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Eliner O, Schreiber H, Cohen G, Biron-Shental T, Kovo M. The impact of fetal sex on pregnancy and neonatal outcomes in twin gestation. Arch Gynecol Obstet 2024; 310:801-806. [PMID: 38896275 DOI: 10.1007/s00404-024-07577-0] [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: 05/13/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Fetal sex is independently associated with pregnancy complications and impacts neonatal outcomes. Evidence suggests that females have an advantage over males, with a better outcome in the perinatal period. In addition, fetal outcome in twin gestations is also related to the intrauterine position of the fetus, such as the first, the presenting or second twin. It has been demonstrated that the neonatal outcome of the second fetus is worse than that of the first fetus. This study aimed to examine the influence of fetal sex on obstetric outcomes in twin pregnancies based on the location of the fetus in the uterus. METHODS Retrospective study. Maternal and obstetric outcomes were compared among three groups: male‒male, female‒female, and male‒female groups. Comparisons of neonatal outcomes were performed among the four groups: male A-male B, male A-female B, female A-male B, and female A-female B. RESULTS A total of 1073 twin gestations were included, comprising 288 male‒male, 288 female‒female, and 497 male‒female gestations. A greater percentage of neonates admitted to the NICU was observed for male fetuses than for female fetuses. Adverse composite neonatal outcome was more common in the male‒male group than in the female‒male group and in the female‒female group. CONCLUSION Twin gestation with a first twin male tends to have worse neonatal outcomes than does twin gestation with a first twin female. The presence of a male co-twin increases the risk of adverse outcomes.
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Affiliation(s)
- O Eliner
- Department of Obstetrics and Gynecology, Meir Medical Center, Israel affiliate to Tel Aviv University, Kfar Saba, Israel.
- The Faculty of Medical and Health Sciences, Tel Aviv University, Kfar Saba, Israel.
| | - H Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, Israel affiliate to Tel Aviv University, Kfar Saba, Israel
- The Faculty of Medical and Health Sciences, Tel Aviv University, Kfar Saba, Israel
| | - G Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, Israel affiliate to Tel Aviv University, Kfar Saba, Israel
- The Faculty of Medical and Health Sciences, Tel Aviv University, Kfar Saba, Israel
| | - T Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Israel affiliate to Tel Aviv University, Kfar Saba, Israel
- The Faculty of Medical and Health Sciences, Tel Aviv University, Kfar Saba, Israel
| | - M Kovo
- Department of Obstetrics and Gynecology, Meir Medical Center, Israel affiliate to Tel Aviv University, Kfar Saba, Israel
- The Faculty of Medical and Health Sciences, Tel Aviv University, Kfar Saba, Israel
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Peeva M, Badeghiesh A, Baghlaf H, Dahan MH. Adverse obstetric outcomes in women with PCOS and multiple gestations. Reprod Biomed Online 2023; 46:379-389. [PMID: 36503681 DOI: 10.1016/j.rbmo.2022.10.009] [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: 02/22/2022] [Revised: 06/23/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
RESEARCH QUESTION Does multiple gestation alter the risks for adverse obstetric outcomes in women with polycystic ovary syndrome (PCOS)? DESIGN Retrospective population-based cohort study using data from the HCUP-NIS from 2004 to 2014. A total of 14,882 women with PCOS, who delivered within that time period, were identified. The study group comprised women with PCOS who had had a multiple gestation (n = 880); the reference group was comprised of the remaining women with PCOS and singleton gestation (n = 14,002). RESULTS In women with PCOS, multiple gestation increased the risks of pregnancy complications including pregnancy-induced hypertension (adjusted odds ratio [aOR] 2.030; 95% confidence interval [CI] 1.676-2.460), pre-eclampsia (aOR 2.879; 95% CI 2.277-3.639), pre-eclampsia and eclampsia superimposed on pre-existing hypertension (aOR 1.917; 95% CI 1.266-2.903) and gestational diabetes (aOR 1.358; 95% CI 1.114-1.656). Multiple gestation increases the risk of preterm premature rupture of membranes (aOR 5.807; 95% CI 4.153-8.119), preterm delivery (aOR 8.466; 95% CI 7.071-10.135), Caesarean section (aOR 5.146; 95% CI 4.184-6.329), post-partum haemorrhage (aOR 1.540; 95% CI 1.065-2.228) and the need for transfusion (aOR 3.268; 95% CI 2.010-5.314), as well as wound complications (aOR 3.089; 95% CI 1.647-5.794). Neonates born to mothers with PCOS and having multiple gestations are more likely to be small for gestational age when compared to singleton neonates born to mothers with PCOS (aOR 4.606; 95% CI 3.480-6.095). Among PCOS women with multiple gestations, obesity increased the risks of developing pregnancy-induced hypertension (P < 0.001), pre-eclampsia (P < 0.001) and wound complications (P = 0.045). CONCLUSION These results highlight the importance of single embryo transfer and ovulation induction to develop a single follicle in women with PCOS. Obesity further increases obstetrical complications.
