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The Cochrane Database of Systematic... Apr 2015Monoamniotic twin pregnancies are formed when a single egg is fertilised and the resulting inner cell mass splits to form twins sharing the same amniotic sac. This... (Review)
Review
BACKGROUND
Monoamniotic twin pregnancies are formed when a single egg is fertilised and the resulting inner cell mass splits to form twins sharing the same amniotic sac. This condition is rare and affects about one in 10,000 pregnancies overall. Monoamniotic twin pregnancies are susceptible to complications including cord entanglement, increased congenital anomalies, intrauterine growth restriction, twin-to-twin transfusion syndrome and increased perinatal mortality. All twin pregnancies also carry additional maternal risks including pre-eclampsia, anaemia, antepartum haemorrhage, postpartum haemorrhage and operative delivery.The optimal timing for the delivery of monoamniotic twins is not known. The options include 'planned early delivery' between 32 and 34 weeks, or alternatively awaiting spontaneous labour at least up until the usual time of planned delivery for other monochorionic twins (approximately 36 to 38 weeks' gestation), unless there is a specific indication for earlier delivery.
OBJECTIVES
To assess whether routine early delivery in monoamniotic twin pregnancies improves fetal, neonatal or maternal outcomes compared with 'expectant management'. Expectant management means awaiting spontaneous labour at least up until the usual time of planned delivery for other monochorionic twins (approximately 36 to 38 weeks' gestation in many centres), unless a specific indication for delivery occurs in the meantime, e.g. for non-reassuring antenatal testing.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015).
SELECTION CRITERIA
Published and unpublished randomised controlled trials (including cluster-randomised trials) comparing outcomes for women and infants who were randomised to planned early delivery of a monoamniotic twin pregnancy with outcomes for women and infants who were randomised to either planned term delivery or expectant management. However, we did not identify any trials for inclusion in this review.Quasi-randomised controlled trials, trials published in abstract form only, and trials using a cross-over design are not eligible for inclusion in this review.
DATA COLLECTION AND ANALYSIS
No trials were identified by the search strategy.
MAIN RESULTS
No trials were identified by the search strategy.
AUTHORS' CONCLUSIONS
Monoamniotic twins are rare, and there is insufficient randomised controlled evidence on which to draw strong conclusions about the best management. In their absence, we can refer to historical case series and expert consensus. Management plans should take into consideration the availability of high-quality neonatal care if early delivery is chosen. Women and their families should be involved in the decision making about these high-risk pregnancies.Ongoing, multicentre audits of maternal and perinatal outcomes for monoamniotic twins are needed in order to inform families and clinicians about up-to-date perinatal outcomes with contemporary obstetric practice. Research should consider the social and economic implications of planned interventions, as well as the perinatal outcomes.
Topics: Delivery, Obstetric; Female; Humans; Pregnancy; Pregnancy, Twin; Twins, Monozygotic; Watchful Waiting
PubMed: 25906204
DOI: 10.1002/14651858.CD008820.pub2 -
Reproductive Health Sep 2019Unwanted pregnancies are considered as one of the most important public health risks. Regarding the importance of the unwanted pregnancy in the country and helping... (Review)
Review Meta-Analysis
BACKGROUND
Unwanted pregnancies are considered as one of the most important public health risks. Regarding the importance of the unwanted pregnancy in the country and helping health policy-makers obtain more accurate information on this issue, this study aims to provide a systematic review and meta-analytical on the prevalence of unwanted pregnancies in Iran.
METHODS
The present study was carried out using meta-analysis. Articles related to the topic were obtained through SID, Magiran, Scopus, PubMed, and ScienceDirect and Google Scholar databases from 2001 to 2017, Articles written based on cross-sectional studies were included in the study and other overviews, case-control, cohort, and interventional studies were excluded from the list of articles. Heterogeneity of studies was investigated using I index and data analysis was performed in Comprehensive Meta-Analysis software (Version 3).
RESULTS
In 23 articles, the prevalence of unwanted pregnancy in Iranian women was 27.9% (95%CI: 24-32.1%). The meta-regression analysis was used in two sample sizes and years of study. It was reported that as the sample size and Years increases, the prevalence of the unwanted pregnancy decrease, this difference was also statistically significant (P = 0.000).
CONCLUSION
Considering that the prevalence of unwanted pregnancy is high in Iran, it is necessary that health policy makers take effective measures to enhance the awareness of couples and public information about the risks of the unwanted pregnancy.
