). Women were re-interviewed postnatally to assess pregnancy outcome. Postnatal depression was assessed using the WHO's Self-Reporting Questionnaire. Multivariable regressions were conducted, with the choice of confounders informed by a pre-existing conceptual epidemiological hierarchy.
RESULTS
Planned pregnancies are associated with a reduced risk of any (adjusted RR 0.90 [95%CI 0.86, 0.95]) or high symptoms of depression (adjusted RR 0.76 [95%CI 0.63, 0.91]) compared to unplanned pregnancies in rural Malawi. There was no relationship between pregnancy intention and the composite measure of miscarriage, stillbirth, low birthweight and neonatal death. There was some evidence that greater pregnancy intention was associated with reduced adjusted risk of stillbirth (0·93 [95%CI 0·87, 1·00]).
CONCLUSION
Our study is the first to use a psychometrically valid measure of pregnancy intention, and to do so antenatally. As pregnancy intention increases, the risk of postnatal depression and, possibly, stillbirth decreases. This suggests a new, clinical use for the LMUP; identifying women antenatally who are at risk of these adverse pregnancy outcomes.
Topics: Abortion, Spontaneous; Adolescent; Cohort Studies; Depression, Postpartum; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Malawi; Male; Perinatal Death; Poverty; Pregnancy; Pregnancy Outcome; Pregnancy, Unplanned; Self Report; Stillbirth
PubMed: 30335769
DOI: 10.1371/journal.pone.0205487 -
Reproductive Biomedicine Online Jul 2017The current systematic review and meta-analysis evaluates the perinatal outcomes in twin pregnancies following multifetal pregnancy reduction (MPR) compared with... (Meta-Analysis)
Meta-Analysis Review
The current systematic review and meta-analysis evaluates the perinatal outcomes in twin pregnancies following multifetal pregnancy reduction (MPR) compared with non-reduced twins. We considered all studies comparing perinatal outcomes of twin pregnancies following MPR to non-reduced twin pregnancies. Our search yielded 639 publications, of which 91 were assessed for eligibility. A total of 22 studies met our inclusion criteria. Overall, fetal reduction of triplets to twins resulted in comparable perinatal outcomes to non-reduced twins with regards to gestational age and birthweight at delivery, pregnancy loss prior to 24 weeks, as well as the development of gestational diabetes and hypertensive disorders of pregnancy. Of all outcomes, only the Caesarean section rate was significantly higher in the MPR group compared with the non-reduced twins group with an odds ratio of 1.95 (95% confidence interval 1.33-2.87). This meta-analysis suggests that MPR of triplet pregnancies to twins is associated with comparable perinatal outcomes to that of non-reduced twins. This information can further help in guiding, and probably reassuring, clinician and patient decision-making when faced with high-order multifetal pregnancies.
Topics: Decision Making; Female; Humans; Pregnancy; Pregnancy Reduction, Multifetal; Pregnancy, Triplet; Pregnancy, Twin
PubMed: 28434652
DOI: 10.1016/j.rbmo.2017.04.001 -
Women's Health Issues : Official... 2017Each year, nearly one-half of all pregnancies in the United States are unintended. Risk factors of unintended pregnancy have been studied without attention to whether... (Review)
Review
BACKGROUND
Each year, nearly one-half of all pregnancies in the United States are unintended. Risk factors of unintended pregnancy have been studied without attention to whether the pregnancy was the woman's first unintended pregnancy or whether she had had more than one. Little is known about the prevalence, incidence, and risk factors for multiple unintended pregnancies. The purpose of this paper is to present a systematic review of the extant literature on the risk factors for multiple unintended pregnancies in women in the United States, and whether these factors are specific to multiple unintended pregnancies.
METHODS
PubMed, PsychInfo, CINAHL, Web of Science, and JSTOR databases were searched for empirical research studies performed after 1979, in the United States, with a primary outcome of multiple unintended pregnancies. Articles that did not establish the intendedness of the studied pregnancies were excluded.
