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Park JY, Lee KN, Kim HJ, Choe K, Cho A, Kim B, Seo J, Kwon H, Kim JW, Bae JG, Sung JH, Lee SJ, Jung YM, Han YJ, Hong S, Chung JH, Won HS, Jun JK. Pregnancy outcomes of cerclage in twin gestations: a multicenter retrospective cohort study. J Matern Fetal Neonatal Med 2024; 37:2355495. [PMID: 38880661 DOI: 10.1080/14767058.2024.2355495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/10/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVES To determine the effects of cerclage on twin pregnancies. METHODS A multicenter, retrospective, cohort study was conducted at 10 tertiary centers using a web-based data collection platform. The study population included twin pregnancies delivered after 20 weeks of gestation. Patients with one or two fetal deaths before 20 weeks of gestation were excluded. Maternal characteristics, including prenatal cervical length (CL) and obstetric outcomes, were retrieved from the electronic medical records. RESULTS A total of 1,473 patients had available data regarding the CL measured before 24 weeks of gestation. Seven patients without CL data obtained prior to cerclage were excluded from the analysis. The study population was divided into two groups according to the CL measured during the mid-trimester: the CL ≤2.5 cm group (n = 127) and the CL >2.5 cm group (n = 1,339). A total of 127 patients (8.7%) were included in the CL ≤2.5 cm group, including 41.7% (53/127) who received cerclage. Patients in the CL >2.5 cm group who received cerclage had significantly lower gestational age at delivery than the control group (hazard ratio (HR): 1.8; 95% confidence interval (CI): 1.11-2.87; p = .016). Patients in the CL ≤2.5 cm group who received cerclage had a significantly higher gestational age at delivery than the control group (HR: 0.5; 95% CI: 0.30-0.82; p value = .006). CONCLUSIONS In twin pregnancies with a CL ≤2.5 cm, cerclage significantly prolongs gestation. However, unnecessary cerclage in women with a CL >2.5 cm may result in a higher risk of preterm labor and histologic chorioamnionitis although this study has a limitation originated from retrospective design.
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Affiliation(s)
- Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyong-No Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hyeon Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kiroong Choe
- Department of Computer Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Aeri Cho
- Department of Computer Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Bohyoung Kim
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea
| | - Jinwook Seo
- Department of Computer Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Hayan Kwon
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Woon Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Gon Bae
- Department of Obstetrics and Gynecology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Jin Lee
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Young Mi Jung
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - You Jung Han
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Subeen Hong
- Department of Obstetrics and Gynecology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Hoon Chung
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Huang L, Wang W, Wang Y, Chen J, Jin S, Qi X, Qian Y, Cheng Q. Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: a retrospective study from a single centre. BMC Pregnancy Childbirth 2024; 24:467. [PMID: 38977997 PMCID: PMC11229292 DOI: 10.1186/s12884-024-06659-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/25/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVE Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality worldwide, and cervical incompetence (CIC) is a significant contribution. Cervical cerclage (CC) is an effective obstetric intervention. However, many clinical factors affect the success rate of surgery. The objective was to investigate and compare the pregnancy and neonatal outcomes of patients who underwent ultrasound- and physical examination-indicated cervical cerclage and to explore the influencing factors of preterm delivery before 34 weeks. METHODS The sociodemographic characteristics and clinical data of patients with a diagnosis of cervical incompetence who underwent ultrasound- and physical examination-indicated transvaginal cervical cerclage at Nanjing Maternal and Child Health Hospital from January 2020 to December 2022 were retrospectively analyzed. The pregnancy and neonatal outcomes of the patients were evaluated. Continuous variables were compared using Student's t test (for normally distributed data) or the Mann-Whitney U test (for nonnormally distributed data). Categorical variables were analysed using the chi-square test or Fisher's exact test. Additionally, logistic regression analyses and receiver operating characteristic curves were used to evaluate the associations of inflammatory markers with maternal and neonatal outcomes. RESULTS This study included 141 participants who underwent cervical cerclage, including 71 with ultrasound-indicated cerclage and 70 with physical examination-indicated cerclage. Compared to those in the ultrasound-indicated cerclage group, the duration from cerclage to delivery, birth weight, and APGAR score in the physical examination-indicated cerclage group were significantly lower, and the rates of delivery at < 28 weeks, < 32 weeks, < 34 weeks, and < 37 weeks of gestation and neonatal mortality were significantly higher (all P < 0.05). Compared to those in the physical ultrasound-indicated cerclage group, in the physical examination-indicated cerclage group, maternal blood inflammatory markers, such as C-reactive protein (CRP), the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI) were significantly higher (P < 0.05). Additionally, maternal blood inflammatory markers, such as the CRP, white blood cell count, platelet to lymphocyte ratio (PLR), SII, and SIRI were significantly higher in the group with delivery before 34 weeks of gestation. Furthermore, the results demonstrated that twin pregnancy had the highest OR for preterm delivery before 34 weeks of gestation (OR = 3.829; 95% CI 1.413-10.373; P = 0.008), as well as the following: the SII level (OR = 1.001; 95% CI 1.000-1.002; P = 0.003) and CRP level (OR = 1.083; 95% CI 1.038-1.131; P = 0.022). The risk factors for preterm delivery before 34 weeks of gestation were twin gestation, an increased SII level and an increased CRP level, which had good combined predictive value. CONCLUSION In patients with cervical insufficiency, ultrasound-indicated cervical cerclage appears to lead to better pregnancy outcomes than physical examination-indicated cerclage. Twin pregnancy and maternal blood inflammatory markers, such as the CRP level and the SII, are associated with preterm delivery before 34 weeks of gestation.
