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Jernman RM, Stefanovic V. Multifetal pregnancy reductions and selective fetocide in a tertiary referral center - a retrospective cohort study. J Perinat Med 2024; 52:255-261. [PMID: 38281159 DOI: 10.1515/jpm-2023-0414] [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: 10/04/2023] [Accepted: 12/23/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Multiple pregnancies involve several complications, most often prematurity, but also higher anomaly rates. Reducing fetuses generally improves pregnancy outcomes. We conducted this study to evaluate the obstetrical and neonatal results after multifetal pregnancy reduction (MFPR) in the largest tertiary hospital in Finland. METHODS This retrospective cohort study included all MFPR managed in Helsinki University Hospital during a 13 year period (2007-2019). Data on pregnancies, parturients and newborns were collected from patient files. The number of fetuses, chorionicities and amnionicities were defined in first-trimester ultrasound screening. RESULTS There were 54 MFPR cases included in the final analyses. Most often the reduction was from twins to singletons (n=34, 63 %). Majority of these (25/34, 73.5 %) were due to co-twin anomaly. Triplets (n=16, 29.6 %) were reduced to twins (n=7, 13 %) or singletons (n=9, 16.7 %), quadruplets (n=2, 3.7 %) and quintuplets (n=2, 3.7 %) to twins. Most (33/54, 61.1 %) MFPR procedures were done by 15+0 weeks of gestation. There were six miscarriages after MFPR and one early co-twin miscarriage. In the remaining 47 pregnancies that continued as twins (n=7, 14.9 %) or singletons (n=40, 85.1 %) the liveborn rate was 90 % for one fetus and 71.4 % for two fetuses. CONCLUSIONS Most MFPR cases were pregnancies with an anomalous co-twin. The whole pregnancy loss risk was 11.1 % after MFPR. The majority (70.6 %) of twins were spontaneous, whereas all quadruplets, quintuplets, and 56.3 % of triplets were assisted reproductive technologies (ART) pregnancies. Careful counselling should be an essential part of obstetrical care in multiple pregnancies, which should be referred to fetomaternal units for MFPR option.
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Affiliation(s)
- Riina Maria Jernman
- Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Akkuş F, Doğru Ş, Atcı AA, Dal Y, Arıcı ECA, Acar A. The initial number of fetuses in multiple pregnancy before reduction affects perinatal outcomes. J Obstet Gynaecol Res 2023; 49:2664-2670. [PMID: 37574597 DOI: 10.1111/jog.15771] [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: 04/14/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE In this study, we aimed to evaluate the perinatal outcomes of dichorionic diamniotic (DCDA) twin pregnancies reduced by the fetal reduction (FR) procedure and cases with continuing DCDA twin pregnancies without FR. MATERIALS AND METHODS FR performed in a university hospital in the last 10 years was evaluated. Pregnancies reduced to DCDA twin pregnancies by reduction from three or more pregnancies and pregnancies that started with DCDA twins and continued with DCDA twins were compared in terms of perinatal outcomes. In the subgroup analysis, those who were reduced from three-chorionic three-amniotic (TCTA) triplets to DCDA twins and those who were reduced to DCDA twin pregnancies from four or more were compared in terms of perinatal outcomes. RESULTS A total of 119 pregnant women were included in the study, 36 patients underwent FR, while 83 patients were DCDA twins who did not undergo FR. The groups were similar in terms of preterm delivery (p = 0.370). There was a higher rate of miscarriage (21.4% vs. 0.0%, p = 0.019) in the group that was reduced to DCDA twins from quadruplet and above pregnancies compared to the group that was reduced from TCTA triplets to DCDA twins. The gestational week at birth was lower in the group reduced to DCDA twins from quadruplets and above pregnancies (31.00 ± 4.31 vs. 34.64 ± 2.88, p = 0.019). CONCLUSION The study's results show that the perinatal outcomes of multiple pregnancies with and without FR are the same As the number of reduced fetuses increases, the rates of preterm birth and miscarriage also increase.