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Affiliation(s)
- Magdalena Peeva
- University of Ottawa, Department of Obstetrics and Gynecology, Ottawa Ontario K1H 8L6, Canada
| | - Ahmad Badeghiesh
- University of Western Ontario, Department of Obstetrics and Gynecology, London Ontario N6A 3K7, Canada
| | - Haitham Baghlaf
- University of Tabuk, Department of Obstetrics and Gynecology, Tabuk, Saudi Arabia
| | - Michael H Dahan
- McGill University, McGill University Health Center, Reproductive Center, Department of Obstetrics and Gynecology, Quebec H2L, Montreal 4S8, Canada.
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Learning Disabilities in Reading and Writing and Type of Delivery in Twin Births. CHILDREN-BASEL 2021; 8:children8100834. [PMID: 34682099 PMCID: PMC8534999 DOI: 10.3390/children8100834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Abstract
The aim of this study was to analyse the relationship between the type of delivery (vaginal or caesarean), as a risk factor, and the likelihood of having learning disabilities in reading (reading accuracy) and writing (phonetic and visual orthography), controlling for the interaction and/or confounding effect of gestational, obstetric, and neonatal variables (maternal age at delivery, gestational age, foetal presentation, Apgar 1, and newborn weight) among six-year-old children born in twin births. In this retrospective cohort study, the exposed and non-exposed cohorts consisted of children born by caesarean section and vaginal delivery, respectively. A total of 124 children born in twin births were evaluated in year one of primary education. Intelligence was measured using the K-BIT test; reading and writing variables were evaluated using the Evalúa-1 battery of tests, and clinical records were used to measure gestational, obstetric, and neonatal variables. Binary logistic regressions applied to each dependent variable indicated that caesarean delivery is a possible independent risk factor for difficulties in reading accuracy and phonetic and visual orthography. Future research using larger samples of younger children is required to analyse the relationship between obstetric and neonatal variables and the different basic indicators of reading and writing.