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Affiliation(s)
- Linxiang Huang
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Wenting Wang
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China
| | - Yuchuan Wang
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China
| | - Jie Chen
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China
| | - Shuping Jin
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China
| | - Xiaoxuan Qi
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China
| | - Yujia Qian
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China.
| | - Qing Cheng
- Department of Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, 210004, China.
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Miao H, He H, Nie C, Ren J, Luo X. Spatiotemporal Characteristics and Risk Factors for All and Severity-Specific Preterm Births in Southern China, 2014-2021: Large Population-Based Study. JMIR Public Health Surveill 2024; 10:e48815. [PMID: 38888944 PMCID: PMC11220432 DOI: 10.2196/48815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/17/2023] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The worldwide incidence of preterm births is increasing, and the risks of adverse outcomes for preterm infants significantly increase with shorter gestation, resulting in a substantial socioeconomic burden. Limited epidemiological studies have been conducted in China regarding the incidence and spatiotemporal trends of preterm births. Seasonal variations in risk indicate the presence of possible modifiable factors. Gender influences the risk of preterm birth. OBJECTIVE This study aims to assess the incidence rates of preterm birth, very preterm birth, and extremely preterm birth; elucidate their spatiotemporal distribution; and investigate the risk factors associated with preterm birth. METHODS We obtained data from the Guangdong Provincial Maternal and Child Health Information System, spanning from January 1, 2014, to December 31, 2021, pertaining to neonates with gestational ages ranging from 24 weeks to 42 weeks. The primary outcome measures assessed variations in the rates of different preterm birth subtypes over the course of the study, such as by year, region, and season. Furthermore, we examined the relationship between preterm birth incidence and per capita gross domestic product (GDP), simultaneously analyzing the contributing risk factors. RESULTS The analysis incorporated data from 13,256,743 live births. We identified 754,268 preterm infants and 12,502,475 full-term infants. The incidences of preterm birth, very preterm birth, and extremely preterm birth were 5.69 per 100 births, 4.46 per 1000 births, and 4.83 per 10,000 births, respectively. The overall incidence of preterm birth increased from 5.12% in 2014 to 6.38% in 2021. The incidence of extremely preterm birth increased from 4.10 per 10,000 births in 2014 to 8.09 per 10,000 births in 2021. There was a positive correlation between the incidence of preterm infants and GDP per capita. In more developed economic regions, the incidence of preterm births was higher. Furthermore, adjusted odds ratios revealed that advanced maternal age, multiple pregnancies, and male infants were associated with an increased risk of preterm birth, whereas childbirth in the autumn season was associated with a protective effect against preterm birth. CONCLUSIONS The incidence of preterm birth in southern China exhibited an upward trend, closely linked to enhancements in the care capabilities for high-risk pregnant women and critically ill newborns. With the recent relaxation of China's 3-child policy, coupled with a temporary surge in advanced maternal age and multiple pregnancies, the risk of preterm birth has risen. Consequently, there is a pressing need to augment public health investments aimed at mitigating the risk factors associated with preterm birth, thereby alleviating the socioeconomic burden it imposes.
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Affiliation(s)
- Huazhang Miao
- Department of Healthcare, Guangdong Women and Children Hospital, Guangzhou, China
| | - Hui He
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Guangdong Women and Children Hospital, Guangzhou, China
| | - Chuan Nie
- Neonatology Department, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jianbing Ren
- Neonatology Department, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xianqiong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Guangdong Women and Children Hospital, Guangzhou, China
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Li J, Yang S, Zou L, Liu X, Deng D, Huang R, Hua L, Wu Q. Cervical elastography: finding a novel predictor for improving the prediction of preterm birth in uncomplicated twin pregnancies. Arch Gynecol Obstet 2024; 309:2401-2410. [PMID: 37368143 DOI: 10.1007/s00404-023-07105-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE This study set out to investigate a novel ultrasound parameter using cervical elastosonography for improving the prediction of spontaneous preterm birth (sPTB) in twin pregnancies. STUDY DESIGN The study was comprised of 106 twin pregnancies from October 2020 to January 2022 in Beijing Obstetrics and Gynecology Hospital. They were divided into two groups according to gestational age (GA) at delivery (delivery < 35 weeks and delivery ≥ 35 weeks). There were five elastographic parameters: Elasticity Contrast Index (ECI), Cervical Hardness Ratio (CHR), Closed Internal cervical ostium Strain rate (CIS); External cervical ostium strain rate (ES), CIS/ES ratio and Cervical Length (CL). All of the clinical and ultrasonic indicators with P < 0.1 were considered candidate indicators via univariate logistic regression. Based on the extracted unified combination of clinical indicators, the combinations of permutation with the candidate ultrasound indicators were performed step by step in multivariable logistic regression. The best ultrasound indicator with the lowest Akaike Information Criterion (AIC) and the highest Areas Under the receiver operating characteristic Curve (AUC) was chosen for establishing the prediction score. RESULTS Over 30% (36/106) of those who delivered before 35 weeks gestation. There were distinct differences in the clinical characteristics and cervical elastography parameters between the two groups. Seven major clinical variables were identified as a unified clinical indicator. CISmin as the best ultrasound elastography predictor indicated the lowest AIC and the highest AUC and outperformed alternative indicators significantly in the prediction of delivery before 35 weeks of gestation. Unfortunately, CLmin which was commonly used in clinical practice ranked far from all of the cervical elastography parameters and presented the highest AIC and the lowest AUC. A preliminary scoring rule was established and the ability to predict the risk of sPTB in twin pregnancies was improved (Accuracy: 0.896 vs 0.877; AIC: 81.494 vs 91.698; AUC: 0.923 vs 0.906). CONCLUSIONS The cervical elastosonography predictor such as CISmin might be a more useful indicator applied for enhancing the ability in predicting twin pregnancies preterm birth than CL. Furthermore, there would be more benefits for advancing clinical decision-making in actual clinical practice by using cervical elastosonography in the near future.
