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Clinical Obstetrics and Gynecology Sep 2015
Topics: Female; Humans; Pregnancy; Pregnancy, High-Risk; Pregnancy, Multiple; Reproductive Techniques, Assisted
PubMed: 26230173
DOI: 10.1097/GRF.0000000000000139 -
BioMed Research International 2022To report the pregnancy and neonatal outcomes in patients with twin pregnancies who underwent ultrasound-indicated cerclage (UIC) and to compare them to patients with...
BACKGROUND
To report the pregnancy and neonatal outcomes in patients with twin pregnancies who underwent ultrasound-indicated cerclage (UIC) and to compare them to patients with singleton pregnancies undergoing the same procedures.
METHODS
Patients who underwent UIC between January 2010 and December 2020 at Kangnam Sacred Heart Hospital were reviewed. We compared characteristics, pregnancy, and neonatal outcomes between patients with singleton and twin pregnancies.
RESULTS
A total of 94 women (56 singleton and 38 twin pregnancies) underwent UIC were included. The mean gestational age (GA) at cerclage and preoperative cervical length (CL) were not significantly different. Twin pregnancies were more likely to deliver at earlier median gestations than singletons (singleton, 36 + 1 weeks vs twin, 32 + 6 weeks, and = 0.004). The frequency of preterm delivery <34 weeks in twin group was higher than in singleton group (15 (26.8%) vs 20 (52.6%) and =0.016). However, the frequency of preterm delivery <32, <28, and <24 weeks was not significantly different between two groups. Although neonatal weights in singleton pregnancies were heavier than twin pregnancies, neonatal mortality and morbidities were not significantly different between two groups. Among various factors contributing to preterm birth, preoperative CL ≤ 15 mm was independently associated with a higher risk of preterm delivery before 34 weeks. Furthermore, pregnancy and neonatal outcomes of twin pregnancies with cervical length ≤ 15 mm are comparable with those of singleton pregnancies (GA at delivery, singleton, 35 + 1 weeks vs twin, 32 + 5 weeks, and = 0.24; neonatal mortality, singleton, 3.4% vs twin, 4.8%, and = 0.64).
CONCLUSION
The pregnancy and neonatal outcomes of UIC in twin pregnancies were comparable to those in singleton pregnancies, especially when CL is ≤15 mm. UIC might be considered a safe procedure for twin pregnancies.
Topics: Pregnancy; Humans; Infant, Newborn; Female; Cerclage, Cervical; Premature Birth; Cohort Studies; Pregnancy Outcome; Retrospective Studies
PubMed: 36506914
DOI: 10.1155/2022/9450141 -
The Journal of Maternal-fetal &... Dec 2023To review the usefulness of the sFlt-1/PlGF ratio to detect adverse pregnancy outcomes related to placental dysfunction in twin pregnancies. (Review)
Review
OBJECTIVE
To review the usefulness of the sFlt-1/PlGF ratio to detect adverse pregnancy outcomes related to placental dysfunction in twin pregnancies.
METHODS
A systematic review in Pubmed-Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, and National Guideline was performed. Studies were selected if they were published in the last 10 years, included a sample size equal to or greater than 10 twin gestations, determined the sFlt-1/PIGF ratio, and revealed the pregnancy outcome of the included patients.
RESULTS
A total of 11 studies were selected. Outcomes related to the association between sFlt-1/PlGF ratio throughout pregnancy and perinatal outcome, particularly related to placental dysfunction (early and late-onset preeclampsia and FGR), were collected. The vast majority of studies showed an increased sFlt-1/PlGF ratio in twin pregnancies complicated with preeclampsia or other adverse perinatal outcomes compared with uneventful pregnancies. The included articles revealed promising results when evaluating the usefulness of the sFlt-1/PlGF ratio to rule out preeclampsia. The scarce available data regarding FGR suggests that the sFlt-1/PlGF ratio is a promising tool for detecting this pregnancy complication. Data concerning other aspects of the sFlt-1/PlGF ratio, such as its evolution during healthy twin pregnancies or variations according to chorionicity, is limited.
CONCLUSION
The sFlt-1/PlGF ratio in twin pregnancies is useful to detect, and particularly to rule out adverse pregnancy outcomes related to placental dysfunction, such as preeclampsia or FGR.
Topics: Pregnancy; Female; Humans; Pregnancy Outcome; Pregnancy, Twin; Placenta Growth Factor; Pre-Eclampsia; Biomarkers; Vascular Endothelial Growth Factor Receptor-1; Placenta
PubMed: 37408114
DOI: 10.1080/14767058.2023.2230514 -
Contraception Feb 2021Abortion is often characterized as an inherently difficult decision, despite research demonstrating high decision certainty among abortion patients. Minimal research has...
