Multiple pregnancy, fetal reduction and selective termination

Comparison of neonatal outcomes between multiples and singletons among very low birth weight infants: the Korean Neonatal Network cohort study

OBJECTIVE

To compare neonatal outcomes between multiples and singletons among very low birth weight infants, this was a prospective cohort study that was conducted by collecting data registered in the Korean Neonatal Network database.

METHODS

From January 2013 to December 2016, there were 8265 infants in the Korean Neonatal Network database, and 2958 of them were from multiples. Among them, 2636 infants were twins, 308 infants were triplets, and 14 infants were quadruplets. Maternal and neonatal variables including and mortality major morbidity were compared. Finally, the predicted rates of major morbidity between singletons and multiples.

RESULTS

Multiples had higher gestational age, birth weight, Apgar score at 5 min, rates of cesarean section and artificial reproductive technology but lower maternal hypertension, oligohydramnios, chorioamnionitis rates and Clinical Risk Index for Babies scores II without base excess than the singletons. In univariate analysis, multiples had a lower incidence of respiratory distress syndrome, bronchopulmonary dysplasia, and sepsis. The mortality rate was not significantly different for overall gestational ages except for those born at ≤26 weeks of gestation. In multivariate logistic analysis, the incidences of intraventricular hemorrhage (grade ≥3), and retinopathy of prematurity requiring treatment were significantly higher than the singletons.

CONCLUSIONS

Mortality was not significantly different between multiples and singletons according to overall gestational age, except for multiples born at ≤26 weeks. A significant higher risk of intraventricular hemorrhage and retinopathy of prematurity requiring treatment was found in multiples. A new strategy to improve the mortality of immature multiples born at ≤26 weeks of gestation should be developed.

A Costly Choice? In Vitro Fertilization and Those That Terminate: Working towards an Understanding in a Post-Roe America

Abortion continues to be a hotly debated topic in the United States, despite the majority of the populace endorsing it as a legal right. The June 2022 ruling from the Supreme Court turned the legal question about abortion back to the states, which will drastically reduce abortion services in the country and confine abortion access mainly to the coasts. The intersection between abortion and a pregnancy achieved using assisted reproductive technology is one that lacks understanding. While presumed to be rare, as data is not collected in the US about abortions, this intersection exists but is understudied. This paper illuminates the little that we know to date about this intersection as well as where our knowledge is profoundly lacking. Creating a better sense of understanding will enable clinics to counsel patients appropriately when the intersection arises.

Permissibility of Multifetal Pregnancy Reduction from The Shiite Point of View

Background

Advancements in medical technology have significantly increased the possibility of successful infertility treatment. Medical interventions in the initial process of pregnancy that intend to increase the chances of pregnancy create the risk of multifetal pregnancies for both mothers and fetuses. Physicians attempt to reduce the numbers of fetuses in order to decrease this risk and guarantee the continuation of pregnancy. The aim of this paper is to understand the Shiite instruction in terms of the risks multifetal pregnancies have for fetuses and if it is permissible to reduce the numbers of fetuses. An affirmative answer will lead to the development of Islamic criteria for reduction of the number of embryos.

Materials and Methods

This analytical-descriptive research gathered relevant data as a literature search. We reviewed a number of Islamic resources that pertained to the fetus; after a description of the fundamentals and definitions, we subsequently analyzed juridical texts. The order of reduction was inevitably determined by taking into consideration the rules that governed the abortion provisions or general juridical rules. We also investigated the UK law as a comparison to the Shiite perspective.

Results

The primary ordinance states that termination of an embryo is not permitted and is considered taboo. However, fetal reductions that occur in emergency situations where there is no option or ordinary indication are permitted before the time of ensoulment. The goal of reduction can be chosen from different ways.

Conclusion

According to Shiite sources, fetal reduction is permitted. Defective fetuses are the criteria for selective reduction. If none are defective, the criteria are possibility and facility. But if the possibility of selection is equally for more than one fetus, the criterion is importance (for example one fetus is healthier).