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Affiliation(s)
- Jinghua Li
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Shufa Yang
- Department of Prenatal Diagnostic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Liying Zou
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Xiaowei Liu
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Di Deng
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Ruizhen Huang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Lin Hua
- Capital Medical University of Biomedical Engineering, Beijing, 100069, China.
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
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Roero S, Benedetto G, Charrier L, Ingala A, Ronco A, Fea T, Borgarello V, Bossotti C, Arduino S, Revelli A. Is the Early Screening of Lower Genital Tract Infections Useful in Preventing Adverse Obstetrical Outcomes in Twin Pregnancy? J Clin Med 2024; 13:2673. [PMID: 38731202 PMCID: PMC11084808 DOI: 10.3390/jcm13092673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Objectives: Twin pregnancy implies a higher risk of preterm birth and, consequently, higher neonatal morbidity and mortality. In singleton pregnancies, infections of the lower genital tract (LGTIs) and bacterial vaginosis are associated with preterm labor, and their early detection has been proven effective in reducing complications like the preterm premature rupture of membranes (pPROM) and preterm delivery. The same evidence, however, is lacking for twin pregnancies. This study aimed to evaluate whether the early identification and treatment of LGTIs or bacterial vaginosis in asymptomatic women with twin pregnancy could reduce the rate of miscarriages, pPROM, and preterm birth. Methods: This study performed a retrospective comparison of 285 women with a multiple pregnancy submitted for a cervico-vaginal swab only at 20-22 weeks (Single Test Group, STG), and 199 women who underwent the swab at 12-14 and again at 20-22 weeks (Double Test Group, DTG). All women included in the study had a twin pregnancy and were followed up at Sant'Anna Hospital, Turin (Italy), between September 2012 and February 2021. Results: In STG, 21.7% of patients had a positive swab; in DTG, 19.9% had an early positive swab that was immediately treated by targeted antibiotics; and 16.7% had a mid-pregnancy positive swab. The DTG showed a significantly lower incidence of pPROM in univariate analysis (14.4% vs. 23.1%, p = 0.021), which was confirmed by multivariate analysis (OR 0.55, CI 0.33-0.93, p = 0.025). Conclusions: Our study suggests that, in asymptomatic women with twin pregnancy, the early screening of LGTIs and bacterial vaginosis by a cervico-vaginal swab at 12-14 weeks of gestational age is effective in reducing the risk of pPROM.
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Affiliation(s)
- Sofia Roero
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant’Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy
| | - Giulia Benedetto
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant’Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy
| | - Lorena Charrier
- Departement of Public Health and Pediatrics, A.O.U. Città della Salute e della Scienza, University of Turin, Via Santena 5, 10126 Turin, Italy
| | - Agata Ingala
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant’Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy
| | - Alice Ronco
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant’Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy
| | - Teresa Fea
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant’Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy
| | - Valentina Borgarello
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant’Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy
| | - Carlotta Bossotti
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant’Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy
| | - Silvana Arduino
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant’Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy
| | - Alberto Revelli
- Twin Pregnancy Care Unit, Gynecology and Obstetrics 2U, A.O.U. Città della Salute e della Scienza, Sant’Anna Hospital, University of Turin (Department of Surgical Sciences), Via Ventimiglia 1, 10126 Turin, Italy
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6
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Wu T, Li S, Gong X, Li J, Li X, Zhai Y, Huang J, Li X, Li L, Yang J, Wang X, Shi H, Yuan P, Zhao Y, Wei Y. Longitudinal Cervical Length Measurements and Spontaneous Preterm Birth in Singleton and Twin Pregnancies. JAMA Netw Open 2024; 7:e244592. [PMID: 38602679 PMCID: PMC11009824 DOI: 10.1001/jamanetworkopen.2024.4592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/23/2024] [Indexed: 04/12/2024] Open
Abstract