OBJECTIVE
Abortion is often characterized as an inherently difficult decision, despite research demonstrating high decision certainty among abortion patients. Minimal research has examined decision certainty among people planning to continue a pregnancy. We examined whether women seeking abortion experience lower decision certainty than those planning to continue pregnancies and whether certainty differs by pregnancy intendedness.
STUDY DESIGN
We administered the decisional conflict scale (DCS) to pregnant women (n = 149) at 8 U.S. primary and reproductive health clinics. Using Poisson regression models adjusted for sociodemographic and pregnancy characteristics, we evaluated differences in DCS scores (<25/100 vs ≥25/100) by pregnancy decision and whether pregnancy intention modified the effect of pregnancy decision on certainty.
RESULTS
Over one-half (58%) of respondents planned to have an abortion, 32% to continue the pregnancy, and 10% were unsure. DCS scores were low overall (median 9.4/100; IQR: 1.6, 25.0), indicative of high certainty, and the percentage scoring ≥25/100, reflecting any uncertainty, did not differ by pregnancy decision (23% abortion vs 19% continuing, p = 0.55). In a multivariable model, there was no statistically significant interaction between pregnancy decision (abortion vs continuing pregnancy) and intention. However, the predicted percentage reporting any uncertainty among respondents with intended pregnancies was comparable among those decided on abortion (13%) and continuing the pregnancy (16%). Among those with unintended pregnancies, these figures were 25% among those decided on abortion vs 36% among those continuing.
CONCLUSION
Levels of certainty about a pregnancy decision were high and appeared to depend more on whether the pregnancy was intended or unintended than on the pregnancy decision itself.
IMPLICATIONS
Similar levels of uncertainty among individuals who decided to have an abortion versus continue a pregnancy challenge the narrative that abortion is a particularly difficult medical and personal decision. The prevalence of some uncertainty among respondents continuing pregnancies suggests voluntary options counseling may be useful for some patients in prenatal care settings.
Topics: Abortion, Induced; Decision Making; Female; Humans; Intention; Pregnancy; Pregnancy, Unplanned; Uncertainty
PubMed: 33189708
DOI: 10.1016/j.contraception.2020.11.003 -
Acta Veterinaria Hungarica Mar 2019The aim of this study was to examine the effect of twin pregnancy, fetal laterality, the number of corpora lutea (CL) and cavitary CL on pregnancy losses in...
The aim of this study was to examine the effect of twin pregnancy, fetal laterality, the number of corpora lutea (CL) and cavitary CL on pregnancy losses in Holstein-Friesian cows with a positive pregnancy diagnosis based on ultrasonography between days 29-42 after AI. Pregnancy was confirmed by transrectal palpation between days 57-70 after AI and at the time of drying-off as well. Twin pregnancy rate was 8.4% at the time of the early pregnancy examination. Pregnancy loss did not differ between singleton- and twin-carrying animals either between days 57-70 of gestation or at drying-off. More losses occurred in singletons between days 29-42 and 57-70 in cows with cavitary than in cows with noncavitary CL (12.1% vs. 3.6%; P < 0.05) and in cows with double CL than in cows with single CL (7.3% vs. 3.6% %; P < 0.05). Between days 57-70 of gestation and drying-off this difference was still significant (20.7% vs. 3.7%; P < 0.001), while it was non-significant between cows with one CL (5.7%) vs. double CL (3.7%). Cavity occurrence was not affected by hormone therapy prior to AI (either PGF2α or OvSynch; 4.4% vs. 5.4%, respectively); however, the number of CL was reduced by the treatments (11.6 vs. 19.6%; P < 0.0005). In twin pregnancies there was no difference in the pregnancy losses between bilateral and unilateral pregnancies at any time point. The length of gestation was 278.2 ± 10.5 (singleton) and 267.4 ± 31.2 (twin) days, respectively (P < 0.01). The stillbirth ratio was higher in twin carriers than in singleton carriers (19.5% vs. 5.3%; P < 0.001).