RESULTS
Seven studies were identified. For multiple unintended pregnancies, incidence rates ranged from 7.4 to 30.9 per 100 person-years and prevalence rates ranged from 17% to 31.6%. Greater age; identifying as Black or Hispanic; nonvoluntary first intercourse, particularly at a young age; sex trade involvement; and previous abortion were found to be associated with multiple unintended pregnancies. Use of intrauterine devices or combined oral contraceptives were found to decrease the risk of multiple unintended pregnancies.
CONCLUSIONS
This review suggests a small number of modifiable factors that may be used to better predict and manage multiple unintended pregnancies.
Topics: Abortion, Induced; Adolescent; Adult; Coitus; Female; Humans; Income; Intrauterine Devices; Marital Status; Poverty; Pregnancy; Pregnancy, Unplanned; Rape; Risk Factors; United States; Young Adult
PubMed: 28284587
DOI: 10.1016/j.whi.2017.02.002 -
Birth (Berkeley, Calif.) Jun 2021In a previous study, we showed that the obstetric complication rate after in vitro fertilization (IVF) pregnancy was 40%. The main objective of our study was to... (Observational Study)
Observational Study
BACKGROUND
In a previous study, we showed that the obstetric complication rate after in vitro fertilization (IVF) pregnancy was 40%. The main objective of our study was to determine maternal prognosis factors that influence the IVF pregnancy outcome.
METHODS
We conducted an observational retrospective monocentric study between January 2014 and January 2018. Pregnancy over 22 gestational weeks (GW) obtained after IVF in our infertility clinic was included. Maternal characteristics and pregnancy outcome were collected.
RESULTS
Data from 498 IVF pregnancies were analyzed. The most significant maternal prognosis factors for obstetric complications were maternal age above 40 years (OR 3,0 [95% IC 1,30-7,09], P = 0,010), twin pregnancies (3.8 [95% IC 1.49-9.99], P = .005), daily maternal smoking above 10 cigarettes (7.1 [95% IC 1.22-41.74], P = .029), maternal obesity (2.2 [95% IC 1.19-4.07], P = .012), endometriosis stages III and IV (6.4 [95% IC 1.52-27.04], P = .011), and history of ovarian hyperstimulation syndrome (OHSS) in early pregnancy (5.7 [95% IC 1.29-24.74], P = .021). Risk increase was independent of pregnancy type (singleton or twin) and allowed the elaboration of 2 nomograms.
CONCLUSIONS
Our study showed a link between some maternal factors and increase in obstetric complications after IVF. Screening of these factors during preconceptional visit is essential to identify at high-risk pregnancies and adapt their monitoring.
Topics: Adult; Female; Fertilization in Vitro; Humans; Nomograms; Pregnancy; Pregnancy Outcome; Pregnancy, Twin; Retrospective Studies
PubMed: 33529415
DOI: 10.1111/birt.12528 -
Evaluation of a New Model for Human Chorionic Gonadotropin Rise in Pregnancies of Unknown Viability.Obstetrics and Gynecology Jul 2023To evaluate the performance of a new human chorionic gonadotropin (hCG) threshold model to classify pregnancies as viable or nonviable using a longitudinal cohort of...
OBJECTIVE
To evaluate the performance of a new human chorionic gonadotropin (hCG) threshold model to classify pregnancies as viable or nonviable using a longitudinal cohort of individuals with pregnancy of unknown viability. The secondary objective was to compare the new model with three established models.
METHODS
This is a single-center, retrospective cohort study of individuals seen at the University of Missouri from January 1, 2015, until March 1, 2020, who had at least two consecutive quantitative hCG serum levels with an initial level greater than 2 milli-international units/mL and 5,000 milli-international units/mL or less, with the first interval between laboratory draws no greater than 7 days. Prevalence of correct classification of viable intrauterine pregnancies, ectopic pregnancies, and early pregnancy losses was evaluated with a new proposed hCG threshold model and compared with three established models describing minimum expected rates of hCG rise for a viable intrauterine pregnancy.