Importance Changes in cervical length in twin pregnancies exhibit various patterns, but it is unclear whether the mechanism underlying spontaneous preterm birth (sPTB) is consistent. The existence of detailed phenomena in singleton pregnancies is also unclear. Objectives To explore the different patterns in cervical length trajectories in singleton and twin pregnancies and to analyze whether the immunological mechanisms of sPTB are consistent among these cervical length patterns. Design, Setting, and Participants This cohort study recruited pregnant individuals who received antenatal care and delivered at Peking University Third Hospital in Beijing, China, between January 1, 2014, and December 31, 2022. Individuals with singleton and twin pregnancies were included. Exposures Cervical length measurements and white blood cell (WBC) indicators. Main Outcomes and Measures The primary outcome was sPTB. Longitudinal trajectory cluster analysis was used to identify patterns of changes in cervical length in singleton and twin pregnancies. A random-effects model with cubic spline was used to fit and compare the longitudinal trajectory of WBC indicators among early preterm birth, moderate to late preterm birth, and term birth. Results A total of 43 559 pregnant individuals were included; of these, 41 706 had singleton pregnancies (mean [SD)] maternal age, 33.0 [4.0] years) and 1853 had twin pregnancies (mean [SD] maternal age, 33.3 [3.6] years). Two distinct patterns of cervical length changes were observed in both singleton and twin pregnancies: shortened (21 366 singletons and 546 twins) and stable (20 340 singletons and 1307 twins). In singleton pregnancies, WBC count was associated with early sPTB in individuals with both shortened cervix (odds ratio [OR], 1.35; 95% CI, 1.00-1.82) and stable cervix (OR, 1.64; 95% CI, 1.07-2.50). However, for twin pregnancies, the association of WBC count (OR, 3.13; 95% CI, 1.58-6.18) with the risk of early sPTB was observed only in individuals with a shortened cervix. Conclusions and Relevance This study identified 2 distinct cervical length patterns: shortened and stable. These patterns revealed 2 preterm birth mechanisms in twin pregnancies, with the immunopathogenesis of sPTB found only in the shortened cervix pattern; in singleton pregnancies, maternal immune response was associated with a higher risk of sPTB regardless of a shortened or stable cervix.
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Affiliation(s)
- Tianchen Wu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Shuang Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Xiaoli Gong
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Jiaxin Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Xuening Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Yujia Zhai
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Jiaqi Huang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Xiaona Li
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Luyao Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Jing Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Xueju Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Huifeng Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Pengbo Yuan
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Peking University Third Hospital, Beijing, China
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7
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De Vito M, Cetraro J, Capannolo G, Alameddine S, Patelli C, D'Antonio F, Rizzo G. Cervical length as a screening tool for preterm birth in twin pregnancies: a systematic review and critical evaluation of quality clinical practice guidelines. J Perinat Med 2024; 52:262-269. [PMID: 38105222 DOI: 10.1515/jpm-2023-0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/23/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Twin pregnancies are at increased risk of preterm birth (PTB) compared to singletons. Evaluation of cervical length (CL) represents the optimal tool to screen PTB in singleton. Conversely, there is less evidence on the use of CL in twins. Our aim was to evaluate the methodological quality and clinical heterogeneity of clinical practice guidelines (CPGs) on the CL application in twins using AGREE II methodology. METHODS MEDLINE, Scopus, and websites of the main scientific societies were examined. The following aspects were evaluated: diagnostic accuracy of CL, optimal gestational age at assessment and interventions in twin pregnancies with reduced CL. The quality of the published CPGs was carried out using "The Appraisal of Guidelines for REsearch and Evaluation (AGREE II)" tool. The quality of guideline was rated using a scoring system. Each considered item was evaluated by the reviewers on a seven-point scale that ranges from 1 (strongly disagree) to 7 (strongly agree). A cut-off >60 % identifies a CPGs as recommended. RESULTS The AGREE II standardized domain scores for the first overall assessment had a mean of 74 %. The score was more than 60 % in the 66.6 % of CPGs analyzed indicating an agreement between the reviewers on recommending the use of these CPGs. A significant heterogeneity was found; there was no specific recommendation on CL assessment in about half of the published CPGs. There was also significant heterogeneity on the CL cut-off to prompt intervention. CONCLUSIONS Despite the fact that the AGREE II analysis showed that the majority of the included guidelines are of good quality, there was a significant heterogeneity among CPGs as regard as the indication, timing, and cut-off of CL in twins as well as in the indication of interventions.
