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Gynakologisch-geburtshilfliche Rundschau 2007Twin and multiple pregnancies carry an increased risk compared to singleton pregnancies and a challenge in obstetrical management. Multiple births are a worldwide issue,...
Twin and multiple pregnancies carry an increased risk compared to singleton pregnancies and a challenge in obstetrical management. Multiple births are a worldwide issue, especially due to the increased incidence in several countries in the last few years. Prenatal care and obstetrical management call for specific solutions due to specific risks in such pregnancies. The present papers try to give both an overview and to offer a deeper insight into selected problems of obstetrical care for multiple pregnancies.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Pregnancy, High-Risk; Pregnancy, Multiple; Prenatal Care; Prenatal Diagnosis; Reproductive Techniques, Assisted
PubMed: 17272930
DOI: 10.1159/000098118 -
The Journal of Maternal-fetal &... Jul 2004To study the effects of multifetal pregnancy reduction (MFPR) as a means to reduce the adverse outcome of multiple gestations.
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.
Topics: Abortion, Spontaneous; Female; Humans; Infant, Newborn; Infant, Premature; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal; Retrospective Studies
PubMed: 15370079
DOI: 10.1080/14767050410001728962 -
Maternal and Child Health Journal Mar 2010Published studies show poor pregnancy outcomes associated with unintended pregnancies are disproportionately higher than in planned pregnancies and place a burden on the...
OBJECTIVES
Published studies show poor pregnancy outcomes associated with unintended pregnancies are disproportionately higher than in planned pregnancies and place a burden on the health care system. This study was designed to compare pregnancy intention rates, compare sociodemographic characteristics of women by pregnancy intention and compare pregnancy outcomes in a managed care setting.
METHODS
A large managed health care organization in California conducted a retrospective medical record review of 1,784 women seeking prenatal care in 2002 to learn how women self-reported their pregnancy intention, compare pregnancy intention rates between this health plan to the national data, and to compare antecedents and pregnancy outcomes based on pregnancy intention.
RESULTS
Overall, 62.1% of pregnancies were self-reported as intended with 26.4% mistimed and 11.4% unwanted. Being young, single, having lower educational attainment, having other living children, consuming alcohol and being a woman of color were the greatest predictors of having an unintended pregnancy. Despite these predictors, birth outcomes for unintended pregnancies in this setting showed no statistical difference from planned pregnancies.
CONCLUSION
Awareness of pregnancy intention of the women who are at greatest risk may be an important contributor to improving birth outcomes and health plan decisions about reproductive care services. Early entry to prenatal care and integrated services that decrease substance abuse and support high-risk pregnancy management are important contributors to reducing poor pregnancy outcomes.
Topics: Adolescent; Adult; California; Female; Humans; Managed Care Programs; Pregnancy; Pregnancy Outcome; Pregnancy, Unwanted; Retrospective Studies; Surveys and Questionnaires; Young Adult
PubMed: 19152103
DOI: 10.1007/s10995-009-0446-5 -
Reproductive Biomedicine Online Nov 2016Multifetal pregnancy reduction (MPR) is an accepted method of reducing complications of triplet pregnancies and higher-order multifetal pregnancies. Eighty-three... (Comparative Study)
Comparative Study
Multifetal pregnancy reduction (MPR) is an accepted method of reducing complications of triplet pregnancies and higher-order multifetal pregnancies. Eighty-three pregnancies that underwent early (68 weeks) transvaginal MPR were compared with 125 pregnancies that underwent late (11-14 weeks) transabdominal MPR. Rates of pregnancy loss, preterm delivery, gestational diabetes and hypertensive disorders were similar among both groups. Early MPR was associated with a lower risk for small for gestational age newborns (6.5% versus 19.2%; P = 0.034; OR 0.32; 95% CI 0.11 to 0.92) and a higher risk for single-fetus loss (6% versus 0.8%; P = 0.041; OR 10.58; 95% CI 1.1 to 101.94). Preterm delivery rates seemed to be similar between the two groups. In MPR from triplets, an apparent benefit was observed for early MPR in preterm deliveries before 37 weeks, whereas, in MPR from high-order pregnancies, a benefit was observed for late MPR in deliveries before 32 weeks. Perinatal outcomes of twin pregnancies after early and late MPR seem to be grossly similar. Optimal timing for multifetal reduction depends on other factors, namely, the selectivity of the procedure and patient's preference.
Topics: Abortion, Spontaneous; Female; Gestational Age; Humans; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal; Pregnancy, Twin; Premature Birth; Retrospective Studies; Time Factors
PubMed: 27593480
DOI: 10.1016/j.rbmo.2016.08.015 -
Journal of Reproductive and Infant... Mar 2024Nearly half of all pregnancies in the U.S. are classified as unintended (e.g. unplanned, mistimed, or unwanted), which have been linked to numerous adverse consequences...