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Affiliation(s)
- Fatih Akkuş
- Department of Obstetrics and Gynecology, Perinatology Department, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Şükran Doğru
- Department of Obstetrics and Gynecology, Perinatology Department, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Aslı Altınordu Atcı
- Department of Obstetrics and Gynecology, Perinatology Department, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Yusuf Dal
- Department of Obstetrics and Gynecology, Perinatology Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Elifsena Canan Alp Arıcı
- Department of Obstetrics and Gynecology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Ali Acar
- Department of Obstetrics and Gynecology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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Yimin Z, Minyue T, Yanling F, Huanmiao Y, Saijun S, Qingfang L, Xiaoling H, Lanfeng X. Fetal Reduction Could Improve but Not Completely Reverse the Pregnancy Outcomes of Multiple Pregnancies: Experience From a Single Center. Front Endocrinol (Lausanne) 2022; 13:851167. [PMID: 35813622 PMCID: PMC9263074 DOI: 10.3389/fendo.2022.851167] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the effectiveness and limitations of multifetal pregnancy reduction (MFPR) on the improvement of pregnancy outcomes of triplet or twin pregnancies conceived by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). METHODS We performed a cohort study of women undergoing IVF or ICSI from 2002-2016 in reproductive center, women's hospital, Zhejiang University School of Medicine. The cohort included 502 women who underwent MFPR and 9641 non-reduced women. Pregnancy outcomes were gestational age (GA) at delivery, pregnancy loss, preterm delivery, low birth weight (LBW), very low birth weight (VLBW), and small for gestational age (SGA). Multiple linear regression and logistic regression models were used to compare pregnancy outcomes between groups. RESULTS Triplets reduced to singletons had a longer median GA (39.07 vs 37.00, P<0.001), and lower rates of LBW (8.9% vs 53.2%, P<0.001) and SGA (17.8% vs 44.7%, P=0.001) than triplets reduced to twins, with a similar pregnancy loss rate (6.7% vs 6.6%, P=0.701). Twins reduced to singletons had a comparable pregnancy loss rate (4.8% vs. 6.5%, P=0.40), a longer median GA (38.79 vs. 37.00, P<0.001), and lower rates of LBW (13.5% vs. 47.0%, P<0.001) and SGA (13.5% vs. 39.6%, P<0.001) than primary twins. Triplets reduced to twins had higher rates of LBW (53.2% vs. 47.0%, P=0.028) and SGA (44.7% vs. 39.6%, P=0.040) than primary twins, with a similar pregnancy loss rate (6.6% vs. 6.5%, P=0.877). Singletons reduced from triplets/twins had higher rates of preterm delivery (15.8% vs. 7.3%, P<0.001), LBW (12.3% vs. 4.32%, P<0.001), VLBW (2.3% vs. 0.4%, P=0.002), and SGA (14.6% vs.6.6%, P<0.001) than primary singletons, with a comparable pregnancy loss rate (5.3% vs. 5.4%, P=0.671). CONCLUSIONS This study suggests that the pregnancy loss rate is similar between reduction and non-reduction groups. MFPR improves pregnancy outcomes, including the risk of preterm delivery, LBW, and SGA, but still could not completely reverse the adverse pregnancy outcomes of multiple pregnancies.