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Affiliation(s)
- Marika De Vito
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Jessica Cetraro
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Giulia Capannolo
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
| | - Sara Alameddine
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
| | - Chiara Patelli
- Department of Obstetrics and Gynecology, Università di Verona, Verona, Italy
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
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8
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Qiu L, Lv M, Chen L, Chen Z, Shen J, Wang M, Cai Y, Zhao B, Luo Q. Comparison of two emergency cervical cerclage techniques in twin pregnancies: A retrospective cohort study matched with cervical dilation. Int J Gynaecol Obstet 2024; 164:1036-1046. [PMID: 37712448 DOI: 10.1002/ijgo.15081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/05/2023] [Accepted: 08/17/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES This retrospective cohort study aimed to assess the efficacy of emergency cervical cerclage (ECC) performed with the combined McDonald-Shirodkar technique in twin pregnancies between 18 and 26 weeks of pregnancy with painless cervical dilation 1 to 6 cm. METHODS A retrospective cohort study matched with the degree of cervical dilation was conducted. The study group (case group) included women with twin pregnancies undergoing combined McDonald-Shirodkar approach with cervical dilation ≥1 cm between 18 to 26 weeks of gestation at four institutions, from December 2015 to December 2022. To minimize confounding factors, we elucidated the causality structure using a directed acyclic graph and performed 1:1 case-control matching. A control group underwent the McDonald approach. The primary outcome was gestational age (GA) at delivery. The secondary outcomes were pregnancy latency; the rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks; and neonatal outcomes. Additional subanalysis was performed by dividing the patients into two subgroups of women with cervical dilation ≥3 cm and <3 cm. RESULTS A total of 84 twin pregnancies were managed with either the combined McDonald-Shirodkar approach (case group: n = 42) or the McDonald approach (control group: n = 42). Demographic characteristics were not significantly different in the two groups (P > 0.05). After adjusting for confounders that were represented by a directed acyclic graph, median GA at delivery was significantly higher (30.5 vs 27 weeks; Bate: 3.40 [95% confidence interval (CI), 2.13-4.67], P < 0.001) and median pregnancy latency was significantly longer (56 vs 28 days; Bate: 24.04 [95% CI, 13.31-34.78], P < 0.001) in the case group compared with the control group. Rates of spontaneous preterm birth at <28, <30, <32, and <34 weeks were significantly lower in the case group than in the control group. For neonatal outcomes, there was higher birth weight (1543.75 vs 980 g; Bate: 420.08 [95% CI, 192.18-647.98], P < 0.001) and significantly lower overall perinatal mortality (7.1% vs 31%; adjusted odds ratio, 0.16 [95% CI, 0.04-0.70], P = 0.014) in the case group compared with the control group. When cervical dilation was ≥3 cm, the combined McDonald-Shirodkar procedure can significantly reduce perinatal mortality (8.3% vs 46.7%; adjusted odds ratio, 0.09 [95% CI, 0.01-0.77], P = 0.028), significantly decrease the risk of delivery at <28 and <30 weeks, and prolong GA at delivery and pregnancy latency compared with the McDonald procedure. CONCLUSIONS ECC performed with the combined McDonald-Shirodkar procedure in women with twin pregnancies who have cervical dilation 1 to 6 cm in midtrimester pregnancy may reduce the rate of spontaneous preterm birth and improve perinatal and neonatal outcomes compared with the McDonald procedure, especially for twin pregnancies in women with cervical dilation of 3 to 6 cm and prolapsed membranes.
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Affiliation(s)
- Liping Qiu
- Department of Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, China
| | - Min Lv
- Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Lujiao Chen
- Department of Obstetrics, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Zi Chen
- Department of Obstetrics, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Jayan Shen
- Department of Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, China
| | - Minmin Wang
- Department of Obstetrics, The First People's Hospital of Fuyang, Fuyang, Zhejiang, China
| | - Yuliang Cai
- Department of Obstetrics, Shaoxing Maternity & Child Health Care Hospital, Shaoxing, Zhejiang, China
| | - Baihui Zhao
- Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
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Xu W, Ni X, Liu Y, Meng L, Ru P, Gu Z, Yan Y, Yuan W, Su X, Liu M, Duan T. Transvaginal cerclage for prevention of preterm birth in twin pregnancies with cervical dilatation or shortening: A prospective observational study. Int J Gynaecol Obstet 2024; 164:942-950. [PMID: 37621196 DOI: 10.1002/ijgo.15061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To investigate the efficacy of transvaginal cerclage in twin pregnancies with cervical shortening, and to narrow the threshold cervical length for transvaginal cerclage. METHODS This is a prospective cohort study and 177 twin pregnancies with asymptomatic cervical dilatation or cervical length of 15 mm or less between 16+0 and 25+6 weeks of pregnancy were included. Patients independently chose either transvaginal cerclage (n = 129) or no cerclage treatment (n = 48) after being consulted on the risk and potential benefit of transvaginal cerclage. The primary outcome measures were gestational age at delivery and neonatal survival rate. RESULTS Compared with the no cerclage group, the cerclage group exhibited a higher gestational age at delivery (32.1 ± 4.5 vs 28.3 ± 6.2 weeks, P < 0.001) and a higher neonatal survival rate (86.4% vs 47.9%, P < 0.001). Subgroup analysis showed that in twin pregnancies with cervical dilatation or cervical length less than 10 mm, the cerclage group had significantly higher gestational age at delivery (31.3 ± 4.6 vs 23.4 ± 4.3 weeks, P < 0.001) and a higher neonatal survival rate (123 [85.4%] vs 4 [9.1%], P < 0.001) than the no cerclage group, but in twins when cervical length was 10-15 mm, the two measures were similar between the two groups. CONCLUSION Transvaginal cerclage may provide benefits for twins when cervical dilatation or cervical length is less than 10 mm, but its efficacy might not extend to twins when the cervical length is 10-15 mm. Further evidence is needed to confirm the efficacy of transvaginal cerclage for twin pregnancies with a short cervix.