OBJECTIVES
Nearly half of all pregnancies in the U.S. are classified as unintended (e.g. unplanned, mistimed, or unwanted), which have been linked to numerous adverse consequences for maternal and child outcomes. Recent evidence suggests that happiness about a pregnancy is often a better predictor of maternal and infant health outcomes than pregnancy intentions, but few studies have examined maternal predictors of pregnancy happiness.
METHODS
Using a clinic-based sample of pregnant women ( = 177), we apply multiple regression analysis to examine the association between maternal adverse childhood experiences and pregnancy happiness, as well as the moderating role of pregnancy intentions.
RESULTS
Women with more childhood adversity and pregnancies that were unplanned and mistimed or unwanted reported lower levels of pregnancy happiness, compared with women with less childhood adversity and intended pregnancies. However, pregnancy intentions did not moderate the relationship between maternal adverse childhood experiences and pregnancy happiness.
CONCLUSION
Our results suggest that pregnancy happiness is lower among mothers with a history of childhood adversity and pregnancies classified as unplanned and mistimed or unwanted. Understanding the factors that impact pregnancy happiness is critical to inform prenatal clinical practice and health policy, particularly when caring for those with a history of adversity.
Topics: Infant; Child; Pregnancy; Female; Humans; Pregnancy, Unplanned; Pregnancy, Unwanted; Happiness; Intention; Adverse Childhood Experiences
PubMed: 35819014
DOI: 10.1080/02646838.2022.2097208 -
The Journal of Obstetrics and... Nov 2023In this study, we aimed to evaluate the perinatal outcomes of dichorionic diamniotic (DCDA) twin pregnancies reduced by the fetal reduction (FR) procedure and cases with...
OBJECTIVE
In this study, we aimed to evaluate the perinatal outcomes of dichorionic diamniotic (DCDA) twin pregnancies reduced by the fetal reduction (FR) procedure and cases with continuing DCDA twin pregnancies without FR.
MATERIALS AND METHODS
FR performed in a university hospital in the last 10 years was evaluated. Pregnancies reduced to DCDA twin pregnancies by reduction from three or more pregnancies and pregnancies that started with DCDA twins and continued with DCDA twins were compared in terms of perinatal outcomes. In the subgroup analysis, those who were reduced from three-chorionic three-amniotic (TCTA) triplets to DCDA twins and those who were reduced to DCDA twin pregnancies from four or more were compared in terms of perinatal outcomes.
RESULTS
A total of 119 pregnant women were included in the study, 36 patients underwent FR, while 83 patients were DCDA twins who did not undergo FR. The groups were similar in terms of preterm delivery (p = 0.370). There was a higher rate of miscarriage (21.4% vs. 0.0%, p = 0.019) in the group that was reduced to DCDA twins from quadruplet and above pregnancies compared to the group that was reduced from TCTA triplets to DCDA twins. The gestational week at birth was lower in the group reduced to DCDA twins from quadruplets and above pregnancies (31.00 ± 4.31 vs. 34.64 ± 2.88, p = 0.019).
CONCLUSION
The study's results show that the perinatal outcomes of multiple pregnancies with and without FR are the same As the number of reduced fetuses increases, the rates of preterm birth and miscarriage also increase.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Abortion, Spontaneous; Fetus; Pregnancy Outcome; Pregnancy, Twin; Premature Birth; Retrospective Studies; Pregnancy Reduction, Multifetal; Pregnancy, Multiple
PubMed: 37574597
DOI: 10.1111/jog.15771 -
Harefuah Mar 2002The high success rate in IVF treatments is followed by a high rate of multiple pregnancies. Over 30% of IVF pregnancies are multiples and carrying higher risk to the... (Review)
Review
INTRODUCTION
The high success rate in IVF treatments is followed by a high rate of multiple pregnancies. Over 30% of IVF pregnancies are multiples and carrying higher risk to the neonates compared with singleton pregnancy. Twin pregnancy is less dangerous then high order multiple pregnancy but it has a significantly higher risk factor compared with singleton pregnancy. Therefore, it is crucial to find methods to reduce twin pregnancy rate. The goal of this review is to present the peril of twin pregnancy and to evaluate the alternative of selective single embryo transfer (SET) in order to reduce the rate of multiple pregnancies in IVF.
METHODS
Survey of the literature on SET.
RESULTS
Patients with high pregnancy rate bear higher risk for multiple pregnancy. In these cases transfer of single high quality embryo can result in a pregnancy rate of over 30% without the risk of multiple pregnancies. Selective SET may lead to a significant decrease in multiple pregnancies rate with only a slight drop in the general pregnancy rate.
CONCLUSIONS
Selective SET in patients with elevated chance to conceive may result in good pregnancy rate without the risk of multiple pregnancy.
