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Romanian Journal of Ophthalmology 2021Due to the increasing rate of couples suffering from infertility, recently, the use of assisted reproductive technology (ART) has increased by 5%-10% per year. Some ART... (Review)
Review
Due to the increasing rate of couples suffering from infertility, recently, the use of assisted reproductive technology (ART) has increased by 5%-10% per year. Some ART pregnancies are at risk of obstetric and neonatal complications, but it is unknown whether the procedures used or the etiology of infertility influences this risk. Multiple ART pregnancies are responsible for the increased rate of prematurity and its associated complications. Also, it has been demonstrated that ART pregnancies have a higher risk of congenital anomalies. The rate of ART-associated ocular abnormalities is incompletely known due to a small number of studies conducted regarding this pathology. In this paper, we presented a review of literature on ocular anomalies associated with ART in order to raise awareness of the need to implement ophthalmological screening in children from pregnancies obtained by ART. ART = assisted reproductive techniques, IVF = in vitro fertilization, ICSI = intracytoplasmic sperm injection, LBW = low birth weight, ROP = retinopathy of prematurity.
Topics: Child; Female; Fertilization in Vitro; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Reproductive Techniques, Assisted; Sperm Injections, Intracytoplasmic
PubMed: 35087971
DOI: 10.22336/rjo.2021.65 -
Yonsei Medical Journal Apr 2002As a result of the increased use of drugs that enhance fertility, and the advent of in vitro fertilization and embryo transfer over the last 2 decades, the incidence of... (Review)
Review
As a result of the increased use of drugs that enhance fertility, and the advent of in vitro fertilization and embryo transfer over the last 2 decades, the incidence of multifetal pregnancies has increased exponentially. In parallel with this increase methods of care for women carrying multiple fetuses have become more complex and well developed. Importantly, it has become obvious that in the case of such pregnancies the rates of mortality and morbidity of both fetuses and mothers, particularly in cases where four or more fetuses are involved, are extremely high. Improvements in the techniques of assisted fertilization should result in fewer iatrogenic multifetal pregnancies and a commensurate decrease in related risks. Fetal reduction seems to be an acceptable method of improving maternal and fetal outcome in high order multiple pregnancies despite the many unresolved medical and ethical dilemmas.
Topics: Ethics, Medical; Female; Humans; Pregnancy; Pregnancy Reduction, Multifetal; Pregnancy, Multiple
PubMed: 11971220
DOI: 10.3349/ymj.2002.43.2.252 -
American Journal of Obstetrics and... May 2023Twin pregnancies carry a higher risk of congenital and structural malformations, and pregnancy complications including miscarriage, stillbirth, and intrauterine fetal...
BACKGROUND
Twin pregnancies carry a higher risk of congenital and structural malformations, and pregnancy complications including miscarriage, stillbirth, and intrauterine fetal death, compared with singleton pregnancies. Carrying a fetus with severe malformations or abnormal karyotype places the remaining healthy fetus at an even higher risk of adverse outcome and pregnancy complications. Maternal medical conditions or complicated obstetrical history could, in combination with twin pregnancy, cause increased risks for both the woman and the fetuses. To our knowledge, no previous studies have evaluated and compared the outcomes of all dichorionic twin pregnancies and compared the results of reduced twins with those of nonreduced and primary singletons in a national cohort. These data are important for clinicians when counseling couples about fetal reduction and its implications.
OBJECTIVE
This study aimed to describe and compare the risks of adverse pregnancy outcomes, including the risk of pregnancy loss, in a national cohort of all dichorionic twins-reduced, nonreduced, and primary singletons. In addition, we examined the implications of gestational age at fetal reduction on gestational age at delivery.
STUDY DESIGN
This was a retrospective cohort study of all Danish dichorionic twin pregnancies, including pregnancies undergoing fetal reduction and a large proportion of randomly selected primary singleton pregnancies with due dates between January 2008 and December 2018. The primary outcome measures were adverse pregnancy outcomes (defined as miscarriage before 24 weeks, stillbirth from 24 weeks, or single intrauterine fetal death in nonreduced twin pregnancies), preterm delivery, and obstetrical pregnancy complications. Outcomes after fetal reduction were compared with those of nonreduced dichorionic twins and primary singletons.