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Affiliation(s)
- Wenyi Xu
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaotian Ni
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yun Liu
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lulu Meng
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ping Ru
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhuorong Gu
- Department of Obstetrics and Gynecology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Yan
- Department of Obstetrics and Gynecology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenjun Yuan
- Department of Obstetrics and Gynecology, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiujuan Su
- Clinical Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ming Liu
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Duan
- Department of Obstetrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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10
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Liping Q, Min L, Chen C, Wang M, Luo Q. Efficacy of emergency cervical cerclage in twin pregnancies and factors affecting the clinical effects of emergency cerclage. J Matern Fetal Neonatal Med 2023; 36:2198632. [PMID: 37031971 DOI: 10.1080/14767058.2023.2198632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVES To estimate clinical effects of emergency cervical cerclage in twin pregnancies with cervical dilation ≥1.0 cm in mid-trimester of gestation and to identify risk factors after cerclage. METHODS This retrospective cohort study included 99 twin pregnancies with cervical dilation ≥1cm in the mid-trimester of gestation at three institutions, from December 2015 through December 2021. The cases were treated with emergency cervical cerclage (52 cases) or expectant management (47 cases). Compare the pregnancy and neonatal outcomes of the two groups. Multiple logistic regression analysis was used to determine the independent risk factors associated with cerclage. RESULTS Cerclage placement was associated with significantly longer gestation age and prolongation of the gestational latency (p < .05). In the cases, compared to expectant treatments, spontaneous preterm birth (sPTB) at <26, <28, <30, <32 weeks was significantly less frequent (p < .05). Pre-operation WBC > 11.55 × 109/L, CRP > 10.1 and cervical dilation >3.5 cm were found to be independent risk factors for delivery 28 weeks after cerclage. CONCLUSIONS Cervical cerclage in twin pregnancies with cervical dilation ≥1.0 cm in mid-trimester of gestation may prolong pregnancy and gestation age, and improve pregnancy and neonatal outcomes compared with expectant management. The strongest predictor of sPTB before 28 weeks after ECC were pre-operation WBC >11.55 × 109/L, CRP > 10.1 and cervical dilation >3.5 cm.
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Affiliation(s)
- Qiu Liping
- Department of Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, China
| | - Lv Min
- Department of Obstetrics, Women's Hospital, Zhejiang university, School of Medicine, Hangzhou, Zhejiang, China
| | - Cheng Chen
- Department of Obstetrics, Women's Hospital, Zhejiang university, School of Medicine, Hangzhou, Zhejiang, China
| | - Minmin Wang
- Department of Obstetrics, The First People's Hospital of Fuyang, Hangzhou, Zhejiang, China
| | - Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang university, School of Medicine, Hangzhou, Zhejiang, China
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11
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Pi Z, Chen Y, Nie Z, Peng J, Jiang Z. Association between pre-pregnancy body mass index and the risk of preterm birth: a mediating effect of hypertensive disorders of pregnancy. J Matern Fetal Neonatal Med 2023; 36:2224489. [PMID: 37365012 DOI: 10.1080/14767058.2023.2224489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/29/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE We aim to explore the mediating effect of hypertensive disorders of pregnancy (HDP) on the relationship between pre-pregnancy body mass index (BMI) and the risk of preterm birth (PTB) in women with singleton live births. METHODS Demographic and clinical data of 3,249,159 women with singleton live births were extracted from the National Vital Statistics System (NVSS) database in this retrospective cohort study. The associations between pre-pregnancy BMI and HDP, HDP, and PTB, and pre-pregnancy BMI and PTB were evaluated using univariate and multivariate logistic regression analyses, with odds ratios (ORs) and 95% confidence intervals (CIs). Structural equation modeling (SEM) was used to explore the mediating effect of HDP on the relationship between pre-pregnancy BMI and PTB. RESULTS In total, 324,627 women (9.99%) had PTB. After adjustment for covariables, there were significant associations between pre-pregnancy BMI and HDP [OR = 2.07, 95% CI: 2.05-2.09)], HDP and PTB [OR = 2.54, 95% CI: (2.52-2.57)], and pre-pregnancy BMI and PTB [OR = 1.03, 95% CI: 1.02-1.03)]. The effect of pre-pregnancy BMI on PTB was significantly mediated by HDP with a mediation proportion of 63.62%, especially in women of different ages and having gestational diabetes mellitus (GDM) or not. CONCLUSION HDP may play a mediating role in the effect of pre-pregnancy BMI on PTB risk. Women preparing for pregnancy should pay close attention to BMI, and pregnant women should monitor and develop interventions for HDP to reduce the risk of PTB.