Topics: Female; Humans; Iran; Pregnancy; Pregnancy, Unwanted; Prevalence
PubMed: 31484563
DOI: 10.1186/s12978-019-0804-8 -
American Journal of Obstetrics and... Feb 2024This study aimed to assess the risk of adverse maternal and perinatal complications between twin and singleton pregnancies affected by gestational diabetes mellitus and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to assess the risk of adverse maternal and perinatal complications between twin and singleton pregnancies affected by gestational diabetes mellitus and the respective group without gestational diabetes mellitus (controls).
DATA SOURCES
A literature search was performed using MEDLINE, Embase, and Cochrane from January 1980 to May 2023.
STUDY ELIGIBILITY CRITERIA
Observational studies reporting maternal and perinatal outcomes in singleton and/or twin pregnancies with gestational diabetes mellitus vs controls were included.
METHODS
This was a systematic review and meta-analysis. Pooled estimate risk ratios with 95% confidence intervals were generated to determine the likelihood of adverse pregnancy outcomes between twin and singleton pregnancies with and without gestational diabetes mellitus. Heterogeneity among studies was evaluated in the model and expressed using the I statistic. A P value of <.05 was considered statistically significant. The meta-analyses were performed using Review Manager (RevMan Web). Version 5.4. The Cochrane Collaboration, 2020. Meta-regression was used to compare relative risks between singleton and twin pregnancies. The addition of multiple covariates into the models was used to address the lack of adjustments.
RESULTS
Overall, 85 studies in singleton pregnancies and 27 in twin pregnancies were included. In singleton pregnancies with gestational diabetes mellitus, compared with controls, there were increased risks of hypertensive disorders of pregnancy (relative risk, 1.85; 95% confidence interval, 1.69-2.01), induction of labor (relative risk, 1.36; 95% confidence interval, 1.05-1.77), cesarean delivery (relative risk, 1.31; 95% confidence interval, 1.24-1.38), large-for-gestational-age neonate (relative risk, 1.61; 95% confidence interval, 1.46-1.77), preterm birth (relative risk, 1.36; 95% confidence interval, 1.27-1.46), and admission to the neonatal intensive care unit (relative risk, 1.43; 95% confidence interval, 1.38-1.49). In twin pregnancies with gestational diabetes mellitus, compared with controls, there were increased risks of hypertensive disorders of pregnancy (relative risk, 1.69; 95% confidence interval, 1.51-1.90), cesarean delivery (relative risk, 1.10; 95% confidence interval, 1.06-1.13), large-for-gestational-age neonate (relative risk, 1.29; 95% confidence interval, 1.03-1.60), preterm birth (relative risk, 1.19; 95% confidence interval, 1.07-1.32), and admission to the neonatal intensive care unit (relative risk, 1.20; 95% confidence interval, 1.09-1.32) and reduced risks of small-for-gestational-age neonate (relative risk, 0.89; 95% confidence interval, 0.81-0.97) and neonatal death (relative risk, 0.50; 95% confidence interval, 0.39-0.65). When comparing relative risks in singleton vs twin pregnancies, there was sufficient evidence to suggest that twin pregnancies have a lower relative risk of cesarean delivery (P=.003), have sufficient adjustment for confounders, and have lower relative risks of admission to the neonatal intensive care unit (P=.005), stillbirths (P=.002), and neonatal death (P=.001) than singleton pregnancies.
CONCLUSION
In both singleton and twin pregnancies, gestational diabetes mellitus was associated with an increased risk of adverse maternal and perinatal outcomes. In twin pregnancies, gestational diabetes mellitus may have a milder effect on some adverse perinatal outcomes and may be associated with a lower risk of neonatal death.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Diabetes, Gestational; Hypertension, Pregnancy-Induced; Perinatal Death; Pregnancy Outcome; Pregnancy, Twin; Premature Birth; Retrospective Studies; Observational Studies as Topic
PubMed: 37595821
DOI: 10.1016/j.ajog.2023.08.011 -
Seminars in Arthritis and Rheumatism Jun 2021There is limited robust evidence on the course of pregnancy and its outcomes in women with psoriatic arthritis (PsA) on which to base recommendations for the management... (Review)
Review
BACKGROUND
There is limited robust evidence on the course of pregnancy and its outcomes in women with psoriatic arthritis (PsA) on which to base recommendations for the management of these patients.
OBJECTIVE
The primary objective was to review available data on (I) disease activity during pregnancy and on (II) adverse pregnancy outcomes (APO) in women with PsA. Secondly, neonatal outcomes and treatment of the rheumatic disease were investigated.
METHODS
Systematic literature search within the databases Pubmed and Embase until 30 Nov 2020 was performed. Additionally, reference lists of included studies and of review articles revealed by the search were screened. All full text articles identified and published in English language were systematically evaluated by two reviewers. All studies that reported on one of the primary outcomes and included at least five pregnancies in women with PsA were considered.