RESULTS
Of an initial cohort of 1,295 individuals, 688 patients met inclusion criteria. One hundred sixty-seven individuals (24.3%) had a viable intrauterine pregnancy; 463 (67.3%) had an early pregnancy loss; and 58 (8.4%) had an ectopic pregnancy. A new model based on the total additive percent rise of hCG at 4 and 6 days after initial hCG (70% or greater and 200% or greater rise, respectively) was created. The new model was able to correctly identify 100% of viable intrauterine pregnancies while minimizing incorrect classification of early pregnancy losses and ectopic pregnancies as normal pregnancies. At 4 days after initial hCG, 14 ectopic pregnancies (24.1%) and 44 early pregnancy losses (9.5%) were incorrectly classified as potentially normal pregnancies. At 6 days after initial hCG, only seven ectopic pregnancies (12.1%) and 25 early pregnancy losses (5.6%) were incorrectly classified as potentially normal pregnancies. In established models, up to nine intrauterine pregnancies (5.4%) were misclassified as abnormal pregnancies and up to 26 ectopic pregnancies (44.8%) and 58 early pregnancy losses (12.5%) were incorrectly classified as potentially normal pregnancies.
CONCLUSION
The proposed new hCG threshold model optimizes a balance between identifying potentially viable intrauterine pregnancies and minimizing misdiagnosis of ectopic pregnancies and early pregnancy losses. External validation in other cohorts is needed before widespread clinical use.
Topics: Pregnancy; Female; Humans; Abortion, Spontaneous; Retrospective Studies; Pregnancy, Ectopic; Chorionic Gonadotropin; Pregnancy Complications
PubMed: 37290108
DOI: 10.1097/AOG.0000000000005235 -
Journal of Applied Physiology... Apr 2021In conjunction with significant cardiovascular adaptation, changes in cardioautonomic balance, specifically greater sympathetic activation and vagal withdrawal, are...
In conjunction with significant cardiovascular adaptation, changes in cardioautonomic balance, specifically greater sympathetic activation and vagal withdrawal, are considered normal adaptations to healthy singleton pregnancy. Cardiovascular adaptation to twin pregnancy is more profound than that of singleton pregnancies; however, the changes in cardioautonomic control during multifetal gestation are unknown. To address this gap, beat-by-beat blood pressure (photoplethysmography) and heart rate (lead II electrocardiogram) were measured continuously in 25 twin pregnancies and 25 singleton pregnancies (matched for age, prepregnancy body mass index, and gestational age) during 10 min of rest. Data extracted from a 3- to 5-min period were used to analyze heart rate variability (HRV), blood pressure variability (BPV), cardiovagal baroreflex gain, and cardiac intervals as indicators of cardioautonomic control. Independent tests were used to determine statistical differences between groups (α = 0.05), and the false rate discovery was determined to adjust for multiple comparisons. Resting heart rate was greater in twin compared with singleton pregnancies (91 ± 10 vs. 81 ± 10 beats/min; = 0.001), but blood pressure was not different. Individuals with twin pregnancies had lower HRV, evidenced by lower standard deviation of R-R intervals (32 ± 11 vs. 47 ± 18 ms; = 0.001), total power (1,035 ± 810 vs. 1,945 ± 1,570 ms; = 0.004), and high frequency power (224 ± 262 vs. 810 ± 806 ms; < 0.001) compared with singleton pregnancies. There were no differences in cardiac intervals, BPV, and cardiovagal baroreflex gain between groups. Our findings suggest that individuals with twin pregnancies have greater sympathetic and lower parasympathetic contributions to heart rate and that cardiac, but not vascular, autonomic control is impacted during twin compared with singleton pregnancy. Individuals with healthy twin pregnancies had lower overall heart rate variability compared with those with singleton pregnancies at similar gestational ages. These results suggest a greater sympathetic and reduced parasympathetic contribution to cardiac control in twin pregnancies. Baseline heart rate was elevated, while arterial pressure and spontaneous cardiovagal baroreflex gain were not different between groups. This was result of the upward resetting of the cardiovagal baroreflex during healthy twin pregnancy, thus maintaining arterial pressure.
Topics: Autonomic Nervous System; Baroreflex; Blood Pressure; Female; Heart Rate; Humans; Pregnancy; Pregnancy, Twin
PubMed: 33356983
DOI: 10.1152/japplphysiol.00707.2020