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Affiliation(s)
- Zixin Pi
- Department of Obstetrics and Gynecology, The First People's Hospital of Jiangxia District, Wuhan City. Union Jiangnan Hospital Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Yinghui Chen
- Department of Obstetrics and Gynecology, Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong, P.R. China
| | - Zhimin Nie
- Department of Science and Education, The First People's Hospital of Jiangxia District, Wuhan City. Union Jiangnan Hospital Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Jing Peng
- Department of Obstetrics and Gynecology, The First People's Hospital of Jiangxia District, Wuhan City. Union Jiangnan Hospital Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Zhaoyang Jiang
- Department of Obstetrics and Gynecology, Shenzhen Maternity &Child Healthcare Hospital, Shenzhen, Guangdong, P.R. China
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12
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Jiang Y, Du Y, Su R, Zhou X, Wei L, Zhang J, Zhu S, Zhang H, Fang C, Chen Y, Gao P, Zhang L, Wang S, Yu J, He M, Ding W, Feng L. Long-term outcomes of offspring from multiple gestations: a two-sample Mendelian randomization study on multi-system diseases using UK Biobank and FinnGen databases. J Transl Med 2023; 21:608. [PMID: 37684631 PMCID: PMC10492369 DOI: 10.1186/s12967-023-04423-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/05/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Assisted reproductive technologies (ART) have increased the incidence of multiple births, which can have a negative impact on maternal and offspring health. The study aimed to investigate the association between genetically predicted multiple birth and the risk of 42 common diseases of the nervous, psychiatric, cardiovascular, respiratory, digestive, and endocrine systems. METHODS The study utilized two-sample Mendelian randomization (MR) analysis to explore the potential causal relationship between genetically predicted multiple birth and the genetically predicted risk of diseases. The study used the FinnGen and UK Biobank datasets for analysis. RESULTS The study found no significant causal relationship between multiple birth and psychiatric disorders. However, the lower limits of the 95% confidence intervals for bipolar affective disorder and anxiety disorders were not robust, indicating a need for further investigation. The study found that multiple birth may be a strong risk factor for infantile cerebral palsy, and caution is necessary in both natural and ART multiple births. The study revealed a potential causal relationship between multiple birth and coronary heart disease, ischemic heart disease, and deep vein thrombosis, which may be related to abnormal intrauterine environments in multiple pregnancies. Surprisingly, multiple birth appears to have a protective effect against some respiratory diseases, such as chronic obstructive pulmonary disease and asthma. CONCLUSIONS The study highlights the need for caution regarding the risk of infantile cerebral palsy, cardiovascular diseases, and psychiatric disorders in multiple birth. Our study can lead to the development of preventive strategies and improved clinical management for affected infants.
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Affiliation(s)
- Yi Jiang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yuanyuan Du
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Rui Su
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Xuan Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Lijie Wei
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Jingyi Zhang
- Department of Obstetrics and Gynecology Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Shenglan Zhu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Huiting Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Chenyun Fang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yuting Chen
- Department of Obstetrics and Gynecology Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Peng Gao
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Liangnan Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Shaoshuai Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Jun Yu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Mengzhou He
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Wencheng Ding
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China.
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, Hubei, China.
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Michalopoulos S, Tsikouras P, Varlami V, Lambrinos D, Bothou A, Nikolettos K, Papanikolopoulou S, Marinos G, Iatrakis G, Nikolettos N. Retrospective Study of the Correlation Between Twin Pregnancies and Perinatal Outcome in Association to the Impact of Preterm Birth. Mater Sociomed 2023; 35:215-221. [PMID: 37795161 PMCID: PMC10545924 DOI: 10.5455/msm.2023.35.215-221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Background Twin pregnancies make up 2% to 4% of all births. Incidence of spontaneous twin pregnancies varies around the world, with percentages ranging from 8/1000 to >17/1000 births. The variation in twin pregnancy rates is thought to be due to dizygotic pregnancies, since monozygotic pregnancies have a consistent incidence of 3.5/1000 to 4/1000 births. The incidence of twin pregnancies after the widespread use of assisted reproduction has increased significantly. Objective The purpose of the present study is to investigate factors , who contribute to improve the perinatal outcome in twin pregnancies. Support will be provided by the results of twin pregnancies by the Department of Obstetrics and Gynaecology of Demokrition University of Thrace (Alexandroupolis, Greece) in the last fifteen years. Methods From the above Department, data were collected on the number of twin pregnancies, maternal age, gestational age, mode of delivery (spontaneous delivery or caesarean section), birth weight and rate of twin pregnancies with assisted reproduction. Results The results showed the increasing trend of twin pregnancies and births. A total of 304 twin pregnancies were identified (rate 2.75%). The rate of assisted reproduction was 34.83% in our sample, while the rate of cesarean deliveries was 95.5%, showing a large increase in recent years. In ten cases, normal delivery was successfully performed. The gestational age in twin pregnancies that ended with normal delivery was 37.37 + 3 weeks and the fetuses were both cephalic presentations. The main reason for admission of newborns to the NICU Department was prematurity. Conclusion The constantly improving education of perinatalists and understanding of the pathophysiology may lead to individualization of their treatment, and improvement of their prognosis based on recent scientific data from other international centers.