RESULTS
The review of 734 search results revealed 13 eligible publications reporting on a total of 2,332 pregnancies in women with PsA. Nine studies reported on PsA activity and showed an increase or worsening of disease activity after delivery compared to the pregnancy period. APOs were reported by nine studies. Adjusted analyses of APOs did not show an increased risk for gestational diabetes, small for gestational age and low birth weight in PsA patients in relation to the respective comparator groups. However, there were signals for a higher pre-eclampsia, elective caesarean section and preterm birth risk in PsA pregnancies. Meta-analysis was not performed due to study heterogeneity.
DISCUSSION
This review showed a postpartum deterioration of disease activity in women with PsA and no risk elevation for gestational diabetes, small for gestational age and low birth weight. A higher risk for pre-eclampsia, elective caesarean section and preterm birth in PsA pregnancies cannot be ruled out. Differences in the studies investigated limit overall summary statements on disease activity and APOs in women with PsA. Harmonization of study approaches, instruments and outcome reporting is crucial to ensure informed counselling of patients with PsA before, during and after pregnancy that is based on robust data.
PROSPERO REGISTRATION NUMBER
CRD42020162242.
Topics: Arthritis, Psoriatic; Cesarean Section; Female; Humans; Infant, Newborn; Postpartum Period; Pregnancy; Pregnancy Outcome; Premature Birth
PubMed: 33887551
DOI: 10.1016/j.semarthrit.2021.04.003 -
Contraception Jan 2019To understand how young people conceptualize planned, unplanned and "in-between" pregnancies.
OBJECTIVE
To understand how young people conceptualize planned, unplanned and "in-between" pregnancies.
METHODS
We conducted individual qualitative interviews with 50 young (ages 18-24) women and their male partners (n=100) in the San Francisco Bay Area to investigate prospective pregnancy intentions. In this analysis, we focused on participants' conceptualization of planned and unplanned pregnancies, as well as a status in between planned and unplanned.
RESULTS
Conceptualizations of pregnancy planning were influenced by personal experiences and life circumstances, including previous unplanned pregnancies. While many participants held up planned pregnancies as an ideal, the majority of participants (n=71) also felt that a status in between planned and unplanned pregnancy existed. Many described this in-between stage occurring when someone is "not not trying" or would find an unplanned pregnancy acceptable. Notably, a few participants mentioned that pregnancy planning was not possible because either it was uncommon among their peers or they felt a general lack of control over pregnancy.
CONCLUSION
Our analysis suggests that binary operationalization of pregnancies as "planned" and "unplanned" neglects the complexity of young people's lived experiences and perspectives. Contraceptive counseling approaches that allow patients the flexibility to express their considerations and feelings toward a potential future pregnancy could improve the quality of family planning visits and patient-provider interactions.
IMPLICATIONS
The traditional binary conceptualization of pregnancies as planned and unplanned may not holistically capture the diverse perspectives of young people. Increased understanding of the complexities in young people's conceptualizion of pregnancy planning can inform family planning care that is inclusive, relevant and supportive of a variety of perspectives.
Topics: Adolescent; Contraception Behavior; Family Planning Services; Female; Humans; Intention; Male; Pregnancy; Pregnancy, Unplanned; Qualitative Research; San Francisco; Sexual Partners; Young Adult
PubMed: 30120926
DOI: 10.1016/j.contraception.2018.08.012 -
JAMA Neurology May 2023Pregnant women who have epilepsy need adequate engagement, information, and pregnancy planning and management to improve pregnancy outcomes. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Pregnant women who have epilepsy need adequate engagement, information, and pregnancy planning and management to improve pregnancy outcomes.
OBJECTIVE
To investigate perinatal outcomes in women with epilepsy compared with women without epilepsy.
DATA SOURCES
Ovid MEDLINE, Embase, CINAHL, and PsycINFO were searched with no language or date restrictions (database inception through December 6, 2022). Searches also included OpenGrey and Google Scholar and manual searching in journals and reference lists of included studies.
STUDY SELECTION
All observational studies comparing women with and without epilepsy were included.
DATA EXTRACTION AND SYNTHESIS
The PRISMA checklist was used for abstracting data and the Newcastle-Ottawa Scale for risk-of-bias assessment. Data extraction and risk-of-bias assessment were done independently by 2 authors with mediation conducted independently by a third author. Pooled unadjusted odds ratios (OR) or mean differences were reported with 95% CI from random-effects (I2 heterogeneity statistic >50%) or fixed-effects (I2 < 50%) meta-analyses.