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Zhang JW, Branch W, Hoffman M, De Jonge A, Li SH, Troendle J, Zhang J. In which groups of pregnant women can the caesarean delivery rate likely be reduced safely in the USA? A multicentre cross-sectional study. BMJ Open 2018; 8:e021670. [PMID: 30082355 PMCID: PMC6078266 DOI: 10.1136/bmjopen-2018-021670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/19/2018] [Accepted: 06/18/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To identify obstetrical subgroups in which (1) the caesarean delivery (CD) rate may be reduced without compromising safety and (2) CD may be associated with better perinatal outcomes. DESIGN A multicentre cross-sectional study. SETTING 19 hospitals in the USA that participated in the Consortium on Safe Labor. PARTICIPANTS 228 562 pregnant women in 2002-2008. MAIN OUTCOME MEASURES Maternal and neonatal safety was measured using the individual Weighted Adverse Outcome Score. METHODS Women were divided into 10 subgroups according to a modified Robson classification system. Generalised estimated equation model was used to examine the relationships between mode of delivery and Weighted Adverse Outcome Score in each subgroup. RESULTS The overall caesarean rate was 31.2%. Repeat CD contributed 29.5% of all CD, followed by nulliparas with labour induction (15.3%) and non-cephalic presentation (14.3%). The caesarean rates in induced nulliparas with a term singleton cephalic pregnancy and women with previous CD were 31.6% and 82.0%, respectively. CD had no clinically meaningful association with perinatal outcomes in most subgroups. However, in singleton preterm breech presentation and preterm twin gestation with the first twin in non-cephalic presentation, CD was associated with substantially improved maternal and perinatal outcomes. CONCLUSIONS Women with repeat CD, term non-cephalic presentation, term twins or other multiple gestation and preterm births may be the potential targets for safely reducing prelabour CD rate, while nulliparas or multiparas with spontaneous or induced labour, women with repeat CD, term non-cephalic presentation, term twins or other multiple gestation and preterm births are potential targets for reducing intrapartum CD rate without compromising maternal and neonatal safety in the USA. On the other hand, CD may still be associated with better perinatal outcomes in women with singleton preterm breech presentation or preterm twins with the first twin in non-cephalic presentation.
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Affiliation(s)
- Jin-Wen Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- MOE - Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ware Branch
- Intermountain Healthcare and University of Utah, Utah, USA
| | | | - Ank De Jonge
- AVAG and the Amsterdam University Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Sheng-Hui Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- MOE - Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - James Troendle
- National Institute of Heart, Lung and Blood Institute, National Institutes of Health, Maryland, USA
| | - Jun Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- MOE - Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Delivery of the second twin: influence of presentation on neonatal outcome, a case controlled study. BMC Pregnancy Childbirth 2018; 18:176. [PMID: 29776396 PMCID: PMC5960113 DOI: 10.1186/s12884-018-1815-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 05/01/2018] [Indexed: 12/15/2022] Open
Abstract
Background Spontaneous vaginal twin delivery after 32nd week of gestation is safe when first twin presenting cephalic. Aim of this study is to identify obstetric factors influencing the condition of second twin and to verify whether non-cephalic presentation and vaginal breech delivery of the second twin is safe. Methods This is a retrospective case controlled cohort study of 717 uncomplicated twin deliveries ≥32 + 0 weeks of gestation from 2005 to 2014 in two tertiary perinatal centers. Obstetric parameters were evaluated in three groups with descriptive, univariate logistic regression analysis for perinatal outcome of second twins. Results The three groups included twins delivered by elective cesarean section ECS (n = 277, 38.6%), by unplanned cesarean section UPC (n = 233, 32.5%) and vaginally (n = 207, 28.9%). Serious adverse fetal outcome is rare and we found no differences between the groups. Second twins after ECS had significant better umbilical artery UA pH (p < 0.001) and better Apgar compared to UPC (p = 0.002). Variables for a fetal population “at risk” for adverse neonatal outcome after vaginal delivery (UA pH < 7.20, Apgar 5´ < 9) were associated with higher gestational age (p = 0.001), longer twin-twin interval (p = 0.05) and vacuum extraction of twin A (p = 0.04). Non-cephalic presentation of second twins was not associated (UA pH < 7.20 OR 1.97, CI 95% 0.93–4.22, p = 0.07, Apgar 5´ < 9 OR 1.63, CI 95% 0.70–3.77, p = 0.25, Transfer to neonatal intermediate care unit p = 0.48). Twenty-one second twins (2,9%) were delivered by cesarean section following vaginal delivery of the first twin. Even though non-cephalic presentation was overrepresented in this subgroup, outcome variables were not significantly different compared to cephalic presentation. Conclusions Even though elective cesarean means reduced stress for second twins this seems not to be clinically relevant. Non-cephalic presentation of the second twin does not significantly influence the perinatal outcome of the second twin but might be a risk factor for vaginal-cesarean birth.