RESULTS
In total, 9735 dichorionic twin pregnancies were included, of which 172 (1.8%) were reduced. In addition, 16,465 primary singletons were included. Fetal reductions were performed between 11 and 23 weeks by transabdominal needle-guided injection of potassium chloride, and outcome data were complete for all cases. Adverse pregnancy outcome was observed in 4.1% (95% confidence interval, 1.7%-8.2%) of reduced twin pregnancies, and 2.4% (95% confidence interval, 0.7%-6.1%) were delivered before 28 weeks, and 4.2% (95% confidence interval, 1.7%-8.5%) before 32 weeks. However, when fetal reduction was performed before 14 weeks, adverse pregnancy outcomes occurred in only 1.4% (95% confidence interval, 0.0%-7.4%), and delivery before 28 and 32 weeks diminished to 0% (95% confidence interval, 0.0%-5.0%) and 2.8% (95% confidence interval, 0.3%-9.7%), respectively. In contrast, 3.0% (95% confidence interval, 2.7%-3.4%) of nonreduced dichorionic twins had an adverse pregnancy outcome, and 1.9% (95% confidence interval, 1.7%-2.1%) were delivered before 28 weeks, and 7.3% (95% confidence interval, 6.9%-7.7%) before 32 weeks. Adverse pregnancy outcomes occurred in 0.9% (95% confidence interval, 0.7%-1.0%) of primary singletons, and 0.2% (95% confidence interval, 0.1%-0.3%) were delivered before 28 weeks, and 0.7% (95% confidence interval, 0.6%-0.9%) before 32 weeks. For reduced twins, after taking account of maternal factors and medical history, it was demonstrated that the later the fetal reduction was performed, the earlier the delivery occurred (P<.01). The overall risk of pregnancy complications was significantly lower among reduced twin pregnancies than among nonreduced dichorionic twin pregnancies (P=.02).
CONCLUSION
In a national 11-year cohort including all dichorionic twin pregnancies, transabdominal fetal reduction by needle guide for fetal or maternal indication was shown to be safe, with good outcomes for the remaining co-twin. Results were best when the procedure was performed before 14 weeks.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Pregnancy Outcome; Pregnancy, Twin; Pregnancy Reduction, Multifetal; Abortion, Spontaneous; Retrospective Studies; Stillbirth; Fetal Death; Pregnancy Complications; Gestational Age; Twins, Dizygotic; Denmark
PubMed: 36441092
DOI: 10.1016/j.ajog.2022.10.028 -
International Journal of Gynecological... Feb 2020Limited data are available on the frequency and time trends of pregnancy-associated cancers, particularly from Southern European countries. The aim of this study was to...
OBJECTIVE
Limited data are available on the frequency and time trends of pregnancy-associated cancers, particularly from Southern European countries. The aim of this study was to analyze the frequency and time trends of pregnancy-associated cancer in Italy.
METHODS
This was a population-based linkage study using the regional hospital discharge forms database of four Italian regions with more than 17 million inhabitants. All resident women with a hospital discharge form reporting a birth or abortion in the time period under consideration were identified. The time period of the study was 2003-2015 for the Piemonte and Puglia region, 2006-2015 for the Tuscany region, and 2005-2015 for the Veneto region. Risk of developing a pregnancy-associated cancer was calculated as the ratio of the number of pregnancy-related cancers to the total number of pregnancies.
RESULTS
A total of 2 297 648 pregnancies were identified. Overall, the pregnancy-associated cancer frequency was 134.8 per 100 000 pregnancies: the frequency ranged from 127.1 in Puglia to 157.3 in Tuscany. The frequency for 100 000 pregnancies was 66.4 in women aged <30 years; the risk increased with age, with a frequency of 275.6 among women aged 40+ years. Approximately two-thirds of cancers were associated with pregnancies resulting in a delivery and one-third with pregnancies resulting in a termination of pregnancy or spontaneous pregnancy loss. No clear trend emerged in the risk of pregnancy-associated cancer per 100 000 pregnancies and calendar year.