Topics: Embryo Transfer; Female; Fertilization in Vitro; Humans; Pregnancy; Pregnancy Reduction, Multifetal; Pregnancy, Multiple
PubMed: 11944228
DOI: No ID Found -
Postgraduate Medicine Jun 1984
Topics: Female; Humans; Pregnancy; Pregnancy Complications
PubMed: 6728732
DOI: 10.1080/00325481.1984.11698640 -
Women's Health Issues : Official... 2010Half of all U.S. pregnancies are categorized as unintended at conception, but concerns persist that existing measures of pregnancy intention do not adequately reflect...
OBJECTIVE
Half of all U.S. pregnancies are categorized as unintended at conception, but concerns persist that existing measures of pregnancy intention do not adequately reflect the complexities of reproductive desires and preferences. We explored new strategies for categorizing viewpoints toward future pregnancy focusing on young, low-income, African-American women, and assessed the stability of these viewpoints over time. For pregnancies that occurred during the study, we examined the utility of the newly derived categories for predicting retrospective measures of intendedness.
METHODS
Data were collected using Q-methodology, a technique for eliciting subjective viewpoints and identifying shared patterns among individuals. African-American women ages 15 to 25 and at risk for pregnancy were recruited at clinics serving low-income populations. The women sorted statements reflecting attitudes and preferences regarding future pregnancy into a distribution on a continuum from "least true for me" to "most true for me." We used by-person factor analysis to derive latent viewpoints.
RESULTS
We identified six factors each reflecting a unique viewpoint about future pregnancy. These were a pregnancy seeking factor, one reflecting both ambivalence and low reproductive control, and four reflecting pregnancy avoidance, with distinctions around social support, reproductive control, and desired pregnancy timing. Distribution of factors differed by age group, as well as by retrospective categorization of pregnancy intention for those women who became pregnant during the study.
CONCLUSION
Our categories provide a nuanced reflection of women's points of view about future pregnancies, and, with further validation, may prove useful for predicting or preventing contraceptive nonuse, undesired conceptions, and associated adverse outcomes.
Topics: Adolescent; Adult; Black or African American; Age Factors; Factor Analysis, Statistical; Family Planning Services; Female; Forecasting; Humans; Intention; Poverty; Predictive Value of Tests; Pregnancy; Pregnancy, Unplanned; Prospective Studies; Retrospective Studies; Social Support; Time Factors; Young Adult
PubMed: 20833067
DOI: 10.1016/j.whi.2010.06.005 -
Journal of Perinatal Medicine Mar 2024Multiple pregnancies involve several complications, most often prematurity, but also higher anomaly rates. Reducing fetuses generally improves pregnancy outcomes. We...
OBJECTIVES
Multiple pregnancies involve several complications, most often prematurity, but also higher anomaly rates. Reducing fetuses generally improves pregnancy outcomes. We conducted this study to evaluate the obstetrical and neonatal results after multifetal pregnancy reduction (MFPR) in the largest tertiary hospital in Finland.
METHODS
This retrospective cohort study included all MFPR managed in Helsinki University Hospital during a 13 year period (2007-2019). Data on pregnancies, parturients and newborns were collected from patient files. The number of fetuses, chorionicities and amnionicities were defined in first-trimester ultrasound screening.
RESULTS
There were 54 MFPR cases included in the final analyses. Most often the reduction was from twins to singletons (n=34, 63 %). Majority of these (25/34, 73.5 %) were due to co-twin anomaly. Triplets (n=16, 29.6 %) were reduced to twins (n=7, 13 %) or singletons (n=9, 16.7 %), quadruplets (n=2, 3.7 %) and quintuplets (n=2, 3.7 %) to twins. Most (33/54, 61.1 %) MFPR procedures were done by 15+0 weeks of gestation. There were six miscarriages after MFPR and one early co-twin miscarriage. In the remaining 47 pregnancies that continued as twins (n=7, 14.9 %) or singletons (n=40, 85.1 %) the liveborn rate was 90 % for one fetus and 71.4 % for two fetuses.
CONCLUSIONS
Most MFPR cases were pregnancies with an anomalous co-twin. The whole pregnancy loss risk was 11.1 % after MFPR. The majority (70.6 %) of twins were spontaneous, whereas all quadruplets, quintuplets, and 56.3 % of triplets were assisted reproductive technologies (ART) pregnancies. Careful counselling should be an essential part of obstetrical care in multiple pregnancies, which should be referred to fetomaternal units for MFPR option.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pregnancy Reduction, Multifetal; Tertiary Care Centers; Retrospective Studies; Pregnancy Outcome; Pregnancy, Multiple; Abortion, Spontaneous; Gestational Age
PubMed: 38281159
DOI: 10.1515/jpm-2023-0414