MAIN OUTCOMES AND MEASURES
Maternal, fetal, and neonatal complications.
RESULTS
Of 8313 articles identified, 76 were included in the meta-analyses. Women with epilepsy had increased odds of miscarriage (12 articles, 25 478 pregnancies; OR, 1.62; 95% CI, 1.15-2.29), stillbirth (20 articles, 28 134 229 pregnancies; OR, 1.37; 95% CI, 1.29-1.47), preterm birth (37 articles, 29 268 866 pregnancies; OR, 1.41; 95% CI, 1.32-1.51) and maternal death (4 articles, 23 288 083 pregnancies; OR, 5.00; 95% CI, 1.38-18.04). Neonates born to women with epilepsy had increased odds of congenital conditions (29 articles, 24 238 334 pregnancies; OR, 1.88; 95% CI, 1.66-2.12), neonatal intensive care unit admission (8 articles, 1 204 428 pregnancies; OR, 1.99; 95% CI, 1.58-2.51), and neonatal or infant death (13 articles, 1 426 692 pregnancies; OR, 1.87; 95% CI, 1.56-2.24). The increased odds of poor outcomes was increased with greater use of antiseizure medication.
CONCLUSIONS AND RELEVANCE
This systematic review and meta-analysis found that women with epilepsy have worse perinatal outcomes compared with women without epilepsy. Women with epilepsy should receive pregnancy counseling from an epilepsy specialist who can also optimize their antiseizure medication regimen before and during pregnancy.
Topics: Infant; Pregnancy; Infant, Newborn; Female; Humans; Premature Birth; Pregnancy Outcome; Pregnancy Complications; Epilepsy; Abortion, Spontaneous
PubMed: 36912826
DOI: 10.1001/jamaneurol.2023.0148 -
Transplant International : Official... 2023For counseling it is important to know if pregnancy after Living Kidney Donation (LKD) affects long-term outcomes of the mono-kidney and the mother. Therefore, we...
For counseling it is important to know if pregnancy after Living Kidney Donation (LKD) affects long-term outcomes of the mono-kidney and the mother. Therefore, we performed a retrospective multicenter study in women ≤45 years who donated their kidney between 1981 and 2017. Data was collected via questionnaires and medical records. eGFR of women with post-LKD pregnancies were compared to women with pre-LKD pregnancies or nulliparous. eGFR before and after pregnancy were compared in women with post-LKD pregnancies. Pregnancy outcomes post-LKD were compared with pre-LKD pregnancy outcomes. 234 women (499 pregnancies) were included, of which 20 with pre- and post-LKD pregnancies (68) and 26 with only post-LKD pregnancies (59). Multilevel analysis demonstrated that eGFR was not different between women with and without post-LKD pregnancies ( = 0.23). Furthermore, eGFR was not different before and after post-LKD pregnancy ( = 0.13). More hypertensive disorders of pregnancy (HDP) occurred in post-LKD pregnancies ( = 0.002). Adverse fetal outcomes did not differ. We conclude that, despite a higher incidence of HDP, eGFR was not affected by post-LKD pregnancy. In line with previous studies, we found an increased risk for HDP after LKD without affecting fetal outcome. Therefore, a pregnancy wish alone should not be a reason to exclude women for LKD.
Topics: Pregnancy; Humans; Female; Kidney Transplantation; Kidney; Living Donors; Pregnancy Outcome; Tissue and Organ Harvesting
PubMed: 37448449
DOI: 10.3389/ti.2023.11181 -
BMC Pregnancy and Childbirth Dec 2023A growing number of reproductive-age women in the U.S. have chronic medical conditions, increasing their risk of perinatal morbidity and mortality. Still, they...
BACKGROUND
A growing number of reproductive-age women in the U.S. have chronic medical conditions, increasing their risk of perinatal morbidity and mortality. Still, they experience unintended pregnancies at similar rates to low-risk mothers. We have limited understanding of how these individuals consider decisions about pregnancy and contraceptive use. The purpose of this study was to understand factors that influence reproductive decision-making among pregnant women with chronic medical conditions.
METHODS
We conducted 28 semi-structured interviews with pregnant women with pre-existing medical conditions admitted to a tertiary maternal hospital to examine factors influencing reproductive decision making. Maternal demographic characteristics, medical history, and pregnancy outcome data were obtained through participant surveys and abstraction from electronic health records. Interview transcripts were coded and analyzed using Dedoose® with both deductive and inductive content analysis.