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Affiliation(s)
| | | | - Vassiliki Varlami
- Neonatal Intensive Care Unit of University Hospital Alexandroupolis, Greece
| | | | - Anastasia Bothou
- Department of Obstetrics and Gynecology, Democritus Univesity of Thrace, Greece
| | | | | | - Georgios Marinos
- Georgios Marinos, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Iatrakis
- Department of Obstetrics and Gynecology, Democritus Univesity of Thrace, Greece
| | - Nikolaos Nikolettos
- Department of Obstetrics and Gynecology, Democritus Univesity of Thrace, Greece
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14
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Lee SU, Jung G, Kim HW, Ko HS. How to screen the cervix and reduce the risk of spontaneous preterm birth in asymptomatic women without a prior preterm birth. Obstet Gynecol Sci 2023; 66:337-346. [PMID: 37439085 PMCID: PMC10514583 DOI: 10.5468/ogs.23022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/16/2023] [Accepted: 06/13/2023] [Indexed: 07/14/2023] Open
Abstract
Preterm birth (PTB) is a leading cause of perinatal morbidity and mortality globally. PTB rates have increased in South Korea despite reduction in birth rates. A history of PTB is a strong predictor of subsequent PTB and screening of cervical length between 16 0/7 weeks and 24 0/7 weeks of gestation is recommended in women with a singleton pregnancy and a prior spontaneous PTB. However, the prediction and prevention of spontaneous PTBs in women without a prior PTB remain a matter of debate. The scope of this review article comprises cervical screening and prevention strategies for PTB in asymptomatic women without a prior PTB, based on recent evidence and guidelines.
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Affiliation(s)
- Seon Ui Lee
- Department of Obstetrics and Gynecology, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
| | - Gyul Jung
- Department of Obstetrics and Gynecology, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
| | - Han Wool Kim
- Department of Obstetrics and Gynecology, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
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15
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Lin N, Shen P, Hu H, Song W, Hu Y, Dai Y, Zhou YH. Maternal and Neonatal Outcomes of Twin Pregnant Women With Anemia. Twin Res Hum Genet 2023:1-6. [PMID: 37650223 DOI: 10.1017/thg.2023.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The aim of this study was to investigate the prevalence of anemia in twin pregnancies and the influence of anemia on maternal and neonatal outcomes. This retrospective study included twin pregnant women who delivered in a tertiary hospital in China from January 2018 to December 2018. Patients were divided by WHO criteria (hemoglobin <11.0 g/dL): the anemic and nonanemic groups. Patients with anemia were further classified as recovered or unrecovered subgroup after oral iron therapy. Maternal and neonatal outcomes in women carrying twins were compared using Student's t test and the chi-squared test or the Fisher exact test. Univariable and multivariable logistic regression models were used to determine the association of maternal and neonatal characteristics with anemia. Linear regression analysis was used to estimate mean birth weight and gestational week. The prevalence of anemia was 42.6% (182/427) in twin pregnancies. The anemic group had higher rates of low 1-minute Apgar score (4.4% vs. 1.8%, p = .028), perinatal death (1.9% vs. 0.2%, p = .012) and neonatal intensive care unit (NICU) admission (27.2% vs. 20.2%, p = .017; adjusted OR, 1.478; 95% CI [1.07, 2.044]). The recovered subgroup had lower NICU admission rate (13.5% vs. 30.3%, p = .006; OR, 0.388; 95% CI [0.186, 0.809]), higher gestational week and birth weight (β, 0.954 week; 95% CI [0.114, 1.794] and β, 171.01 g; 95% CI [9.894, 332.126] respectively). The prevalence of anemia in twin gestation is high. Anemia is associated with adverse neonatal outcomes, and correction of anemia significantly improved the pregnancy outcomes.
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Affiliation(s)
- Nacheng Lin
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ping Shen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Huilian Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Wenying Song
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yimin Dai
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yi-Hua Zhou
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
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Gulersen M, Blitz MJ, Lenchner E, Lal T, Rochelson B, Bornstein E. Time interval to delivery in asymptomatic twin pregnancies with a short cervix at 23-28 weeks' gestation. J Perinat Med 2022; 51:510-516. [PMID: 36279186 DOI: 10.1515/jpm-2022-0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the risk and timing of spontaneous preterm birth (PTB) in asymptomatic twin pregnancies with a short cervical length (CL≤25 mm) at 23-28 weeks of gestation. METHODS Multicenter retrospective cohort study of asymptomatic twin pregnancies with a short CL between 23 and 28 weeks' gestation within a university health system from 1/2012 to 12/2019. Cases were divided into 4 groups based on CL measurement (≤10 mm, 11-15 mm, 16-20 mm, and 21-25 mm). The primary outcome was time interval from presentation to delivery. Secondary outcomes included delivery within one and two weeks of presentation, and delivery prior to 32, 34, and 37 weeks, respectively. RESULTS 104 patients were included. The time interval from presentation to delivery was significantly different among the four groups (p<0.001), with the CL≤10 mm group having the shortest time interval to delivery. Regardless of the CL measurement, spontaneous PTB within one and two weeks was extremely uncommon and occurred in only one patient within the study cohort (1/104, 1.0%). The risk of spontaneous PTB was highest in the shortest CL group (CL ≤ 10 mm; 53.8% PTB<32 weeks, 61.5% PTB<34 weeks, 92.3% PTB<37 weeks). CONCLUSIONS Asymptomatic twin pregnancies with a CL ≤ 10 mm had the shortest time interval to delivery and thus represent a specifically high risk group for sPTB. Although all patients were at high risk of sPTB, only one delivered within 1 or 2 weeks of presentation.
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Affiliation(s)
- Moti Gulersen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Matthew J Blitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, South Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Bay Shore, NY, USA
| | - Erez Lenchner
- Biostatistics and Data Management, New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Tara Lal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Burton Rochelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Eran Bornstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital -Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
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