Topics: Animals; Cattle; Cattle Diseases; Corpus Luteum; Female; Logistic Models; Pregnancy; Pregnancy, Animal; Pregnancy, Multiple; Risk Factors; Stillbirth
PubMed: 30922099
DOI: 10.1556/004.2019.013 -
Seminars in Reproductive Medicine Mar 2022The association between adolescent childbearing and adverse maternal and birth outcomes has been well documented. Adverse adolescent pregnancy outcomes are associated... (Review)
Review
The association between adolescent childbearing and adverse maternal and birth outcomes has been well documented. Adverse adolescent pregnancy outcomes are associated with substantial risk of long-term morbidities for the young mother and their newborns. Multiple levels of social disadvantage have been related to adverse pregnancy outcomes among adolescent mothers. Patterns of cumulative social adversity define the most marginalized group of adolescents at the highest risk of experiencing adverse maternal and birth outcomes. Using a social determinants of health (SDOH) framework, we present an overview of the current scientific evidence on the influence of these conditions on adolescent pregnancy outcomes. Multiple SDOH such as residence in remote areas, low educational attainment, low socioeconomic status, and lack of family and community support have been linked with increased risk of adverse pregnancy outcomes among adolescents. Based on the PROGRESS-Plus equity framework, this review highlights some SDOH aspects that perinatal health researchers, clinicians, and policy makers should consider in the context of adolescent pregnancies. There is a need to acknowledge the intersectional nature of multiple SDOH when formulating clinical and societal interventions to address the needs of the most marginalized adolescent in this critical period of life.
Topics: Adolescent; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy in Adolescence; Social Determinants of Health
PubMed: 34500474
DOI: 10.1055/s-0041-1735847 -
Autoimmunity Reviews Aug 2015Systemic vasculitis (SV) are uncommon diseases that rarely affect women during their reproductive age; little data, mainly retrospective, is available on this topic. The... (Review)
Review
OBJECTIVE
Systemic vasculitis (SV) are uncommon diseases that rarely affect women during their reproductive age; little data, mainly retrospective, is available on this topic. The aim of our study was to evaluate maternal/neonatal outcome and disease course before, during and after pregnancy.
METHODS
Sixty-five pregnancies in 50 women with SV were followed by a multispecialistic team in 8 institutions between 1995 and 2014. Clinical data on pregnancy, 1year before and 1year after delivery was retrospectively collected. The rate of pregnancy complications was compared to that of a General Obstetric Population (GOP) of 3939 women.
RESULTS
In 2 patients the diagnosis of SV was done during pregnancy; 59 out of the remaining 63 started when maternal disease was quiescent. We recorded 56 deliveries with 59 live births, 8 miscarriages and 1 fetal death. In SV, preterm, particularly early preterm (<34weeks) deliveries and cesarean sections appeared significantly more frequent than in GOP (11.3% vs 5.0%, p=0.049 and 48.2% vs 31.0%, p=0.009). Vasculitis-related complications occurred in 23 pregnancies (35.4%), with 5 severe events (7.7%) including 3 cases of transient ischemic attack (TIA). Data about the post-partum period were available for 56 pregnancies: 12 flares (21.4%) occurred, with 1 severe event (1.8%).
CONCLUSION
SV patients can have successful pregnancies (especially during a disease remission phase) despite an increased rate of preterm delivery. Severe flares were limited, but the occurrence of 3 TIA suggests that particular attention should be given to possible thrombotic complications in SV patients during pregnancy and puerperium.
Topics: Abortion, Spontaneous; Cesarean Section; Female; Fetal Death; Humans; Multicenter Studies as Topic; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Systemic Vasculitis
PubMed: 25858351
DOI: 10.1016/j.autrev.2015.03.009 -
Kathmandu University Medical Journal... 2022Background Teenage pregnancy is considered a high-risk pregnancy in terms of reproductive outcome and the subsequent financial constraint. Objective To assess the... (Meta-Analysis)
Meta-Analysis
Background Teenage pregnancy is considered a high-risk pregnancy in terms of reproductive outcome and the subsequent financial constraint. Objective To assess the prevalence of teenage pregnancy, associated risk factors, and outcomes in the context of Nepal. Method We searched electronic databases to search relevant articles published from January 2000 till October 2020 using the keywords with appropriate Boolean operators. All the data were extracted into a standardized form designed in Excel. We conducted a statistical analysis using Comprehensive Meta-Analysis Software (CMA) version 3. Data pooled for proportion with 95% confidence interval (CI). A Forest plot was used to visualize the degree of variation between studies. Result Fourteen studies were included in the analysis after the rigorous screening of 4425 studies. Prevalence of teenage pregnancy was 13.2% (Proportion, 0.132; CI, 0.077- 0.215). Among teenage pregnancies, 11.8% were already multigravida (Proportion, 0.118; CI, 0.029-0.374). Among teen pregnancies, 18.6% were illiterate; among the literate, only 25.9% were of education above grade 10,31.9% were unaware of contraceptive methods, and only 3.2% reported using any contraception methods. 75.4% of teenage pregnancies had a vaginal delivery with or without episiotomy, 6.5% by instrumental deliveries, and 21.5% by cesarean section. Preterm delivery was 12.0%, and post-term delivery was 8.2%. Abortion was reported in 11.1% of teenage pregnancies. Major tears were reported in 52.9%, obstructed labor was in 4%, and pre-labor rupture of the membrane was in 7.0% of teenage pregnancies. The low birth weight of newborns was 19.4%. Stillbirth and neonatal deaths were 1.7% and 1.4%, respectively. Conclusion The prevalence of teenage pregnancy in Nepal was 13.2%. The majority of them did not use any form of contraceptives; and had low education. Several maternal and neonatal complications were reported among teenage pregnancies.