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Sarac Sivrikoz T, DEMIR O, Halil Kalelioglu I, Has R, Karakas Paskal E, Kundakci Ozdemir P, Yuksel A. The effects of early or late multifetal reduction procedure on perinatal outcomes in multiple pregnancies reduced to twins or singletons: A single tertiary center experience. Eur J Obstet Gynecol Reprod Biol 2022; 270:195-200. [DOI: 10.1016/j.ejogrb.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 02/09/2023]
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Binh NT, Son NK, Phuong DT, Huong DT, Hoan NP, Hoa NT, Duc NM, Ha NM. Proliferation and Differentiation of Dopaminergic Neurons from Human Neuroepithelial Stem Cells Obtained from Embryo Reduction Following In Vitro Fertilization. Med Arch 2021; 75:280-285. [PMID: 34759448 PMCID: PMC8563046 DOI: 10.5455/medarh.2021.75.280-285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Recent advances in stem cell technologies have rekindled an interest in the use of cell therapies to treat patients with Parkinson’s disease. Although the transplantation of dopaminergic mesencephalic human fetal brain tissue has previously been reported in the treatment of patients with Parkinson’s disease, this method is limited by the availability of tissue obtained from each human embryo. Objective: Our study aimed to isolate, culture, proliferate, and differentiate dopaminergic neurons from human neuroepithelial stem cells obtained from embryo reduction procedures performed in multifetal pregnancies following in vitro fertilization. Materials and Methods: A total of 201 human embryos were dissected for isolation and culture of neuroepithelial stem cells for proliferation and differentiation into dopaminergic neurons. All embryos were obtained from embryo reduction procedures performed in multifetal pregnancies after in vitro fertilization treatments. Results: Human neuroepithelial stem cells were isolated and cultured from embryos from 6.0 to 8.0 weeks. Neuroepithelial stem cells were successfully isolated, proliferated, and differentiated into dopaminergic neurons. The cells adhered to the surfaces of cell culture plates after 2 days and could be proliferated and differentiated into neurons within 4 days. Cultured cells expressed the dopaminergic marker tyrosine hydroxylase after 6 days, suggesting that these cells were successfully differentiated into dopaminergic neurons. Conclusion: The successful isolation, culture, proliferation, and differentiation of human dopaminergic neurons from embryo reductions performed for multifetal pregnancies after in vitro fertilization suggests that this pathway may serve as a potential source of cell therapy materials for use in the treatment of Parkinson’s disease.
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Affiliation(s)
- Nguyen Thi Binh
- Department of Histology and Embryology, Hanoi Medical University, Hanoi, Vietnam.,IVF and Tissue Engineering Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Khang Son
- Department of Histology and Embryology, Hanoi Medical University, Hanoi, Vietnam.,IVF and Tissue Engineering Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Dao Thuy Phuong
- Department of Histology and Embryology, Hanoi Medical University, Hanoi, Vietnam.,IVF and Tissue Engineering Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Do Thuy Huong
- Department of Histology and Embryology, Hanoi Medical University, Hanoi, Vietnam.,IVF and Tissue Engineering Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Phuc Hoan
- Department of Histology and Embryology, Hanoi Medical University, Hanoi, Vietnam.,IVF and Tissue Engineering Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Thanh Hoa
- Department of Histology and Embryology, Hanoi Medical University, Hanoi, Vietnam.,IVF and Tissue Engineering Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Histology and Embryology, Hanoi Medical University, Hanoi, Vietnam.,IVF and Tissue Engineering Center, Hanoi Medical University Hospital, Hanoi, Vietnam.,IVF and Tissue Engineering Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Manh Ha
- Department of Histology and Embryology, Hanoi Medical University, Hanoi, Vietnam.,IVF and Tissue Engineering Center, Hanoi Medical University Hospital, Hanoi, Vietnam
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Shea S, Paniz-Mondolfi A, Sordillo E, Nowak M, Dekio F. Florid Bacillus cereus Infection of the Placenta Associated With Intrauterine Fetal Demise. Pediatr Dev Pathol 2021; 24:361-365. [PMID: 33729850 DOI: 10.1177/1093526621999026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bacillus cereus is a gram-positive, rod-shaped bacterium that is commonly implicated in foodborne illness but has also become increasingly recognized as a source of serious non-gastrointestinal infections, including sepsis, meningitis, and pneumonia. Non-gastrointestinal B. cereus infections have been identified in children, especially in neonates; however, there are no previously described cases of fetal demise associated with B. cereus placental infection. We present a case of acute chorioamnionitis-related intrauterine fetal demise of twin A at 17 weeks gestation, noted two days after selective termination of twin B. Histological examination revealed numerous gram-positive bacilli in placental tissue, as well as fetal vasculature, in the setting of severe acute necrotizing chorioamnionitis and subchorionitis, intervillous abscesses, acute villitis, and peripheral acute funisitis. Cultures of maternal blood and placental tissue both yielded growth of B. cereus. This case underscores the importance of B. cereus as a human pathogen, and specifically demonstrates its potential as an agent of severe intraamniotic and placental infection with poor outcomes for the fetus.