CONCLUSION
No clear time trend was observed in the frequency of pregnancy-associated cancers in Italy during the last 10 years, the rates being 104, 164, and 130 per 100 000 pregnancies, respectively, in 2003, 2010, and 2015.
Topics: Adult; Female; Humans; Italy; Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic
PubMed: 31744888
DOI: 10.1136/ijgc-2019-000828 -
Journal of the Chinese Medical... Apr 2015To analyze the pregnancy complications and pregnancy outcome relating to the disease activity of systemic lupus erythematosus before conception and during pregnancy.
BACKGROUND
To analyze the pregnancy complications and pregnancy outcome relating to the disease activity of systemic lupus erythematosus before conception and during pregnancy.
METHODS
Seventy-two pregnancies were collected in a single tertiary medical center within a 5-year period. Twelve pregnancies were terminated due to various causes in the first half of pregnancy. Analysis of pregnancy complications and pregnancy outcome relating to the lupus activity before conception and during pregnancy was made among the remaining 60 pregnancies with gestational length > 26 weeks. The assessment of lupus activity was based on the routine monitoring, including urine routine, white blood cell count, hemoglobin and platelet count, erythrocyte sediment rate, serum titers of C3, C4, and double-stranded DNA. Monitoring of renal function with daily urinary protein loss and clearance rate of creatinine was needed when worsened nephropathy was suspected.
RESULTS
The etiologies of the terminated pregnancies were deteriorated nephropathy (6 cases), involvement of central nervous system (1 case), unwanted pregnancy due to drug exposure (3 cases), and two early intrauterine fetal deaths (both during the 23(rd) week of gestation). Pregnancy complications were related to the lupus activity before conception [odds ratio = 0.238, 95% confidence interval (CI) = 0.073, 0.778, p = 0.014] and during pregnancy (odds ratio = 0.153, 95% CI = 0.031, 0.754, p = 0.012). Meanwhile, pregnancy outcome significantly related to the lupus activity of the preconception period and during pregnancy. The gestational length was significantly longer in the pregnancies with remitted lupus activity either before conception (38.2 ± 1.6 weeks vs. 36.3 ± 3.4 weeks, p = 0.011 and 95% CI = -3.454, -0.478) or during pregnancy (38.2 ± 1.6 weeks vs. 35.2 ± 3.8 weeks, p = 0.005 and with 95% CI = -4.988, -1.005). Significant relationships were also found between newborn birth weights and lupus activity preconceptionally (2940 ± 389 g vs. 2448 ± 674 g, p = 0.002 and 95% CI = -792, -192) and after having conceived (2960 ± 383 g vs. 2136 ± 585 g, p < 0.001 and 95% CI = -1081, -568). Multivariate analysis showed that lupus remission during pregnancy was correlated with a significantly longer gestation, since pregnant women with active lupus had a three-fold greater risk of preterm deliveries (hazard ratio = 3.022, 95% CI = 1.261, 7.242) compared with pregnant women without active lupus.
CONCLUSION
In order to reduce the incidence of pregnancy complication, especially preterm delivery, and to gain good pregnancy outcome, good preparation before conception and good control of the disease during pregnancy are mandatory.
Topics: Abortion, Spontaneous; Adult; Birth Weight; Female; Gestational Age; Humans; Lupus Erythematosus, Systemic; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth
PubMed: 25747013
DOI: 10.1016/j.jcma.2014.11.008 -
BMC Pregnancy and Childbirth May 2022Due to the extensive development of assisted reproductive technology, the number of twin pregnancies has increased significantly over recent decades. Twin pregnancy is...
BACKGROUND
Due to the extensive development of assisted reproductive technology, the number of twin pregnancies has increased significantly over recent decades. Twin pregnancy is the most representative type of multiple pregnancies and is associated with high infant morbidity and mortality. Perinatal complications of twin pregnancy are also markedly increased compared with those of single pregnancy. Transabdominal selective reduction (SR) is a remedial intervention. This study aimed to research the adverse outcomes of transabdominal selective reduction of twin pregnancy and the correlation between the reduction week and pregnancy outcomes.