RESULTS
Out of 33 eligible participants, 30 consented to participate and 28 completed interviews. The majority of participants identified as black, Christian, made less than $23,000 yearly, and had a variety of preexisting medical conditions. Overarching themes included: 1) Perceived risks-benefits of pregnancy, 2) Perceived risks-benefits of birth control, 3) Determinants of contraceptive utilization, and 4) Perceived reproductive self-agency. Contraception was viewed as acceptable, but with concerning physical and psychological side effects. Although some considered pregnancy as a health threat, more experienced pregnancy as positive and empowering. Few planned their pregnancies.
CONCLUSIONS
Preexisting health conditions did not significantly influence reproductive decision-making. Barriers to birth control use were generally based in patient value-systems instead of external factors. Interventions to improve uptake and use of birth control in this cohort should focus on improving care for chronic health conditions and influencing patient knowledge and attitudes toward contraception.
Topics: Pregnancy; Humans; Female; Contraception; Pregnancy, Unplanned; Contraceptive Agents; Pregnancy Outcome; Decision Making; Contraception Behavior
PubMed: 38082419
DOI: 10.1186/s12884-023-06093-4 -
International Journal of Environmental... Apr 2020The fastest aging society with the lowest fertility rate can be buffered by support for healthy pregnancies using sociocultural approaches. We aimed to address adult...
The fastest aging society with the lowest fertility rate can be buffered by support for healthy pregnancies using sociocultural approaches. We aimed to address adult perceptions of a healthy pregnancy and explored their needs and concerns about childbirth across the lifespan. We conducted a qualitative study using content analysis to investigate general perceptions of a healthy pregnancy after focus-group interviews with adult men and women. We interviewed 60 participants in nine group sessions of 5 to 8 people per group. Three major themes emerged that affect healthy pregnancies: Taking responsibility for a prepared pregnancy, factors that interfere with a healthy pregnancy, and improving strategies for a healthy pregnancy. For the first theme, the two main concerns were financial and parenthood preparation. Factors interfering with a healthy pregnancy had direct and indirect causes, considering personal, social, and cultural changes. Strategies for a healthy pregnancy included family and workplace support, systematic education, and governmental support for financial preparation and health screening. Participants averred that various kinds of support (financial, healthcare, and career) are needed for a healthy pregnancy and childbirth. This public awareness could promote better decisions toward healthy pregnancy with more sociocultural approaches in the various settings of home, school, and the workplace.
Topics: Adult; Child; Delivery, Obstetric; Female; Focus Groups; Health Status; Humans; Male; Parturition; Pregnancy; Qualitative Research
PubMed: 32260300
DOI: 10.3390/ijerph17072460 -
Journal of Pediatric and Adolescent... Oct 2019Sexual minority women are more likely than heterosexual peers to have a teen pregnancy, though little is known about origins of this disparity. Our objective was to...
STUDY OBJECTIVE
Sexual minority women are more likely than heterosexual peers to have a teen pregnancy, though little is known about origins of this disparity. Our objective was to describe teen pregnancy experiences among sexual minority women and elucidate potential risk factors.
DESIGN
As a part of the SexuaL Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) study, in-depth semistructured interviews and surveys were conducted.
SETTING
Across the United States.
PARTICIPANTS
Interviews were conducted with 10 sexual minority cisgender women, ages 21-66 years, who experienced a teen pregnancy.
MAIN OUTCOME MEASURES
Interview transcripts were analyzed using immersion/crystallization and template organizing style approaches. The themes were contextualized using survey data and organized into a conceptual model.
RESULTS AND CONCLUSION
Participants first became pregnant between ages 12 and 19 years; all pregnancies were described as unintentional. Half of the pregnancies resulted from sexual assault. Most of the remaining pregnancies resulted from consensual sex with a boyfriend or regular partner with whom the participant reported inconsistent or no contraceptive use. Five primary themes emerged from participants' interviews: (1) sexuality; (2) life history and contextual factors before pregnancy; (3) abuse and assault; (4) reactions to the pregnancy; and (5) pregnancy outcomes. Future research should assess each theme to explore its contribution to the higher burden of teen pregnancies among sexual minority compared with heterosexual women; such data can inform public health prevention campaigns and evidenced-based curricula for health care providers who care for adolescents.
Topics: Adolescent; Adult; Adverse Childhood Experiences; Aged; Child; Child Abuse; Female; Humans; Middle Aged; Pregnancy; Pregnancy in Adolescence; Pregnancy, Unplanned; Qualitative Research; Risk Factors; Sexual and Gender Minorities; Surveys and Questionnaires; United States; Young Adult
PubMed: 31145986
DOI: 10.1016/j.jpag.2019.05.009