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Affiliation(s)
- Stephanie Shea
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Emilia Sordillo
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Nowak
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Fumiko Dekio
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
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Zemet R, Haas J, Bart Y, Barzilay E, Zloto K, Argaman N, Schwartz N, Weisz B, Yinon Y, Mazaki-Tovi S, Lipitz S. Pregnancy outcome after multifetal pregnancy reduction of triplets to twins versus reduction to singletons. Reprod Biomed Online 2019; 40:445-452. [PMID: 32067870 DOI: 10.1016/j.rbmo.2019.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/12/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION Does fetal reduction of triplet pregnancies to singleton result in superior obstetric and neonatal outcomes compared with triplets reduced to twins? DESIGN A historical cohort study including 285 trichorionic and dichorionic triplet pregnancies that underwent abdominal fetal reduction at 11-14 weeks in a single tertiary referral centre. The study population comprised two groups: reduction to twins (n = 223) and singletons (n = 62). Main outcome measures were rates of pregnancy complications, preterm delivery and neonatal outcomes. Non-parametric statistical methods were employed. RESULTS Triplet pregnancies reduced to twins delivered earlier (36 versus 39 weeks, P < 0.001) with higher prevalence of Caesarean section (71.1% versus 32.2%, P < 0.001) compared with triplets reduced to singletons. Preterm delivery rates were significantly higher in twins compared with singletons prior to 37 weeks (56.9% versus 13.6%, P < 0.001), 34 weeks (20.2% versus 3.4%, P = 0.002) and 32 weeks (9.6% versus 0%, P = 0.01). No significant difference was found in the rate of pregnancy loss before 24 weeks (1.3% in twins versus 4.8% in singletons, P = 0.12) or in the rate of intrauterine fetal death after 24 weeks (0.4% versus 0%, P = 1.0). Both groups had comparable obstetrical complications and neonatal outcomes, except for higher rates of neonatal intensive care unit admission in twins (31.9% versus 6.8%, P < 0.001). CONCLUSIONS Reduction of triplets to singletons rather than twins resulted in superior obstetric outcomes without increasing the procedure-related complications. However, because the rate of extreme prematurity in pregnancies reduced to twins was low, the overall outcome of those pregnancies was favourable. Therefore, the option of reduction to singletons should be considered in cases where the risk of prematurity seems exceptionally high.
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Affiliation(s)
- Roni Zemet
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Bart
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Keren Zloto
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natan Argaman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Schwartz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Yinon
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Lipitz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Outcomes of Multifetal Reduction: A Hospital-Based Study. J Obstet Gynaecol India 2017; 68:264-269. [PMID: 30065540 DOI: 10.1007/s13224-017-1024-1] [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: 04/20/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022] Open
Abstract
Background Higher-order multiple (HOM) pregnancies are associated with increased incidences of pregnancy complications mainly abortions, pre-eclampsia, preterm delivery and fetal death. Multifetal reduction (MFR) during first trimester and subsequent delivery of twins can reduce pregnancy associated morbidities. This study was conducted to evaluate the maternal and fetal outcomes of MFR procedure in patients with HOMs those managed in a tertiary care hospital. Methods and Material It was a prospective observational study carried out in a tertiary care military hospital, India, and all women with higher-order multiples (triplets or more) conceived spontaneously or after infertility treatment (ovulation induction, intra-uterine insemination, or in vitro fertilization) during the 3-year period from Jan 2014 to Dec 2016 were included for MFR. Demographic and clinical data, and obstetric and neonatal outcomes were tabulated. Results The study included 32 HOM pregnancies which underwent MFR. 16% patients had pre-eclampsia and 12% patients had gestational diabetes. The study had 2 pregnancy losses before 24 weeks period of gestation (POG). 70% patients underwent cesarean delivery with mean gestational age of 35.5 weeks. Average birth weight of newborn was 1820 gm and 80% of them required NICU admission. Conclusion Favorable pregnancy outcomes can be achieved after multifetal reductions during first trimester in higher-order multiples, but the procedure is not totally safe.
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