OBJECTIVE
The purpose of this study was to examine the adverse outcomes of the transabdominal selective reduction of twin pregnancy and the correlation between the reduction week and pregnancy outcomes.
METHODS
A retrospective cohort study of the transabdominal reduction of twin pregnancy was conducted in a single prenatal diagnosis medical centre from September 2012 to October 2020. According to chorionicity, women with twin pregnancies were divided into 2 groups: dichorionic (DC) twin pregnancies and monochorionic (MC) twin pregnancies. Women with DC twin pregnancies underwent potassium chloride reduction, and those with MC twin pregnancies underwent radiofrequency ablation (RFA). The reduction indications included pregnancy complications, foetal abnormalities, and maternal factors. The perinatal outcomes of different chorionic twins after reduction were analysed. Each foetus with an adverse outcome was included. The relative relationship between the reduction weeks and delivery weeks of twins was examined by correlation analysis.
RESULTS
A total of 161 women were included in this study. A total of 112 women had DC twin pregnancies, and 49 women had MC twin pregnancies. Preterm delivery rates were significantly higher in the MC twin reduction group than in the DC twin reduction group prior to 37 weeks (53.1% vs. 29.5%, P = 0.004). The mean gestational age at delivery of the foetuses in the DC twin group that underwent SR was significantly older than that of those in the MC twin group that underwent SR (36.9 ± 4.0 vs. 33.5 ± 6.6 weeks, P = 0.001). The number of DC twins that underwent SR and were delivered after 37 weeks was obviously greater than that of the MC twins that underwent SR (70.5% vs. 46.9%, P = 0.004). The foetal survival rate was 95.5% in the DC twin reduction group and 77.6% in the MC twin reduction group. If the indication of TTTS was not included, there was no significant difference in the foetal survival rate of the DC and MC twin reduction groups (95.5% vs. 86.2%, P = 0.160). Cotwin death 1 week after reduction was greater in the MC group (6.1% vs. 0%, P = 0.027). Compared to other indications, this finding indicated that a significantly lower proportion of women remained undelivered after selective reduction with the indication of TTTS. There was a significant negative correlation between the reduction weeks and delivery weeks of the two groups (P < 0.01), and the best opportunity for reduction was before 22 weeks of gestation.
CONCLUSION
These findings highlighted an obviously negative correlation between the reduction week and delivery week. The transabdominal selective reduction of twin pregnancy should be considered for a lower rate of miscarriage or premature delivery if the reduction week takes place earlier in pregnancy. The rate of preterm delivery was the lowest when transabdominal selective reduction was completed before 22 weeks of gestation. Compared with other RFA indications, a higher rate of premature delivery was shown for MC twins with a reduction indication of TTTS. TTTS with sIUGR might be one of the reasons for the adverse outcomes of reduction for MC twin pregnancy.
Topics: Female; Gestational Age; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy, Twin; Premature Birth; Retrospective Studies; Twins, Dizygotic; Twins, Monozygotic
PubMed: 35585573
DOI: 10.1186/s12884-022-04754-4 -
Medical Anthropology Quarterly Jun 2018This article explores the way that surrogacy and normal pregnancy share cultural assumptions about pregnancy. Through a juxtaposition of our ethnographic studies of two...
This article explores the way that surrogacy and normal pregnancy share cultural assumptions about pregnancy. Through a juxtaposition of our ethnographic studies of two groups of Jewish-Israeli women-women who have undergone "normal," low-risk pregnancies and women who have given birth as gestational surrogates-we argue that surrogacy and pregnancy emerge as potent metaphors for one another. Both pregnant women and surrogates divided their bodies into two separate realms: fetus and maternal pregnant body. Both trivialized the effect of gestational influence on fetal health, making the fetus seem detached from gestational capacities of the mother. We argue for closer scrutiny of the way local cultural priorities and experiences of pregnancy shape surrogacy and for bringing the scholarship on pregnancy and on surrogacy into deeper conversation.
Topics: Adult; Anthropology, Medical; Female; Humans; India; Israel; Pregnancy; Surrogate Mothers; Ultrasonography, Prenatal
PubMed: 29023968
DOI: 10.1111/maq.12419 -
BMC Pregnancy and Childbirth Mar 2024Unplanned pregnancy is common, and although some research indicates adverse outcomes for the neonate, such as death, low birth weight, and preterm birth, results are...