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Bellizzi S, Sobel H, Betran AP, Temmerman M. Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries. J Glob Health 2018; 8:010404. [PMID: 29423189 PMCID: PMC5782831 DOI: 10.7189/jogh.08.010404] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Around the world, the incidence of multiple pregnancies reaches its peak in the Central African countries and often represents an increased risk of death for women and children because of higher rates of obstetrical complications and poor management skills in those countries. We sought to assess the association between twins and early neonatal mortality compared with singleton pregnancies. We also assessed the role of skilled birth attendant and mode of delivery on early neonatal mortality in twin pregnancies. Methods We conducted a secondary analysis of individual level data from 60 nationally-representative Demographic and Health Surveys including 521 867 singleton and 14 312 twin births. We investigated the occurrence of deaths within the first week of life in twins compared to singletons and the effect of place and attendance at birth; also, the role of caesarean sections against vaginal births was examined, globally and after countries stratification per caesarean sections rates. A multi-level logistic regression was used accounting for homogeneity within country, and homogeneity within twin pairs. Results Early neonatal mortality among twins was significantly higher when compared to singleton neonates (adjusted odds ratio (aOR) 7.6; 95% confidence interval (CI) = 7.0-8.3) in these 60 countries. Early neonatal mortality was also higher among twins than singletons when adjusting for birth weight in a subgroup analysis of those countries with data on birth weight (n = 20; less than 20% of missing values) (aOR = 2.8; 95% CI = 2.2-3.5). For countries with high rates (>15%) of caesarean sections (CS), twins delivered vaginally in health facility had a statistically significant (aOR = 4.8; 95% CI = 2.4-9.4) increased risk of early neonatal mortality compared to twins delivered through caesarean sections. Home twin births without SBA was associated with increased mortality compared with delivering at home with SBA (aOR = 1.3; 95% CI = 1.0-1.8) and with vaginal birth in health facility (aOR = 1.7; 95% CI = 1.4-2.0). Conclusions Institutional deliveries and increased access of caesarian sections may be considered for twin pregnancies in low- and middle- income countries to decrease early adverse neonatal outcomes.
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Affiliation(s)
- Saverio Bellizzi
- World Health Organization, Western Pacific Regional Office, Manila, Philippines
| | - Howard Sobel
- World Health Organization, Western Pacific Regional Office, Manila, Philippines
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium.,Aga Khan University East Africa, Nairobi, Kenya
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Birth management and fetal outcome in multiple gestation: analysis of 1.444 births. Arch Gynecol Obstet 2017; 297:61-69. [PMID: 29018972 DOI: 10.1007/s00404-017-4559-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Since the late 1990s, controversies came up concerning the mode of delivery for multiples births. The twin birth study indicated no difference in maternal and fetal outcome between planned vaginal delivery and planned caesarean section, but did not analyze the influence of maternal and fetal characteristics or the obstetric management in vaginal birth. The purpose of this study is to analyze these parameters regarding fetal outcome. METHODS A large-scale retrospective analysis of twin births (n = 1.444) was performed at a university medical center. The analysis included pregnancy, delivery, and maternal and fetal parameters, including pH and base excess (BE) differences between the first- and second-born twin (delta pH, delta BE). RESULTS Delta pH correlated significantly with the birth interval for various positions of twins in the womb (p < 0.05). The longer the birth interval, the greater the delta pH with a lower pH of the second twin. Delta BE values were significantly correlated with the birth interval for a combination of twins in cephalic and breech presentation. Furthermore, it could be shown that higher differences in birth weight between the first/second twin are associated with higher delta pH, higher delta BE values (all p < 0.05). We found significantly decreasing delta pH values in vaginal deliveries over secondary and, finally, primary caesarean sections (p < 0.001). CONCLUSION We conclude a vaginal delivery of twin appears safe if experienced staff monitor birth weight discrepancies, birth interval, and blood values consequently. A good outcome also for the second twin delivered spontaneously is nevertheless feasible if experienced staff is available.
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