Topics: Adolescent; Pregnancy; Infant, Newborn; Humans; Female; Pregnancy in Adolescence; Cesarean Section; Nepal; Contraception; Risk Factors; Pregnancy Outcome
PubMed: 37017171
DOI: No ID Found -
Ultrasound in Obstetrics & Gynecology :... May 2023To evaluate outcomes of dichorionic twin pregnancies undergoing early vs late selective termination of pregnancy (ST). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate outcomes of dichorionic twin pregnancies undergoing early vs late selective termination of pregnancy (ST).
METHODS
MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to March 2022. The primary outcome of this study was pregnancy loss prior to 24 weeks' gestation. The secondary outcomes included preterm birth (PTB) before 37, 34, and 32 weeks, preterm prelabor rupture of membranes (PPROM), gestational age (GA) at delivery, Cesarean delivery, mean birth weight, 5-min Apgar score < 7, overall neonatal morbidity and neonatal survival. Only prospective or retrospective studies reporting data on the outcome of early (before 18 weeks) vs late (at or after 18 weeks) ST in dichorionic twin pregnancies were considered suitable for inclusion. Quality assessment of the included studies was performed using the Newcastle-Ottawa scale for cohort studies. Random-effects head-to-head meta-analysis was used to analyze the data.
RESULTS
Seven studies reporting on 649 dichorionic twin pregnancies were included in this systematic review. The risk of pregnancy loss prior to 24 weeks was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST (1% vs 8%; odds ratio (OR), 0.25 (95% CI, 0.10-0.65); P = 0.004). The risk of PTB was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST when considering PTB before 37 weeks (19% vs 45%; OR, 0.36 (95% CI, 0.23-0.57); P < 0.00001), before 34 weeks (4% vs 19%; OR, 0.24 (95% CI, 0.11-0.54); P = 0.0005) and before 32 weeks (4% vs 20%; OR, 0.21 (95% CI, 0.05-0.85); P = 0.03). The mean birth weight was significantly greater in the early-ST group (mean difference (MD), 392.2 g (95% CI, 59.1-726.7 g); P = 0.02), as was the mean GA at delivery (MD, 2.47 weeks (95% CI, 0.04-4.91 weeks); P = 0.049). There was no significant difference between dichorionic twin pregnancies undergoing early compared with late ST in terms of PPROM (P = 0.27), Cesarean delivery (P = 0.38), 5-min Apgar score < 7 (P = 0.35) and neonatal survival of the non-reduced twin (P = 0.54).
CONCLUSIONS
The risk of pregnancy loss prior to 24 weeks and the rate of PTB before 37, 34 and 32 weeks were significantly higher in dichorionic twin pregnancies undergoing late vs early ST, thus highlighting the importance of early diagnosis of fetal anomalies in twin pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pregnancy, Twin; Premature Birth; Birth Weight; Retrospective Studies; Prospective Studies; Abortion, Spontaneous; Gestational Age; Pregnancy Outcome
PubMed: 36412550
DOI: 10.1002/uog.26126 -
Issues in Law & Medicine 2022The selective termination of one or more fetuses in higher order multiple pregnancies began in the 1980s in response to the increased rate of multiples arising from... (Review)
Review
The selective termination of one or more fetuses in higher order multiple pregnancies began in the 1980s in response to the increased rate of multiples arising from assisted reproductive technology (ART). Multifetal Pregnancy Reduction (MFPR) was justified by improving outcomes for the remaining offspring and their mother, and while the evidence suggests prematurity and the morbidity associated with it are reduced, there is a cost in increased miscarriage and mortality. As perinatal care has advanced, the margins of improvement have narrowed and hence the cost/benefit ratio. At the same time, MFPR has morphed from a rare procedure undertaken for quadruplets and higher, to one in which triplets and twins are increasingly reduced to a singleton, and more so for social reasons. This review considers the evidence for MFPR's efficacy and risks, along with those changes over time. Notably absent is research on the surviving children or the ongoing physical and mental health of mothers. The ethical reasoning used by practitioners and others is also explored, as is the culture of ART and abortion that drive the practice.
Topics: Pregnancy; Infant, Newborn; Female; Child; Humans; Pregnancy, Multiple; Abortion, Induced; Pregnancy Reduction, Multifetal; Abortion, Spontaneous; Infant, Premature
PubMed: 36629789
DOI: No ID Found