BACKGROUND
Unplanned pregnancy is common, and although some research indicates adverse outcomes for the neonate, such as death, low birth weight, and preterm birth, results are inconsistent. The purpose of the present study was to investigate associated neonatal outcomes of an unplanned pregnancy in a Swedish setting.
METHODS
We conducted a retrospective cohort study in which data from 2953 women were retrieved from the Swedish Pregnancy Planning Study, covering ten Swedish counties from September 2012 through July 2013. Pregnancy intention was measured using the London Measurement of Unplanned Pregnancy. Women with unplanned pregnancies and pregnancies of ambivalent intention were combined and referred to as unplanned. Data on neonatal outcomes: small for gestational age, low birth weight, preterm birth, Apgar score < 7 at 5 min, and severe adverse neonatal outcome defined as death or need for resuscitation at birth, were retrieved from the Swedish Medical Birth Register.
RESULTS
The prevalence of unplanned pregnancies was 30.4%. Compared with women who had planned pregnancies, those with unplanned pregnancies were more likely to give birth to neonates small for gestational age: 3.6% vs. 1.7% (aOR 2.1, 95% CI 1.2-3.7). There were no significant differences in preterm birth, Apgar score < 7 at 5 min, or severe adverse neonatal outcome.
CONCLUSIONS
In a Swedish setting, an unplanned pregnancy might increase the risk for birth of an infant small for gestational age.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Child, Preschool; Pregnancy Outcome; Premature Birth; Retrospective Studies; Infant, Low Birth Weight; Pregnancy, Unplanned
PubMed: 38493168
DOI: 10.1186/s12884-024-06401-6 -
Hong Kong Medical Journal = Xianggang... Dec 2019The popularity of in vitro fertilisation has continuously increased throughout the past 40 years owing to an increased incidence of infertility and delayed planning for... (Review)
Review
The popularity of in vitro fertilisation has continuously increased throughout the past 40 years owing to an increased incidence of infertility and delayed planning for pregnancy. The aim of this paper is to review the current situation of in vitro fertilisation in Hong Kong. In Hong Kong, in 2018, 7995 women underwent 5055 fresh and 5050 frozen-thawed embryo in vitro fertilisation cycles, resulting in an ongoing pregnancy rate of 33.7% per transfer. However, in vitro fertilisation is associated with several problems, including a high rate of multiple pregnancies and risks associated with cross-border reproductive care. Single embryo transfer is a simple strategy to reduce multiple pregnancies without compromising the cumulative live birth rate.
Topics: Adult; Female; Fertilization in Vitro; Hong Kong; Humans; Pregnancy; Pregnancy Outcome
PubMed: 31796641
DOI: 10.12809/hkmj198057 -
Chimerism 2013Fetal cells transfer to the mother during pregnancy and can persist long-term as microchimerism. Acquisition of microchimerism may also occur during pregnancy loss,...
Fetal cells transfer to the mother during pregnancy and can persist long-term as microchimerism. Acquisition of microchimerism may also occur during pregnancy loss, either miscarriage or pregnancy termination. Because nearly half of all pregnancies end in loss, we recently investigated the magnitude of fetal cell transfer during pregnancy loss and whether obstetric clinical factors impacted cell transfer. Prospective measurement of fetal cellular microchimerism before and after miscarriage and termination of pregnancy demonstrated a significant transfer of fetal cells in these pregnancies, with higher concentrations of fetal microchimerism in pregnancy termination vs. miscarriage and in those that were managed surgically vs. medically. The frequency of pregnancy loss as a proportion of all pregnancies, and the overrepresentation of fetal genetic abnormalities in pregnancy loss suggest that the resultant acquisition of fetal microchimerism could have a unique and substantial impact on women's health.
Topics: Abortion, Induced; Abortion, Spontaneous; Chimerism; Female; Fetus; Humans; Male; Maternal-Fetal Exchange; Pregnancy; Prospective Studies
PubMed: 23723084
DOI: 10.4161/chim.24915